Abstinence from tobacco use has been a common goal for many treatment programs. However, only a relatively small number of smokers are willing to quit tobacco use in the immediate future. Furthermore, of those who try to quit tobacco use, many are not successful in achieving abstinence. Tobacco reduction may be an important transitional goal for these individuals prior to abstinence or possibly even a treatment endpoint. However, relatively limited information is available on the effectiveness or consequences of recommending reduced tobacco use either by using nicotine replacements or behavioral methods. The primary goals of this research proposal are to systematically examine and compare the effects of different approaches for reducing tobacco use in tightly-controlled, short- term, outpatient, clinical studies. Subjects will be cigarette smokers who are interested in reducing cigarette smoking and not seriously interested in quitting within the next 30 days. Three studies are proposed. In each of these studies, reduction in smoking will occur over the course of 6 weeks, in which smokers are encouraged to reduce by 25% increments every two weeks.
The aim i s to reduce consumption of cigarettes by at least 75%. The first study will examine the effects of different instructional methods for nicotine gum use to reduce cigarette consumption. The instructional method that produces the greatest reduction in cigarette use will be selected for the subsequent studies. The second study will examine various nicotine replacement and behavioral methods for cigarette reduction to determine which approach produces the greatest reduction in tobacco use. The third study will focus on the most effective treatment selected from Study 2 and compare this condition with a placebo control. In addition, a combination of approaches (e.g., nicotine patch plus another nicotine replacement agent or behavioral treatment) will be examined to determine whether combining treatments will lead to a significantly greater reduction of tobacco exposure and toxicity compared to a placebo control condition and to the single method approach. These studies should determine whether these approaches are effective in reducing tobacco exposure and toxicity, enhancing motivation to quit, or increasing number of quit attempts. The cost-effectiveness of these treatments will also be determined. The results from these studies can be used to direct treatments in the other research projects proposed in this center grant.
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