) Despite decades of research on smoking cessation in diverse populations, a very high percentage of individuals continue to smoke, particularly lower-income and minority subjects. While clinic-based smoking cessation programs are clearly effective, they are not particularly cost effective and very few smokers want to utilize these programs in their smoking cessation attempts. Nicotine replacement therapy (NRT) and physician-based programs are potentially cost effective and highly generalizable. Moreover, patients seek these services when trying to stop smoking. However, efficacy estimates of NRT, with and without formal behavioral intervention, vary markedly. The potential utility of NRT programs suggest that it is important to determine the minimal level of behavioral intervention necessary to significantly increase NRT therapy effectiveness. Thus, the Specific Aims of the current project are as follows: (1) To recruit approximately 600 smokers through provider practices, with practices being randomly assigned to one of three interventions: (a) NRT with an enhanced standard of care; (b) NRT plus a behavioral intervention that uses physician and health educator contacts and targeted relapse prevention strategies; and (c) NRT plus an equally intensive but less costly behavioral intervention employing minimal professional staff, (2) To evaluate initial smoking cessation outcome, cost effectiveness, and long-term (i.e., 12 month follow-up) efficacy of these three interventions.
