This revised proposal will address several limitations of existing programs to help hospitalized smokers, including reach and exportability. We will use the RE-AIM evaluation model to investigate an innovative intervention for reaching and involving smokers about to have out-patient surgery or an invasive endoscopic medical procedure (sigmoidoscopy/colonoscopy) in Kaiser Permanente-Colorado, but who decline to participate in cessation-based smoking activities. Based upon preliminary work and previous experience with harm reduction interventions with smokers, we will offer a harm reduction program with the goal of helping smokers achieve a 2/3 reduction in daily cigarette intake. The theory-based intervention will include goal setting and frequent feedback, barriers-based problem-solving, and other social-cognitive procedures tailored to the smoker and his or her social environment. It will be delivered both before surgery (or endoscopic procedures) and after, by a combination of phone counseling and tailored mailings, similar to that of the smoking cessation program (Project 1) proposed as part of this Interactive RO1 application. Previous work in our lab and by other investigators indicates that 50-75 percent reduction in number of cigarettes smoked is achievable and can be done in a way that does not result in compensatory smoking, so that reductions in biochemical exposures are achieved and maintained.Following a year of developmental work, we will conduct a randomized trial with 340 smokers to compare the harm reduction program to a control condition that will receive generic mailings. Following the RE-AIM model, key outcomes of the project will be 1) Reach (percent and representativeness of smokers who participate in this program); 2) Effectiveness: reductions in number of cigarettes, cotinine, and CO levels at 3 months follow-up; 3) Adoption: the percent of physicians who participate in the program; 4) Implementation: the percent of participants who receive and use each of several intervention components; and 5) Maintenance: the cessation rate, reduction in number of cigarettes and saliva cotinine, and CO levels at one-year follow-up.This is one of two projects being submitted using the Interactive Research Project Grant funding mechanism. Crossproject analyses will be conducted on various RE-AIM dimensions related to dissemination and economic outcomes. Taken together, both projects will provide an important test of an integrated program for an underserved population (patients in the hospital setting) that recognizes cessation and harm reduction as complementary strategies.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
1R01CA090974-01A1
Application #
6561265
Study Section
Special Emphasis Panel (ZRG1-RPHB-2 (01))
Program Officer
Djordjevic, Mirjana V
Project Start
2003-04-01
Project End
2007-09-30
Budget Start
2003-04-01
Budget End
2004-03-31
Support Year
1
Fiscal Year
2003
Total Cost
$540,454
Indirect Cost
Name
Kaiser Foundation Research Institute
Department
Type
DUNS #
150829349
City
Oakland
State
CA
Country
United States
Zip Code
94612
Gaglio, Bridget; Smith, Tammy L; Estabrooks, Paul A et al. (2010) Using theory and technology to design a practical and generalizable smoking reduction intervention. Health Promot Pract 11:675-84
Estabrooks, Paul A; Gaglio, Bridget; Morse, Erica Ferro et al. (2010) Defining and understanding success at smoking reduction: a mixed-methods study. Addict Behav 35:1113-9
Ritzwoller, Debra P; Sukhanova, Anna; Gaglio, Bridget et al. (2009) Costing behavioral interventions: a practical guide to enhance translation. Ann Behav Med 37:218-27
Glasgow, Russell E; Gaglio, Bridget; Estabrooks, Paul A et al. (2009) Long-term results of a smoking reduction program. Med Care 47:115-20
Glasgow, Russell E; Estabrooks, Paul A; Marcus, Alfred C et al. (2008) Evaluating initial reach and robustness of a practical randomized trial of smoking reduction. Health Psychol 27:780-8
Levinson, Arnold H; Glasgow, Russell E; Gaglio, Bridget et al. (2008) Tailored behavioral support for smoking reduction: development and pilot results of an innovative intervention. Health Educ Res 23:335-46
Jilcott, Stephanie; Ammerman, Alice; Sommers, Janice et al. (2007) Applying the RE-AIM framework to assess the public health impact of policy change. Ann Behav Med 34:105-14
Green, Lawrence W; Glasgow, Russell E (2006) Evaluating the relevance, generalization, and applicability of research: issues in external validation and translation methodology. Eval Health Prof 29:126-53
Glasgow, Russell E; Gaglio, Bridget; France, Eric K et al. (2006) Do behavioral smoking reduction approaches reach more or different smokers? Two studies; similar answers. Addict Behav 31:509-18