The goal of this line of research is to develop and evaluate interventions that maintain nonsmoking, and in so doing, better understand the processes leading to smoking cessation and relapse. This is a competing continuation application for a line of research that has produced 42 journal articles, 18 book chapters, and 27 abstracts over a 20-year period. Certain population subgroups are at risk for continued smoking and relapse; one subgroup is smokers 50+ years of age, who are increasing in number as the general population ages. Smoking is a serious health risk factor for older individuals. Smoking cessation dramatically reduces mortality and morbidity from cancer, cardiac disease, and other illnesses in this age group. Recent practice guidelines call for research on pharmacological strategies for smokers 50+ years. Data indicates that these smokers are highly nicotine dependent and have a high prevalence of """"""""subsyndromal depression."""""""" Our group has worked extensively with nicotine dependent and depressed smokers. This earlier work will be used to inform an innovative intervention. Thus, the specific aims of the proposed work are to test a series of hypotheses about the efficacy and cost-effectiveness of four interventions for older smokers. Participants (N=432) will be randomly assigned to one of four intervention conditions: (1) counseling control; (2) standard (12 week) Nicotine Replacement Therapy (NRT); (3) extended (52 week) psychosocial support/standard NRT; (4) extended psychosocial support/extended (52 week) NRT. Participants will be assessed at baseline on smoking, nicotine dependence, diagnosis, demographics, mood, social support, health status, motivation for change, and drug and alcohol use. At weeks 12, 24, 36, 52 and 104, participants will be assessed on self-reports of smoking verified by carbon monoxide and anatabine/anabasine, and measures of mood, social support, health status and motivation for change. Urinary cotinine will be collected at week 104. The prototypical data analysis strategy is GEE. Also, we will complete exploratory analyses to determine those variables that best predict smoking treatment outcome, and differential response to the extended interventions in older smokers.
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