The general aim of the proposed research is to study the process of recycling participants in a smoking cessation program who either fail to quit or who quit and relapse. Recycling unsuccessful attempters and relapses into additional treatment regimens is especially critical for those who despite having lung disease, have still not been able to achieve permanent abstinence. Cigarette smoking is the primary contributing factor to lung cancer deaths and the major cause of chronic obstructive lung disease in the U.S. for both men and women. For many smokers, relapse is a frequent and expected stage in smoking cessation, and multiple attempts are needed to achieve long-term success. In the proposed research, 500 smokers will be randomly assigned to one of two treatment conditions: Standard treatment or Recycling. Treatment for both will consist of 7 weekly group sessions followed by 8 counselor- led phone calls. Differences between the two conditions will occur in the content of the phone calls. In the Recycling condition unsuccessful attempters and relapses will receive a multicomponent package aimed at helping them to re-achieve abstinence. The Standard treatment subjects will receive an attention-control treatment during the phone calls. Follow-up data, including biochemical verification of abstinence, will be collected 3, 6, and 12 months after the last phone call. We hypothesize that more attempters and relapses in the Recycling condition will achieve a subsequent quit episode, will do so sooner, and will have higher rates of abstinence during the follow-ups than subjects in the Standard condition. We will also examine the roles of several psychosocial variables in the recycling process and the extent to which they are related to subjects' recycling efforts and successes. These include adherence to the recycling program, self- efficacy, coping attempts, social support, and negative affect. Finally, we will conduct separate statistical analyses to determine the effects of the intervention on subsamples of subjects who are either at high risk for or who suffer from lung disease. Information about pulmonary functioning and respiratory symptoms will be collected from all subjects.
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