Evaluating a population-based recruitment approach and a stage-based expert system intervention for smoking cessation.

A stage-matched expert system intervention was evaluated on 4144 smokers in a two-arm randomized control trial with four follow-ups over 24 months. Smokers were recruited by random digit-dial calls, and 80.0% of the eligible smokers were enrolled. Individualized and interactive expert system computer reports were sent at 0, 3, and 6 months. The reports provided feedback on 15 variables relevant for progressing through the stages. The primary outcomes were point prevalence and prolonged abstinence rates. At 24 months, the expert system resulted in 25.6% point prevalence and 12% prolonged abstinence, which were 30% and 56% greater than the control condition. Abstinence rates at each 6-month follow-up were significantly greater in the Expert System (ES) condition than in the comparison condition with the absolute difference increasing at each follow-up. A proactive home-based stage-matched expert system smoking cessation program can produce both high participation rates and relatively high abstinence rates.

[1]  W. Rakowski,et al.  Stages of change and decisional balance for 12 problem behaviors. , 1994, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[2]  W F Velicer,et al.  Measuring processes of change: applications to the cessation of smoking. , 1988, Journal of consulting and clinical psychology.

[3]  Diane C. Thompson,et al.  The validity of self-reported smoking: a review and meta-analysis. , 1994, American journal of public health.

[4]  W F Velicer,et al.  Relapse situations and self-efficacy: an integrative model. , 1990, Addictive behaviors.

[5]  S. Curry,et al.  Self-help interventions for smoking cessation. , 1993, Journal of consulting and clinical psychology.

[6]  R Little,et al.  Intent-to-treat analysis for longitudinal studies with drop-outs. , 1996, Biometrics.

[7]  J. Hollis,et al.  Biochemical validation of smoking status: pros, cons, and data from four low-intensity intervention trials. , 1993, Addictive behaviors.

[8]  D. Rubin,et al.  Statistical Analysis with Missing Data. , 1989 .

[9]  R. Jeffery,et al.  Direct mail recruitment to home-based smoking and weight control programs: a comparison of strategies. , 1989, Preventive medicine.

[10]  W F Velicer,et al.  Patterns of Change: Dynamic Typology Applied to Smoking Cessation. , 1991, Multivariate behavioral research.

[11]  J. L. Schwartz.  Review and evaluation of smoking cessation methods : the United States and Canada, 1978-1985 , 1987 .

[12]  J. Hughes.  Combined psychological and nicotine gum treatment for smoking: a critical review. , 1991, Journal of substance abuse.

[13]  Joseph Waksberg,et al.  Sampling Methods for Random Digit Dialing , 1978 .

[14]  K Y Liang,et al.  Longitudinal data analysis for discrete and continuous outcomes. , 1986, Biometrics.

[15]  W A Hunt,et al.  Relapse rates in addiction programs. , 1971, Journal of clinical psychology.

[16]  K.,et al.  Work site smoking cessation: a meta-analysis of long-term quit rates from controlled studies. , 1990, Journal of occupational medicine. : official publication of the Industrial Medical Association.

[17]  M. Mittelmark,et al.  Changes in adult cigarette smoking in the Minnesota Heart Health Program. , 1995, American journal of public health.

[18]  W F Velicer,et al.  A criterion measurement model for health behavior change. , 1996, Addictive behaviors.

[19]  W F Velicer,et al.  Decisional balance measure for assessing and predicting smoking status. , 1985, Journal of personality and social psychology.

[20]  C. Perry,et al.  Community-wide prevention of cardiovascular disease: education strategies of the Minnesota Heart Health Program. , 1986, Preventive medicine.

[21]  J O Prochaska,et al.  Strong and weak principles for progressing from precontemplation to action on the basis of twelve problem behaviors. , 1994, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[22]  S. Fortmann,et al.  Changes in adult cigarette smoking prevalence after 5 years of community health education: the Stanford Five-City Project. , 1993, American journal of epidemiology.

[23]  M. Fiore,et al.  Tobacco dependence and the nicotine patch. Clinical guidelines for effective use. , 1992, JAMA.

[24]  W F Velicer,et al.  The process of smoking cessation: an analysis of precontemplation, contemplation, and preparation stages of change. , 1991, Journal of consulting and clinical psychology.

[25]  W F Velicer,et al.  Applying the transtheoretical model to a representative sample of smokers. , 1995, Addictive behaviors.

[26]  R. Carleton,et al.  The Pawtucket Heart Health Program: community changes in cardiovascular risk factors and projected disease risk. , 1995, American journal of public health.

[27]  W F Velicer,et al.  Standardized, individualized, interactive, and personalized self-help programs for smoking cessation. , 1993, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[28]  A. Folsom,et al.  Community education for cardiovascular disease prevention: risk factor changes in the Minnesota Heart Health Program. , 1994, American journal of public health.

[29]  W F Velicer,et al.  An expert system intervention for smoking cessation. , 1993, Patient education and counseling.

[30]  J. Hollis,et al.  Take heart: results from the initial phase of a work-site wellness program. , 1995, American journal of public health.

[31]  W L Haskell,et al.  Effects of communitywide education on cardiovascular disease risk factors. The Stanford Five-City Project. , 1990, JAMA.

[32]  D B Abrams,et al.  A comparative evaluation of a restrictive smoking policy in a general hospital. , 1989, American journal of public health.

[33]  W. Velicer,et al.  Understanding and intervening with the total population of smokers , 1993 .

[34]  Mitchell H. Gail,et al.  Community Intervention Trial for Smoking Cessation (COMMIT): I. cohort results from a four-year community intervention. , 1995, American journal of public health.

[35]  C. S. Davis.  A computer program for regression analysis of repeated measures using generalized estimating equations. , 1993, Computer methods and programs in biomedicine.

[36]  F B Hu,et al.  Comparison of population-averaged and subject-specific approaches for analyzing repeated binary outcomes. , 1998, American journal of epidemiology.

[37]  R. Groves,et al.  Telephone Survey Methodology. , 1990 .

[38]  W F Velicer,et al.  Assessing outcome in smoking cessation studies. , 1992, Psychological bulletin.

[39]  M. Gail,et al.  Community intervention trial for smoking cessation (COMMIT): II. Changes in adult cigarette smoking prevalence. , 1995, American journal of public health.

[40]  W F Velicer,et al.  Distribution of smokers by stage in three representative samples. , 1995, Preventive medicine.

[41]  J. Hollis,et al.  Patient referral to a smoking cessation program: who follows through? , 1992, The Journal of family practice.

[42]  J. Prochaska,et al.  Stages and processes of self-change of smoking: toward an integrative model of change. , 1983, Journal of consulting and clinical psychology.