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Integrating individual and public health perspectives for treatment of tobacco dependence under managed health care: A combined stepped-care and matching model

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Annals of Behavioral Medicine

Abstract

There is an increasing momentum to integrate prevention into mainstream health care. Three decades of research on tobacco dependence can provide insights into the conceptual, clinical, economic, and service delivery challenges to such an integration. Biological sciences, cognitive-behavioral, clinical treatment outcome, and public health arenas are selectively reviewed. The key conceptual issues are explored relevant to the optimal delivery of quality smoking cessation treatments for the general population of adult smokers at reasonable cost. A comprehensive model for adult smoking cessation treatment is developed. The model consists of an overarching public health approach, focusing on enhancing motivational level from low motivation to quit to high motivation. A common outcome metric of overall impact is proposed to facilitate comparisons between clinical and public health interventions. Smokers are then assessed and triaged into one of three treatment steps of minimal, moderate, and maximal intensity and cost. Smoker individual differences at both the population and individual level are also taken into account as part of a tailoring or matching strategy within and across the stepped interventions. Smoker profiles include sociocultural, nicotine dependence, and comorbidity factors. The result is a hybrid stepped-care matching model. The model serves to illustrate some of the needs and challenges facing future tobacco dependence research and practice. Comparisons are made between tobacco control and other preventive medicine practices in terms of cost per quality adjusted life-year saved. The barriers and opportunities under managed care are explored. The conceptual principles identified here could be used as a guidepost for integrating other preventive medicine programs into the evolving managed health care system.

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References

  1. Lichtenstein E, Glasgow RE: Smoking cessation: What have we learned over the past decade?Journal of Consulting and Clinical Psychology. 1992,60:1–10.

    Google Scholar 

  2. U.S. Department of Health and Human Services:Reducing the Health Consequences of Smoking: 25 Years of Progress. A Report of the Surgeon General, DHHS Publication No. (CDC) 89-8411. Rockville, MD: Centers for Disease Control, Center for Disease Prevention and Health Promotion, Office of Smoking and Health, 1989.

    Google Scholar 

  3. Cigarette smoking among adults—United States, 1993.Morbidity and Mortality Weekly Report. 1994,43:925–930.

    Google Scholar 

  4. Abrams DB, Emmons KM, Niaura R, Goldstein MG, Sherman CB: Tobacco dependence: An integration of individual and public health perspectives. In Nathan P, McCrady B, Langenbucher J, Frankenstein W (eds),Annual Review of Addictions Treatment and Research (Vol. 1). New York: Pergamon Press, 1991, 331–396.

    Google Scholar 

  5. Orleans CT: Treating nicotine dependence is medical settings: A stepped-care model. In Orleans CT, Slade J (eds),Nicotine Addiction: Principles and Management. New York: Oxford University Press, 1993.

    Google Scholar 

  6. Goldstein MG, Niaura R, Abrams DB: Pharmacological and behavioral treatment of nicotine dependence: Nicotine as a drug of abuse. In Stoudemire A, Vogel B (eds),Advances in Medical Psychiatry Practice (Vol. 1). Washington, DC: American Psychiatric Press, Inc., 1991, 541–596.

    Google Scholar 

  7. Hughes JR: An algorithm for smoking cessation.Archives of Family Medicine. 1994,3:280–285.

    PubMed  CAS  Google Scholar 

  8. Fiore MC, Novotny TE, Pierce JP, et al: Methods used to quit smoking in the United States: Do cessation programs help?Journal of the American Medical Association. 1990,263:2760–2765.

    PubMed  CAS  Google Scholar 

  9. Fiore MC, Novotny TE, Pierce JP, et al: Trends in cigarette smoking in the United States. The challenging influence of gender and race.Journal of the American Medical Association. 1989,261(1): 49–55.

    PubMed  CAS  Google Scholar 

  10. Oster G, Colditz GA, Kelly NL: The economic costs of smoking and the benefits of quitting.Preventive Medicine. 1984,13:377–389.

    PubMed  CAS  Google Scholar 

  11. Oster G, Huse DM, Delea TE, et al: Cost-effectiveness of nicotine gum as an adjunct to physician's advice against smoking.Journal of the American Medical Association. 1986,256:1315–1318.

    PubMed  CAS  Google Scholar 

  12. Shepard DS, Stason WB, Perry HM, Carmen BA, Nagurney JT: Multivariate cost-effectiveness analysis: An application to optimizing ambulatory care for hypertension.Inquiry. 1995,32(3): 320–331.

    PubMed  CAS  Google Scholar 

  13. Zeckhauser RJ, Shepard DS: Where now for saving lives?Law and Contemporary Problems. 1976,40(4):5–45.

    Google Scholar 

  14. Velicer WF, Prochaska JO, Rossi JS, Snow MG: Assessing outcome in smoking cessation studies.Psychological Bulletin. 1992,111:23–41.

    PubMed  CAS  Google Scholar 

  15. Bandura A:Social Foundations of Thoughts and Action: A Social-Cognitive Theory. Englewood Cliffs, NJ: Prentice Hall, 1986.

    Google Scholar 

  16. Miller WR, Rollnick S:Motivational Interviewing: Preparing People to Change Addictive Behavior. New York: Guilford Press, 1991.

    Google Scholar 

  17. Abrams DB, Biener L: Motivational characteristics of smokers at the workplace: A public health challenge.Preventive Medicine. 1992,21:679–687.

    PubMed  CAS  Google Scholar 

  18. Brownell K, Marlatt GA, Lichtenstein E, Wilson GT: Understanding and preventing relapse.American Psychologist. 1986,41:765–782.

    PubMed  CAS  Google Scholar 

  19. Prochaska JO, DiClemente CC: Stages and processes of self-change of smoking: Toward an integrative model of change.Journal of Consulting and Clinical Psychology. 1983,51:390–395.

    PubMed  CAS  Google Scholar 

  20. Bandura A: Moving in forward gear in health promotion and disease prevention. Annual Meeting of the Society of Behavioral Medicine. San Diego, CA: 1995.

  21. Owen N, Wakefield M, Roberts L, Esterman A: Stages of readiness to quit smoking: Population prevalence and correlates.Health Psychology. 1992,11:413–417.

    PubMed  CAS  Google Scholar 

  22. Burns D, Pierce JP:Tobacco Use in California 1990–1991. Sacramento, CA: California Department of Health Services, 1992.

    Google Scholar 

  23. Kaplan RM, Pierce JP, Gilpin EA, Johnson M, Bal DG: Stages of smoking cessation: The 1990 California Tobacco Survey.Tobacco Control (in press, 1996).

  24. Hollis JF, Lichtenstein E, Vogt TM, Stevens VJ, Biglan A: Nurse-assisted counseling for smokers in primary care.Annals of Internal Medicine. 1993,118:521–525.

    PubMed  CAS  Google Scholar 

  25. Centers for Disease Control and Prevention: Medical-care expenditures attributable to cigarette smoking—United States, 1993.Morbidity and Mortality Weekly Report. 1994,43:469–472.

    Google Scholar 

  26. Centers for Disease Control and Prevention: Surveillance for smoking-attributable mortality and years of potential life lost, by state—United States, 1990.Morbidity and Mortality Weekly Report. 1994,43:1–8.

    Google Scholar 

  27. Abrams DB, Orleans CT, Niaura RN, et al: Treatment issues: Towards a stepped-care model.Tobacco Control. 1993,2:S17-S37.

    Google Scholar 

  28. DiClemente CC, Prochaska JO, Gilbertini M: Self-efficacy and the stages of change of smoking.Cognitive Therapy and Research. 1985,9:81–200.

    Google Scholar 

  29. Curry S, Wagner EH, Grothaus LC: Intrinsic and extrinsic motivation for smoking cessation.Journal of Consulting and Clinical Psychology. 1990,58(3):310–316.

    PubMed  CAS  Google Scholar 

  30. Curry SJ, McBride CM: Relapse prevention for smoking cessation: Review and evaluation of concepts and interventions.Annual Review of Public Health. 1994,15:345–366.

    PubMed  CAS  Google Scholar 

  31. Britt J, Curry SJ, McBride C, Grothaus L, Louie D: Implementation and acceptance of outreach telephone counseling for smoking cessation with non-volunteer smokers.Health Education Quarterly. 1994,21(1):55–68.

    PubMed  CAS  Google Scholar 

  32. Curry SJ, Wagner EH, Grothaus LC: Evaluation of intrinsic and extrinsic motivation interventions with a self-help smoking cessation program.Journal of Consulting and Clinical Psychology. 1991,59(2):318–324.

    PubMed  CAS  Google Scholar 

  33. Abrams DB, Boutwell WB, Grizzle J, et al: Cancer control at the workplace: The working well trial.Preventive Medicine. 1994,23:15–27.

    PubMed  CAS  Google Scholar 

  34. Rogers EM:Diffusion of Innovations (3rd Ed.). New York: The Free Press, 1983.

    Google Scholar 

  35. Glanz K, Lewis FM, Rimer BK (eds):Health Behavior and Health Education. San Francisco, CA: Jossey-Bass Publishers, 1990.

    Google Scholar 

  36. Marlatt GA, Gordon JR:Relapse Prevention. New York: Guilford Press, 1985.

    Google Scholar 

  37. Abrams DB: Integrating basic, clinical, and public health research for alcohol-tobacco interactions. In Fertig JB, Allen JP (eds),NIAAA Alcohol Research Monograph, Alcohol and Tobacco: From Basic Science to Policy, NIH Publication No. 95-3931. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, 1995.

    Google Scholar 

  38. Abrams DB, Marlatt GA, Sobell MB: Overview of Section II: Treatment, early intervention, and policy. In Fertig J, Allen JP (eds),NIAAA Alcohol Research Monograph, Alcohol and Tobacco: From Basic Science to Policy, NIH Publication No. 95-3931. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, 1995.

    Google Scholar 

  39. Abrams DB, Rohsenow DJ, Niaura RS, et al: Smoking and treatment outcome for alcoholics: Effects on coping skills, urge to drink, and drinking rates.Behavior Therapy. 1992,23(2):283–297.

    Google Scholar 

  40. Emmons K, Marcus B, Linnan L, Rossi J, Abrams D: Mechanisms in multiple risk factor interventions: Smoking, physical activity and dietary fat.Preventive Medicine. 1994,23:481–489.

    PubMed  CAS  Google Scholar 

  41. U.S. Department of Health and Human Services:The Health Consequences of Smoking.Nicotine Addiction: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Office on Smoking and Health, 1988.

    Google Scholar 

  42. American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders (3rd Ed. Revised). Washington, DC: American Psychiatric Association, 1987.

    Google Scholar 

  43. Hughes JR, Higgins ST, Hatsukami DK: Effects of abstinence from tobacco: A critical review. In Kozlowski LT, Annis H, Capell H (eds),Recent Advances in Alcohol and Drug Problems (Vol. 10). New York: Plenum Press, 1990, 317–397.

    Google Scholar 

  44. Shiffman S: Tobacco “chippers”—Individual differences in tobacco dependence.Psychopharmacology. 1989,97:539–547.

    PubMed  CAS  Google Scholar 

  45. Pinto RP, Abrams DB, Monti PM, Jacobus S: Nicotine dependence and likelihood of quitting smoking.Addictive Behaviors. 1987,12:371–374.

    PubMed  CAS  Google Scholar 

  46. Hughes JR: Combined psychological and nicotine gum treatment for smoking: A critical review.Journal of Substance Abuse. 1991,3:337–350.

    PubMed  CAS  Google Scholar 

  47. Fagerstrom KO, Schneider NG: Measuring nicotine dependence: A review of the Fagerstrom Tolerance Questionnaire.Journal of Behavioural Medicine. 1989,12(2):159–182.

    CAS  Google Scholar 

  48. Cohen S, Lichtenstein E, Prochaska JO, et al: Debunking myths about self-quitting: Evidence from 10 prospective studies of persons who attempt to quit smoking by themselves.American Psychologist. 1989,44:1355–1365.

    PubMed  CAS  Google Scholar 

  49. Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom KO: The Fagerstrom Test for Nicotine Dependence: A revision of the Fagerstrom Tolerance Questionnaire.British Journal of Addiction. 1991,86:1119–1127.

    PubMed  CAS  Google Scholar 

  50. Abrams DB, Follick MJ, Biener L, Carey K, Hitti J: Saliva cotinine as a measure of smoking status in field settings.American Journal of Public Health. 1987,77:846–848.

    PubMed  CAS  Google Scholar 

  51. Pomerleau CS, Pomerleau OF, Majchrzak MS, Kloska DD, Malakuti R: Relationship between nicotine tolerance questionnaire scores and plasma cotinine.Addictive Behaviors. 1990,15:73–81.

    PubMed  CAS  Google Scholar 

  52. Niaura R, Goldstein M, Abrams D: A bioinformational systems perspective on tobacco dependence.British Journal of Addiction. 1991,86:593–597.

    PubMed  CAS  Google Scholar 

  53. Pomerleau OF, Collins AC, Shiffman S, Pomerleau CS: Why some people smoke and others do not: New perspectives.Journal of Consulting and Clinical Psychology. 1993,61:723–731.

    PubMed  CAS  Google Scholar 

  54. Killen JD, Fortmann SP: Role of nicotine dependence in smoking relapse: Results from a prospective study using population-based recruitment methodology.International Journal of Behavioral Medicine. 1994,1(4):320–334.

    PubMed  CAS  Google Scholar 

  55. Killen JD, Fortmann SP, Kraemer HC, Varady A, Newman B: Who will relapse? Symptoms of nicotine dependence predict long-term relapse after smoking cessation.Journal of Consulting and Clinical Psychology. 1992,60(5):797–801.

    PubMed  CAS  Google Scholar 

  56. Killen JD, Fortmann SP, Telch MJ, Newman B: Are heavy smokers different from light smokers? A comparison after 48 hours without cigarettes.Journal of the American Medical Association. 1988,260:1581–1585.

    PubMed  CAS  Google Scholar 

  57. Shiffman S: Smoking cessation treatment: Any progress?Journal of Consulting and Clinical Psychology. 1993,61:718–722.

    PubMed  CAS  Google Scholar 

  58. Pomerleau OF, Collins AC, Shiffman S, Pomerleau CS: Why some people smoke and others do not: New perspectives.Journal of Consulting and Clinical Psychology. 1993,61:723–731.

    PubMed  CAS  Google Scholar 

  59. Pomerleau OV, Rosecrans J: Neuroregulatory effects of nicotine.Psychoneuroendocrinology. 1989,6:407–423.

    Google Scholar 

  60. Hughes JR, Hatsukami DK, Mitchell JE, et al: Prevalence of smoking among psychiatric outpatients.American Journal of Psychiatry. 1986,143:993–997.

    PubMed  CAS  Google Scholar 

  61. Battjes RJ: Smoking as an issue in alcohol and drug abuse treatment.Addictive Behaviors. 1988,13:225–230.

    PubMed  CAS  Google Scholar 

  62. Istvan J, Matarazzo J: Tobacco, alcohol, and caffeine use: A review of their interrelationship.Psychological Bulletin. 1984,95: 301–326.

    PubMed  CAS  Google Scholar 

  63. Rounsaville BJ, Kosten TR, Weissman MM, et al:Evaluating and Treating Depressive Disorders in Opiate Addicts, DHHS Publication No. (ADM) 85-1406. Washington, DC: U.S. Government Printing Office, 1985.

    Google Scholar 

  64. Burling TA, Ziff DC: Tobacco smoking: A comparison between alcohol and drug abuse inpatients.Addictive Behaviors. 1988,13: 185–190.

    PubMed  CAS  Google Scholar 

  65. Hughes JR: Treatment of smoking cessation in smokers with a past history of alcohol/drug problems.Journal of Substance Abuse Treatment. 1993,10:181–187.

    PubMed  CAS  Google Scholar 

  66. Fertig J, Allen JP (eds):NIAAA Alcohol Research Monograph, Alcohol and Tobacco: From Basic Science to Policy, NI Publication No. 95-3931. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, 1995.

    Google Scholar 

  67. Hurt RD, Eberman KM, Croghan IT, et al: Nicotine dependence treatment during inpatient treatment for other addictions: A prospective intervention trial.Alcoholism: Clinical and Experimental Research. 1994,18:867–872.

    CAS  Google Scholar 

  68. Glassman AH, Stetner F, Walsh BT, et al: Heavy smokers, smoking cessation, and clonidine.Journal of the American Medical Association. 1988,259:2863–2866.

    PubMed  CAS  Google Scholar 

  69. Hall SM, Munoz R, Reus V: Depression and smoking treatment: A clinical trial of an affect regulation treatment.NIDA Research Monographs. 1992,119:326.

    Google Scholar 

  70. Breslau N, Kilbey MM, Andreski P: Nicotine dependence, major depression, and anxiety in young adults.Archives of General Psychiatry. 1991,48:1069–1074.

    PubMed  CAS  Google Scholar 

  71. Breslau N, Kilbey MM, Andreski P: Nicotine dependence and major depression: New evidence from a prospective investigation.Archives of General Psychiatry. 1993,50:31–35.

    PubMed  CAS  Google Scholar 

  72. Anda RF, Williamson DF, Escobedo LG, et al: Depression and the dynamics of smoking: A national perspective.Journal of the American Medical Association. 1990,264:1541–1545.

    PubMed  CAS  Google Scholar 

  73. Niaura R, Goldstein M, DePue J, et al: Fluoxetine, symptoms of depression, and smoking cessation. The Society of Behavioral Medicine, Sixteenth Anniversary Meeting. San Diego, CA: March, 1995.

  74. Gritz ER, Kristeller J, Burns DM: High-risk groups and patients with medical comorbidity. In Orleans CT, Slade J (eds),Nicotine Addiction: Principles and Management. New York: Oxford University Press, 1993.

    Google Scholar 

  75. Windsor RA, Cutter G, Morris J, et al: The effectiveness of smoking cessation methods for smokers in public health maternity clinics: A randomized trial.American Journal of Public Health. 1985,75:1389–1392.

    PubMed  CAS  Google Scholar 

  76. Taylor CB, Houston-Miller N, Killen J, DeBusk RF: Smoking cessation after acute myocardial infarction: Effects of a nurse-managed intervention.Annals of Internal Medicine. 1990,113: 118–123.

    PubMed  CAS  Google Scholar 

  77. Ockene J, Kristeller J, Goldberg R, et al: Smoking cessation and severity of disease: The coronary artery smoking intervention study.Health Psychology. 1992,11:119–126.

    PubMed  CAS  Google Scholar 

  78. Orleans CT, Rotberg H, Quade D, Lees P: A hospital quit-smoking consult service: Clinical report and intervention guidelines.Preventive Medicine. 1990,19:198–212.

    PubMed  CAS  Google Scholar 

  79. Richmond R, Webster IW: A smoking cessation program for use in general practice.Medical Journal of Australia. 1985,142:190–194.

    PubMed  CAS  Google Scholar 

  80. Risser NL, Belcher DW: Adding spirometry, carbon monoxide, and pulmonary symptom results to smoking cessation counseling.Journal of General Internal Medicine. 1990,5:16–22.

    PubMed  CAS  Google Scholar 

  81. Fisher EB, Haire-Joshue D, Morgan GD, et al: Smoking and smoking cessation.American Review of Respiratory Disease. 1990,142:702–720.

    PubMed  Google Scholar 

  82. Hurt RD, Dale LC, et al: A comprehensive model for the treatment of nicotine dependence in a medical setting.Medical Clinics of North America. 1992,76(2):495–514.

    PubMed  CAS  Google Scholar 

  83. Benowitz NL: Nicotine replacement therapy: What has been accomplished —Can we do better?Drugs. 1993,45:157–170.

    PubMed  CAS  Google Scholar 

  84. Fiore MC, Jorenby DE, Baker TB, Kenford SL: Tobacco dependence and the nicotine patch: Clinical guidelines on effective use.Journal of the American Medical Association. 1992,26:2687–2694.

    Google Scholar 

  85. Marlatt GA, Tapert SF: Harm reduction: Reducing the risks of addictive behaviors. In Baer JS, Marlatt GA, McMahon R (eds),Addictive Behaviors Across the Lifespan. Newbury Park, CA: Sage Publications, 1993.

    Google Scholar 

  86. Kozlowski L, Ferrence RG: Statistical control in research on alcohol and tobacco mortality.British Journal of Addiction. 1990,85:271–278.

    PubMed  CAS  Google Scholar 

  87. Kozlowski LT, Pope MA, Lux JE: Prevalence of the misuse of ultra-low tar cigarettes by blocking filter vents.American Journal of Public Health. 1988,78:694–695.

    PubMed  CAS  Google Scholar 

  88. Orleans CT: Smoking cessation in primary care settings.Journal of the Medical Society of New Jersey. 1988,85(2):116–125.

    CAS  Google Scholar 

  89. U.S. Department of Health and Human Services:The Health Benefits of Smoking Cessation: A Report of the Surgeon General, DHHS Publication No. (CDC) 90-8416. Washington, DC: U.S. Government Printing Office, 1990.

    Google Scholar 

  90. Abrams DB, Wilson GT: Clinical advances in treatment of smoking and alcohol addiction. In Frances AJ, Hales RE (eds),The American Psychiatric Association: Annual Review, Psychiatric Update (Vol. 5). Washington, DC: American Psychiatric Press, 1986, 606–626.

    Google Scholar 

  91. Brown RA, Goldstein MG, Niaura R, Emmons KM, Abrams DB: Nicotine dependence: Assessment and management. In Stoudemire A, Vogel BS (eds),Psychiatric Care of the Medical Patient. New York: Oxford University Press, 1993, 877–902.

    Google Scholar 

  92. Lichtenstein E, Glasgow RE, Abrams DB: Social support in smoking cessation: In search of effective interventions.Behavioral Therapy. 1986,17:607–619.

    Google Scholar 

  93. Abrams DB, Monti PM, Carey KB, Pinto RP, Jacobus SI: Reactivity to smoking cues and relapse: Two studies of discriminant validity.Behaviour Research and Therapy. 1988,26(3):225–233.

    PubMed  CAS  Google Scholar 

  94. Schwartz JL:Review and Evaluation of Smoking Cessation Methods: The United States and Canada, NIH Publication NO. 87-2940. Bethesda, MD: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, 1987.

    Google Scholar 

  95. Hughes JR: Possible effects of smoke-free inpatient units on psychiatric diagnosis and treatment.Journal of Clinical Psychiatry. 1993,54:109–114.

    PubMed  CAS  Google Scholar 

  96. Curry SJ: Self-help interventions for smoking cessation.Journal of Consulting and Clinical Psychology. 1993,61(5):790–803.

    PubMed  CAS  Google Scholar 

  97. Lando HA, Pirie PL, McGovern PG, et al. A comparison of self-help approaches to smoking cessation.Addictive Behaviors. 1991,16(5):183–193.

    PubMed  CAS  Google Scholar 

  98. Glynn T, Boyd G, Gruman J: Essential elements of self-help/minimal intervention strategies for smoking cessation.Health Education Quarterly. 1990,17:329–345.

    PubMed  CAS  Google Scholar 

  99. Velicer WF, Prochaska JO, Bellis JM, et al: An expert system intervention for smoking cessation.Addictive Behaviors. 1993,18:269–290.

    PubMed  CAS  Google Scholar 

  100. Strecher VJ, Kreuter M, DenBoer D-J, et al: The effects of computer-tailored smoking cessation messages in family practice settings.Journal of Family Practice: 1994,39:262–270.

    PubMed  CAS  Google Scholar 

  101. Orleans CT, Resch N, Noll E, et al: Use of transdermal nicotine in a state-level prescription plan for the elderly: Problems and promise. Unpublished Manuscript. Philadelphia, PA: Fox Chase Cancer Center, 1993.

    Google Scholar 

  102. Glynn TJ, Manley M: Physicians, cancer control, and the treatment of nicotine dependence: Defining success.Health Education Research. 1989,4:479–487.

    Google Scholar 

  103. Glynn TJ, Manley MW:How to Help Your Patient Stop Smoking: A National Cancer Institute Manual for Physicians, DHHS Publication No. 89-3064. Washington, DC: National Cancer Institute, 1991.

    Google Scholar 

  104. National Heart Lung and Blood Institute:Nurses: Help Your Patients Stop Smoking. NIH Publication No. 90-2962. Washington, DC: National Cancer Institute, 1990.

    Google Scholar 

  105. Mecklenburg RE, Christen AG, Gerbert B, et al:How to Help Your Patients Stop Using Tobacco: A National Cancer Institute Manual for the Oral Health Team, NIH Publication No. 91-3191. Washington, DC: National Cancer Institute 1990.

    Google Scholar 

  106. National Heart Lung and Blood Institute:How You Can Help Patients Stop Smoking: Opportunities for Respiratory Care Practitioners, NIH Publication No. 89-2961. Washington, DC: National Cancer Institute, 1989.

    Google Scholar 

  107. Glynn TJ: Relative effectiveness of physician-initiated smoking cessation programs.Cancer Bulletin. 1988,40(6):359–364.

    Google Scholar 

  108. Orleans CT, Glynn TJ, Manley MW, Slade J: Minimal contact quit smoking strategies for medical settings. In Orleans CT, Slade J (eds),Nicotine Addiction: Principles and Management. New York: Oxford University Press, 1993.

    Google Scholar 

  109. Manley M, Epps R, Husten C, Glynn T, Shopland D: Clinical interventions in tobacco control.Journal of the American Medical Association. 1991,266(22):3172–3173.

    PubMed  CAS  Google Scholar 

  110. Ockene JK, Quirk ME, Goldberg R, et al: A residents' training program for the development of smoking intervention skills.Archives of Internal Medicine. 1988,148:1039–1045.

    PubMed  CAS  Google Scholar 

  111. Cummings KM, Giovino G, Emont SL, et al: Factors influencing success in counseling patients to stop smoking.Patient Education Counseling. 1986,8:189–200.

    Google Scholar 

  112. Fiore MC: The new vital sign: Assessing and documenting smoking status.Journal of the American Medical Association. 1991.266:3183–3184.

    PubMed  CAS  Google Scholar 

  113. Orleans CT, Schoenbach VJ, Wagner E, et al: Self-help quit smoking interventions: Effects of self-help materials, social support instructions, and telephone counseling.Journal of Consulting and Clinical Psychology. 1991,3:439–448.

    Google Scholar 

  114. Ossip-Klein DJ, Giovino GA, Megahed N, et al: Effects of a smokers' hotline: Results of a 10-county self-help trial.Journal of Consulting and Clinical Psychology. 1991,59:325–332.

    PubMed  CAS  Google Scholar 

  115. Pierce JP, Anderson DM, Meissner HI, et al: Promoting smoking cessation in the United States: The effect of public service announcements on the cancer information service telephone line.Journal of the National Cancer Institute. 1992, 677–683.

  116. Glasgow R, Lando H, Hollis J, McFae S, LaChance P: A stop smoking telephone helpline that nobody called.American Journal of Public Health. 1993,83:252–254.

    PubMed  CAS  Google Scholar 

  117. Silagy C, Mant D, Fowler G, Lodge M: Meta-analysis on efficacy of nicotine replacement therapies in smoking cessation.The Lancet. 1994,343:139–142.

    CAS  Google Scholar 

  118. Hughes JR: Combining behavioral therapy and pharmacotherapy for smoking cessation: An update. In Harris LS (ed),Integrating Behavior Therapies with Medication in the Treatment of Drug Dependence. Washington, DC: U.S. Government Printing Office, 1995.

    Google Scholar 

  119. Fiore MC, Smith SS, Jorenby DE, Baker TB: The effectiveness of the nicotine patch for smoking cessation: A meta-analysis.Journal of the American Medical Association. 1994,271:1940–1947.

    PubMed  CAS  Google Scholar 

  120. Fortmann SP, Killen JD, Telch MJ, Newman B: Minimal contact treatment for smoking cessation: A placebo controlled trial of nicotine polacrilex and self-directed relapse prevention. Initial results of the Stanford Stop Smoking Project.Journal of the American Medical Association. 1988,260:1575–1580.

    PubMed  CAS  Google Scholar 

  121. Hughes JR: Pharmacotherapy for smoking cessation: Unvalidated assumptions, anomalies, and suggestions for future research.Journal of Consulting and Clinical Psychology (in press, 1996).

  122. Tonnesen P: Dose and nicotine dependence as determinants of nicotine gum efficacy. In Pomerleau OF, Pomerleau CS (eds),Nicotine Replacement: A Critical Evaluation, New York: Alan R. Liss, Inc., 1988, 129–144.

    Google Scholar 

  123. Lam W, Sze PC, Sacks HS, Chalmers TC: Meta-analysis of randomized controlled trials of nicotine chewing gum.The Lancet. 1987,2(8549):27–30.

    CAS  Google Scholar 

  124. Abelin T, Muller P, Buehler A, Vesanen K, Imhof PR: Controlled trial of transdermal nicotine patch in tobacco withdrawal.The Lancet. 1989,1:7–12.

    CAS  Google Scholar 

  125. Tonnesen P, Norregaard J, Simonsen K, Sawe U: A double-blind trial of a 16-hour transdermal nicotine patch in smoking cessation.New England Journal of Medicine. 1991,325:311–316.

    PubMed  CAS  Google Scholar 

  126. Lando HA, McGovern PG, Barrios FX, Etringer BD: Comparative evaluation of American Cancer Society and American Lung Association smoking cessation clinics.American Journal of Public Health. 1990,80:554–559.

    PubMed  CAS  Google Scholar 

  127. Ornish SA, Zisook S, McAdams LA: Effects of transdermal clonidine treatment on withdrawal symptoms associated with cigarette smoking: A randomized controlled trial.Archives of Internal Medicine. 1988,148:2027–2031.

    PubMed  CAS  Google Scholar 

  128. Monti PM, Rohsenow DJ, Abrams DB: Smoking among alcoholics before, during, and after treatment: Implications for treatment and policy. In Fertig JB, Allen JP (eds),NIAAA Alcohol Research Monograph, Alcohol and Tobacco: From Basic Science to Policy, NIH Publication No. 95-3931. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, 1995.

    Google Scholar 

  129. Pomerleau OF, Bell CS, Benowitz NL, et al: Task Force 4: Nicotine and smoking relapse.Health Psychology. 1986,5(Suppl.): 41–51.

    PubMed  Google Scholar 

  130. Covey LS, Glassman AH: A meta-analysis of double-blind placebo-controlled trials of clonidine for smoking cessation.British Journal of Addiction. 1991,86:991–998.

    PubMed  CAS  Google Scholar 

  131. Davison R, Kaplan K, Fintel D, et al: The effect of clonidine on the cessation of cigarette smoking.Clinical Pharmacology and Therapeutics. 1988,44:265–267.

    PubMed  CAS  Google Scholar 

  132. Gourlay SG, Benowitz NL: Is clonidine an effective smoking cessation therapy?Drugs. 1995,50:197–207.

    PubMed  CAS  Google Scholar 

  133. Gawin FH, Compton M, Byck R: Buspirone reduces smoking.Archives of General Psychiatry. 1989,46:288–289.

    PubMed  CAS  Google Scholar 

  134. Hilleman DE, Mohiuddin SM, Del Core MG, Sketch MH: Effect of buspirone on withdrawal symptoms associated with smoking cessation.Archives of Internal Medicine. 1992,152:350–352.

    PubMed  CAS  Google Scholar 

  135. Edwards NB, Murphy JK, Downs AD, et al: Antidepressants and nicotine withdrawal symptoms. The American Psychiatric Association Annual Meeting. Montreal, Canada: 1988.

  136. Edwards NB, Downs AD, Murphy JK, et al: Brief doxepin therapy for smoking cessation. The American Psychiatric Association Annual Meeting. San Francisco, CA: 1989.

  137. Edwards NB, Murphy JK, Downs AD, et al: Doxepin as an adjunct to smoking cessation: A double-blind pilot study.American Journal of Psychiatry. 1989,146:373–376.

    PubMed  CAS  Google Scholar 

  138. Klesges RC, Klesges LM: Cigarette smoking as a dietary strategy in a university population.International Journal of Eating Disorders. 1988,7:413–419.

    Google Scholar 

  139. Russell PO, Epstein LH: Smoking. In Blechman EA, Brownell KD (eds),Handbook of Behavioral Medicine for Women. New York: Pergamon Press, 1988, 369–383.

    Google Scholar 

  140. Klesges RC, Meyers AW, Klesges LM, et al: Smoking, body weight, and their effects on smoking behavior: A comprehensive review of the literature.Psychological Bulletin. 1989,106:204–230.

    PubMed  CAS  Google Scholar 

  141. Marcus BH, Albrecht AE, Niaura RS, et al: Usefulness of physical exercise for maintaining smoking cessation in women.American Journal of Cardiology. 1991,68:406–407.

    PubMed  CAS  Google Scholar 

  142. Streator JA, Sargent RC, Ward DC: A study of factors associated with weight change in women who attempt smoking cessation.Addictive Behaviors. 1989,14:523–530.

    Google Scholar 

  143. Niaura R, Shiffman S: Alcohol & tobacco: From basic science to policy. Overview and commentary on psychosocial and biological mechanisms. In Fertig J, Allen JP (eds),NIAAA Alcohol Research Monograph, Alcohol and Tobacco: From Basic Science to Policy, NIH Publication No. 95-3931. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, 1995.

    Google Scholar 

  144. Pinney J, Henningfield JE, Shiffman S, Stitzer ML: Issues in smoking cessation: Who quits and who pays? A national conference. Behavioral Biology Research Center, The Johns Hopkins University School of Medicine and Corporate Health Policies Group. Bethesda, MD: April, 1993.

    Google Scholar 

  145. Pinney J: Review of the current status of smoking cessation in the USA: Assumptions and realities.Tobacco Control. 1995,4(Suppl. 2):S10-S14.

    Google Scholar 

  146. Stevens VJ, Glasgow RE, Hollis J, Lichtenstein E, Vogt TM: Smoking cessation intervention for hospital patients.Medical Care. 1993,31:65–72.

    PubMed  CAS  Google Scholar 

  147. Bertera RL, Oehl LK, Telepchak JM: Self-help versus group approaches to smoking cessation in the workplace: Eighteen-month follow-up and cost analysis.American Journal of Health Promotion. 1990,4:187–192.

    Google Scholar 

  148. Schauffler HH, Parkinson MD: Health insurance coverage for smoking cessation services.Health Education Quarterly. 1993,20:185–206.

    PubMed  CAS  Google Scholar 

  149. Ershoff DH, Quinn VP, Mullen PD, Lairson DR: Pregnancy and medical cost outcomes of a self-help prenatal smoking cessation program in an HMO.Public Health Reports. 1990,105:340–347.

    PubMed  CAS  Google Scholar 

  150. Cummings SR, Rubin SM, Oster G: The cost-effectiveness of counseling smokers to quit.Journal of the American Medical Association. 1989,1:75–79.

    Google Scholar 

  151. Marks JS, Koplan JP, Hogue CJ, Dalmat ME: A cost-benefit/cost-effectiveness analysis of smoking cessation for pregnant women.American Journal of Preventive Medicine. 1990,6(5):282–289.

    PubMed  CAS  Google Scholar 

  152. Altman DG, Flora JA, Fortmann SP, Farquhar JW: The cost-effectiveness of three smoking cessation programs.American Journal of Public Health. 1987,77(2):162–165.

    PubMed  CAS  Google Scholar 

  153. Hughs J, Wadland W, Fenwick J, Lewis J, Bickel WK: Effect of cost on the self-administration and efficacy of nicotine gum: A preliminary study.Preventive Medicine. 1991,20:486–496.

    Google Scholar 

  154. Parkinson MD, Shauffler HH, Kottke TE, et al: Report of the Tobacco Policy Research Study Group on reimbursement and insurance in the United States.Tobacco Control. 1992, (Suppl. 1):52–56.

    Google Scholar 

  155. Warner K, Murt H: Economic incentive for health.Annual Review of Public Health. 1984,5:107–133.

    PubMed  CAS  Google Scholar 

  156. Emmons KM, Abrams DB, Marshall R, et al: A study of exposure to environmental tobacco smoke in naturalistic settings.American Journal of Public Health. 1992,82:24–28.

    PubMed  CAS  Google Scholar 

  157. Emmons KM, Hammond SK, Abrams DB: The impact of smoking cessation on non-smokers' exposure to environmental tobacco smoke.Health Psychology. 1995,13:516–520.

    Google Scholar 

  158. Marcus BH, Emmons K, Abrams DB, et al: Restrictive workplace smoking policies: Impact on non-smoker's tobacco exposure.Journal of Public Health Policy. 1992,13(1):42–51.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Behavioral Medicine, Brown University School of Medicine, The Miriam Hospital, 164 Summit Avenue, 02906, Providence, RI, USA

    David B. Abrams

  2. Fox Chase Cancer Center, Philadelphia, USA

    C. Tracy Orleans

  3. Brown University School of Medicine, Providence, USA

    Raymond S. Niaura & Michael G. Goldstein

  4. University of Rhode Island, Kingston, USA

    James O. Prochaska & Wayne Velicer

Authors
  1. David B. Abrams
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  2. C. Tracy Orleans
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  3. Raymond S. Niaura
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  4. Michael G. Goldstein
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  5. James O. Prochaska
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  6. Wayne Velicer
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Additional information

Preparation of this manuscript was supported in part by National Institutes of Health grants: R01CA 38309; R01HL32318; and P01CA50087 from the National Cancer Institute and National Heart, Lung and Blood Institute, USA.

The authors thank Dr. Neil Grunberg, Dr. Susan Curry, and two other anonymous reviewers for providing such detailed and valuable feedback that significantly improved the final paper. The authors thank Lori Krawetz and Barbara Doll for their invaluable assistance in preparing this paper.

This paper is based in part on a presentation made at the National Conference: Issues in Smoking Cessation: Who Quits and Who Pays? The Johns Hopkins University School of Medicine, Washington, DC, April 13, 1993. The proceedings were published inTobacco Control, 1993,2(Suppl.):S17–S37.

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Abrams, D.B., Orleans, C.T., Niaura, R.S. et al. Integrating individual and public health perspectives for treatment of tobacco dependence under managed health care: A combined stepped-care and matching model. Ann Behav Med 18, 290–304 (1996). https://doi.org/10.1007/BF02895291

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