Step Care treatment for smoking cessation.
We compared the effectiveness of a ‘stepped care’ approach with increasing treatment intensity (‘Step Care’) to one with repeated treatments (‘Recycle’) among cigarette smokers interested in quitting smoking. Step 1 of the Step Care intervention consisted of a single counseling session, nicotine patch for six weeks and telephonic contact. For smokers not achieving tobacco abstinence 6 months after randomization with Step 1, the intensity of the intervention increased to four counseling sessions, bupropion sustained-release, nine telephone calls and three mailings (Step 2). For those not achieving tobacco abstinence 12 months after randomization, smokers received six behavioral counseling sessions, nicotine patch and nicotine gum, nine telephone calls and three mailings (Step 3). The Recycle participants received one session of health behavior counseling, six weeks of the nicotine patch and a telephone call at each step. 270 cigarette smokers were randomized. At 24 months after randomization using an intention to treat analysis, no statistically significant difference was observed in prolonged smoking abstinence between the Step Care and Recycle condition (16.9% versus 9.4%; adjusted OR = 1.88; 95% CI 0.88–4.01; P =0.10). Additional research is needed to explore whether a stepped care intervention increases long-term smoking abstinence rates compared with repeating the same intervention.
Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Jon O
JO
Ebbert
Center for Population Sciences, Department of Preventive Medicine, University of Tennessee Heath Science Center, 66 North Pauline Street, Suite 633, Memphis, TN 38163, USA.
Melissa A
MA
Little
Center for Population Sciences, Department of Preventive Medicine, University of Tennessee Heath Science Center, 66 North Pauline Street, Suite 633, Memphis, TN 38163, USA.
Robert C
RC
Klesges
Center for Population Sciences, Department of Preventive Medicine, University of Tennessee Heath Science Center, 66 North Pauline Street, Suite 633, Memphis, TN 38163, USA.
Zoran
Z
Bursac
Department of Preventive Medicine, University of Tennessee Heath Science Center, 66 North Pauline Street, Suite 633, Memphis, TN 38163, USA.
Karen C
KC
Johnson
Department of Preventive Medicine, University of Tennessee Heath Science Center, 66 North Pauline Street, Suite 633, Memphis, TN 38163, USA.
Fridtjof
F
Thomas
Departments of Internal Medicine and Psychological and Brain Sciences, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA and.|Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Iowa City, IA 52246, USA.
Mark W
MW
Vander Weg
D000328:Adult; D016642:Bupropion / Q000008:administration & dosage; D003376:Counseling / Q000379:methods*; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D016540:Smoking Cessation; D013689:Telephone; D013997:Time Factors; D061485:Tobacco Use Cessation Devices
D016642:Bupropion