Long-term results of a smoking reduction program

Med Care. 2009 Jan;47(1):115-20. doi: 10.1097/MLR.0b013e31817e18d1.


Introduction: There have been few comprehensive evaluations of smoking reduction, especially in health care delivery systems, and little is known about its cost, maintenance of reduced smoking, or robustness across patient subgroups.

Methods: A generally representative sample of 320 adult smokers from an HMO scheduled for outpatient surgery or a diagnostic procedure was randomized to enhanced usual care or a theory-based smoking reduction intervention that combined telephone counseling and tailored newsletters. Outcomes included cigarettes smoked, carbon monoxide levels, and costs.

Results: Both intervention and control conditions continued to improve from 3- to 12-month assessments. Between-condition differences using intent-to-treat analyses on both self-report and carbon monoxide measures were nonsignificant by the 12-month follow-up (25% vs. 19% achieved 50% or greater reductions in cigarettes smoked). The intervention was implemented consistently despite logistical constraints and was generally robust across patient characteristics (eg, education, ethnicity, health literacy, dependence).

Conclusions: In the absence of nicotine replacement therapy, the long-term effects of this smoking reduction intervention seem modest and nonsignificant. Future research is indicated to enhance intervention effects and conduct more comprehensive economic analyses of program variations.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Ambulatory Surgical Procedures
  • Biomarkers
  • Carbon Monoxide / analysis
  • Colorado
  • Diagnostic Imaging
  • Directive Counseling*
  • Female
  • Health Maintenance Organizations / economics*
  • Humans
  • Male
  • Middle Aged
  • Outcome and Process Assessment, Health Care*
  • Patient Education as Topic / economics*
  • Patient Education as Topic / methods*
  • Periodicals as Topic*
  • Program Evaluation
  • Self Efficacy
  • Smoking Cessation / economics*
  • Smoking Cessation / methods*
  • Telephone
  • Time Factors
  • Young Adult


  • Biomarkers
  • Carbon Monoxide