5291
document
Counselor and stimulus control enhancements of a stage-matched expert system intervention for smokers in a managed care setting . BACKGROUND Previous research has demonstrated the efficacy of an interactive expert system intervention for smoking cessation for a general population . The intervention provides individualized feedback that guides participants through the stages of change for cessation . Enhancing the expert system by adding proactive telephone counseling or a stimulus control computer designed to produce nicotine fading could produce preventive programs with greater population impacts . METHODS Four interventions were compared : ( a ) the interactive expert system intervention ; ( b ) the expert system intervention plus counselor calls ; ( c ) the expert system intervention plus the stimulus control computer ; and ( d ) an assessment only condition . A 4 ( intervention ) x 4 ( occasions ) ( 0,6,12 , and 18 months ) design was used . Smokers were contacted at home via telephone or mail . The initial subject pool was the 24,178 members of a managed care company . Screening was completed for 19,236 members ( 79.6 % ) , of whom 4,653 were smokers ; 85.3 % of the smokers were enrolled . RESULTS Thirty-eight percent were in the precontemplation stage , 45 % in the contemplation stage , and only 17 % in the preparation stage . At 18 months , the expert system resulted in 23.2 % point prevalence abstinence , which was 33 % greater than that of assessment only . The counselor enhancement produced increased cessation at 12 months but not at 18 months . The stimulus control computer produced no improvement , resulting in 20 % worse cessation rates than the assessment only condition . CONCLUSIONS The enhanced conditions failed to outperform the expert system alone . The study also demonstrated the ability of the interactive expert system to produce significantly greater cessation in a population of smokers than assessment alone .
5292
Intervention_Educational
stage-matched expert system intervention
5293
Intervention_Educational
interactive expert system intervention
5294
Intervention_Educational
the interactive expert system intervention
5295
Intervention_Educational
expert system intervention plus counselor calls
5296
Intervention_Educational
expert system intervention plus the stimulus control computer
5297
Intervention_Educational
assessment only condition
5298
Intervention_Educational
interactive expert system
5299
Outcome_Other
stage-matched expert system intervention for smokers
5300
Outcome_Other
efficacy
5301
Outcome_Mental
prevalence abstinence
5302
Outcome_Mental
cessation
5303
Outcome_Other
improvement
5304
Outcome_Mental
cessation
5305
Outcome_Other
outperform
5306
Outcome_Other
expert system
5307
Outcome_Mental
cessation
5308
Participant_Condition
smokers
5309
Participant_Sample-size
24,178
5310
Participant_Sample-size
19,236
5311
Participant_Sample-size
4,653