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 interacti ve expert system intervention for smoking cessation for a general populatio n. The intervention provides individualized feedback that guides participan ts through the stages of change for cessation. Enhancing the expert system by adding proactive telephone counseling or a stimulus control computer des igned to produce nicotine fading could produce preventive programs with gre ater population impacts. Methods. Four interventions were compared: (a) the interactive expert syste m 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 telepho ne or mail. The initial subject pool was the 24,178 members of a managed ca re company. Screening was completed for 19,236 members (79.6%), of whom 4,6 53 were smokers; 85.3% of the smokers were enrolled. Results. Thirty-eight percent were in the precontemplation stage, 45% in th e 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 produc ed increased cessation at;12 months but not at 18 months. The stimulus cont rol computer produced no improvement, resulting in 20% worse cessation rate s 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 s ystem to produce significantly greater cessation in a population of smokers than assessment alone. (C) 2000 American Health Foundation and Academic Pr ess.