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Smokers (N = 3,030) were randomized to receive 1 of 3 interventions: (a) a self-help quit kit, (b) a quit kit plus 1 telephone counseling session, or (c) a quit kit plus up to 6 telephone counseling sessions, scheduled according to relapse probability. Both counseling groups achieved significantly higher abstinence rates than the self-help group. The rates for having quit for at least 12 months by intention to treat were 5.4% for self-help, 7.5% for single counseling, and 9.9% for multiple counseling. The 12-month continuous abstinence rates for those who made a quit attempt were 14.7% for self-help, 19.8% for single counseling, and 26.7% for multiple counseling. A dose-response relation was observed, as multiple sessions produced significantly higher abstinence rates than a single session. The first week after quitting seems to be the critical period for intervention.Telephone counseling has attracted increasing interest as an alternative system for delivery of services in the field of smoking cessation (e.g., Anderson, Duffy, Hallet, & Marcus, 1992;Curry, McBride, Louie, Grothaus, & Wagner, 1992;DeBusk et al., 1994; Lando, Hellerstedt, Pirie, & McGovern, 1992;Orleans et al., 1991;Ossip-Klein et al., 1991;Prochaska, DiClemente, Velicer, & Rossi, 1993;Shiffman, Read, Maltese, Rapkin, & Jarvik, 1985). From the smoker's standpoint, its main attractions are accessibility and convenience. There are no transportation difficulties and fewer scheduling conflicts than in most other cessation programs. Also, receiving counseling in the privacy of one's home provides treatment access to individuals who might not normally seek "counseling" to quit smoking. These factors encourage smokers to use the service (Zhu etal., 1995 cantly increases the success rate (e.g., Orleans et al., 1991;Ossip-Klein et al., 1991), others report only a short-term effect, with the long-term outlook no better than that of selfhelp(e.g., Curry etal., 1992; Lando etal., 1992). Those studies that have shown a significant intervention effect for telephone counseling, however, did not include a randomized design to test for a dose-response relation between the number of sessions and the treatment effect.The present study examined the effects of two levels of telephone counseling and compared them with the effects of a selfhelp approach. The lower intensity counseling consisted of one session before quitting. The higher intensity counseling included the same pre-quit session plus up to five sessions after the smoker had quit. We tested two hypotheses: (a) that counseling would produce a higher abstinence rate than a self-help quit kit, and (b) that multiple sessions of counseling would produce a higher abstinence rate than a single session.

Prospective data from the California Tobacco Surveys (n = 2066) were used to perform a critical test of the Prochaska et al. (1991) stages of change model. When the stages of change model was used as a stand alone predictor, smokers in preparation at baseline were more likely to be in cessation at follow-up than smokers in pre-contemplation at baseline (ORadj = 1.9). When stage membership was combined with baseline measures of addiction including smoking behaviors and quitting history, it was not a significant predictor of future cessation. A prediction equation that combined daily vs. occasional smoking, cigarettes per day smoked, life-time quits of at least a year, and quits of more than 5 days in the previous year discriminated smokers in cessation at follow-up of 1 to 2 years better than did the stages of change model. The area under the ROC curve for the equation based on addiction measures was 69.3% vs. 55.1% for the stages of change. Cessation rates ranged from 7.7% to 35.7% for the four-category addiction equation compared with 15.1% to 24.9% for stages of change model.

Prospective data from the California Tobacco Surveys (n = 2066) were used to perform a critical test of the Prochaska et al. (1991) stages of change model. When the stages of change model was used as a stand alone predictor, smokers in preparation at baseline were more likely to be in cessation at follow-up than smokers in pre-contemplation at baseline (ORadj = 1.9). When stage membership was combined with baseline measures of addiction including smoking behaviors and quitting history, it was not a significant predictor of future cessation. A prediction equation that combined daily vs. occasional smoking, cigarettes per day smoked, life-time quits of at least a year, and quits of more than 5 days in the previous year discriminated smokers in cessation at follow-up of 1 to 2 years better than did the stages of change model. The area under the ROC curve for the equation based on addiction measures was 69.3% vs. 55.1% for the stages of change. Cessation rates ranged from 7.7% to 35.7% for the four-category addiction equation compared with 15.1% to 24.9% for stages of change model.