The Multiphase Optimization Strategy (MOST) is a new methodological approach for building, optimizing, and evaluating multicomponent interventions. Conceptually rooted in engineering, MOST emphasizes efficiency and careful management of resources to move intervention science forward steadily and incrementally. MOST can be used to guide the evaluation of research evidence, develop an optimal intervention (the best set of intervention components), and enhance the translation of research findings, particularly Type II translation. This article uses an ongoing study to illustrate the application of MOST in the evaluation of diverse intervention components derived from the phase-based framework reviewed in the companion article by Baker et al. (1). The article also discusses considerations, challenges, and potential benefits associated with using MOST and similar principled approaches to improving intervention efficacy, effectiveness and cost-effectiveness. The applicability of this methodology may extend beyond smoking cessation to the development of behavioral interventions for other chronic health challenges.

Posttraumatic stress disorder (PTSD) was examined as a risk factor for suicidal ideation in Iraq and Afghanistan War veterans (N = 407) referred to Veterans Affairs mental health care. The authors also examined if risk for suicidal ideation was increased by the presence of comorbid mental disorders in veterans with PTSD. Veterans who screened positive for PTSD were more than 4 times as likely to endorse suicidal ideation relative to non-PTSD veterans. Among veterans who screened positive for PTSD (n = 202), the risk for suicidal ideation was 5.7 times greater in veterans who screened positive for two or more comorbid disorders relative to veterans with PTSD only. Findings are relevant to identifying risk for suicide behaviors in Iraq and Afghanistan War veterans.

A Web-based survey of adults who experienced loss during the September 11, 2001, terrorist attacks was conducted to examine the prevalence and correlates of complicated grief (CG) 2.5-3.5 years after the attacks. Forty-three percent of a study group of 704 bereaved adults across the United States screened positive for CG. In multivariate analyses, CG was associated with female gender, loss of a child, death of deceased at the World Trade Center, and live exposure to coverage of the attacks on television. Posttraumatic stress disorder, major depression, anxiety, suicidal ideation, and increase in post-9/11 smoking were common among participants with CG. A majority of the participants with CG reported receiving grief counseling and psychiatric medication after 9/11. Clinical and policy implications are discussed.

Despite advances in tobacco dependence treatment in the past two decades, progress has been inconsistent and slow. This paper reviews pervasive methodological issues that may contribute to the lack of timely progress in tobacco treatment science including: the lack of a dynamic model or framework of the cessation process, inefficient study designs, and the use of distal outcome measures that poorly index treatment effects. The authors then present a phase-based cessation framework that partitions the cessation process into four discrete phases based on current theories of cessation and empirical data. These phases include: 1) Motivation, 2) Precessation, 3) Cessation, and 4) Maintenance. Within this framework it is possible to identify phase-specific challenges that a smoker would encounter while quitting smoking, intervention components that would address these phase-specific challenges, mechanisms via which such interventions would exert their effects and optimal outcome measures linked to these phase-specific interventions. Investigation of phase-based interventions can be accelerated by using efficient study designs that would permit more timely development of an optimal smoking cessation treatment package.At a Brookings Institute Conference, David Kessler, former FDA Commissioner, observed that the impressive progress made in AIDS research can be attributed, in part, to the development of "surrogate endpoints" such as HIV viral load that index treatment effects in randomized clinical trials far earlier than the obvious clinical endpoint of survival duration (1). Kessler advocated the development of such surrogates for other diseases such as cancer: measures that would index effects that are powerfully linked with ultimate outcomes, but that can be ascertained relatively quickly and cheaply relative to such outcomes. As Kessler's observations suggest, standard operating procedures within a research field can profoundly influence progress, regardless of other factors such as innovative ideas, powerful theories, and level of financial support. The current paper identifies methods in the field of tobacco research that may be hobbling progress in discovering and validating effective interventions. It then recommends several complementary strategies that may improve the yield of tobacco dependence treatment research, some of which may be relevant to other areas of research as well.Potential Conflicts of Interest: Timothy B. Baker, Robin Mermelstein, Megan E. Piper, Jessica W. Cook, Stevens S. Smith, and Tanya R. Schlam have no potential conflicts of interest to disclose. Douglas E. Jorenby has received research support from the National Institute on Drug Abuse, the National Cancer Institute, Pfizer, Inc., Sanofi-Synthelabo, and Nabi Biopharmaceuticals. He has received support for educational activities from the National Institute on Drug Abuse and the Veterans Administration, and consulting fees from Nabi Biopharmaceuticals. Stevens S. Smith has received research support from Elan Corporation, plc. Over t...

Women, Blacks, and smokers with less education are at elevated risk for cessation failure, and research is needed to understand this risk and develop pharmacological and psychosocial interventions to improve their long-term cessation rates.