Using RE-AIM to evaluate a practical and generalizable smoking reduction study

Our research group has developed a smoking reduction intervention that was designed to be broadly applicable and is integrated into other smoking modification options in a large managed care organization. The focus of the intervention was on behavioral approaches to reduce the number of cigarettes smoked, and not on the use of alternative tobacco products. A social-ecological theoretical approach, including risk perceptions, self-efficacy, problem solving, and environmental support was used for intervention development. A generally representative sample of 320 adult smokers from an HMO scheduled for an outpatient surgery or procedure was randomized to enhanced usual care or the theory-based smoking reduction intervention that combined telephone counseling and tailored newsletters. Assessments were conducted at baseline, 3-, and 12-months. We used the RE-AIM framework to enhance the understanding of the effectiveness and generalizability of this intervention. Results will include the reach of this smoking reduction program offered in conjunction with other smoking services of a large HMO. Effectiveness of the program (short-term and long-term outcomes) was assessed by a 50% or greater reduction in smoking rate and a 50% reduction in biochemical validation measures. The program was well implemented with 79% of all intervention participants received at least three of the four phone calls, (96% of those who did not withdraw from the program), and 73% received four or more newsletters (89% of those who did not withdraw). While results of this study are encouraging additional research is indicated to evaluate public health impact.