Providing an integrated program of low intensity tobacco cessation services in a health maintenance organization

This paper reports on the development, promotion and use of a coordinated program of low intensity intervention services designed to appeal to smokers (and smokeless tobacco users) at various stages of change. An initial package of four components: a telephone advice line, self-help materials, single session group meetings and bi-monthly newsletter was offered to subjects in a variety of different settings (outpatient clinics, dental offices, worksites, hospitals) within a health maintenance (HMO) program project. Based upon consumer response and formative evaluations, these components were modified during the course of the year-long intervention. Results revealed differences in use of the various components of the program, with greatest use of self-help materials (manuals, 'tobacco substitutes' and a computerized smoking cessation aid) and least response to group meetings and the advice line. Most encouraging was the finding that it was possible to reach heavy smokers and to engage them in tobacco cessation activities through a centralized program of low intensity services. Data are presented on member characteristics associated with use/non-use of the various low intensity resources and suggestions are made for wider use of such interventions in other health care systems.