A Pragmatic Framework for Smoking Cessation: Implications for Clinical and Public Health Programs

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Smoking cessation research and programs are shifting toward reaching populations. A framework for intervention for tobacco and other addictive behaviors is presented that can accommodate this emerging paradigm as well as more traditional clinical approaches. Smoking cessation is seen to be determined by 3 sets of factors: (a) motivation, which includes both readiness to try to quit and persistence in the face of withdrawal and stress; (b) addiction level; and (c) environmental supports and barriers. Coping skills that provide ways of dealing with these factors are seen as the essential content of cessation programs. The implications of this framework for assessment and intervention are discussed, with particular attention to the different requirements of clinical (intensive, aimed at self-selected smokers) and population-based (brief, aimed at all smokers in a setting) programs.

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