Cigarette smoking is the leading cause of death accounting for more than 480,000 deaths each year, and 16
million Americans suffer from one or more diseases caused by smoking. Cessation can significantly reduce the
risk of disease even for those who have smoked for decades. Interventions using a combination of behavioral
approaches that focus on maintaining smokers' motivation to quit, providing specific techniques for quitting and
relapse prevention, and using Nicotine Replacement Therapy (NRT) are effective at helping tobacco users quit.
However, standard behavioral treatment may not appeal to, or be effective for, some smokers and novel
approaches are needed to assist these individuals. Guided Imagery (GI) is a form of mind-body therapy that
involves controlled, multi-sensory visualization of specific mental images. GI is an effective therapeutic tool to
change behaviors including tobacco use. Multiple studies have shown that exposure to GI results in significantly
increased abstinence rates compared to controls or those taking bupropion. A large proportion of the U.S.
population uses integrative health approaches. A GI tobacco cessation intervention could appeal to smokers not
interested in using a behavioral approach. Although GI is an effective tool for smoking cessation, the mode of
delivery has generally been in person, limiting dissemination to large populations. Systematic and meta-analytic
reviews have shown that telephone quitlines are a highly scalable way to help individuals quit smoking. Quitlines
are available in all 50 U.S. states, Puerto Rico and Guam. The proposed project is highly responsive to PAR-20-
154 by delivering a GI intervention via telephone which is highly scalable and could greatly increase the reach
and accessibility of an effective GI smoking cessation intervention. We recently completed a randomized
feasibility trial of the Be Smoke Free program. Although not powered to determine efficacy, the intervention
showed promise in helping participants to quit and showed high consumer satisfaction. We developed
procedures for recruiting participants and surpassed our recruitment goals. We had >90% retention at 8-weeks
and >80% at 6-months. We also found high levels of adherence. The results of this randomized feasibility study
indicate that a fully powered study of a GI tobacco cessation intervention delivered via telephone is warranted.
Therefore, the objective of this R01 application is to conduct a randomized controlled trial to test the
efficacy of the Be Smoke Free, telephone-based, GI intervention (IC) for smoking cessation compared to
active behavioral control (CC). The study will recruit 1,200 diverse smokers from three states, Arizona, New
York, and West Virginia to increase generalizability. Participants will be randomly assigned to receive either the
IC or CC delivered by telephone by University of Arizona study coaches and will be assessed at 3- and 6-months
post-enrollment by study staff. The primary outcome is biochemically verified 7-day point prevalence abstinence
at 6 months. This innovative and rigorously designed project conducted by an experienced team has the potential
to improve public health through the delivery of an innovative integrative GI intervention via telephone.