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DURHAM, N.C. -- Addiction is a powerful force: even the fear of watching a loved one succumb to lung cancer is not enough to cause most smokers to quit. Just 15 percent of smokers stop when a relative is diagnosed with lung cancer, said Lori Bastian, M.D., an internist at Duke University Medical Center.

Bastian is trying to change those odds through a new program aimed at smoking relatives of lung cancer patients at Duke, the University of North Carolina at Chapel Hill and the Durham VA Medical Center. The Family Ties smoking cessation program provides stress management and coping skills to family members of lung cancer patients with the goal of helping them quit the habit.

Bastian's hypothesis is that people who receive counseling will be more likely to quit smoking than people who attempt to quit without such interventions. The physical addiction is but one component of tobacco use, she says, while the psychological and social components often go ignored in a smoking cessation attempt.

"A nicotine patch may not be enough," said Bastian. "We have a group of smokers who are often interested in stopping but don't have the tools needed to be successful. Family members often tell us they are motivated to quit but the stress of caring for their relative with lung cancer makes it the worst time in their lives to try."

Bastian's team identifies participants by asking lung cancer patients to provide the names of relatives who are willing to attempt quitting smoking. Half the relatives will receive brochures and a cassette that provide education on the deleterious effects of smoking and how to quit, along with a free supply of nicotine patches.

The other half will receive these same materials in addition to a series of telephone counseling sessions in which they are taught coping skills and stress management tools. The six counseling sessions will teach strategies such as progressive muscle relaxation; the use of imagery to help smokers mentally gravitate to a relaxing and safe haven; positive self-talk and rewards that help smokers reframe their negative thoughts into positive ones; and practice sessions to incorporate these skills into daily living.

Thus far, the feedback has been positive, said Bastian.

"People love the progressive relaxation; they say it really helps," she said. With guided imagery, smokers are encouraged to focus upon an image, symbol, place, or experience that brings about calming feelings with the goal of improving their mental, physical and emotional health. Such techniques are used with considerable success among seriously ill patients in hospitals nationwide, said Bastian.

Bastian's team follows up with smokers for a year after the 12-week intervention has ended to determine their success rates. Saliva samples are taken to ensure the accuracy of self reports from smokers who have quit.

"Our hypothesis is that smokers who receive counseling will be more likely to quit smoking," said Bastian. "We are hoping for a 25 percent to 30 percent success rate, which appears to be low but would be a significant improvement over the current rate."