Computer expert systems for African–American smokers in physicians offices: A feasibility study Arthur M. Hoffman ⁎ , Colleen A. Redding, David Goldberg, Donna Añel, James O. Prochaska, Peter M. Meyer, Dilip Pandey Rush University Medical Center, IL 60612, USA Available online 15 June 2006 Abstract Background. Stage-based computer expert systems (CES), delivered in physician offices, may offer unique opportunities to combine high participation and high efficacy, resulting in a high public health impact. Applying this technology in settings serving low-income African– American smokers, with the addition of practical tools for stress reduction, may help to reduce disparities in morbidity and mortality from smoking-related diseases. Methods. Ninety-eight African–American smokers were recruited from a publicly funded, continuity care clinic waiting room to a study of computer interactive feedback and stress reduction audiotapes. The study was designed to assess: participation and retention rates; acceptability of both the computer expert system and the audiotapes; the fit of the transtheoretical model for the target population; and the 6-month shift in stages of change. Results. Overall, 55.6% of invited smokers participated, 75.5% were seen at all three observation points. The CES and the audiotape were rated as highly interesting, relevant, and new, and most participants tried them. The predictable relationship between stage and decisional balance was reproduced in this low income African–American population. Significant stage progression occurred from baseline to 3 months (P = 0.011), from 3 to 6 months (P = 0.0001), and from baseline to 6 months (P = 0.0001). Conclusions. These data support the feasibility, acceptability and potential efficacy of stage-tailored computer interactive feedback plus stress reduction intervention delivered at the point of service to low-income African–Americans. © 2006 Elsevier Inc. All rights reserved. Keywords: Smoking cessation; African–Americans; Health services accessibility; Primary health care; Adults; Stages of change; Transtheoretical model; Tailored intervention; Computer expert system intervention Introduction The likelihood that physicians will adequately assess, assist, or follow people who smoke remains well under 40%, and in many cases under 10% (Goldstein et al., 1997, 2003; Ellerbeck et al., 2001; Grimley et al., 2001). This despite evidence that each element of the 5 A's (ask, advise, assess, assist, arrange follow-up) is efficacious (Stewart and Rosser, 1982; Kuller et al., 1982; Baumgartner, 1982; The Tobacco Use and Dependence Clinical Practice Guideline Panel, Staff, and Consortium Representatives, 2000) and enhanced by pharmacotherapy (The Tobacco Use and Dependence Clinical Practice Guideline Panel, Staff, and Consor- tium Representatives, 2000); the opportunity offered by the estimated 823.5 million visits made to physician offices in the United States in the year 2000 (Cherry and Woodwell, 2002); and years of widely disseminating the 5A Model guideline (The Tobacco Use and Dependence Clinical Practice Guideline Panel, Staff, and Consortium Representatives, 2000; Fowler et al., 1989; Bello, 1994; Orleans, 1985; AAFP, 1996; Daly et al., 1993). Physician counseling of smokers is adversely affected by time pressure on office visits; limited training and self-efficacy in behavioral assessment and intervention; and lack of reimbursement (Rigotti et al., 2002; McIlvain et al., 2002). Expert computer systems are considered a strategy for tapping the public health potential of office-based cessation interventions (Sciamanna et al., 1999; Wadland et al., 1999). Expert systems can deliver a consistent, non-judgmental tone; evidence-based Preventive Medicine 43 (2006) 204 – 211 www.elsevier.com/locate/ypmed ⁎ Corresponding author. E-mail address: arthur_hoffman@rush.edu (A.M. Hoffman). 0091-7435/$ - see front matter © 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.ypmed.2006.03.025