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Smokers who see a doctor for any reason at several clinics in the Milwaukee, Madison and Janesville areas will automatically be offered free help to quit smoking as part of a "real-world" study by the University of Wisconsin Center for Tobacco Research and Intervention announced Sunday.

The research, funded by a $12 million grant from the National Cancer Institute, will hone in on the most effective approach to help patients quit smoking. Researchers already know counseling and medication work, but they don't know how much of each works best, and how to easily deliver that treatment in a systematic way at health care clinics.

This is the largest grant the UW Center for Tobacco Research and Intervention has received since it was founded in 1992. It's expected to cover counseling and/or medication for more than 2,000 people at 20 clinics over five years.

The research, which will begin next year, continues a pre-existing collaboration with four health care systems: UW Health, Aurora Health Care, Dean Health System and MercyCare Health Plans. The health care systems have been working with the UW center on clinic-based smoking cessation research over the past two decades.

"It's helpful for a doctor to urge a patient to quit, but it's not enough," said Michael Fiore, a UW-Madison professor of medicine and nationally known expert on tobacco who founded the UW Center for Tobacco Research and Intervention.

"Smoking in 2014 is not just a bad habit, it's a powerful addiction that often requires intensive treatment," said Fiore, who also serves as the center's director and co-authored "Reducing Tobacco Use-A Report of the Surgeon General" in 2000.

Nationally, about 18% of adults smoke, and 90% of those who smoke by age 20 become addicted to tobacco. In Wisconsin, 19.5% of adults smoke.

In recent surveys, 80% of adult smokers said they wanted to quit and regretted starting, Fiore said. Each year, 50% of smokers try to quit cold turkey without counseling or medication. Less than 5% of them succeed, while 15% to 20% who get counseling succeed, and 20% to 40% who get both counseling and medication succeed, according to Fiore.

One of every five deaths in Wisconsin each year is directly caused by smoking.

It's been 50 years since the release of the first surgeon general's report warning of the health hazards of smoking. A surgeon general's report earlier this year noted it's never too late to quit, Fiore sad. Quitting after age 50 may still offer health benefits.

Fiore said the research is based at health care clinics because seven of every 10 smokers visit their doctor every year. "There's no place where more smokers congregate who are receptive and primed to quit," he said.

Epic Systems of Verona will modify electronic health record systems at participating clinics so patients interested in at least cutting down on smoking may be quickly connected with research center employees who can help them. Epic also will make it possible for health care systems to receive feedback on a patient's efforts through the electronic health record so their physician can monitor their progress.

Through electronic health records, the research center also will be able to reach out to smokers who haven't visited the clinic recently but are known from a previous electronic entry in their record to have smoked in the past.

Patients will be contacted by the research center within 24 hours of seeing their doctor and will be randomly assigned a free treatment plan if they decide to participate. Some will be offered counseling; some will be offered nicotine patches or lozenges. Others will be offered both counseling and the patches or lozenges.

"We already know from prior research that counseling and medication are the two foundation stones to helping smokers quit," Fiore said. "Yet, we know very little about the type of counseling (the specific counseling messages that are most effective) or how to administer it (in person, by phone, via smartphone messages)."

Researchers for the first time also will study how to help smokers who have quit, but relapsed, return to successful quitting.

"Since the great majority of smokers who try to quit relapse, it is a giant gap in our science that we don't have effective treatments to help smokers re-quit," Fiore said.

It's win-win for Aurora Health Care, which serves about 1.8 million patients among its clinics.

Over the past five years alone, roughly 1,000 Aurora patients received free smoking cessation assistance through the UW research center, and 30% to 40% quit smoking, said David Smith, medical director for Quality and Care Management at Aurora.

The last research grant covered about 2,500 hours of smoking cessation counseling and $250,000 in medications for Aurora patients, Smith said.

Another 1,000 Aurora patients will be helped through the new grant, Smith said, though Aurora also has made it standard practice to ask patients if they smoke and are interested in cutting down or quitting.

This is the third 5-year UW study Aurora has participated in. The health care system has cut its smoking rate among patients from about 20% to 15% in the last decade, Smith said.

If you are interested in quitting smoking, you can get free counseling and information through the Wisconsin Tobacco Quit Line by calling (800) QUIT-NOW or visitiong the website ctri.wisc.edu/quitline.