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Objectives: To evaluate cost-effectiveness of a tobacco dependence intervention based on self-determination theory (SDT) and consistent with the Public Health Service (PHS)-sponsored Clinical Practice Guideline for Treating Tobacco Use and Dependence., Study Design: Adult smokers were recruited into a randomized cessation-induction trial of an intensive intervention versus community care. Seven-day point prevalence (7dPP) tobacco abstinence and cost-effectiveness of the intervention were examined using 737 participants with health insurance., Methods: Community care (CC) participants received smoking-cessation pamphlets and information on local treatment programs. Intervention participants received those materials and were asked to meet 4 times over 6 months with study counselors to discuss their health in a manner that supported autonomy and perceived competence. The third-party payer's perspective was used for this analysis, and the primary outcome was cost-effectiveness using self-reported 7dPP tobacco abstinence at 6 months. Sensitivity analyses were performed using costs of generic medications, biochemically validated tobacco abstinence, actual rates of tobacco abstinence, life-years saved (not adjusted for quality of life), and costs in 2011 US dollars. A subgroup analysis was conducted using smokers who did not want to stop within 30 days., Results: Smokers in the intervention, relative to CC, were more likely to attain 7dPP tobacco abstinence at 6 months. The overall incremental cost-effectiveness ratio was $1258 per quality-adjusted life-year saved, in US dollars. The sensitivity and subgroup analyses yielded similar results., Conclusions: An intervention based on SDT and consistent with the PHS Guideline facilitated tobacco abstinence among insured smokers and was cost-effective compared with other tobacco dependence and medical interventions.

Terror management theory posits that people tend to respond defensively to reminders of death, including worldview defense, self-esteem striving, and suppression of death thoughts. Seven experiments examined whether trait mindfulness-a disposition characterized by receptive attention to present experience-reduced defensive responses to mortality salience (MS). Under MS, less mindful individuals showed higher worldview defense (Studies 1-3) and self-esteem striving (Study 5), yet more mindful individuals did not defend a constellation of values theoretically associated with mindfulness (Study 4). To explain these findings through proximal defense processes, Study 6 showed that more mindful individuals wrote about their death for a longer period of time, which partially mediated the inverse association between trait mindfulness and worldview defense. Study 7 demonstrated that trait mindfulness predicted less suppression of death thoughts immediately following MS. The discussion highlights the relevance of mindfulness to theories that emphasize the nature of conscious processing in understanding responses to threat.