Hospitalization for elective knee or hip replacement surgery presents an outstanding opportunity to motivate people to quit smoking, because it provides an opportunity to encourage patients to remain smoke-free as they proactively quit to optimize their surgery outcomes. This study will conduct a comparative effectiveness trial of patients who quit smoking pre-operatively, comparing the current standard of care with a novel comprehensive relapse prevention intervention guided by Marlatt's Relapse Prevention Model.

The specific aims of this study are to evaluate the effectiveness and cost-effectiveness of the relapse prevention intervention and will: 1) compare the effectiveness of standard post-operative cessation treatment with a comprehensive relapse prevention intervention on smoking cessation outcomes; 2) conduct a comparative economic analysis to assess the value of the relapse prevention intervention for patients and the healthcare system; and 3) explore the impact of the interventions on surgical complications and readmissions.

Inclusion Criteria:

Patient Participants

• Received preoperative smoking cessation counseling through Orthopedic Surgery Quit Smoking Program
• Undergoing elective knee or hip arthroplasty surgery
• Have not smoked any cigarettes in the week prior to admission and carbon monoxide 4 ppm46,47
• Have a cell phone (for text messaging)
• Provide informed consent in English

Caregiver participants:

• Age ≥ 18 years
• Be a caregiver of the patient participant
• Provide informed consent in English

Exclusion Criteria:

• Patients will be excluded if they used smokeless tobacco or an electronic cigarette in the last 30 days.