Smoking rates remain above 60% for individuals involved in the criminal justice system and contribute to elevated mortality rates in this population. Addressing smoking disparities among justice-involved individuals is a critical public health issue in Minnesota, one of a few states with rising incarceration rates. People who are incarcerated represent the intersection of multiple high-priority populations (disproportionately African-American, Native American, low-income, homeless, on Medicaid, and suffering from mental illness and substance use disorders). This study examines the impact of a smoking cessation intervention for individuals discharged from jail to the community on smoking abstinence. Participants will be randomized to either 1) guideline-based, in-person smoking cessation counseling during incarceration, telephone counseling after incarceration, and nicotine replacement, or 2) enhanced treatment as usual. This study's findings will be used to develop a larger, multi-site study that is fully powered to measure longer-term health and smoking cessation outcomes.

Outcome assessments will be conducted for both arms at 1 week, 3 weeks, and 12 weeks post discharge from jail. During these assessments, seven-day point prevalence abstinence will be bio-verified with exhaled carbon monoxide, and self-reported general health, physical health, mental health, and substance use measures will also be obtained. The analysis is fully powered (i.e., power > .8) to detect significant between group effects on the primary outcome (i.e., the longitudinal, between group effect on bio-verified seven-day point prevalence abstinence over the 3 weeks post discharge). All analyses will be conducted on the intent to treat sample and will utilize pre-specified logistic and linear regression models.

Inclusion Criteria:

• Use of ≥ 1 cigarette per day prior to incarceration
• Expected release from the Hennepin Adult Detention Center to the community within 90 days
• Age 18-64
• English fluency
• Lives within 20 minutes of Hennepin County Medical Center and has no plans to move away from area for 4 months
• Willing to attempt quitting or reducing smoking at discharge
• Has a telephone
• Cleared for nicotine lozenge safety by jail health care provider and willing to use at discharge

Exclusion Criteria:

• Active tuberculosis
• Current mental health crisis (i.e., currently experiencing significant mania, psychosis, or suicidality)
• Unable to ambulate independently
• Acute medical condition that would impair participant's ability to follow-up for assessments
• Expected discharge to a control institutional setting (e.g., locked state mental health facility or prison)
• Active pregnancy
• Heart attack within the last two weeks