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Saul JE, Bonito JA, Provan K, Ruppel E, Leischow SJ. Implementation of tobacco cessation quitline practices in the United States and Canada. Am J Public Health 2014; 104:e98-105. [PMID: 25122024 DOI: 10.2105/ajph.2014.302074] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined relationships between implementation of tobacco quitline practices, levels of evidence of practices, and quitline reach and spending. METHODS In June and July 2009, a total of 176 quitline funders and providers in the United States and Canada completed a survey on quitline practices, in particular quitline-level implementation for the reported practices. From these data, we selected and categorized evidence-based and emerging quitline practices by the strength of the evidence for each practice to increase quitline efficacy and reach. RESULTS The proportion of quitlines implementing each practice ranged from 3% (text messaging) to 92% (providing a multiple-call protocol). Implementation of practices showing higher levels of evidence for increasing either reach or efficacy showed moderate but significant positive correlations with both reach outcomes and spending levels. The strongest correlation was between reach outcomes and spending levels (r=0.80; P<.01). CONCLUSIONS The strong relationship between quitline spending and reach reinforces the need to increase quitline funding to levels commensurate with national cessation goals.
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Affiliation(s)
- Jessie E Saul
- Jessie E. Saul is with the Research Department, North American Quitline Consortium, Phoenix, AZ. Joseph A. Bonito is with the Department of Communication, College of Social and Behavioral Sciences, University of Arizona, Tucson. At the time of the study, Keith Provan was with the Center for Management Innovations in Health Care, School of Government & Public Policy, University of Arizona, Tucson. Erin Ruppel is with the Department of Communication, College of Letters and Science, University of Wisconsin-Milwaukee. Scott J. Leischow is with the Mayo Clinic-Arizona, Mayo Clinic Cancer Center, Scottsdale
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Almeida FA, Pardo KA, Seidel RW, Davy BM, You W, Wall SS, Smith E, Greenawald MH, Estabrooks PA. Design and methods of "diaBEAT-it!": a hybrid preference/randomized control trial design using the RE-AIM framework. Contemp Clin Trials 2014; 38:383-96. [PMID: 24956325 DOI: 10.1016/j.cct.2014.06.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 06/12/2014] [Accepted: 06/13/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Diabetes prevention is a public health priority that is dependent upon the reach, effectiveness, and cost of intervention strategies. However, understanding each of these outcomes within the context of randomized controlled trials is problematic. PURPOSE To describe the methods and design of a hybrid preference/randomized control trial using the RE-AIM framework. METHODS The trial, which was developed using the RE-AIM framework, will contrast the effects of 3 interventions: (1) a standard care, small group, diabetes prevention education class (SG), (2) the small group intervention plus 12 months of interactive voice response telephone follow-up (SG-IVR), and (3) a DVD version of the small group intervention with the same IVR follow-up (DVD-IVR). Each intervention includes personal action planning with a focus on key elements of the lifestyle intervention from the Diabetes Prevention Program (DPP). Adult patients at risk for diabetes will be randomly assigned to either choice or RCT. Those assigned to choice (n=240) will have the opportunity to choose between SG-IVR and DVD-IVR. Those assigned to RCT group (n=360) will be randomly assigned to SG, SG-IVR, or DVD-IRV. Assessment of primary (weight loss, reach, & cost) and secondary (physical activity, & dietary intake) outcomes will occur at baseline, 6, 12, and 18 months. CONCLUSION This will be the first diabetes prevention trial that will allow the research team to determine the relationships between reach, effectiveness, and cost of different interventions.
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Affiliation(s)
- Fabio A Almeida
- Fralin Translational Obesity Research Center, Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, United States.
| | - Kimberlee A Pardo
- Fralin Translational Obesity Research Center, Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, United States.
| | - Richard W Seidel
- Department of Psychiatry, Carilion Clinic, Roanoke, VA 24014, United States.
| | - Brenda M Davy
- Fralin Translational Obesity Research Center, Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, United States.
| | - Wen You
- Department of Agriculture and Applied Economics, Virginia Tech, Blacksburg, VA 24061, United States.
| | - Sarah S Wall
- Fralin Translational Obesity Research Center, Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, United States.
| | - Erin Smith
- Fralin Translational Obesity Research Center, Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, United States.
| | - Mark H Greenawald
- Department of Family and Community Medicine, Carilion Clinic, Roanoke, VA 24013, United States.
| | - Paul A Estabrooks
- Fralin Translational Obesity Research Center, Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, United States; Department of Family and Community Medicine, Carilion Clinic, Roanoke, VA 24013, United States.
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Shochet I, Montague R, Smith C, Dadds M. A qualitative investigation of adolescents' perceived mechanisms of change from a universal school-based depression prevention program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:5541-54. [PMID: 24859679 PMCID: PMC4053869 DOI: 10.3390/ijerph110505541] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 05/14/2014] [Accepted: 05/15/2014] [Indexed: 11/29/2022]
Abstract
A recent meta-analysis provides evidence supporting the universal application of school-based prevention programs for adolescent depression. The mechanisms underlying such successful interventions, however, are largely unknown. We report on a qualitative analysis of 109 Grade 9 students' beliefs about what they gained from an evidence-based depression prevention intervention, the Resourceful Adolescent Program (RAP-A). Fifty-four percent of interviewees articulated at least one specific example of program benefit. A thematic analysis of responses revealed two major themes, improved interpersonal relationships and improved self-regulation, both stronger than originally assumed. A more minor theme also emerged-more helpful cognitions. It is postulated that both improved interpersonal relationships and improved self-regulation are likely to enhance one another, and more helpful cognitions may express its contribution through enhanced self-regulation. These findings broaden our understanding of the impact of depression prevention programs, beginning to illuminate how such programs benefit participants.
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Affiliation(s)
- Ian Shochet
- School of Psychology and Counselling, Queensland University of Technology, Brisbane 4059, Australia.
| | - Roslyn Montague
- New South Wales Institute of Psychiatry, Sydney 2145, Australia.
| | - Coral Smith
- School of Psychology and Counselling, Queensland University of Technology, Brisbane 4059, Australia.
| | - Mark Dadds
- School of Psychology, University of New South Wales, Sydney 2052, Australia.
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Proactive tobacco treatment for low income smokers: study protocol of a randomized controlled trial. BMC Public Health 2014; 14:337. [PMID: 24716466 PMCID: PMC3995758 DOI: 10.1186/1471-2458-14-337] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 04/02/2014] [Indexed: 11/29/2022] Open
Abstract
Background There is a high prevalence of smoking and high burden of tobacco-related diseases among low-income populations. Effective, evidenced-based smoking cessation treatments are available, but low-income smokers are less likely than higher-income smokers to use these treatments, especially the most comprehensive forms that include a combination of pharmacotherapy and intensive behavioral counseling. Methods/Design The primary objectives of this randomized controlled trial are to compare the effects of a proactive tobacco treatment intervention compared to usual care on population-level smoking abstinence rates and tobacco treatment utilization rates among a diverse population of low-income smokers, and to determine the cost-effectiveness of proactive tobacco treatment intervention. The proactive care intervention systematically offers low-income smokers free and easy access to evidence-based treatments and has two primary components: (1) proactive outreach to current smokers in the form of mailed invitation materials and telephone calls containing targeted health messages, and (2) facilitated access to free, comprehensive, evidence-based tobacco cessation treatments in the form of NRT and intensive, telephone-based behavioral counseling. The study aims to include a population-based sample (N = 2500) of adult smokers enrolled in the Minnesota Health Care Programs (MHCP), a state-funded health insurance plan for low-income persons. Baseline data is obtained from MHCP administrative databases and a participant survey that is conducted prior to randomization. Outcome data is collected from a follow-up survey conducted 12 months after randomization and MHCP administrative data. The primary outcome is six-month prolonged smoking abstinence at one year and is assessed at the population level. All randomized individuals are asked to complete the follow-up survey, regardless of whether they participated in tobacco treatment. Data analysis of the primary aims will follow intent-to-treat methodology. Discussion There is a critical need to increase access to effective tobacco dependence treatments. This randomized trial evaluates the effects of proactive outreach coupled with free NRT and telephone counseling on the population impact of tobacco dependence treatment. If proven to be effective and cost-effective, national dissemination of proactive treatment approaches would reduce tobacco-related morbidity, mortality, and health care costs for low income Americans. Clinical trials registration ClinicalTrials.gov: NCT01123967
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Rohsenow DJ, Martin RA, Monti PM, Colby SM, Day AM, Abrams DB, Sirota AD, Swift RM. Motivational interviewing versus brief advice for cigarette smokers in residential alcohol treatment. J Subst Abuse Treat 2014; 46:346-55. [PMID: 24210533 PMCID: PMC3947086 DOI: 10.1016/j.jsat.2013.10.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 08/29/2013] [Accepted: 10/04/2013] [Indexed: 11/24/2022]
Abstract
Residential treatment for substance use disorders (SUD) provides opportunity for smoking intervention. A randomized controlled trial compared: (1) motivational interviewing (MI) to brief advice (BA), (2) in one session or with two booster sessions, for 165 alcoholics in SUD treatment. All received nicotine replacement (NRT). MI and BA produced equivalent confirmed abstinence, averaging 10% at 1 month, and 2% at 3, 6 and 12 months. However, patients with more drug use pretreatment (>22 days in 6 months) given BA had more abstinence at 12 months (7%) than patients in MI or with less drug use (all 0%). Boosters produced 16-31% fewer cigarettes per day after BA than MI. Substance use was unaffected by treatment condition or smoking cessation. Motivation to quit was higher after BA than MI. Thus, BA plus NRT may be a cost-effective way to reduce smoking for alcoholics with comorbid substance use who are not seeking smoking cessation.
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Affiliation(s)
- Damaris J Rohsenow
- Providence Veterans Affairs Medical Center, Providence, RI 02908, USA; Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02912, USA.
| | - Rosemarie A Martin
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02912, USA
| | - Peter M Monti
- Providence Veterans Affairs Medical Center, Providence, RI 02908, USA; Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02912, USA
| | - Suzanne M Colby
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02912, USA
| | - Anne M Day
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02912, USA
| | - David B Abrams
- Brown University Medical School, Providence, RI 02912, USA
| | - Alan D Sirota
- Providence Veterans Affairs Medical Center, Providence, RI 02908, USA; Brown University Medical School, Providence, RI 02912, USA
| | - Robert M Swift
- Providence Veterans Affairs Medical Center, Providence, RI 02908, USA; Brown University Medical School, Providence, RI 02912, USA
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Carpenter MJ, Jardin BF, Burris JL, Mathew AR, Schnoll RA, Rigotti NA, Cummings KM. Clinical strategies to enhance the efficacy of nicotine replacement therapy for smoking cessation: a review of the literature. Drugs 2014; 73:407-26. [PMID: 23572407 DOI: 10.1007/s40265-013-0038-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A number of smoking cessation pharmacotherapies have led to increases in quitting and thus to significant benefits to public health. Among existing medications, nicotine replacement therapy (NRT) has been available the longest, has the largest literature base in support, and is the only option for over-the-counter access. While the short-term efficacy of NRT is well documented in clinical trials, long-term abstinence rates associated with using NRT are modest, as most smokers will relapse. This literature review examines emerging clinical strategies to improve NRT efficacy. After an initial overview of NRT and its FDA-approved indications for use, we review randomized trials in which clinical delivery of NRT was manipulated and tested, in an attempt to enhance efficacy, through (1) duration of use (pre-quit and extended use), (2) amount of use (high-dose and combination NRT), (3) tailoring to specific smoker groups (genotype and phenotype), or (4) use of NRT for novel purposes (relapse prevention, temporary abstinence, cessation induction). Outcomes vary within and across topic area, and we highlight areas that offer stronger promise. Combination NRT likely represents the most promising strategy moving forward; other clinical strategies offer conflicting evidence but deserve further testing (pre-quit NRT or tailored treatment) or offer potential utility but are in need of further, direct tests. Some areas, though based on a limited set of studies, do not offer great promise (high-dose and extended treatment NRT). We conclude with a brief discussion of emergent NRT products (e.g., oral nicotine spray, among others), which may ultimately offer greater efficacy than current formulations. In order to further lower the prevalence of smoking, novel strategies designed to optimize NRT efficacy are needed.
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Affiliation(s)
- Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA.
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Dunton GF, Liao Y, Grana R, Lagloire R, Riggs N, Chou CP, Robertson T. State-wide dissemination of a school-based nutrition education programme: a RE-AIM (Reach, Efficacy, Adoption, Implementation, Maintenance) analysis. Public Health Nutr 2014; 17:422-30. [PMID: 23218458 PMCID: PMC10282239 DOI: 10.1017/s1368980012005186] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 08/29/2012] [Accepted: 10/04/2012] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The current study evaluated the overall public health impact of the 'Shaping Up My Choices' (SMC) programme, a 10-week school-based nutrition education curriculum developed for third-grade students, using the RE-AIM (Reach, Efficacy, Adoption, Implementation, Maintenance) framework. DESIGN Randomized controlled trial to evaluate the programme and secondary analysis of archival data to describe dissemination. Data were collected from programme records, teacher surveys and student pre-, post- and 3-month follow-up surveys. SETTING Public elementary schools in California. SUBJECTS An evaluation sample (938 students and nineteen teachers) and a dissemination sample (195 245 students and 7359 teachers). RESULTS In the evaluation sample, differences between the control and intervention groups were observed for nutrition knowledge, self-efficacy, outcome expectancies, and intakes of vegetables, fruit (girls only), soda, and low-nutrient high-energy foods from pre- to post-survey. Group differences in change in knowledge, outcome expectancies and vegetable intake were sustained through the 3-month follow-up (efficacy). One hundred per cent of intervention teachers in the evaluation sample implemented all of the lessons (implementation). The dissemination sample represented 42% of third-grade students (reach) and 39% of third-grade classrooms in public elementary schools in California during 2010-2011 (adoption). Thirty-seven per cent of third-grade teachers in the dissemination sample reordered SMC materials during the subsequent school year (2011-2012; maintenance). CONCLUSIONS The SMC programme demonstrates the potential for moderate to high public health impact.
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Affiliation(s)
- Genevieve Fridlund Dunton
- Department of Preventive Medicine, University of Southern California, 2001 N. Soto Street Building (SSB), 3rd Floor, Room 302E, MC 9239, Los Angeles, CA 90033-9045, USA
| | - Yue Liao
- Department of Preventive Medicine, University of Southern California, 2001 N. Soto Street Building (SSB), 3rd Floor, Room 302E, MC 9239, Los Angeles, CA 90033-9045, USA
| | - Rachel Grana
- Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, CA, USA
| | - Renee Lagloire
- Harder + Company Community Research, Los Angeles, CA, USA
| | - Nathaniel Riggs
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA
| | - Chih-Ping Chou
- Department of Preventive Medicine, University of Southern California, 2001 N. Soto Street Building (SSB), 3rd Floor, Room 302E, MC 9239, Los Angeles, CA 90033-9045, USA
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Stanczyk NE, Bolman C, Smit ES, Candel MJJM, Muris JWM, de Vries H. How to encourage smokers to participate in web-based computer-tailored smoking cessation programs: a comparison of different recruitment strategies. HEALTH EDUCATION RESEARCH 2014; 29:23-40. [PMID: 24287402 DOI: 10.1093/her/cyt104] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The reach, retention and costs of four strategies aimed to recruit smokers for participation in a computer-tailored smoking cessation intervention was explored. The study was part of a randomized controlled trial whereby 832 respondents were randomized to three conditions. Smokers were invited by general practitioners (GPs), newspapers, Internet and other strategies (i.e. mailing organizations) to take part. ANOVA's/Chi-square tests explored sample differences. Logistic regression analyses investigated differences between the samples regarding retention and smoking behaviour. Smokers recruited via GPs (N = 144) had a lower educational level and suffered more from chronic obstructive pulmonary disease compared with respondents recruited via Internet (N = 307) (χ(2) = 11.554, df = 3, P = 0.009). Less motivated respondents recruited by GPs were more likely to return to study compared with the less motivated respondents recruited by 'other recruitment' strategies (χ(2) = 6.416, df = 3, P = 0.093). Highly addicted respondents recruited from newspapers (N = 213) were less likely to make a quit attempt compared with highly addicted respondents recruited by GPs (OR = 0.334, P = 0.035). Females from newspapers were less likely to remain abstinent compared with the GP sample (OR = 0.337, P = 0.005). Recruitment via GPs showed highest costs. Recruitment strategy influenced the type of smokers. Group differences were associated with different patterns of quitting.
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Affiliation(s)
- N E Stanczyk
- Department of Health Promotion, School for Public Health and Primary Care (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands, Department of Psychology, Open University of the Netherlands, P.O. 2960, 6419 AT Heerlen, The Netherlands, Department of Methodology and Statistics, School for Public Health and Primary Care (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands and Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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Cobb NK, Jacobs MA, Saul J, Wileyto EP, Graham AL. Diffusion of an evidence-based smoking cessation intervention through Facebook: a randomised controlled trial study protocol. BMJ Open 2014; 4:e004089. [PMID: 24448847 PMCID: PMC3902462 DOI: 10.1136/bmjopen-2013-004089] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Online social networks represent a potential mechanism for the dissemination of health interventions including smoking cessation; however, which elements of an intervention determine diffusion between participants is unclear. Diffusion is frequently measured using R, the reproductive rate, which is determined by the duration of use (t), the 'contagiousness' of an intervention (β) and a participant's total contacts (z). We have developed a Facebook 'app' that allows us to enable or disable various components designed to impact the duration of use (expanded content, proactive contact), contagiousness (active and passive sharing) and number of contacts (use by non-smoker supporters). We hypothesised that these elements would be synergistic in their impact on R, while including non-smokers would induce a 'carrier' state allowing the app to bridge clusters of smokers. METHODS AND ANALYSIS This study is a fractional factorial, randomised control trial of the diffusion of a Facebook application for smoking cessation. Participants recruited through online advertising are randomised to 1 of 12 cells and serve as 'seed' users. All user interactions are tracked, including social interactions with friends. Individuals installing the application that can be traced back to a seed participant are deemed 'descendants' and form the outcome of interest. Analysis will be conducted using Poisson regression, with event count as the outcome and the number of seeds in the cell as the exposure. RESULTS The results will be reported as a baseline R0 for the reference group, and incidence rate ratio for the remainder of predictors. ETHICS AND DISSEMINATION This study uses an abbreviated consent process designed to minimise barriers to adoption and was deemed to be minimal risk by the Institutional Review Board (IRB). Results will be disseminated through traditional academic literature as well as social media. If feasible, anonymised data and underlying source code are intended to be made available under an open source license. CLINICALTRIALSGOV REGISTRATION NUMBER NCT01746472.
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Affiliation(s)
- Nathan K Cobb
- Division of Pulmonary and Critical Care, Georgetown University Medical Center, Washington DC, USA
- Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Megan A Jacobs
- Schroeder Institute for Tobacco Research and Policy Studies, American Legacy Foundation, Washington DC, USA
| | - Jessie Saul
- North American Research and Analysis, Inc, Faribault, Minnesota, USA
| | - E Paul Wileyto
- Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Amanda L Graham
- Schroeder Institute for Tobacco Research and Policy Studies, American Legacy Foundation, Washington DC, USA
- Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC, USA
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Lindström M. Social capital, social class and tobacco smoking. Expert Rev Pharmacoecon Outcomes Res 2014; 8:81-9. [DOI: 10.1586/14737167.8.1.81] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Cobb NK, Poirier J. Effectiveness of a multimodal online well-being intervention: a randomized controlled trial. Am J Prev Med 2014; 46:41-8. [PMID: 24355670 DOI: 10.1016/j.amepre.2013.08.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 07/15/2013] [Accepted: 08/27/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Well-being encompasses physical, psychological, and social aspects of health and predicts healthcare utilization and expenditures. Despite their potential clinical impact, interventions that leverage social network effects to target well-being are uncommon. PURPOSE Using a pragmatic design, to evaluate the effectiveness of an online well-being intervention as part of ongoing program development. DESIGN Randomized, placebo-controlled, parallel-group trial with longitudinal outcome measurements at baseline, 30 days, and 90 days. PARTICIPANTS/SETTING A total of 1503 U.S.-based adults were enrolled. Recruitment, eligibility verification, and baseline data collection were conducted entirely online; follow-up took place online or by phone. The study was conducted in 2012. INTERVENTION A multimodal e-mail-, web-, and mobile-based intervention (Daily Challenge), in which participants receive daily suggestions of small health actions that they complete in a social environment. A traditional weekly health newsletter served as control. MAIN OUTCOME MEASURE Overall well-being as measured by the Individual-level Well-Being Assessment and Scoring Method (scale: 0 to 100). RESULTS Follow-up rates reached 68.7% (n=1032) at 30 days and 62.6% (n=940) at 90 days. Overall, 84.6% of treatment group participants visited the website, and 76.5% opened program e-mails (vs 51.1% in the control group). Daily Challenge improved well-being significantly more than control at 30 days (2.27 points, p=0.004) and at 90 days (2.35 points, p=0.004). A dose response for intensity of use was observed at 30 days (p=0.001) and 90 days (p=0.003). Well-being improvement was greater in participants with than without social ties in the program (at 30 days: p=0.02; at 90 days: p=0.003). CONCLUSIONS A multimodal online intervention leveraging social network effects significantly improved well-being over control. Higher levels of participation as well as increasing levels of social integration were associated with greater improvement in well-being. TRIAL REGISTRATION www.clinicaltrials.gov (NCT01586949).
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Affiliation(s)
- Nathan K Cobb
- Division of Pulmonary and Critical Care, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia; MeYou Health LLC, Boston, Massachusetts
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Vidrine JI, Shete S, Li Y, Cao Y, Alford MH, Galindo-Talton M, Rabius V, Sharp B, Harmonson P, Zbikowski SM, Miles L, Wetter DW. The Ask-Advise-Connect approach for smokers in a safety net healthcare system: a group-randomized trial. Am J Prev Med 2013; 45:737-41. [PMID: 24237916 PMCID: PMC4023543 DOI: 10.1016/j.amepre.2013.07.011] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 05/17/2013] [Accepted: 07/29/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Because smoking has a profound impact on socioeconomic disparities in illness and death, it is crucial that vulnerable populations of smokers be targeted with treatment. The U.S. Public Health Service recommends that all patients be asked about their smoking at every visit and that smokers be given brief advice to quit and referred to treatment. PURPOSE Initiatives to facilitate these practices include the 5A's (ask, advise, assess, assist, arrange) and Ask-Advise-Refer (AAR). Unfortunately, primary care referrals are low, and most smokers referred fail to enroll. This study evaluated the efficacy of the Ask-Advise-Connect (AAC) approach to linking smokers with treatment in a large, safety net public healthcare system. DESIGN The study design was a pair-matched group-randomized trial with two treatment arms. SETTING/PARTICIPANTS Ten safety net clinics in Houston TX. INTERVENTION Clinics were randomized to AAC (n=5; intervention) or AAR (n=5; control). Licensed vocational nurses (LVNs) were trained to assess and record the smoking status of all patients at all visits in the electronic health record. Smokers were given brief advice to quit. In AAC, the names and phone numbers of smokers who agreed to be connected were sent electronically to the Texas quitline daily, and patients were proactively called by the quitline within 48 hours. In AAR, smokers were offered a quitline referral card and encouraged to call on their own. Data were collected between June 2010 and March 2012 and analyzed in 2012. MAIN OUTCOME MEASURES The primary outcome was impact, defined here as the proportion of identified smokers that enrolled in treatment. RESULTS The impact (proportion of identified smokers who enrolled in treatment) of AAC (14.7%) was significantly greater than the impact of AAR (0.5%), t(4)=14.61, p=0.0001, OR=32.10 (95% CI=16.60, 62.06). CONCLUSIONS The AAC approach to aiding smoking cessation has tremendous potential to reduce tobacco-related health disparities.
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Niaura RS, Pearson JL, Abrams DB. Compensation predicts smoking cessation failure. Psychopharmacology (Berl) 2013; 230:261-6. [PMID: 23748381 PMCID: PMC3809341 DOI: 10.1007/s00213-013-3150-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Accepted: 05/14/2013] [Indexed: 11/25/2022]
Abstract
RATIONALE Compensation is a potential result of decreasing the available nicotine and tar dose in cigarettes. There is little published data linking compensation with cessation. OBJECTIVES We sought to examine whether compensation in response to restricted cigarette yield is associated with difficulty quitting smoking. METHODS Questionnaires and blood samples were collected from 174 smokers interested in quitting smoking as part of a larger smoking cessation study. Participants were instructed to use a filter designed to remove 50 % of tar and nicotine from the cigarette but otherwise smoke normally. Participants returned after 3 days of using the filter for follow-up data collection. RESULTS Nicotine levels and cigarettes per day decreased after use of the filter. Baseline nicotine and change in nicotine pre/post filter use, but not cigarettes per day or change in cigarettes per day were associated with smoking abstinence at 30 days. CONCLUSIONS Smokers who demonstrate sensitivity to the biological or behavioral consequences of decreased nicotine content in tobacco smoke have greater difficulty quitting. These findings suggest the need for personalized cessation treatment linked to behavioral compensation.
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Affiliation(s)
- Raymond S Niaura
- The Schroeder Institute for Tobacco Research and Policy Studies at Legacy, 1724 Massachusetts Ave. NW, Washington, DC, 20036, USA,
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Smokers who seek help in specialized cessation clinics: How special are they compared to smokers in general population? J Smok Cessat 2013. [DOI: 10.1017/jsc.2013.23] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction: Patients of specialized nicotine dependence clinics are hypothesized to form a distinct subpopulation of smokers due to the features associated with treatment seeking. The aim of the study was to describe this subpopulation of smokers and compare it to smokers in general population.Material and methods: A chart review of 796 outpatients attending a specialized nicotine dependence clinic, located in Toronto, Ontario, Canada was performed. Client smoking patterns and sociodemographic characteristics were compared to smokers in the general population using two Ontario surveys – the Ontario Tobacco Survey (n = 898) and the Centre for Addiction and Mental Health Monitor (n = 457).Results: Smokers who seek treatment tend to smoke more and be more heavily addicted. They were older, had longer history of smoking and greater number of unsuccessful quit attempts, both assisted and unassisted. They reported lower education and income, had less social support and were likely to live with other smokers.Conclusions: Smokers who seek treatment in specialized centers differ from the smokers in general population on several important characteristics. These same characteristics are associated with lower chances for successful smoking cessation and sustained abstinence and should be taken into consideration during clinical assessment and treatment planning.
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Niaura R, Chander G, Hutton H, Stanton C. Interventions to address chronic disease and HIV: strategies to promote smoking cessation among HIV-infected individuals. Curr HIV/AIDS Rep 2013; 9:375-84. [PMID: 22972495 DOI: 10.1007/s11904-012-0138-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Tobacco use, especially cigarette smoking, is higher than average in persons living with HIV/AIDS (PLWHA). The Public Health Service Clinical Practice Guideline for Treating Tobacco Use and Dependence states that, during every medical encounter, all smokers should be offered smoking cessation counseling, along with approved medications. The Guideline also recognizes PLWHA as a priority population, given the scarcity of research on effective cessation treatments in this group. The scant evidence suggests that conventional treatments, though worthwhile, are not as successful as might be hoped for. The reasons for this are not entirely clear, but may have to do with the complex array of medical and psychosocial factors that complicate their lives. Clinicians should consider re-treatment strategies for those patients who encounter difficulty when quitting smoking with conventional approaches, switching or augmenting treatments as needed to minimize adverse experiences, and to maximize tolerability, adherence, and cessation outcomes.
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Affiliation(s)
- Raymond Niaura
- Schroeder Institute for Tobacco Research and Policy Studies, Legacy, 1724 Massachusetts Avenue NW, Washington, DC 20036, USA.
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Graham AL, Cha S, Papandonatos GD, Cobb NK, Mushro A, Fang Y, Niaura RS, Abrams DB. Improving adherence to web-based cessation programs: a randomized controlled trial study protocol. Trials 2013; 14:48. [PMID: 23414086 PMCID: PMC3599396 DOI: 10.1186/1745-6215-14-48] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 01/25/2013] [Indexed: 11/26/2022] Open
Abstract
Background Reducing smoking prevalence is a public health priority that can save more lives and money than almost any other known preventive intervention. Internet interventions have the potential for enormous public health impact given their broad reach and effectiveness. However, most users engage only minimally with even the best designed websites, diminishing their impact due to an insufficient ‘dose’. Two approaches to improve adherence to Internet cessation programs are integrating smokers into an online social network and providing free nicotine replacement therapy (NRT). Active participation in online communities is associated with higher rates of cessation. Integrating smokers into an online social network can increase support and may also increase utilization of cessation tools and NRT. Removing barriers to NRT may increase uptake and adherence, and may also increase use of online cessation tools as smokers look for information and support while quitting. The combination of both strategies may exert the most powerful effects on adherence compared to either strategy alone. Methods/Design This study compares the efficacy of a smoking cessation website (WEB) alone and in conjunction with free NRT and a social network (SN) protocol designed to integrate participants into the online community. Using a 2 (SN, no SN) x 2 (NRT, no NRT) randomized, controlled factorial design with repeated measures at baseline, 3 months, and 9 months, this study will recruit N = 4,000 new members of an internet cessation program and randomize them to: 1) WEB, 2) WEB + SN, 3) WEB + NRT, or 4) WEB + SN + NRT. Hypotheses are that all interventions will outperform WEB and that WEB + SN + NRT will outperform WEB + NRT and WEB + SN on 30-day point prevalence abstinence at 9 months. Exploratory analyses will examine theory-driven hypotheses about the mediators and moderators of outcome. Discussion Addressing adherence in internet cessation programs is critical and timely to leverage their potential public health impact. This study is innovative in its use of a social network approach to improve behavioral and pharmacological treatment utilization to improve cessation. This approach is significant for reducing tobacco’s devastating disease burden and for optimizing behavior change in other arenas where adherence is just as critical. Trial registration ISRCTN:ISRCTN45127327
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Affiliation(s)
- Amanda L Graham
- Schroeder Institute for Tobacco Research and Policy Studies, Legacy, 1724 Massachusetts Avenue, NW Washington, DC 20036, USA.
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Naar-King S, Outlaw AY, Sarr M, Parsons JT, Belzer M, Macdonell K, Tanney M, Ondersma SJ. Motivational Enhancement System for Adherence (MESA): pilot randomized trial of a brief computer-delivered prevention intervention for youth initiating antiretroviral treatment. J Pediatr Psychol 2013; 38:638-48. [PMID: 23359664 DOI: 10.1093/jpepsy/jss132] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To pilot test a two-session computer-delivered motivational intervention to facilitate adherence among youth with HIV newly prescribed antiretroviral treatment (ART). METHODS Youth (N = 76) newly prescribed ART were recruited from 8 sites, and were randomized to the intervention or an active nutrition and physical activity control. Primary outcomes were HIV-1 viral load at baseline, 3 months, and 6 months, and self-reported adherence at 3 and 6 months. RESULTS Satisfaction ratings were high. Effect sizes suggested that the intervention group showed a greater drop than controls in viral load from baseline to 6 months (Cohen's d = 0.39 at 3 months; d = 0.19 at 6 months), and had greater percent undetectable by 6 months (d = 0.28). Effects sizes were medium to large for 7-day and weekend adherence. CONCLUSIONS A brief computer-delivered motivational intervention showed promise for youth starting ART and is ready to be tested in a full-scale clinical trial.
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Richardson A, Graham AL, Cobb N, Xiao H, Mushro A, Abrams D, Vallone D. Engagement promotes abstinence in a web-based cessation intervention: cohort study. J Med Internet Res 2013; 15:e14. [PMID: 23353649 PMCID: PMC3636070 DOI: 10.2196/jmir.2277] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 09/07/2012] [Accepted: 09/25/2012] [Indexed: 11/26/2022] Open
Abstract
Background Web-based smoking cessation interventions can have a public health impact because they are both effective in promoting cessation and can reach large numbers of smokers in a cost-efficient manner. Their potential impact, however, has not been realized. It is still unclear how such interventions promote cessation, who benefits most, and how to improve their population impact. Objective To examine the effectiveness of a highly promoted Web-based smoking cessation intervention to promote quit behavior over time, identify the most effective features, and understand who is most likely to use those features by using unweighted and weighted analyses to estimate the impact in the broader pool of registered site users. Methods A sample of 1033 new adult registrants was recruited from a Web-based smoking cessation intervention by using an automated study management system. Abstinence was assessed by self-report through a mixed-mode follow-up (online survey with telephone follow-up for nonrespondents) at 1, 3, and 6 months. Software tracked respondents’ online activity. Generalized estimating equations (GEE) were used to examine predictors of website utilization and how utilization promoted abstinence using unweighted and weighted data. Results The 7-day point prevalence abstinence rates at 6 months ranged from 20.68% to 11.13% in the responder and intent-to-treat samples, respectively. Predictors of abstinence in unweighted analyses included number of visits to the website as well as accessing specific interactive or engaging features. In weighted analyses, only number of visits was predictive of abstinence. Motivation to quit was a key predictor of website utilization, whereas negative partner support decreased the likelihood of increasing visits or accessing engaging features. Conclusions Engagement is critical to promoting smoking cessation. The next generation of Web-based smoking cessation interventions needs to maximize the initial engagement of all new visitors and work to retain those smokers who proceed to register on the site.
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Affiliation(s)
- Amanda Richardson
- Department of Research and Evaluation, Legacy, Washington, DC 20036, United States.
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Drake BF, Quintiliani LM, Sapp AL, Li Y, Harley AE, Emmons KM, Sorensen G. Comparing strategies to assess multiple behavior change in behavioral intervention studies. Transl Behav Med 2013; 3:114-121. [PMID: 23504621 DOI: 10.1007/s13142-013-0195-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Alternatives to individual behavior change methods have been proposed, however, little has been done to investigate how these methods compare. PURPOSE To explore four methods that quantify change in multiple risk behaviors targeting four common behaviors. METHODS We utilized data from two cluster-randomized, multiple behavior change trials conducted in two settings: small businesses and health centers. Methods used were: (1) summative; (2) z-score; (3) optimal linear combination; and (4) impact score. RESULTS In the Small Business study, methods 2 and 3 revealed similar outcomes. However, physical activity did not contribute to method 3. In the Health Centers study, similar results were found with each of the methods. Multivitamin intake contributed significantly more to each of the summary measures than other behaviors. CONCLUSIONS Selection of methods to assess multiple behavior change in intervention trials must consider study design, and the targeted population when determining the appropriate method/s to use.
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Affiliation(s)
- Bettina F Drake
- Department of Surgery, Washington University School of Medicine (Drake), St. Louis, MO; Department of General Internal Medicine, Boston University Medical Center (Quintiliani), Boston, MA; Department of Biostatistics, Harvard School of Public Health (Li), Boston, MA; University of Wisconsin, School of Public Health (Harley), Milwaukee, WI; Center for Community-Based Research, Department of Society, Human Development and Health, Harvard School of Public Health (Sapp, Emmons, Sorensen), Boston, MA
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Napolitano MA, Hayes S, Bennett GG, Ives AK, Foster GD. Using Facebook and text messaging to deliver a weight loss program to college students. Obesity (Silver Spring) 2013; 21:25-31. [PMID: 23505165 DOI: 10.1002/oby.20232] [Citation(s) in RCA: 261] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 04/11/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Between 31 and 35% of the college-aged population is overweight or obese, yet few weight loss trials for this population have been conducted. This study examined the feasibility, acceptability, and initial efficacy of a technology-based 8-week weight loss intervention among college students. DESIGN AND METHODS Students (N = 52) were randomly assigned to one of the three arms: Facebook (n = 17); Facebook Plus text messaging and personalized feedback (n = 18); Waiting List control (n = 17), with assessments at 4 weeks and 8 weeks (post-treatment). Participants were 20.47 ± 2.19 years old, 86.45 ± 17.11 kg, with a body mass index of 31.36 ± 5.3 kg/m(2) . Participants were primarily female (86.5%), and the sample was racially diverse (57.7% Caucasian, 30.8% African American, 5.8% Hispanic, and 5.7% other races). RESULTS The primary outcome was weight loss after 8 weeks (post-treatment); 96.0% of the participants completed this assessment. At 8 weeks, the Facebook Plus group had significantly greater weight loss (-2.4 ± 2.5 kg) than the Facebook (-0.63 ± 2.4 kg) and Waiting List (-0.24 ± 2.6 kg) (both Ps < 0.05). Weight change at 8 weeks was not significantly different between the Facebook and Waiting List groups. CONCLUSIONS Results show preliminary efficacy and acceptability of the two active intervention arms (97.0% found the program helpful, 81.3% found the videos/handouts helpful, and 100% would recommend the program to others). Results indicate the potential for an innovative weight loss intervention that uses technology platforms (Facebook and text messaging) that are frequently used and already integrated into the cultural life of college students.
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Marcano Belisario JS, Bruggeling MN, Gunn LH, Brusamento S, Car J. Interventions for recruiting smokers into cessation programmes. Cochrane Database Syst Rev 2012; 12:CD009187. [PMID: 23235672 PMCID: PMC6485998 DOI: 10.1002/14651858.cd009187.pub2] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Tobacco control is a top public health priority around the globe due to the high prevalence of cigarette smoking and its associated morbidity and mortality. Much effort has been focused on establishing the effectiveness of different smoking cessation strategies. This review, however, aims to address the initial challenge faced by smoking cessation programmes: recruitment of smokers. OBJECTIVES The primary objective of this review was to determine the effectiveness of different strategies for recruiting smokers into cessation programmes. The secondary objective was to determine the impact that these strategies had on smoking cessation rates at least six months after enrolment into a cessation programme. SEARCH METHODS We searched the specialised register of the Cochrane Tobacco Addiction Group using a search strategy which included the terms ('recruit$', 'invit$', 'enter', 'entry', 'enrolment') combined with ('smok$', 'cigarette', 'smoking cessation', 'tobacco') in the title, abstract or keyword fields. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and registers of current and ongoing trials. We also searched the reference lists of included studies. SELECTION CRITERIA We included randomised controlled trials and cluster randomised controlled trials that compared at least two different methods of recruiting current smokers into a smoking cessation programme. We also included those studies which focused on the effectiveness of a smoking cessation programme as long as the study involved multiple recruitment methods and reported results of the recruitment phase. DATA COLLECTION AND ANALYSIS From each included study, we extracted data on the type of participants, type of recruitment strategies (i.e., setting, mode of communication used, intensity and duration) and comparisons, and on randomisation, allocation concealment, and blinding procedures.Our primary outcome was the proportion of smokers successfully recruited to each cessation programme compared to alternative modalities of recruitment. Our secondary outcome was smoking cessation for at least six months. Given the substantial heterogeneity across recruitment interventions and participants, we adopted a narrative synthesis approach for summarising results. MAIN RESULTS This review includes 19 studies with a total of 14,890 participants. We categorised the included studies according to the modes used to deliver the recruitment strategy: head to head comparison of individual recruitment strategies; comparison of the same delivery mode but with different content or intensity; and the addition of another mode to an existing recruitment method.We identified three studies that made head-to-head comparisons of different types of recruitment strategies. Of these, only one study detected a significant effect, finding that a personal phone call was more effective than a generic invitation letter (RR 40.73, 95% CI 2.53 to 654.74). Five studies compared interventions using the same delivery modes but different content. Results showed that tailored messages through an interactive voice response system resulted in a higher recruitment rate than assessment of smoking status alone using the same system (RR 8.64, 95% CI 4.41 to 16.93), and that text messages indicating scarcity of places available were more effective than generic text message reminders (RR 1.45, 95% CI 1.07 to 1.96). One study compared interventions using the same delivery mode but different intensity and found that allowing for more phone call attempts to reach potential participants can result in better recruitment (RR 1.87, 95% CI 1.61 to 2.18). Finally, 10 studies investigated the effect of adding a recruitment mode to existing recruitment strategies. Findings showed that: adding a text message reminder or real quotes from participants to a personal phone call improved recruitment of participants (RR 3.38, 95% CI 1.26 to 9.08 and RR 29.07, 95% CI 1.74 to 485.70, respectively); that adding a personal phone call to an existing newsletter can also increase recruitment rates (RR 65.12, 95% CI 4.06 to 1045.4]); that a reactive-proactive recruitment phase is more effective than a proactive phase alone (63.8% versus 47.5%, RR not available); and that active recruitment at schools is more effective than passive recruitment (p < 0.001, denominator not available for calculation of RR). Additionally, a number of studies in this category showed that providing incentives can effectively increase the number of participants recruited into smoking cessation programmes.Out of the 19 included studies, only four reported on the effect of recruitment strategy on smoking cessation at six months or longer. Three of these studies compared strategies that used the same delivery mode with different content. Their results were non-significant. The remaining three studies evaluated adding an additional mode to an existing recruitment intervention. Only one of them showed a significant difference in the levels of smoking cessation that favoured the enhanced recruitment strategy, but this may have reflected the offer of incentives once in the programme rather than the recruitment strategy itself (RR at 15 or 18 months 2.60, 95% CI 1.48 to 4.56). AUTHORS' CONCLUSIONS The substantial heterogeneity across the included studies restricts our ability to draw firm conclusions about the effectiveness of different recruitment strategies in relation to recruitment of participants into smoking cessation programmes or levels of smoking cessation. The limited evidence, however, suggests that the following elements may improve the recruitment of smokers into cessation programmes: personal, tailored interventions; recruitment methods that are proactive in nature; and more intensive recruitment strategies (i.e., those strategies that require increased contact with potential participants).
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Affiliation(s)
- José S Marcano Belisario
- School of Public Health, Imperial College LondonGlobal eHealth Unit, Department of Primary Care and Public HealthLondonUK
| | | | - Laura H Gunn
- School of Public Health, Imperial College LondonGlobal eHealth Unit, Department of Primary Care and Public HealthLondonUK
| | - Serena Brusamento
- School of Public Health, Imperial College LondonGlobal eHealth Unit, Department of Primary Care and Public HealthLondonUK
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Meeussen L, Put C, Meganck J, De Peuter S. The gap between attitudes and use in prediction of effect of an online smoking cessation program. JOURNAL OF HEALTH COMMUNICATION 2012; 17:946-959. [PMID: 22724549 DOI: 10.1080/10810730.2012.665419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This article describes an investigation of the effect of attitude toward and use of different components of an online smoking cessation program on stage transition based on the Transtheoretical Model. Participants were 299 users of the StopSmokingCoach, an online smoking cessation program, who completed an online questionnaire concerning their attitudes toward the program and its components within 6 months after registration. These attitude measurements and participants' actual use of the program components were linked to stage transitions of these users. Attitudes toward the StopSmokingCoach and its components were positive; however, only one of these attitude measurements (instructiveness of e-mail tips) predicted actual stage transitions. In contrast, frequency/intensity of use of the coach and 3 of its components (advices, forum, and personal charts, but not the diary, tips, or decisional balance) was significantly related to stage transitions. These results suggest that users do not need to have positive attitudes toward a health program in order to achieve behavioral change. Use of some, but not all program components appears to be more important.
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Affiliation(s)
- Loes Meeussen
- Center for Social and Cultural Psychology, University of Leuven, Leuven, Belgium.
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Glasgow RE, Gaglio B, Bennett G, Jerome GJ, Yeh HC, Sarwer DB, Appel L, Colditz G, Wadden TA, Wells B. Applying the PRECIS criteria to describe three effectiveness trials of weight loss in obese patients with comorbid conditions. Health Serv Res 2012; 47:1051-67. [PMID: 22092292 PMCID: PMC3423177 DOI: 10.1111/j.1475-6773.2011.01347.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To characterize Practice-Based Opportunities for Weight Reduction (POWER) trials along the pragmatic-explanatory continuum. SETTINGS The POWER trials consist of three individual studies that target obesity treatment in primary care settings. DESIGN Using the PRagmatic Explanatory Continuum Indicator Summary (PRECIS) criteria, nine reviewers independently scored each trial. METHODS Average and median ratings, inter-rater reliability, and relationships to additional ratings of the extent to which study designs were explanatory (i.e., efficacy) versus pragmatic (i.e., practical) and related to external validity were determined. PRINCIPAL FINDINGS One trial was consistently rated as being significantly more pragmatic than the others (R(2) =0.43, p< .001), although all three were in the moderate range on the PRECIS scales. Ratings varied across PRECIS dimensions, being most pragmatic on comparison condition and primary outcome. Raters, although undergoing training and using identical definitions, scored their own study as more pragmatic than the other studies/interventions. CONCLUSIONS These results highlight the need for more comprehensive reporting on PRECIS and related criteria for research translation. The PRECIS criteria provide a richer understanding of the POWER studies. It is not clear whether the original criteria are sufficient to provide a comprehensive profile.
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Affiliation(s)
- Russell E Glasgow
- Dissemination and Implementation Science, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Blvd., Room 6144, Rockville, MD 20852, USA.
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Application of the RE-AIM Framework to Evaluate the Impact of a Worksite-Based Financial Incentive Intervention for Smoking Cessation. J Occup Environ Med 2012; 54:610-4. [DOI: 10.1097/jom.0b013e31824b2171] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Smit ES, Hoving C, Cox VCM, de Vries H. Influence of recruitment strategy on the reach and effect of a web-based multiple tailored smoking cessation intervention among Dutch adult smokers. HEALTH EDUCATION RESEARCH 2012; 27:191-199. [PMID: 22058288 DOI: 10.1093/her/cyr099] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This study investigated the influence of two different recruitment strategies on the reach and effect of a web-based multiple tailored smoking cessation program. From May 2009 until June 2010, Dutch adult smokers were recruited via mass media or general practices. Those who completed the baseline questionnaire were followed up during 6 weeks (two follow-ups). Differences between the two samples were assessed regarding baseline characteristics, retention rates, quit attempts and 24-hour point prevalence abstinence. Smokers recruited via general practices (N = 409) were significantly lower educated, less addicted, more motivated to quit smoking and to maintain non-smoking, more often female and more often suffering from cardiovascular or respiratory diseases than mass media respondents (N = 1154). They showed higher retention rates and were more likely to report a quit attempt (64.3 versus 50.7%) and abstinence (43.3 versus 33.1%). More respondents could be recruited via mass media, while general practices respondents showed higher retention rates and were more successful in quitting smoking, though these effects became non-significant when controlling for experimental condition and baseline differences. The choice for a particular recruitment strategy appeared to determine the number and type of smokers recruited and might consequently influence the intervention's potential public health impact.
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Affiliation(s)
- Eline Suzanne Smit
- Department of Health Promotion, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
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Schulz DN, Schneider F, de Vries H, van Osch LADM, van Nierop PWM, Kremers SPJ. Program completion of a web-based tailored lifestyle intervention for adults: differences between a sequential and a simultaneous approach. J Med Internet Res 2012; 14:e26. [PMID: 22403770 PMCID: PMC3376514 DOI: 10.2196/jmir.1968] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 12/09/2011] [Accepted: 01/06/2012] [Indexed: 11/25/2022] Open
Abstract
Background Unhealthy lifestyle behaviors often co-occur and are related to chronic diseases. One effective method to change multiple lifestyle behaviors is web-based computer tailoring. Dropout from Internet interventions, however, is rather high, and it is challenging to retain participants in web-based tailored programs, especially programs targeting multiple behaviors. To date, it is unknown how much information people can handle in one session while taking part in a multiple behavior change intervention, which could be presented either sequentially (one behavior at a time) or simultaneously (all behaviors at once). Objectives The first objective was to compare dropout rates of 2 computer-tailored interventions: a sequential and a simultaneous strategy. The second objective was to assess which personal characteristics are associated with completion rates of the 2 interventions. Methods Using an RCT design, demographics, health status, physical activity, vegetable consumption, fruit consumption, alcohol intake, and smoking were self-assessed through web-based questionnaires among 3473 adults, recruited through Regional Health Authorities in the Netherlands in the autumn of 2009. First, a health risk appraisal was offered, indicating whether respondents were meeting the 5 national health guidelines. Second, psychosocial determinants of the lifestyle behaviors were assessed and personal advice was provided, about one or more lifestyle behaviors. Results Our findings indicate a high non-completion rate for both types of intervention (71.0%; n = 2167), with more incompletes in the simultaneous intervention (77.1%; n = 1169) than in the sequential intervention (65.0%; n = 998). In both conditions, discontinuation was predicted by a lower age (sequential condition: OR = 1.04; P < .001; CI = 1.02-1.05; simultaneous condition: OR = 1.04; P < .001; CI = 1.02-1.05) and an unhealthy lifestyle (sequential condition: OR = 0.86; P = .01; CI = 0.76-0.97; simultaneous condition: OR = 0.49; P < .001; CI = 0.42-0.58). In the sequential intervention, being male (OR = 1.27; P = .04; CI = 1.01-1.59) also predicted dropout. When respondents failed to adhere to at least 2 of the guidelines, those receiving the simultaneous intervention were more inclined to drop out than were those receiving the sequential intervention. Conclusion Possible reasons for the higher dropout rate in our simultaneous intervention may be the amount of time required and information overload. Strategies to optimize program completion as well as continued use of computer-tailored interventions should be studied. Trial Registration Dutch Trial Register NTR2168
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Affiliation(s)
- Daniela N Schulz
- CAPHRI School for Public Health and Primary Care, Department of Health Promotion, Maastricht University, Maastricht, Netherlands.
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Fu SS, van Ryn M, Sherman SE, Burgess DJ, Noorbaloochi S, Clothier B, Joseph AM. Population-based tobacco treatment: study design of a randomized controlled trial. BMC Public Health 2012; 12:159. [PMID: 22394386 PMCID: PMC3312843 DOI: 10.1186/1471-2458-12-159] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 03/06/2012] [Indexed: 11/29/2022] Open
Abstract
Background Most smokers do not receive comprehensive, evidence-based treatment for tobacco use that includes intensive behavioral counseling along with pharmacotherapy. Further, the use of proven, tobacco treatments is lower among minorities than among Whites. The primary objectives of this study are to: (1) Assess the effect of a proactive care intervention (PRO) on population-level smoking abstinence rates (i.e., abstinence among all smokers including those who use and do not utilize treatment) and on utilization of tobacco treatment compared to reactive/usual care (UC) among a diverse population of smokers, (2) Compare the effect of PRO on population-level smoking abstinence rates and utilization of tobacco treatments between African American and White smokers, and (3) Determine the cost-effectiveness of the proactive care intervention. Methods/Design This prospective randomized controlled trial identifies a population-based sample of current smokers from the Department of Veterans Affairs (VA) electronic medical record health factor dataset. The proactive care intervention combines: (1) proactive outreach and (2) offer of choice of smoking cessation services (telephone or face-to-face). Proactive outreach includes mailed invitation materials followed by an outreach call that encourages smokers to seek treatment with choice of services. Proactive care participants who choose telephone care receive VA telephone counseling and access to pharmacotherapy. Proactive care participants who choose face-to-face care are referred to their VA facility's smoking cessation clinic. Usual care participants have access to standard smoking cessation services from their VA facility (e.g., pharmacotherapy, smoking cessation clinic) and from their state telephone quitline. Baseline data is collected from VA administrative databases and participant surveys. Outcomes from both groups are collected 12 months post-randomization from participant surveys and from VA administrative databases. The primary outcome is self-reported smoking abstinence, which is assessed at the population-level (i.e., among those who utilize and those who do not utilize tobacco treatment). Primary analyses will follow intention-to-treat methodology. Discussion This randomized trial is testing proactive outreach strategies offering choice of smoking cessation services, an innovation that if proven effective and cost-effective, will transform the way tobacco treatment is delivered. National dissemination of proactive treatment strategies could dramatically reduce tobacco-related morbidity, mortality, and health care costs. Clinical trials registration ClinicalTrials.gov: NCT00608426.
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Affiliation(s)
- Steven S Fu
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA.
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Sutfin EL, McNamara RS, Blocker JN, Ip EH, O'Brien MC, Wolfson M. Screening and brief intervention for tobacco use by student health providers on college campuses. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2012; 60:66-73. [PMID: 22171731 PMCID: PMC3384718 DOI: 10.1080/07448481.2011.572325] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE This study assessed college students' reports of tobacco screening and brief intervention by student health center providers. PARTICIPANTS Participants were 3,800 students from 8 universities in North Carolina. METHODS Web-based survey of a stratified random sample of undergraduates. RESULTS Fifty-three percent reported ever visiting their student health center. Of those, 62% reported being screened for tobacco use. Logistic regression revealed screening was higher among females and smokers, compared to nonsmokers. Among students who were screened and who reported tobacco use, 50% reported being advised to quit or reduce use. Brief intervention was more likely among current daily smokers compared to current nondaily smokers, as well as at schools with higher smoking rates. Screening and brief intervention were more likely at schools with lower clinic caseloads. CONCLUSIONS Results highlight the need to encourage college health providers to screen every patient at every visit and to provide brief intervention for tobacco users.
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Affiliation(s)
- Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
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79
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Kerns RD, Philip EJ, Lee AW, Rosenberger PH. Implementation of the veterans health administration national pain management strategy. Transl Behav Med 2011; 1:635-43. [PMID: 24073088 PMCID: PMC3717675 DOI: 10.1007/s13142-011-0094-3] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Since its introduction in 1998, the VHA National Pain Management Strategy has introduced and implemented a series of plans for promoting systems improvements in pain care. We present the milestones of VHA efforts in pain management as reflected by the work of the Strategy. This includes the development of the Strategy and its current structure as well as a review of important initiatives such as "pain as the fifth vital sign" and the stepped care model of pain management.
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Affiliation(s)
- Robert D Kerns
- />PRIME Center/11ACSLG, VA Connecticut Healthcare System, West Haven, CT 06516 USA
- />Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510 USA
| | - Errol J Philip
- />Memorial Sloan Kettering Cancer Center, New York, NY 10065 USA
| | - Allison W Lee
- />Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510 USA
| | - Patricia H Rosenberger
- />PRIME Center/11ACSLG, VA Connecticut Healthcare System, West Haven, CT 06516 USA
- />Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510 USA
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80
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Williams DM, Papandonatos GD, Jennings EG, Napolitano MA, Lewis BA, Whiteley JA, Bock BC, Albrecht AE, Dunsiger S, Parisi AF, King AC, Marcus BH. Does tailoring on additional theoretical constructs enhance the efficacy of a print-based physical activity promotion intervention? Health Psychol 2011; 30:432-41. [PMID: 21574710 DOI: 10.1037/a0023084] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To enhance a previously efficacious individually tailored physical activity (PA) promotion intervention by adding theoretical constructs to the tailored feedback. DESIGN We randomly assigned 248 healthy, underactive (moderate to vigorous physical activity [MVPA] min/week < 90) adults (mean age = 48.8 years, SD = 10.0) to receive either (a) a theoretically tailored (based on 5 constructs from the transtheoretical model and social-cognitive theory [SCT]) print-based PA promotion intervention (print) or (b) the same theoretically tailored print-based PA promotion intervention plus enhanced tailoring addressing 5 additional SCT constructs (enhanced print). MAIN OUTCOME MEASURE The 7-day physical activity recall administered at baseline, Month 6, and Month 12, with outcomes operationalized as percentage achieving 150 min/week of MVPA. RESULTS When controlling for covariates, there was a nonsignificant trend in favor of the enhanced print condition reflecting 46% and 50% greater odds of achieving 150 min/week of MVPA at Month 6 and Month 12, respectively. CONCLUSION Enhanced tailoring based on additional theoretical constructs may result in marginal improvements in physical activity outcomes.
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Affiliation(s)
- David M Williams
- Department of Community Health, Brown University, Providence, RI 02912, USA.
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81
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Colby SM, Clark MA, Rogers ML, Ramsey S, Graham AL, Boergers J, Kahler CW, Papandonatos GD, Buka SL, Niaura RS, Abrams DB. Development and reliability of the lifetime interview on smoking trajectories. Nicotine Tob Res 2011; 14:290-8. [PMID: 21994340 DOI: 10.1093/ntr/ntr212] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Assessments of lifetime smoking history are useful in many types of research including surveillance, epidemiology, prevention, intervention, and studies of genetic phenotypes and heritability. Because prospective assessment is impractical for most research, our objective was to develop a reliable retrospective measure of lifetime smoking history. This paper presents descriptive and test-retest reliability data on smoking history variables assessed using the Lifetime Interview on Smoking Trajectories (LIST). METHODS Data were collected on a birth cohort sample of 1,625 men and women (ages 34-44) from the Collaborative Perinatal Project. A subsample of 344 was invited to participate in a retest interview 4-8 weeks later and 220 participated. Indices of test-retest reliability were evaluated for smoking history variables, including: (a) early smoking experiences; (b) age at various smoking milestones, such as first puff, and progression to weekly and daily smoking; (c) smoking rate and time to first cigarette within initial, current, most recent, and heaviest phases; and (d) prolonged nonsmoking phases. RESULTS Responses to whether each of 5 major smoking milestones occurred were all highly reliable (κ = .78-.92), and of the 20 phase-specific variables assessed, more than half were reported at the highest level of reliability. None of the variables demonstrated low reliability. CONCLUSIONS Although retrospective reports have unavoidable limitations, our findings indicate that the LIST is a reliable instrument for assessing detailed retrospective smoking history data and can be used to add to the knowledge base of how patterns of use relate to a variety of outcomes of interest.
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Affiliation(s)
- Suzanne M Colby
- Department of Psychiatry and Human Behavior, Center for Alcohol and Addiction Studies, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA.
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Lau PWC, Lau EY, Wong DP, Ransdell L. A systematic review of information and communication technology-based interventions for promoting physical activity behavior change in children and adolescents. J Med Internet Res 2011; 13:e48. [PMID: 21749967 PMCID: PMC3222183 DOI: 10.2196/jmir.1533] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Revised: 02/17/2011] [Accepted: 03/24/2011] [Indexed: 12/01/2022] Open
Abstract
Background A growing body of research has employed information and communication technologies (ICTs) such as the Internet and mobile phones for disseminating physical activity (PA) interventions with young populations. Although several systematic reviews have documented the effects of ICT-based interventions on PA behavior, very few have focused on children and adolescents specifically. Objectives The present review aimed to systematically evaluate the efficacy and methodological quality of ICT-based PA interventions for children and adolescents based on evidence from randomized controlled trials. Methods Electronic databases Medline, PsycInfo, CINAHL, and Web of Science were searched to retrieve English language articles published in international academic peer-reviewed journals from January 1, 1997, through December 31, 2009. Included were articles that provided descriptions of interventions designed to improve PA-related cognitive, psychosocial, and behavioral outcomes and that used randomized controlled trial design, included only children (6-12 years old) and adolescents (13-18 years old) in both intervention and control groups, and employed Internet, email, and/or short message services (SMS, also known as text messaging) as one or more major or assistive modes to deliver the intervention. Results In total, 9 studies were analyzed in the present review. All studies were published after 2000 and conducted in Western countries. Of the 9 studies, 7 demonstrated positive and significant within-group differences in at least one psychosocial or behavioral PA outcome. In all, 3 studies reported positive and significant between-group differences favoring the ICT group. When between-group differences were compared across studies, effect sizes were small in 6 studies and large in 3 studies. With respect to methodological quality, 7 of the 9 studies had good methodological quality. Failure to report allocation concealment, blinding to outcome assessment, and lack of long-term follow-up were the criteria met by the fewest studies. In addition, 5 studies measured the intervention exposure rate and only 1 study employed objective measures to record data. Conclusion The present review provides evidence supporting the positive effects of ICTs in PA interventions for children and adolescents, especially when used with other delivery approaches (ie, face-to-face). Because ICT delivery approaches are often mixed with other approaches and these studies sometimes lack a comparable control group, additional research is needed to establish the true independent effects of ICT as an intervention delivery mode. Although two-thirds of the studies demonstrated satisfactory methodological quality, several quality criteria should be considered in future studies: clear descriptions of allocation concealment and blinding of outcome assessment, extension of intervention duration, and employment of objective measures in intervention exposure rate. Due to the small number of studies that met inclusion criteria and the lack of consistent evidence, researchers should be cautious when interpreting the findings of the present review.
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Affiliation(s)
- Patrick W C Lau
- Department of Physical Education, Hong Kong Baptist University, Hong Kong, China.
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83
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Acheson SK, Straits-Tröster K, Calhoun PS, Beckham JC, Hamlett-Berry K. Characteristics and Correlates of Cigarette Use Among Recent U.S. Veterans. MILITARY PSYCHOLOGY 2011. [DOI: 10.1080/08995605.2011.570589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Shawn K. Acheson
- a Duke University Medical Center , Durham , North Carolina , USA
- b Durham VAMC , Durham , North Carolina , USA
| | - Kristy Straits-Tröster
- a Duke University Medical Center , Durham , North Carolina , USA
- b Durham VAMC , Durham , North Carolina , USA
- c VA Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center , Durham , North Carolina , USA
| | - Patrick S. Calhoun
- a Duke University Medical Center , Durham , North Carolina , USA
- b Durham VAMC , Durham , North Carolina , USA
- c VA Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center , Durham , North Carolina , USA
| | - Jean C. Beckham
- a Duke University Medical Center , Durham , North Carolina , USA
- b Durham VAMC , Durham , North Carolina , USA
- c VA Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center , Durham , North Carolina , USA
| | - Kim Hamlett-Berry
- d VHA Public Health Strategic Health Care Group , Washington , District of Columbia , USA
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84
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Bowen DJ, Robbins R, Bush N, Meischke H, Ludwig A, Wooldridge J. Effects of a Web-based intervention on women's breast health behaviors. Transl Behav Med 2011; 1:155-164. [PMID: 21643515 PMCID: PMC3104848 DOI: 10.1007/s13142-011-0028-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Helping women make choices to reduce cancer risk and to improve breast health behaviors is important, but the best ways to reach more people with intervention assistance is not known. To test the efficacy of a Web-based intervention designed to help women make better breast health choices, we adapted our previously tested, successful breast health intervention package to be delivered on the Internet, and then we tested it in a randomized trial. We recruited women from the general public to be randomized to either an active intervention group or a delayed intervention control group. The intervention consisted of a specialized Web site providing tailored and personalized risk information to all participants, followed by offers of additional support if needed. Follow-up at 1-year post-randomization revealed significant improvements in mammography screening in intervention women compared with control women (improvement of 13 percentage points). The intervention effects were more powerful in women who increased breast health knowledge and decreased cancer worry during intervention. These data indicate that increases in mammography can be accomplished in population-based mostly insured samples by implementing this simple, low resource intensive intervention.
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Affiliation(s)
- Deborah J Bowen
- />Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., MP-900, Seattle, WA 98109-1024 USA
- />Department of Community Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118 USA
| | - Robert Robbins
- />Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., MP-900, Seattle, WA 98109-1024 USA
| | - Nigel Bush
- />Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., MP-900, Seattle, WA 98109-1024 USA
| | - Hendrika Meischke
- />Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., MP-900, Seattle, WA 98109-1024 USA
| | - Abi Ludwig
- />Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., MP-900, Seattle, WA 98109-1024 USA
| | - Jean Wooldridge
- />Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., MP-900, Seattle, WA 98109-1024 USA
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85
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Graham AL, Cobb NK, Papandonatos GD, Moreno JL, Kang H, Tinkelman DG, Bock BC, Niaura RS, Abrams DB. A randomized trial of Internet and telephone treatment for smoking cessation. ACTA ACUST UNITED AC 2011; 171:46-53. [PMID: 21220660 DOI: 10.1001/archinternmed.2010.451] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND This study aimed to determine the relative effect of Internet and Internet plus telephone treatment for smoking cessation on smoking abstinence among US adults. A priori hypotheses were that Internet enhanced with tailored content and social support would outperform basic Internet (BI) and that enhanced Internet (EI) plus proactive telephone counseling would outperform the other conditions. METHODS The Quit Using Internet and Telephone Treatment (iQUITT) study used a 3-group randomized controlled design comparing BI, EI, and EI and telephone combined (EI+P). The trial was conducted from March 8, 2005, through November 30, 2008. Current adult smokers in the United States who smoked 5 or more cigarettes per day were recruited via search engines. Characteristics of the 2005 participants include mean (SD) age of 35.9 (10.8) years, 51.1% women, and 86.5% white. The follow-up assessment rate at 18 months was 68.2%. The main outcome measure was 30-day point prevalence abstinence measured at 3, 6, 12, and 18 months after randomization using intent-to-treat analysis. RESULTS At 18 months, the 30-day multiple point prevalence abstinence rate across all follow-up intervals was 3.5% (BI), 4.5% (EI), and 7.7% (EI+P), with EI+P significantly outperforming BI and EI. At 18 months, 30-day single point prevalence abstinence rates were 19.0% (BI), 17.4% (EI), and 19.6% (EI+P) and did not differ among the groups. CONCLUSIONS Combined Internet and telephone treatment outperforms static and dynamic Internet interventions. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00282009.
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Affiliation(s)
- Amanda L Graham
- Schroeder Institute for Tobacco Research and Policy Studies, American Legacy Foundation, Washington, DC 20036, USA.
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86
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Hardcastle LE, Record KL, Jacobson PD, Gostin LO. Improving the population's health: the Affordable Care Act and the importance of integration. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2011; 39:317-327. [PMID: 21871030 DOI: 10.1111/j.1748-720x.2011.00602.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Despite evidence indicating that public health services are the most effective means of improving the population's health status, health care services receive the bulk of funding and political support. The recent passage of the Affordable Care Act, which focused on improving access to health care services through insurance reform, reflects the primacy of health care over public health. Although policymakers typically conceptualize health care and public health as two distinct systems, gains in health status are most effectively and cost-efficiently achieved through their integration into a single health system. The Act does little to compel integration; however, there are numerous opportunities to encourage the coordination of public health and health care in the Act's implementation.
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Affiliation(s)
- Lorian E Hardcastle
- O'Neill Institute for National and Global Health at Georgetown University Law Center
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87
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Outcomes of minimal and moderate support versions of an internet-based diabetes self-management support program. J Gen Intern Med 2010; 25:1315-22. [PMID: 20714820 PMCID: PMC2988142 DOI: 10.1007/s11606-010-1480-0] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Revised: 06/07/2010] [Accepted: 07/21/2010] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Internet and other interactive technology-based programs offer great potential for practical, effective, and cost-efficient diabetes self-management (DSM) programs capable of reaching large numbers of patients. This study evaluated minimal and moderate support versions of an Internet-based diabetes self-management program, compared to an enhanced usual care condition. RESEARCH DESIGN AND METHODS A three-arm practical randomized trial was conducted to evaluate minimal contact and moderate contact versions of an Internet-based diabetes self-management program, offered in English and Spanish, compared to enhanced usual care. A heterogeneous sample of 463 type 2 patients was randomized and 82.5% completed a 4-month follow-up. Primary outcomes were behavior changes in healthy eating, physical activity, and medication taking. Secondary outcomes included hemoglobin A1c, body mass index, lipids, and blood pressure. RESULTS The Internet-based intervention produced significantly greater improvements than the enhanced usual care condition on three of four behavioral outcomes (effect sizes [d] for healthy eating = 0.32; fat intake = 0.28; physical activity= 0.19) in both intent-to-treat and complete-cases analyses. These changes did not translate into differential improvements in biological outcomes during the 4-month study period. Added contact did not further enhance outcomes beyond the minimal contact intervention. CONCLUSIONS The Internet intervention meets several of the RE-AIM criteria for potential public health impact, including reaching a large number of persons, and being practical, feasible, and engaging for participants, but with mixed effectiveness in improving outcomes, and consistent results across different subgroups. Additional research is needed to evaluate longer-term outcomes, enhance effectiveness and cost-effectiveness, and understand the linkages between intervention processes and outcomes.
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Abstract
Tailored health communication research represents a very promising line of inquiry that has the potential to produce major impacts on lifestyle behaviors. This study defines tailoring and discusses how tailored interventions operate, including comparing/ contrasting different tailoring channels. Next, the authors review the literature on tailored interventions to change lifestyle behaviors, with a focus on smoking cessation, dietary change, and physical activity, as well as interventions that address multiple lifestyle behaviors. Finally, future directions for tailoring research are discussed. To date, a large literature has amassed showing the promise of tailored programs delivered via print, Internet, local computer/kiosk, telephone, and interpersonal channels. Numerous studies demonstrate that these programs are capable of significant impacts on smoking cessation, dietary change, physical activity, and multiple behavior change. It is concluded that the potential of tailoring will be more fully realized as (a) the field builds a more cumulative science of tailoring and (b) greater dissemination of efficacious tailored programs takes place.
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89
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Multiple healthy behaviors and optimal self-rated health: findings from the 2007 Behavioral Risk Factor Surveillance System Survey. Prev Med 2010; 51:268-74. [PMID: 20647019 DOI: 10.1016/j.ypmed.2010.07.010] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 06/21/2010] [Accepted: 07/13/2010] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The aim of this study was to examine the association between the number of healthy behaviors (i.e., not currently smoking, not currently drinking excessively, physically active, and consuming fruits and vegetables five or more times per day) and optimal self-rated health (SRH) among U.S. adults or adults with cardiovascular diseases (CVDs) or diabetes. METHODS We estimated the age-standardized prevalence of optimal SRH among a total of 430,912 adults who participated in the 2007 Behavioral Risk Factor Surveillance System (BRFSS). Prevalence ratios were produced with multivariate Cox regression models using number of healthy behaviors as a predictor; status of optimal SRH was used as an outcome variable while controlling for sociodemographic and health risk factors. RESULTS The age-standardized prevalence of reporting optimal SRH was 83.5%, 55.6%, and 56.3% among adults overall, and adults with CVDs or diabetes, respectively. Also in the aforementioned order, adults who reported having four healthy behaviors had 33%, 85%, and 87% increased likelihoods of reporting optimal SRH, when compared to their counterparts who reported none of these behaviors. CONCLUSION The findings of this study indicate that number of healthy behaviors is associated with optimal SRH among adults, especially adults with CVDs or diabetes. These findings reinforce the support for identifying and implementing clinical and population-based intervention strategies that effectively promote multiple healthier lifestyle behaviors among adults.
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90
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Muramoto ML, Wassum K, Connolly T, Matthews E, Floden L. Helpers program: A pilot test of brief tobacco intervention training in three corporations. Am J Prev Med 2010; 38:S319-26. [PMID: 20176303 PMCID: PMC4211923 DOI: 10.1016/j.amepre.2009.12.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 11/20/2009] [Accepted: 12/03/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND Quitlines and worksite-sponsored cessation programs are effective and highly accessible, but limited by low utilization. Efforts to encourage use of cessation aids have focused almost exclusively on the smoker, overlooking the potential for friends, family, co-workers, and others in a tobacco user's social network to influence quitting and use of effective treatment. METHODS Longitudinal, observational pilot feasibility study with 6-week follow-up survey. SETTING/PARTICIPANTS Employees of three national corporations, with a combined target audience of 102,100 employees. INTERVENTION The Helpers Program offers web-based, brief intervention training to activate social networks of tobacco users to encourage quitting and use of effective treatment. Helpers was offered from January 10 to March 31, 2008, as a treatment engagement strategy, together with Free & Clear's telephone/web-based cessation services. MAIN OUTCOME MEASURES Website utilization, training completion, post-training changes in knowledge and self-efficacy with delivery of brief interventions, referrals to Free & Clear, and use of brief intervention training. RESULTS There were 19,109 unique visitors to the Helpers website. Of these, 4727 created user accounts; 1427 registered for Helpers Training; 766 completed training. There were 445 visits to the referral page and 201 e-mail or letter referrals generated. There were 67 requests for technical support. Of follow-up survey respondents (n=289), 78.9% reported offering a brief intervention. CONCLUSIONS Offering the Helpers Program website to a large, diverse audience as part of an employer-sponsored worksite health promotion program is both feasible and well accepted by employees. Website users will participate in training, encourage quitting, and refer smokers to quitline services.
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Affiliation(s)
- Myra L Muramoto
- University of Arizona, Department of Family and Community Medicine, Tucson, 85724, USA.
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91
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Abrams DB, Graham AL, Levy DT, Mabry PL, Orleans CT. Boosting population quits through evidence-based cessation treatment and policy. Am J Prev Med 2010; 38:S351-63. [PMID: 20176308 PMCID: PMC4515751 DOI: 10.1016/j.amepre.2009.12.011] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 10/28/2009] [Accepted: 12/03/2009] [Indexed: 11/19/2022]
Abstract
Only large increases in adult cessation will rapidly reduce population smoking prevalence. Evidence-based smoking-cessation treatments and treatment policies exist but are underutilized. More needs to be done to coordinate the widespread, efficient dissemination and implementation of effective treatments and policies. This paper is the first in a series of three to demonstrate the impact of an integrated, comprehensive systems approach to cessation treatment and policy. This paper provides an analytic framework and selected literature review that guide the two subsequent computer simulation modeling papers to show how critical leverage points may have an impact on reductions in smoking prevalence. Evidence is reviewed from the U.S. Public Health Service 2008 clinical practice guideline and other sources regarding the impact of five cessation treatment policies on quit attempts, use of evidence-based treatment, and quit rates. Cessation treatment policies would: (1) expand cessation treatment coverage and provider reimbursement; (2) mandate adequate funding for the use and promotion of evidence-based state-sponsored telephone quitlines; (3) support healthcare systems changes to prompt, guide, and incentivize tobacco treatment; (4) support and promote evidence-based treatment via the Internet; and (5) improve individually tailored, stepped-care approaches and the long-term effectiveness of evidence-based treatments. This series of papers provides an analytic framework to inform heuristic simulation models in order to take a new look at ways to markedly increase population smoking cessation by implementing a defined set of treatments and treatment-related policies with the potential to improve motivation to quit, evidence-based treatment use, and long-term effectiveness.
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Affiliation(s)
- David B Abrams
- Steven A. Schroeder Institute for Tobacco Research and Policy Studies, American Legacy Foundation, Washington DC, USA.
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92
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Dedert EA, Wilson SM, Calhoun PS, Moore SD, Hamlett-Berry KW, Beckham JC. Public health clinical demonstration project for smoking cessation in veterans with posttraumatic stress disorder. Addict Behav 2010; 35:19-22. [PMID: 19737675 DOI: 10.1016/j.addbeh.2009.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Revised: 07/07/2009] [Accepted: 08/06/2009] [Indexed: 11/28/2022]
Abstract
Veterans with posttraumatic stress disorder are at high risk for smoking and experience difficulty with smoking cessation. We designed this clinical demonstration project to provide a low-cost, feasibly implemented smoking cessation intervention that would maximize the number of smokers who accessed the intervention. Five hundred eighty-four veteran smokers were contacted by invitational letters. Interested veterans received follow-up telephone calls using standardized scripts offering three intervention resources: 1) a referral to the National Cancer Institute's Smoking Quitline, 2) web-based counseling, and 3) local Veteran Affairs pharmacologic treatment for smoking cessation. Twenty-three percent of survey recipients participated in the clinical program. Two months after these resources were offered by phone, follow-up phone calls indicated that 25% of participants providing follow-up information reported maintaining smoking abstinence. This clinical demonstration project was associated with a 2.6% impact (i.e., reach [31.1% of smokers accessed intervention] by efficacy [8.4% of those accessing intervention quit]), meaning that 2.6% of the total number of targeted smokers reported 8 week abstinence. Results suggested that this brief, low-cost intervention was feasible and promoted smoking cessation in veterans with posttraumatic stress disorder.
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Affiliation(s)
- Eric A Dedert
- Durham Veterans Affairs Medical Center, Durham, NC 27705, USA.
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93
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Abstract
AIM To examine the efficacy and acceptability of online, interactive interventions for smoking cessation and to identify treatment effect moderators and mediators. METHODS A systematic review and meta-analysis of the literature (1990-2008) was conducted, finding 11 relevant randomized controlled trials. Data were extracted and risk ratios and risk differences estimated with a random effects model. RESULTS There was no evidence of publication bias. Included trials were of variable methodological quality. Web-based, tailored, interactive smoking cessation interventions were effective compared with untailored booklet or e-mail interventions [rate ratio (RR) 1.8; 95% confidence interval (CI) 1.4-2.3] increasing 6-month abstinence by 17% (95% CI 12-21%). No overall effect of interactive compared with static web-based interventions was detected but there was significant heterogeneity, with one study obtaining a clear effect and another failing to find one. Few moderating or mediating factors were evaluated in studies and those that were had little effect. Pooled results suggest that only interventions aimed at smokers motivated to quit were effective (RR 1.3, 95% CI 1.0-1.7). Fully automated interventions increased smoking cessation rates (RR 1.4, 95% CI 1.0-2.0), but evidence was less clear-cut for non-automated interventions. Overall, the web-based interventions evaluated were considered to be acceptable and user satisfaction was generally high. CONCLUSION Interactive, web-based interventions for smoking cessation can be effective in aiding cessation. More research is needed to evaluate the relative efficacy of interactive web-based interventions compared with static websites.
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Affiliation(s)
- Lion Shahab
- Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK.
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Drummond C, Coulton S, James D, Godfrey C, Parrott S, Baxter J, Ford D, Lervy B, Rollnick S, Russell I, Peters T. Effectiveness and cost-effectiveness of a stepped care intervention for alcohol use disorders in primary care: pilot study. Br J Psychiatry 2009; 195:448-56. [PMID: 19880936 DOI: 10.1192/bjp.bp.108.056697] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Screening for alcohol use disorders identifies a wide range of needs, varying from hazardous and harmful drinking to alcohol dependence. Stepped care offers a potentially resource-efficient way of meeting these needs, but requires evaluation in a randomised controlled trial. AIMS To evaluate the feasibility, effectiveness and cost-effectiveness of opportunistic screening and a stepped care intervention in primary care. METHOD A total of 1794 male primary care attendees at six practices in South Wales were screened using the Alcohol Use Disorders Identification Test (AUDIT). Of these, 112 participants who scored 8 or more on the AUDIT and who consented to enter the study were randomised to receive either 5 minutes of minimal intervention delivered by a practice nurse (control group) or stepped care intervention consisting of three successive steps (intervention group): a single session of behaviour change counselling delivered by a practice nurse; four 50-minute sessions of motivational enhancement therapy delivered by a trained alcohol counsellor; and referral to a community alcohol treatment agency. RESULTS Both groups reduced alcohol consumption 6 months after randomisation with a greater, although not significant, improvement for the stepped care intervention. Motivation to change was greater following the stepped care intervention. The stepped care intervention resulted in greater cost savings compared with the minimal intervention. CONCLUSIONS Stepped care was feasible to implement in the primary care setting and resulted in greater cost savings compared with minimal intervention.
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Affiliation(s)
- Colin Drummond
- National Addiction Centre, PO48, Institute of Psychiatry, King's College London, 4 Windsor Walk, London SE5 8BB, UK.
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95
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Peterson AV, Kealey KA, Mann SL, Marek PM, Ludman EJ, Liu J, Bricker JB. Group-randomized trial of a proactive, personalized telephone counseling intervention for adolescent smoking cessation. J Natl Cancer Inst 2009; 101:1378-92. [PMID: 19822836 PMCID: PMC2765261 DOI: 10.1093/jnci/djp317] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Revised: 06/19/2009] [Accepted: 08/12/2009] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The Hutchinson Study of High School Smoking randomized trial was designed to rigorously evaluate a proactive, personalized telephone counseling intervention for adolescent smoking cessation. METHODS Fifty randomly selected Washington State high schools were randomized to the experimental or control condition. High school junior smokers were proactively identified (N = 2151). Trained counselors delivered the motivational interviewing plus cognitive behavioral skills training telephone intervention to smokers in experimental schools during their senior year of high school. Participants were followed up, with 88.8% participation, to outcome ascertainment more than 1 year after random assignment. The main outcome was 6-months prolonged abstinence from smoking. All statistical tests were two-sided. RESULTS The intervention increased the percentage who achieved 6-month prolonged smoking abstinence among all smokers (21.8% in the experimental condition vs 17.7% in the control condition, difference = 4.0%, 95% confidence interval [CI] = -0.2 to 8.1, P = .06) and in particular among daily smokers (10.1% vs 5.9%, difference = 4.1%, 95% CI = 0.8 to 7.1, P = .02). There was also generally strong evidence of intervention impact for 3-month, 1-month, and 7-day abstinence and duration since last cigarette (P = .09, .015, .01, and .03, respectively). The intervention effect was strongest among male daily smokers and among female less-than-daily smokers. CONCLUSIONS Proactive identification and recruitment of adolescents via public high schools can produce a high level of intervention reach; a personalized motivational interviewing plus cognitive behavioral skills training counseling intervention delivered by counselor-initiated telephone calls is effective in increasing teen smoking cessation; and both daily and less-than-daily teen smokers participate in and benefit from telephone-based smoking cessation intervention.
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Affiliation(s)
- Arthur V Peterson
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
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96
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Television-supported self-help for problem drinkers: a randomized pragmatic trial. Addict Behav 2009; 34:451-7. [PMID: 19179014 DOI: 10.1016/j.addbeh.2008.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Revised: 12/12/2008] [Accepted: 12/31/2008] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To test the effectiveness of a television-supported self-help intervention for problem drinking. METHODS Dutch television viewers (N=181) drinking in excess of the guidelines for low-risk alcohol use were randomly assigned either to the Drinking Less TV self-help course (consisting of five televised sessions supplemented by a self-help manual and a self-help website) or to a waitlisted control group. To ensure trial integrity, intervention delivery was mimicked beforehand by sending intervention participants weekly DVDs in advance of the actual telecasts in 2006. Pre-post assessments were carried out on both groups, as well as a 3-month follow-up assessment on the intervention group to study effect maintenance. The primary outcome measure was low-risk drinking. RESULTS The intervention group was more successful than the waitlist group in achieving low-risk drinking at post-intervention (OR=9.4); the effects were maintained in the intervention group at 3-month follow-up. CONCLUSIONS The low-threshold television-based course Drinking Less appears effective in reducing problem drinking.
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97
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Dunton GF, Lagloire R, Robertson T. Using the RE-AIM framework to evaluate the statewide dissemination of a school-based physical activity and nutrition curriculum: "Exercise Your Options". Am J Health Promot 2009; 23:229-32. [PMID: 19288843 DOI: 10.4278/ajhp.071211129] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Examine the reach, efficacy, adoption, implementation, and maintenance of a physical activity and nutrition curriculum for middle-school students. DESIGN Nonexperimental pilot evaluation of a statewide dissemination trial. SETTING California middle schools during the 2006 to 2007 school year. SUBJECTS Sixteen classes (N = 668 students and 16 teachers) sampled from the statewide pool who used the program. INTERVENTION An eight-lesson nutrition and physical activity curriculum, "Exercise Your Options" (EYO), including a teacher guide, video clips, a student activity booklet, and ancillary materials was made available to teachers. MEASURES Program records, classroom observations, teacher surveys, and student presurveys and postsurveys (assessing physical activity, sedentary behaviors, and dietary intake). ANALYSIS Descriptive statistics and multilevel random-coefficient modeling. RESULTS The EYO program reached 234,442 middle-school students in California. During the program, total physical activity increased (p < .001), whereas watching TV/DVDs and playing electronic games/computer use decreased (p < .05). Intake of dairy products increased (p < .05), whereas consumption of sugars/sweets decreased (p < .001). Forty-two percent of eligible middle-school classrooms ordered the program materials. Eighty-six percent of sampled teachers implemented all of the lessons. Over the past 5 years, 51% of all middle-school students in California were exposed to the program. CONCLUSIONS The EYO program showed its potential for moderate to high public health impact among California middle-school students.
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Affiliation(s)
- Genevieve F Dunton
- Cancer Prevention Fellowship Program, Health Promotion Research Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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98
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Grimley DM, Hook EW. A 15-minute interactive, computerized condom use intervention with biological endpoints. Sex Transm Dis 2009; 36:73-8. [PMID: 19125141 DOI: 10.1097/olq.0b013e31818eea81] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Brief face-to-face-behavioral interventions have been shown to be efficacious, but are costly to sustain and to widely disseminate. This study evaluated the efficacy of a 15-minute theory-based behavioral intervention designed to increase condom use and reduce new cases of Neisseria gonorrhoeae and Chlamydia trachomatis. METHODS Participants were randomly assigned via the computer to the intervention or the comparison group stratified by gender and their baseline stage of change (motivational readiness) for using condoms consistently (100%) with their main partners. Behavioral data and biologic specimens for testing of Neisseria gonorrhoeae and Chlamydia trachomatis were obtained at baseline and at 6 months post intervention. The intervention was delivered via an audio, multimedia, computerized application that provided individualized interventions to patients based on their responses to assessment items; comparison patients interacted with a 15-minute, computerized, multiple health risk assessment with no intervention. RESULTS The majority of the sample (N = 430) was black (88%); 54.5% women; with a mean age = 24.5. Assuming all participants who did not return to the clinic at 6 months were not using condoms consistently, 32% of the treatment group versus 23% in the comparison group reported consistent condom use (P = 0.03). The combined Neisseria gonorrhoeae and Chlamydia trachomatis incidence declined to 6% in the intervention group versus 13% in the comparison group (P = 0.04). Results from a regression analysis revealed that the only statically significant predictor of sexually transmitted diseases infection at the follow-up was group assignment (OR = 1.91, 95% confidence index = 1.09-3.34; P = 0.043). CONCLUSIONS These findings suggest that brief, interactive, computer-delivered interventions provided at the evaluation visit increase condom use and reduce sexually transmitted diseases without putting additional burden on clinicians or staff.
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Affiliation(s)
- Diane M Grimley
- Department of Health Behavior, School of Public Health, University of Alabama, Birmingham, AL, USA.
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99
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Noar SM, Palmgreen P, Chabot M, Dobransky N, Zimmerman RS. A 10-year systematic review of HIV/AIDS mass communication campaigns: Have we made progress? JOURNAL OF HEALTH COMMUNICATION 2009; 14:15-42. [PMID: 19180369 DOI: 10.1080/10810730802592239] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The purpose of the current study was to conduct a 10-year systematic review of HIV/AIDS mass communication campaigns focused on sexual behavior, HIV testing, or both (1998-2007) and to compare the results with the last comprehensive review of such campaigns, conducted by Myhre and Flora (2000). A comprehensive search strategy yielded 38 HIV/AIDS campaign evaluation articles published in peer-reviewed journals, representing 34 distinct campaign efforts conducted in 23 countries. The articles were coded on a variety of campaign design and evaluation dimensions by two independent coders. Results indicated that compared with the previous systematic review (1986-1998 period), campaigns increasingly have employed the following strategies: (1) targeted defined audiences developed through audience segmentation procedures; (2) designed campaign themes around behavior change (rather than knowledge change); (3) used behavioral theories; (4) achieved high message exposure; (5) used stronger research designs for outcome evaluation; and (6) included measures of behavior (or behavioral intentions) in outcome assessments. In addition, an examination of 10 campaign efforts that used more rigorous quasi-experimental designs revealed that the majority (8 of 10) demonstrated effects on behavior change or behavioral intentions. Despite these positive developments, most HIV/AIDS campaigns continue to use weak (i.e., preexperimental) outcome evaluation designs. Implications of these results for improved design, implementation, and evaluation of HIV/AIDS campaign efforts are discussed.
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Affiliation(s)
- Seth M Noar
- Department of Communication, University of Kentucky, Lexington, Kentucky 40506-0042, USA.
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100
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Graham AL, Milner P, Saul JE, Pfaff L. Online advertising as a public health and recruitment tool: comparison of different media campaigns to increase demand for smoking cessation interventions. J Med Internet Res 2008; 10:e50. [PMID: 19073542 PMCID: PMC2630839 DOI: 10.2196/jmir.1001] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Revised: 04/24/2008] [Accepted: 08/19/2008] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND To improve the overall impact (reach x efficacy) of cessation treatments and to reduce the population prevalence of smoking, innovative strategies are needed that increase consumer demand for and use of cessation treatments. Given that 12 million people search for smoking cessation information each year, online advertising may represent a cost-efficient approach to reach and recruit online smokers to treatment. Online ads can be implemented in many forms, and surveys consistently show that consumers are receptive. Few studies have examined the potential of online advertising to recruit smokers to cessation treatments. OBJECTIVE The aims of the study were to (1) demonstrate the feasibility of online advertising as a strategy to increase consumer demand for cessation treatments, (2) illustrate the tools that can be used to track and evaluate the impact of online advertising on treatment utilization, and (3) highlight some of the methodological challenges and future directions for researchers. METHODS An observational design was used to examine the impact of online advertising compared to traditional recruitment approaches (billboards, television and radio ads, outdoor advertising, direct mail, and physician detailing) on several dependent variables: (1) number of individuals who enrolled in Web- or telephone-based cessation treatment, (2) the demographic, smoking, and treatment utilization characteristics of smokers recruited to treatment, and (3) the cost to enroll smokers. Several creative approaches to online ads (banner ads, paid search) were tested on national and local websites and search engines. The comparison group was comprised of individuals who registered for Web-based cessation treatment in response to traditional advertising during the same time period. RESULTS A total of 130,214 individuals responded to advertising during the study period: 23,923 (18.4%) responded to traditional recruitment approaches and 106,291 (81.6%) to online ads. Of those who clicked on an online ad, 9655 (9.1%) registered for cessation treatment: 6.8% (n = 7268) for Web only, 1.1% (n = 1119) for phone only, and 1.2% (n = 1268) for Web and phone. Compared to traditional recruitment approaches, online ads recruited a higher percentage of males, young adults, racial/ethnic minorities, those with a high school education or less, and dependent smokers. Cost-effectiveness analyses compare favorably to traditional recruitment strategies, with costs as low as US $5-$8 per enrolled smoker. CONCLUSIONS Developing and evaluating new ways to increase consumer demand for evidence-based cessation services is critical to cost-efficiently reduce population smoking prevalence. Results suggest that online advertising is a promising approach to recruit smokers to Web- and telephone-based cessation interventions. The enrollment rate of 9.1% exceeds most studies of traditional recruitment approaches. The powerful targeting capabilities of online advertising present new opportunities to reach subgroups of smokers who may not respond to other forms of advertising. Online advertising also provides unique evaluation opportunities and challenges to determine rigorously its impact and value.
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Affiliation(s)
- Amanda L Graham
- The Schroeder Institute for Tobacco Research and Policy Studies, American Legacy Foundation, NW, Washington, DC 20036, USA.
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