Smoking cessation via the internet: a randomized clinical trial of an internet intervention as adjuvant treatment in a smoking cessation intervention

Recruitment of live donors by candidates for kidney transplantation

BACKGROUND

Little is known about efforts that renal transplant candidates make to recruit live donors. It was hypothesized that preference for live donor kidney transplantation and greater knowledge about live donor transplantation are associated with candidates' initiating conversations about donation with potential donors.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

A cross-sectional study of renal transplant candidates was performed at initial transplant evaluation. Candidates completed a questionnaire that specified whether they had initiated conversations about donation with any potential donors. The questionnaire also measured preference for live donor transplantation, knowledge about transplantation, concern about donor harm, willingness to ask for help in coping with kidney disease, and social support.

RESULTS

Ninety-six candidates participated. Forty-nine (51%) reported initiating a conversation with at least one potential donor. In multivariable logistic regression, domains associated with initiating a conversation included: preference for live donor transplantation, willingness to ask for help, and female gender. Older age was associated with a lower odds of initiating a conversation. Knowledge, concern about donor harm, social support, and ethnicity were not associated with initiating a conversation with a donor.

CONCLUSIONS

Attempts at donor recruitment by kidney transplant candidates are common. These findings suggest that interventions that influence preferences about transplantation and willingness to ask others for help are logical targets to enhance access to live donor transplantation.

Reliability of internet- versus telephone-administered questionnaires in a diverse sample of smokers

BACKGROUND

Smoking is more prevalent among lower-income individuals and certain racial/ethnic minorities. Addressing tobacco cessation among diverse populations is an urgent public health priority. As Internet use continues to rise among all segments of the US population, Web-based interventions have enormous potential to reach priority populations. Conducting Web-based smoking cessation research in priority populations requires psychometrically sound measurement instruments. To date, only one published study has examined the psychometric properties of Internet-administered measures commonly used in Web-based cessation trials. However, the sample was homogeneous with regard to race/ethnicity and income. We sought to replicate and extend these findings in a more diverse sample of smokers.

OBJECTIVE

The aim was to examine the internal consistency and test-retest reliability of measures commonly used in smoking cessation clinical trials among racial/ethnic minorities and smokers with lower income.

METHODS

Participants were enrolled in a randomized trial of the efficacy of an Internet smoking cessation program between June 2005 and September 2006. Following a baseline telephone assessment and randomization into the parent trial, participants were recruited to the reliability substudy. In phase I of recruitment, all participants in the parent trial were recruited to the substudy; in phase II, all consecutive racial/ethnic minority participants in the parent trial were recruited. Race and ethnicity were assessed via self-report using two standard items from the US Office of Management and Budget. An email was sent 2 days after the telephone assessment with a link to the Internet survey. Measures examined were quit methods, perceived stress, depression, social support, smoking temptations, alcohol use, perceived health status, and income. Internal consistency and test-retest reliability of Internet- versus telephone-administered measures were examined within four strata defined by race/ethnicity (non-Hispanic White, racial/ethnic minority) and annual household income (US $40,000 or less, more than $40,000).

RESULTS

Of the 442 individuals invited, 319 participated (72% response rate): 52.4% were non-Hispanic White, 22.9% Black, 11.6% Hispanic, 7.8% Asian, 4.4% American Indian / Alaska Native, and 1% Native Hawaiian / Other Pacific Islander. About half (49.4%) reported an annual household income of US $40,000 or less, and 25.7% had a high school degree or less. Test-retest reliability was satisfactory to excellent across all strata for the majority of measures examined: 9 of 12 continuous variables had intraclass correlation coefficients > or = 0.70, and 10 of 18 binary variables and both ordinal variables had kappa coefficients > or = 0.70. Test-retest reliability of several quit methods varied across strata.

CONCLUSIONS

Race/ethnicity and income do not affect the psychometric properties of most Internet-administered measures examined. This knowledge adds to the confidence of conducting Web-based smoking cessation research and strengthens the scientific rigor of collecting information via the Internet on racial/ethnic minority and low-income subgroups.

TRIAL REGISTRATION

clinicaltrials.gov NCT00282009 (parent trial).

Tobacco quitlines: looking back and looking ahead

Telephone based tobacco cessation services, or quitlines, have become central components of many comprehensive tobacco control programmes. This paper provides an overview of their history, noting milestones in the growth of quitlines. Key factors in their worldwide adoption were solid evidence from clinical trials with large community samples and strong backing from public health officials. Quitlines are now available throughout most of North America, Europe, Australia and in many other locations around the world. The paper also offers several recommendations for future directions in quitline practice and research. Benchmarks should be established for key areas of quitline implementation, such as accessibility, quality and cost efficiency. Advances in pharmacotherapy, telephony and web based applications should be investigated for opportunities to expand service offerings. Research and development are needed to determine how best to serve a diverse clientele in the most cost effective manner. Funding should be expanded and diversified to enable quitlines to serve much larger numbers of users. Healthcare providers should be targeted for quitline promotion, to engage them in a broad effort to increase the number of patients receiving cessation messages from clinicians. The goal of quitline promotion should expand to include an increase in unaided quit attempts in the population. Early research findings were quickly adopted in quitline practice, and future research to answer questions that have arisen through the implementation of quitlines will probably also find quick adoption.