1
|
Little MA, Reid T, Moncrief M, Cohn W, Wiseman KP, Wood CH, You W, Anderson RT, Krukowski RA. Testing the feasibility of the QuitAid smoking cessation intervention in a randomized factorial design in an independent, rural community pharmacy. Pilot Feasibility Stud 2024; 10:41. [PMID: 38409089 PMCID: PMC10895740 DOI: 10.1186/s40814-024-01465-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 02/14/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Adult smoking rates in the USA are highest in economically depressed rural Appalachia. Pharmacist-delivered tobacco cessation support that incorporates medication therapy management (such as the QuitAid intervention) is a promising approach to address this need. METHODS Twenty-four adult smokers recruited between September and November 2021 through an independent pharmacy in rural Appalachia were randomized in a non-blinded 2 × 2 × 2 factorial design to (1) pharmacist delivered QuitAid intervention (yes vs. no); (2) combination nicotine replacement therapy (NRT) gum + NRT patch (vs. NRT patch); and/or (3) 8 weeks of NRT (vs. standard 4 weeks). Participants received 4 weeks of NRT patch in addition to the components to which they were assigned. Participants completed baseline and 3-month follow-up assessments. Primary outcomes were feasibility of recruitment and randomization, retention, treatment adherence, and fidelity. RESULTS Participants were recruited in 7 weeks primarily through a referral process, commonly referred to as ask-advise-connect (61%). Participants were on average 52.4 years old, 29.2% were male and the majority were white (91.6%) and Non-Hispanic (91.7%). There was a high level of adherence to the interventions, with 85% of QuitAid sessions completed, 83.3% of the patch used, and 54.5% of gum used. Participants reported a high level of satisfaction with the program, and there was a high level of retention (92%). CONCLUSIONS This demonstration pilot randomized controlled study indicates that an ask-advise-connect model for connecting rural smokers to smoking cessation support and providing QuitAid for smoking cessation is feasible and acceptable among rural Appalachian smokers and independent pharmacists. Further investigation into the efficacy of a pharmacist-delivered approach for smoking cessation is needed. TRIAL REGISTRATION The trial was retrospectively registered at ClinicalTrials.gov. Trial #: NCT05649241.
Collapse
Affiliation(s)
- Melissa A Little
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA.
- Cancer Control and Population Health, University of Virginia Cancer Center, Charlottesville, VA, USA.
| | - Taylor Reid
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA
- Cancer Control and Population Health, University of Virginia Cancer Center, Charlottesville, VA, USA
| | - Matthew Moncrief
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA
| | - Wendy Cohn
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA
- Cancer Control and Population Health, University of Virginia Cancer Center, Charlottesville, VA, USA
| | - Kara P Wiseman
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA
- Cancer Control and Population Health, University of Virginia Cancer Center, Charlottesville, VA, USA
| | | | - Wen You
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA
- Cancer Control and Population Health, University of Virginia Cancer Center, Charlottesville, VA, USA
| | - Roger T Anderson
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA
- Cancer Control and Population Health, University of Virginia Cancer Center, Charlottesville, VA, USA
| | - Rebecca A Krukowski
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA
- Cancer Control and Population Health, University of Virginia Cancer Center, Charlottesville, VA, USA
| |
Collapse
|
2
|
Maspero S, Delle S, Kraus L, Pogarell O, Hoch E, Bachner J, Lochbühler K. Short-term effectiveness of the national German quitline for smoking cessation: results of a randomized controlled trial. BMC Public Health 2024; 24:588. [PMID: 38395782 PMCID: PMC10893695 DOI: 10.1186/s12889-024-18104-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The objective of the present study was to examine the short-term effectiveness of the national German quitline for smoking cessation. METHODS A parallel-group, two-arm, superiority, randomized controlled trial with data collection at baseline and post-intervention (three months from baseline) was conducted. Individuals were randomized to either the intervention group, receiving up to six telephone counselling calls, or the control group, receiving an active control intervention (self-help brochure). The primary outcome was the seven-day point prevalence abstinence at post-assessment. Secondary outcomes included changes in smoking-related cognitions and coping strategies from pre- to post-assessment, the perceived effectiveness of intervention components, and the satisfaction with the intervention. RESULTS A total of n = 905 adult daily smokers were assigned to either the intervention group (n = 477) or the control group (n = 428). Intention-to-treat analyses demonstrated that individuals allocated to the telephone counselling condition were more likely to achieve seven-day point prevalence abstinence at post-assessment compared to those allocated to the self-help brochure condition (41.1% vs. 23.1%; OR = 2.3, 95% CI [1.7, 3.1]). Participants who received the allocated intervention in both study groups displayed significant improvements in smoking-related cognitions and coping strategies with the intervention group showing greater enhancements than the control group. This pattern was also found regarding the perceived effectiveness of intervention components and the satisfaction with the intervention. CONCLUSION The present study provides first empirical evidence on the short-term effectiveness of the national German quitline for smoking cessation, highlighting its potential as an effective public health intervention to reduce the burden of disease associated with smoking. TRIAL REGISTRATION This study is registered in the German Clinical Trials Register (DRKS00025343). Date of registration: 2021/06/07.
Collapse
Affiliation(s)
- Simona Maspero
- IFT Institut für Therapieforschung, Centre for Mental Health and Addiction Research, Munich, Germany
| | - Simone Delle
- IFT Institut für Therapieforschung, Centre for Mental Health and Addiction Research, Munich, Germany
| | - Ludwig Kraus
- Department of Public Health Science, Centre for Social Research On Alcohol and Drugs, Stockholm University, Stockholm, Sweden
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Centre of Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Eva Hoch
- IFT Institut für Therapieforschung, Centre for Mental Health and Addiction Research, Munich, Germany
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Joachim Bachner
- Department Health and Sport Sciences, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Kirsten Lochbühler
- IFT Institut für Therapieforschung, Centre for Mental Health and Addiction Research, Munich, Germany.
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Munich, Germany.
| |
Collapse
|
3
|
Pandya A, K S M, Mishra S, Bajaj K. Effectiveness of the QuitSure Smartphone App for Smoking Cessation: Findings of a Prospective Single Arm Trial. JMIR Form Res 2023; 7:e51658. [PMID: 38157243 PMCID: PMC10787327 DOI: 10.2196/51658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/01/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Digital therapies, especially smartphone apps for active and continuous smoking cessation support, are strongly emerging as an alternative smoking cessation therapy. In the Indian context, there is a growing interest in the use of app-based smoking cessation programs; however, there is limited evidence regarding their effectiveness in achieving long-term continuous abstinence. OBJECTIVE This study aimed to evaluate the long-term abstinence effect (up to 30-d abstinence postprogram completion) of a smartphone app, QuitSure, for smoking cessation in active smokers from India. METHODS In this prospective single-arm study, participants who signed up for the QuitSure app were enrolled in this study. The primary end point was the prolonged abstinence (PA) rate from weeks 1 to 4 (day 7 to day 30). Furthermore, data for withdrawal symptoms, relapse reasons, and reasons for not continuing the program were also assessed. RESULTS The quit rate was calculated considering only the participants who followed up and completed the survey sent to them (per protocol) at day 7 and at day 30, respectively. The PA rate at day 7 was found to be 64.5% (111/172; 95% CI 56% to 72%), and the PA rate at day 30 was found to be 55.8% (72/129; 95% CI 45% to 65%). Within the 7-day abstinence period, 60.4% (67/111) of the participants did not have any withdrawal symptoms. The most common mild withdrawal symptoms were mild sleep disturbance (21/111, 18.9%), mild digestive changes (19/111, 17.1%), and coughing (17/111, 15.3%). Severe withdrawal symptoms were rare, with only 5.4% (6/111) experiencing them. For those achieving 30-day postprogram abstinence, 85% (61/72) had no mild withdrawal symptoms, and 99% (71/72) had no severe withdrawal symptoms. Among successful quitters at day 7, a total of 72.1% (80/111) reported minimal to no cravings, which increased to 88% (63/72) at day 30. Furthermore, 78% (56/72) of those with PA at day 30 reported no change in weight or reduced weight. Among participants experiencing relapse, 48% (28/58) cited intense cravings, 28% (16/58) mentioned facing a tragedy, and 26% (15/58) reported relapsing due to alcohol consumption. The PA rates as a result of the QuitSure program were found to be better than those reported in the results of other smoking-cessation app programs' studies. CONCLUSIONS The QuitSure app yields high PA rates and ameliorates symptoms associated with smoking cessation. In order to obtain conclusive evidence regarding the effectiveness and efficacy of the QuitSure program, future research should include appropriate control measures. Nevertheless, the QuitSure program can serve as a valuable adjunct to a conventional smoking cessation treatment program to aid sustained abstinence.
Collapse
Affiliation(s)
- Apurvakumar Pandya
- Parul Institute of Public Health, Parul University, Vadodara, India
- Indian Institute of Public Health, Gandhinagar, India
| | - Mythri K S
- Parul Institute of Public Health, Parul University, Vadodara, India
| | | | | |
Collapse
|
4
|
Britton M, Rogova A, Chen TA, Martinez Leal I, Kyburz B, Williams T, Patel M, Reitzel LR. Texas tobacco quitline knowledge, attitudes, and practices within healthcare agencies serving individuals with behavioral health needs: A multimethod study. Prev Med Rep 2023; 35:102256. [PMID: 37752980 PMCID: PMC10518765 DOI: 10.1016/j.pmedr.2023.102256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/18/2023] [Accepted: 05/19/2023] [Indexed: 09/28/2023] Open
Abstract
Patients with behavioral health conditions have disproportionately high tobacco use rates and face significant barriers to accessing evidence-based tobacco cessation services. Tobacco quitlines are an effective and accessible resource, yet they are often underutilized. We identify knowledge, practices, and attitudes towards the Texas Tobacco Quitline (TTQL) within behavioral healthcare settings in Texas. Quantitative and qualitative data were collected in 2021 as part of a statewide needs assessment in behavioral healthcare settings. Survey respondents (n = 125) represented 23 Federally Qualified Health Centers, 29 local mental health authorities (LMHAs), 12 substance use treatment programs in LMHAs, and 61 standalone substance use treatment centers (26 people participated in qualitative interviews). Over half of respondents indicated familiarity with the TTQL and believed that the TTQL was helpful for quitting. Qualitative findings reveal potential concerns about inconsistency of services, long wait time, and the format of the quitline. About half of respondents indicated that their center promoted patient referral to TTQL, and few indicated that their center had an electronic referral system with direct TTQL referral capacity. Interview respondents reported overall lack of systematic follow up with patients regarding their use of the TTQL services. Findings suggest the need for (1) increased TTQL service awareness among healthcare providers; (2) further investigation into any changes needed to better serve patients with behavioral health conditions who use tobacco; and (3) electronic health record integration supporting direct referrals and enhanced protocols to support patient follow up after TTQL referral.
Collapse
Affiliation(s)
- Maggie Britton
- The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Unit 1440, 1400 Pressler Street, Houston, TX 77030, United States
- University of Houston, Department of Psychological, Health, and Learning Sciences, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, United States
- University of Houston, HEALTH Research Institute, 4349 Martin Luther King Blvd, Houston, TX 77204, United States
| | - Anastasia Rogova
- The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Unit 1440, 1400 Pressler Street, Houston, TX 77030, United States
- University of Houston, Department of Psychological, Health, and Learning Sciences, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, United States
- University of Houston, HEALTH Research Institute, 4349 Martin Luther King Blvd, Houston, TX 77204, United States
| | - Tzuan A. Chen
- University of Houston, Department of Psychological, Health, and Learning Sciences, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, United States
- University of Houston, HEALTH Research Institute, 4349 Martin Luther King Blvd, Houston, TX 77204, United States
| | - Isabel Martinez Leal
- The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Unit 1440, 1400 Pressler Street, Houston, TX 77030, United States
- University of Houston, Department of Psychological, Health, and Learning Sciences, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, United States
- University of Houston, HEALTH Research Institute, 4349 Martin Luther King Blvd, Houston, TX 77204, United States
| | - Bryce Kyburz
- Integral Care, 1430 Collier St, Austin, TX 78704, United States
| | - Teresa Williams
- Integral Care, 1430 Collier St, Austin, TX 78704, United States
| | - Mayuri Patel
- Texas Department of State Health Services, Tobacco Prevention and Control Branch, 1100 West 49th Street, Mail Code 1965, Austin, TX 78756, United States
| | - Lorraine R. Reitzel
- The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Unit 1440, 1400 Pressler Street, Houston, TX 77030, United States
- University of Houston, Department of Psychological, Health, and Learning Sciences, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, United States
| |
Collapse
|
5
|
Kraiss J, Viechtbauer W, Black N, Johnston M, Hartmann‐Boyce J, Eisma M, Javornik N, Bricca A, Michie S, West R, de Bruin M. Estimating the true effectiveness of smoking cessation interventions under variable comparator conditions: A systematic review and meta-regression. Addiction 2023; 118:1835-1850. [PMID: 37132077 PMCID: PMC10952237 DOI: 10.1111/add.16222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 04/07/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND AND AIMS Behavioural smoking cessation trials have used comparators that vary considerably between trials. Although some previous meta-analyses made attempts to account for variability in comparators, these relied on subsets of trials and incomplete data on comparators. This study aimed to estimate the relative effectiveness of (individual) smoking cessation interventions while accounting for variability in comparators using comprehensive data on experimental and comparator interventions. METHODS A systematic review and meta-regression was conducted including 172 randomised controlled trials with at least 6 months follow-up and biochemically verified smoking cessation. Authors were contacted to obtain unpublished information. This information was coded in terms of active content and attributes of the study population and methods. Meta-regression was used to create a model predicting smoking cessation outcomes. This model was used to re-estimate intervention effects, as if all interventions have been evaluated against the same comparators. Outcome measures included log odds of smoking cessation for the meta-regression models and smoking cessation differences and ratios to compare relative effectiveness. RESULTS The meta-regression model predicted smoking cessation rates well (pseudo R2 = 0.44). Standardising the comparator had substantial impact on conclusions regarding the (relative) effectiveness of trials and types of intervention. Compared with a 'no support comparator', self-help was 1.33 times (95% CI = 1.16-1.49), brief physician advice 1.61 times (95% CI = 1.31-1.90), nurse individual counselling 1.76 times (95% CI = 1.62-1.90), psychologist individual counselling 2.04 times (95% CI = 1.95-2.15) and group psychologist interventions 2.06 times (95% CI = 1.92-2.20) more effective. Notably, more elaborate experimental interventions (e.g. psychologist counselling) were typically compared with more elaborate comparators, masking their effectiveness. CONCLUSIONS Comparator variability and underreporting of comparators obscures the interpretation, comparison and generalisability of behavioural smoking cessation trials. Comparator variability should, therefore, be taken into account when interpreting and synthesising evidence from trials. Otherwise, policymakers, practitioners and researchers may draw incorrect conclusions about the (cost) effectiveness of smoking cessation interventions and their constituent components.
Collapse
Affiliation(s)
- Jannis Kraiss
- Radboud Institute for Health SciencesRadboud University Medical CentreNijmegenThe Netherlands
- Department of Psychology, Health, and TechnologyUniversity of TwenteEnschedeThe Netherlands
| | - Wolfgang Viechtbauer
- Department of Psychiatry and NeuropsychologyMaastricht UniversityMaastrichtThe Netherlands
| | - Nicola Black
- Institute of Applied Health Sciences, Health Psychology GroupUniversity of AberdeenAberdeenUK
| | - Marie Johnston
- Institute of Applied Health Sciences, Health Psychology GroupUniversity of AberdeenAberdeenUK
| | | | - Maarten Eisma
- Department of Clinical Psychology and Experimental PsychopathologyUniversity of GroningenGroningenThe Netherlands
| | - Neza Javornik
- Institute of Applied Health Sciences, Health Psychology GroupUniversity of AberdeenAberdeenUK
| | - Alessio Bricca
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and PhysiotherapyUniversity of Southern DenmarkOdenseDenmark
- Department of Physiotherapy and Occupational Therapy, The Research Unit PROgrezNæstved‐Slagelse‐Ringsted HospitalsSlagelseDenmark
| | - Susan Michie
- Centre for Behaviour ChangeUniversity College LondonLondonUK
| | - Robert West
- Department of Epidemiology and Public Health, Health Behaviour Research CentreUniversity College LondonLondonUK
| | - Marijn de Bruin
- Radboud Institute for Health SciencesRadboud University Medical CentreNijmegenThe Netherlands
- Institute of Applied Health Sciences, Health Psychology GroupUniversity of AberdeenAberdeenUK
| |
Collapse
|
6
|
Kreuter MW, Garg R, Fu Q, Caburnay C, Thompson T, Roberts C, Sandheinrich D, Javed I, Wolff JM, Butler T, Grimes LM, Carpenter KM, Pokojski R, Engelbrecht K, Howard V, McQueen A. Helping low-income smokers quit: findings from a randomized controlled trial comparing specialized quitline services with and without social needs navigation. LANCET REGIONAL HEALTH. AMERICAS 2023; 23:100529. [PMID: 37408953 PMCID: PMC10319314 DOI: 10.1016/j.lana.2023.100529] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 07/07/2023]
Abstract
Background Quitting smoking is especially challenging for low-income smokers due to high stress, high smoking prevalence around them, and limited support for quitting. This study aimed to determine whether any of three interventions designed specifically for low-income smokers would be more effective than standard tobacco quitline services: a specialized quitline, the specialized quitline with social needs navigation, or the standard quitline with social needs navigation. Methods Using a randomized 2 × 2 factorial design, low-income daily cigarette smokers (n = 1944) in Missouri, USA who called a helpline seeking assistance with food, rent or other social needs were assigned to receive Standard Quitline alone (n = 485), Standard Quitline + Social Needs Navigation (n = 484), Specialized Quitline alone (n = 485), or Specialized Quitline + Social Needs Navigation (n = 490). The target sample size was 2000, 500 per group. The main outcome was 7-day self-reported point prevalence abstinence at 6-month follow-up. Multiple imputation was used to impute outcomes for those missing data at 6-month follow-up. Binary logistic regression analyses were used to assess differences between study groups. Findings Participants were recruited from June 2017 to November 2020; most were African American (1111 [58%]) or White (666 [35%]), female (1396 [72%]), and reported <$10,000 (957 [51%]) or <$20,000 (1529 [82%]) annual pre-tax household income. At 6-month follow-up (58% retention), 101 participants in the Standard Quitline group reported 7-day point prevalence abstinence (20.8% of those assigned at baseline, 38.1% after imputation). Quit rates in the Specialized Quitline (90 quitters, 18.6%, 38.1%) and Specialized Quitline + Social Needs Navigation (103 quitters, 21.0%, 39.8%) were not different from the Standard Quitline. Quit rates for Standard Quitline + Social Needs Navigation (74 quitters, 15.3%, 30.1%) were significantly lower than Standard Quitline (OR = 0.70, 95% CI = 0.50-0.98). Interpretation A specialized version of a state tobacco quitline was no more effective than standard quitline services in helping low-income smokers quit. Adding social needs navigation to a standard quitline decreased its effectiveness. Trial registration ClinicalTrials.gov Identifier: NCT03194958. Funding National Cancer Institute: R01CA201429.
Collapse
Affiliation(s)
- Matthew W. Kreuter
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Rachel Garg
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Qiang Fu
- Department of Community Health, Tufts University, Medford, MA, USA
| | - Charlene Caburnay
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Tess Thompson
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Christina Roberts
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Dominique Sandheinrich
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Irum Javed
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Jennifer M. Wolff
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Taylor Butler
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Lauren M. Grimes
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | | | - Robin Pokojski
- Community Partnerships, United Way of Greater St. Louis, St. Louis, MO, USA
| | | | - Valerie Howard
- Tobacco Prevention and Control Program, Missouri Department of Health and Senior Services, Jefferson City, MO, USA
| | - Amy McQueen
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
- Division of General Medical Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| |
Collapse
|
7
|
Gordon JS, Armin JS, Giacobbi P, Hsu CH, Marano K, Sheffer CE. Testing the Efficacy of a Scalable Telephone-Delivered Guided Imagery Tobacco Cessation Treatment: Protocol for a Randomized Clinical Trial. JMIR Res Protoc 2023; 12:e48898. [PMID: 37351932 DOI: 10.2196/48898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Tobacco use continues to be a leading preventable cause of death and disease in the United States, accounting for >480,000 deaths each year. Although treatments for tobacco use are effective for many, there is substantial variability in outcomes, and these approaches are not effective for all individuals seeking to quit smoking cigarettes. New, effective therapeutic approaches are needed to meet the preferences of people who want to stop smoking. Guided imagery (GI) is a mind-body technique that involves the guided visualization of specific mental images, which is enhanced with other sensory modalities and emotions. Preliminary evidence provides initial support for the use of GI as a treatment for cigarette smoking. Meta-analyses have shown that standard treatment for cigarette smoking delivered over the telephone via quitlines is effective. A telephone-based intervention that uses GI might provide another effective treatment option and increase the reach and effectiveness of quitlines. OBJECTIVE This study aims to test the efficacy of Be Smoke Free, a telephone-delivered GI treatment for smoking cessation. METHODS This multisite randomized clinical trial (RCT) will compare a novel telephone-delivered GI tobacco cessation treatment with a standard evidence-based behavioral treatment. The study will be conducted over 5 years. In phase 1, we refined protocols and procedures for the New York State and West Virginia sites for use in the RCT. During phase 2, we will conduct an RCT with 1200 participants: 600 (50%) recruited via quitlines and 600 (50%) recruited via population-based methods. Participants will be randomly assigned to either the GI condition or the behavioral condition; both treatments will be delivered by trained study coaches located at the University of Arizona. Assessments will be conducted at baseline and 3 and 6 months after enrollment by University of Arizona research staff. The primary outcome will be self-reported 30-day point prevalence abstinence 6 months after enrollment. Secondary outcomes include biochemically verified 7-day point prevalence abstinence 6 months after enrollment. RESULTS Recruitment in West Virginia and New York began in October 2022. As of March 31, 2023, a total of 242 participants had been enrolled. Follow-up assessments began in November 2022. As of March 31, 2023, of the 118 eligible participants, 97 (82.2%) had completed the 3-month assessment, and 93% (26/28) of eligible participants had completed the 6-month assessment. Biochemical verification and qualitative interviews began in April 2023. Recruitment will continue through 2025 and follow-up assessments through 2026. Primary results are expected to be published in 2027. CONCLUSIONS The Be Smoke Free study is a first-of-its-kind RCT that incorporates GI into telephone-based tobacco cessation treatment. If successful, Be Smoke Free will have substantial benefits for the long-term health of people who use tobacco across the United States. TRIAL REGISTRATION ClinicalTrials.gov NCT05277831; https://clinicaltrials.gov/ct2/show/NCT05277831. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/48898.
Collapse
Affiliation(s)
- Judith S Gordon
- College of Nursing, University of Arizona, Tucson, AZ, United States
| | - Julie S Armin
- Department of Family and Community Medicine, University of Arizona, Tucson, AZ, United States
| | - Peter Giacobbi
- College of Applied Human Sciences, West Virginia University, Morgantown, WV, United States
- School of Public Health, West Virginia University, Morgantown, WV, United States
| | - Chiu-Hsieh Hsu
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Kari Marano
- College of Nursing, University of Arizona, Tucson, AZ, United States
| | - Christine E Sheffer
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| |
Collapse
|
8
|
Yang X, Chen H, Zhang S, Chen X, Sheng Y, Pang J. Association of cigarette smoking habits with the risk of prostate cancer: a systematic review and meta-analysis. BMC Public Health 2023; 23:1150. [PMID: 37316851 DOI: 10.1186/s12889-023-16085-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 06/09/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Association of cigarette smoking habits with the risk of prostate cancer is still a matter of debate. This systematic review and meta-analysis aimed to assess the association between cigarette smoking and prostate cancer risk. METHODS We conducted a systematic search on PubMed, Embase, Cochrane Library, and Web of Science without language or time restrictions on June 11, 2022. Literature search and study screening were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Prospective cohort studies that assessed the association between cigarette smoking habits and the risk of prostate cancer were included. Quality assessment was conducted using the Newcastle-Ottawa Scale. We used random-effects models to obtain pooled estimates and the corresponding 95% confidence intervals. RESULTS A total of 7296 publications were screened, of which 44 cohort studies were identified for qualitative analysis; 39 articles comprising 3 296 398 participants and 130 924 cases were selected for further meta-analysis. Current smoking had a significantly reduced risk of prostate cancer (RR, 0.74; 95% CI, 0.68-0.80; P < 0.001), especially in studies completed in the prostate-specific antigen screening era. Compared to former smokers, current smokers had a significant lower risk of PCa (RR, 0.70; 95% CI, 0.65-0.75; P < 0.001). Ever smoking showed no association with prostate cancer risk in overall analyses (RR, 0.96; 95% CI, 0.93-1.00; P = 0.074), but an increased risk of prostate cancer in the pre-prostate-specific antigen screening era (RR, 1.05; 95% CI, 1.00-1.10; P = 0.046) and a lower risk of prostate cancer in the prostate-specific antigen screening era (RR, 0.95; 95% CI, 0.91-0.99; P = 0.011) were observed. Former smoking did not show any association with the risk of prostate cancer. CONCLUSIONS The findings suggest that the lower risk of prostate cancer in smokers can probably be attributed to their poor adherence to cancer screening and the occurrence of deadly smoking-related diseases, and we should take measures to help smokers to be more compliant with early cancer screening and to quit smoking. TRIAL REGISTRATION This study was registered on PROSPERO (CRD42022326464).
Collapse
Affiliation(s)
- Xiangwei Yang
- Department of Urology, Kidney and Urology Center, Pelvic Floor Disorders Center, The Seventh Affiliated Hospital, Sun Yat-Sen University, No.628 Zhenyuan Road, Shenzhen, 518107, China
| | - Hong Chen
- School of Nursing, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Shiqiang Zhang
- Department of Urology, Kidney and Urology Center, Pelvic Floor Disorders Center, The Seventh Affiliated Hospital, Sun Yat-Sen University, No.628 Zhenyuan Road, Shenzhen, 518107, China
| | - Xianju Chen
- Department of Urology, Kidney and Urology Center, Pelvic Floor Disorders Center, The Seventh Affiliated Hospital, Sun Yat-Sen University, No.628 Zhenyuan Road, Shenzhen, 518107, China
| | - Yiyu Sheng
- Department of Urology, Kidney and Urology Center, Pelvic Floor Disorders Center, The Seventh Affiliated Hospital, Sun Yat-Sen University, No.628 Zhenyuan Road, Shenzhen, 518107, China
| | - Jun Pang
- Department of Urology, Kidney and Urology Center, Pelvic Floor Disorders Center, The Seventh Affiliated Hospital, Sun Yat-Sen University, No.628 Zhenyuan Road, Shenzhen, 518107, China.
| |
Collapse
|
9
|
Lubman DI, Manning V, Arunogiri S, Hall K, Reynolds J, Stragalinos P, Petukhova R, Gerhard R, Tyler J, Bough A, Harris A, Grigg J. A structured, telephone-delivered intervention to reduce methamphetamine use: study protocol for a parallel-group randomised controlled trial. Trials 2023; 24:235. [PMID: 36991490 DOI: 10.1186/s13063-023-07172-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/14/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Australia has one of the highest rates of methamphetamine (MA) use in the world; however, uptake of in-person psychological treatment remains extremely low due to numerous individual (e.g. stigma, shame) and structural (e.g. service accessibility, geographical location) barriers to accessing care. Telephone-delivered interventions are ideally placed to overcome many of the known barriers to treatment access and delivery. This randomised controlled trial (RCT) will examine the efficacy of a standalone, structured telephone-delivered intervention to reduce MA problem severity and related harms. METHODS This study is a double-blind, parallel-group RCT. We will recruit 196 ± 8 individuals with mild to moderate MA use disorder from across Australia. After eligibility and baseline assessments, participants will be randomly allocated to receive either the Ready2Change-Methamphetamine (R2C-M) intervention (n = 98 ± 4; four to six telephone-delivered intervention sessions, R2C-M workbooks and MA information booklet) or control (n = 98 ± 4; four to six ≤5-min telephone check-ins and MA information booklet including information on accessing further support). Telephone follow-up assessments will occur at 6 weeks and 3, 6 and 12 months post-randomisation. The primary outcome is change in MA problem severity (Drug Use Disorders Identification Test, DUDIT) at 3 months post-randomisation. Secondary outcomes are as follows: MA problem severity (DUDIT) at 6 and 12 months post-randomisation, amount of methamphetamine used, methamphetamine use days, methamphetamine use disorder criteria met, cravings, psychological functioning, psychotic-like experiences, quality of life and other drug use days (at some or all timepoints of 6 weeks and 3, 6 and 12 months post-randomisation). Mixed-methods program evaluation will be performed and cost-effectiveness will be examined. DISCUSSION This study will be the first RCT internationally to assess the efficacy of a telephone-delivered intervention for MA use disorder and related harms. The proposed intervention is expected to provide an effective, low-cost, scalable treatment for individuals otherwise unlikely to seek care, preventing future harms and reducing health service and community costs. TRIAL REGISTRATION ClinicalTrials.gov NCT04713124 . Pre-registered on 19 January 2021.
Collapse
Affiliation(s)
- Dan I Lubman
- Turning Point, Eastern Health, Melbourne, Victoria, Australia.
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.
| | - Victoria Manning
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Shalini Arunogiri
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Kate Hall
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Centre for Drug use, Addictive and Anti-social Behaviour Research, Deakin University, Melbourne, Victoria, Australia
| | - John Reynolds
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Peta Stragalinos
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Rachel Petukhova
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Robyn Gerhard
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jonathan Tyler
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
| | - Anna Bough
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
| | - Anthony Harris
- Centre for Health Economics, Monash University, Melbourne, Victoria, Australia
| | - Jasmin Grigg
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
10
|
Bernstein SL, Dziura J, Weiss J, Brooks AH, Miller T, Vickerman KA, Grau LE, Pantalon MV, Abroms L, Collins LM, Toll B. Successful Optimization of Tobacco Dependence Treatment in the Emergency Department: A Randomized Controlled Trial Using the Multiphase Optimization Strategy. Ann Emerg Med 2023; 81:209-221. [PMID: 36585318 PMCID: PMC9868063 DOI: 10.1016/j.annemergmed.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 06/23/2022] [Accepted: 08/08/2022] [Indexed: 12/29/2022]
Abstract
STUDY OBJECTIVE Tobacco dependence treatment initiated in the hospital emergency department (ED) is effective. However, trials typically use multicomponent interventions, making it difficult to distinguish specific components that are effective. In addition, interactions between components cannot be assessed. The Multiphase Optimization Strategy allows investigators to identify these effects. METHODS We conducted a full-factorial, 24 or 16-condition optimization trial in a busy hospital ED to examine the performance of 4 tobacco dependence interventions: a brief negotiation interview; 6 weeks of nicotine replacement therapy with the first dose delivered in the ED; active referral to a telephone quitline; and enrollment in SmokefreeTXT, a free short-messaging service program. Study data were analyzed with a novel mixed methods approach to assess clinical efficacy, cost-effectiveness, and qualitative participant feedback. The primary endpoint was tobacco abstinence at 3 months, verified by exhaled carbon monoxide using a Bedfont Micro+ Smokerlyzer. RESULTS Between February 2017 and May 2019, we enrolled 1,056 adult smokers visiting the ED. Odd ratios (95% confidence intervals) from the primary analysis of biochemically confirmed abstinence rates at 3 months for each intervention, versus control, were: brief negotiation interview, 1.8 (1.1, 2.8); nicotine replacement therapy, 2.1 (1.3, 3.2); quitline, 1.4 (0.9, 2.2); SmokefreeTXT, 1.1 (0.7, 1.7). There were no statistically significant interactions among components. Economic and qualitative analyses are in progress. CONCLUSION The brief negotiation interview and nicotine replacement therapy were efficacious. This study is the first to identify components of ED-initiated tobacco dependence treatment that are individually effective. Future work will address the scalability of the brief negotiation interview and nicotine replacement therapy by offering provider-delivered brief negotiation interviews and nicotine replacement therapy prescriptions.
Collapse
Affiliation(s)
- Steven L Bernstein
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT; Yale Center for Implementation Science, New Haven, CT; Yale Cancer Center, New Haven, CT.
| | - James Dziura
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - June Weiss
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Avis H Brooks
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Ted Miller
- Pacific Institute of Research and Evaluation, Calverton, MD
| | | | - Lauretta E Grau
- Yale Center for Implementation Science, New Haven, CT; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT
| | - Michael V Pantalon
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Lorien Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health at George Washington University, Washington, DC
| | - Linda M Collins
- The Methodology Center and Department of Human Development and Family Studies, Pennsylvania State University, State College, PA
| | - Benjamin Toll
- Yale Cancer Center, New Haven, CT; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| |
Collapse
|
11
|
Lubman DI, Grigg J, Reynolds J, Hall K, Baker AL, Staiger PK, Tyler J, Volpe I, Stragalinos P, Harris A, Best D, Manning V. Effectiveness of a Stand-alone Telephone-Delivered Intervention for Reducing Problem Alcohol Use: A Randomized Clinical Trial. JAMA Psychiatry 2022; 79:1055-1064. [PMID: 36129698 PMCID: PMC9494267 DOI: 10.1001/jamapsychiatry.2022.2779] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/26/2022] [Indexed: 11/14/2022]
Abstract
Importance Despite the magnitude of alcohol use problems globally, treatment uptake remains low. Telephone-delivered interventions have potential to overcome many structural and individual barriers to help seeking, yet their effectiveness as a stand-alone treatment for problem alcohol use has not been established. Objective To examine the effectiveness of the Ready2Change telephone-delivered intervention in reducing alcohol problem severity up to 3 months among a general population sample. Design, Setting, and Participants This double-blind, randomized clinical trial recruited participants with an Alcohol Use Disorders Identification Test (AUDIT) score of greater than 6 (for female participants) and 7 (for male participants) from across Australia during the period of May 25, 2018, to October 2, 2019. Telephone assessments occurred at baseline and 3 months after baseline (84.9% retention). Data collection was finalized September 2020. Interventions The telephone-based cognitive and behavioral intervention comprised 4 to 6 telephone sessions with a psychologist. The active control condition comprised four 5-minute telephone check-ins from a researcher and alcohol and stress management pamphlets. Main Outcomes and Measures The primary outcome was change in alcohol problem severity, measured with the AUDIT total score. Drinking patterns were measured with the Timeline Followback (TLFB) instrument. Results This study included a total of 344 participants (mean [SD] age, 39.9 [11.4] years; range, 18-73 years; 177 male participants [51.5%]); 173 participants (50.3%) composed the intervention group, and 171 participants (49.7%) composed the active control group. Less than one-third of participants (101 [29.4%]) had previously sought alcohol treatment, despite a high mean (SD) baseline AUDIT score of 21.5 (6.3) and 218 (63.4%) scoring in the probable dependence range. For the primary intention-to-treat analyses, there was a significant decrease in AUDIT total score from baseline to 3 months in both groups (intervention group decrease, 8.22; 95% CI, 7.11-9.32; P < .001; control group decrease, 7.13; 95% CI, 6.10-8.17; P < .001), but change over time was not different between groups (difference, 1.08; 95% CI, -0.43 to 2.59; P = .16). In secondary analyses, the intervention group showed a significantly greater reduction in the AUDIT hazardous use domain relative to the control group at 3 months (difference, 0.58; 95% CI, 0.02-1.14; P = .04). A greater reduction in AUDIT total score was observed for the intervention group relative to the control group when adjusting for exposure to 2 or more sessions (difference, 3.40; 95% CI, 0.36-6.44; P = .03) but not 1 or more sessions (per-protocol analysis). Conclusions and Relevance Based on the primary outcome, AUDIT total score, this randomized clinical trial did not find superior effectiveness of this telephone-based cognitive and behavioral intervention compared with active control. However, the intervention was effective in reducing hazardous alcohol use and reduced alcohol problem severity when 2 or more sessions were delivered. Trial outcomes demonstrate the potential benefits of this highly scalable and accessible model of alcohol treatment. Trial Registration ANZCTR Identifier: ACTRN12618000828224.
Collapse
Affiliation(s)
- Dan I. Lubman
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jasmin Grigg
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - John Reynolds
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Kate Hall
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Centre of Drug, Addictive and Anti-social Behaviour Research, Deakin University, Melbourne, Victoria, Australia
| | - Amanda L. Baker
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Petra K. Staiger
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Centre of Drug, Addictive and Anti-social Behaviour Research, Deakin University, Melbourne, Victoria, Australia
| | - Jonathan Tyler
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
| | - Isabelle Volpe
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Peta Stragalinos
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Anthony Harris
- Centre for Health Economics, Monash University, Melbourne, Victoria, Australia
| | - David Best
- Department of Criminology, University of Derby, Derby, United Kingdom
| | - Victoria Manning
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
12
|
Kumar R, Mrigpuri P, Dubey SM, Singh R, Mishra J, Kumar S, Iqra A. One-year continuous abstinence rate for smoking cessation via telephonic counselling: The Indian scenario. Monaldi Arch Chest Dis 2022; 93. [PMID: 36069641 DOI: 10.4081/monaldi.2022.2357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/02/2022] [Indexed: 11/22/2022] Open
Abstract
Tobacco control methods differ by country, with telephonic counseling being one of them. The effectiveness of telephone counseling in smoking cessation has been discussed on several occasions. India's tobacco problem is more complex than that of any other country in the world. To begin with, tobacco is consumed in a variety of ways, and India is a large multilingual country with remarkable cultural diversity. In India, the National Tobacco Quitline Service (NTQLS) is a government-run program. Its data from May 2016 to May 2021 were analyzed retrospectively in this cross-sectional study to determine the prevalence and pattern of tobacco use in India, as well as the abstinence rate for smoking cessation. A total of 4,611,866 calls were received by the Interactive Voice Response system (IVR). The number of calls increased from 600 to 5400 per day after the toll-free number was printed on all tobacco products. Smokeless tobacco use was discovered to be more prevalent, with males significantly more likely to use both smoking and smokeless tobacco. At one month and one year after quitting, 33.42% and 21.9%, respectively, remained tobacco-free. The study emphasizes the efficacy of behavioral counseling in increasing abstinence rates. The printing of a toll-free number on tobacco products is an effective strategy for expanding the operation of quit lines. Despite the challenges of cultural diversity and complex tobacco use, India's quit line service has been able to provide counseling to callers with prolonged abstinence and quit rates comparable to the various quit lines around the world.
Collapse
|
13
|
Wadlin J, Ford DE, Albert MC, Wang NY, Chander G. Implementing an EMR-Based Referral for Smoking Quitline Services with Additional Provider Education, a Cluster-Randomized Trial. J Gen Intern Med 2022; 37:2438-2445. [PMID: 35260960 PMCID: PMC9360303 DOI: 10.1007/s11606-021-07275-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 11/10/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite evidence of their effectiveness, free smoking quitlines are underused. The best way to educate providers about and encourage use of quitlines is not established. We examined if electronic medical record (EMR)-integrated best practices alerts (BPAs) with or without additional provider education resulted in increased quitline referrals. METHODS Waitlist-controlled, cluster-randomized trial of primary care practices assigned to three arms. Providers in participating sites received a new EMR-based BPA for quitline referral and additional education outreach visits, the BPA alone, or usual care. The study was conducted in 2 phases: phase 1 from April 17 to October 16, 2017, and phase 2 from November 9, 2017, to May 8, 2018. In phase 2, the usual-care sites were randomized to either of the two intervention arms. The unit of randomization was primary care practice site. All in-office, primary care provider visits with smokers were included. The primary outcome was referral to the quitline. Secondary outcomes included patient acceptance and enrollment in quitline services. RESULTS Twenty-two practice sites were enrolled. Smoking prevalence at sites ranged from 4.4 to 23%. In phase 1, the BPA-plus-education arm had 5636 eligible encounters and 405 referrals (referral rate 7.2%) while the BPA-only arm had 6857 eligible encounters and 623 referrals (referral rate 9.1%). The usual-care arm had 7434 encounters but no referrals. Comparing the BPA-plus arm to the BPA-only arm, the odds ratio of referral was 0.76 (CI 0.3-1.8). In phase 2, the combined BPA-plus-education sites had 8516 eligible encounters and 475 referrals (rate 5.6%). The BPA-only sites had 9134 eligible encounters and 470 referrals (rate 5.2%). The odds ratio comparing the 2 groups in phase 2 was 1.06 (0.5-2.2). CONCLUSIONS An EMR-based BPA can improve the number of referrals to quitline services, though more work is needed to improve providers' use of quitlines and low patient acceptance of services. Trial Registration NIH Clinicaltrials.gov identifier: NCT03229356.
Collapse
Affiliation(s)
- Joshua Wadlin
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Daniel E Ford
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Michael C Albert
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nae-Yuh Wang
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Geetanjali Chander
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
14
|
Delle S, Kraus L, Maspero S, Pogarell O, Hoch E, Lochbühler K. Effectiveness of the national German quitline for smoking cessation: study protocol of a randomized controlled trial. BMC Public Health 2022; 22:1386. [PMID: 35854238 PMCID: PMC9295518 DOI: 10.1186/s12889-022-13742-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/05/2022] [Indexed: 12/04/2022] Open
Abstract
Background Despite the decline in cigarette smoking prevalence during nearly the past two decades, tobacco use is still widespread in the German adult population, accounting for 125,000 deaths each year and causing tremendous social costs. To accelerate the reduction in tobacco smoking prevalence, evidence-based smoking cessation methods are pivotal to a national tobacco control strategy. The present study aims to evaluate the effectiveness of the national German Smokers Quitline offering cessation support to smokers. Methods A total sample of 910 daily smokers, who are motivated to quit, will be recruited via an online access panel and randomly assigned to either the intervention (telephone counselling) or control condition. In the intervention group, participants will receive up to six proactive phone calls during an intervention period of approximately six weeks. The provided treatment will combine the principles of motivational interviewing and those of the cognitive behavioural approach to treating substance use. Participants in the control condition will receive a self-help brochure to support smoking cessation. Data collection will take place at baseline as well as three (post assessment) and twelve months (follow-up assessment) after baseline assessment. Primary outcome measures will include the seven-day point prevalence abstinence at 3-month and 12-month assessments as well as prolonged abstinence (abstinence over the 12 month period). Secondary outcome measures will include a change in smoking-related cognitions and coping strategies among all participants. Among non-abstainers, treatment success indicators such as a reduction in number of cigarettes smoked per day and changes in the number and duration of quit attempts after intervention start will be assessed. It is expected that after both three and twelve months, smoking cessation rates will be higher in the telephone counselling condition compared to the control condition. Discussion The results will provide insights into the effectiveness of proactive telephone counselling by the national German Smokers Quitline. Trial registration The protocol for this study is registered with the German Clinical Trials Register: DRKS00025343, Date of registration: 2021/06/07, https://www.drks.de/drks_web/setLocale_EN.do
Collapse
Affiliation(s)
- Simone Delle
- IFT Institut für Therapieforschung, Munich, Germany
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, Munich, Germany.,Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden.,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | | | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Eva Hoch
- IFT Institut für Therapieforschung, Munich, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | | |
Collapse
|
15
|
Cao P, Smith L, Mandelblatt JS, Jeon J, Taylor KL, Zhao A, Levy DT, Williams RM, Meza R, Jayasekera J. Cost-Effectiveness of a Telephone-Based Smoking Cessation Randomized Trial in the Lung Cancer Screening Setting. JNCI Cancer Spectr 2022; 6:pkac048. [PMID: 35818125 PMCID: PMC9382714 DOI: 10.1093/jncics/pkac048] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/17/2022] [Accepted: 06/22/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There are limited data on the cost-effectiveness of smoking cessation interventions in lung cancer screening settings. We conducted an economic analysis embedded in a national randomized trial of 2 telephone counseling cessation interventions. METHODS We used a societal perspective to compare the short-term cost per 6-month bio-verified quit and long-term cost-effectiveness of the interventions. Trial data were used to micro-cost intervention delivery, and the data were extended to a lifetime horizon using an established Cancer Intervention Surveillance and Modeling Network lung cancer model. We modeled the impact of screening accompanied by 8 weeks vs 3 weeks of telephone counseling (plus nicotine replacement) vs screening alone based on 2021 screening eligibility. Lifetime downstream costs (2021 dollars) and effects (life-years gained, quality-adjusted life-years [QALYs]) saved were discounted at 3%. Sensitivity analyses tested the effects of varying quit rates and costs; all analyses assumed nonrelapse after quitting. RESULTS The costs for delivery of the 8-week vs 3-week protocol were $380.23 vs $144.93 per person, and quit rates were 7.14% vs 5.96%, respectively. The least costly strategy was a 3-week counseling approach. An 8-week (vs 3-week) counseling approach increased costs but gained QALYs for an incremental cost-effectiveness ratio of $4029 per QALY. Screening alone cost more and saved fewer QALYs than either counseling strategy. Conclusions were robust in sensitivity analyses. CONCLUSIONS Telephone-based cessation interventions with nicotine replacement are considered cost-effective in the lung screening setting. Integrating smoking cessation interventions with lung screening programs has the potential to maximize long-term health benefits at reasonable costs.
Collapse
Affiliation(s)
- Pianpian Cao
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Laney Smith
- Department of Oncology, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Jeanne S Mandelblatt
- Department of Oncology, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Jihyoun Jeon
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Kathryn L Taylor
- Department of Oncology, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Amy Zhao
- Department of Oncology, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - David T Levy
- Department of Oncology, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Randi M Williams
- Department of Oncology, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Jinani Jayasekera
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
16
|
Borrelli B, Endrighi R, Jurasic MM, Hernandez H, Jones E, Ospina J, Cabral HJ, Quintiliani LM, Werntz S. A smoking cessation induction intervention via virtual reality headset during a dental cleaning: protocol for a randomized controlled trial. BMC Public Health 2022; 22:1074. [PMID: 35641925 PMCID: PMC9158367 DOI: 10.1186/s12889-022-13427-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 05/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Effective smoking cessation programs exist but are underutilized by smokers, especially by disadvantaged smokers. Cessation interventions in dental settings have been shown to be effective, but are not consistently delivered due to provider burden and lack of training, especially on how to counsel smokers who are not motivated to quit. METHODS This study is a 2-arm, phase III longitudinal randomized controlled efficacy trial to motivate utilization of evidenced based treatments (EBTs) for smoking cessation (e.g., state quitline, clinic-based counseling, the National Cancer Institute's text message program, and pharmacotherapy). Patients attending an urban dental clinic (n = 376) will be randomized to an intervention group (INT; smoking cessation induction video delivered via VR headset during their teeth cleaning, brochure about EBTs, and a 4-week text message program) or control group (CTRL; relaxation video delivered via VR headset during teeth cleaning, the same brochure as INT, and assessment-only text messages). Assessments will occur at baseline, immediately after the clinic appointment, one-month post-appointment and 3-and 6 months later. We hypothesize INT will be more likely to contact EBTs vs CTRL and have greater utilization rates of EBTs. Secondary objectives are to test the efficacy of INT on point-prevalence smoking abstinence, quit smoking attempts, and motivation to quit vs. CTRL. DISCUSSION Incorporating smoking cessation into a dental clinic visit and targeting all smokers, regardless of motivation to quit, provides proactive reach to cigarette smokers who otherwise may not seek treatment for smoking. TRIAL REGISTRATION NCT04524533 Registered August 24, 2020.
Collapse
Affiliation(s)
- B Borrelli
- Center for Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University, 560 Harrison Avenue, 3rd Floor, Boston, MA, 02118, USA.
| | - R Endrighi
- Center for Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University, 560 Harrison Avenue, 3rd Floor, Boston, MA, 02118, USA
| | - M M Jurasic
- Department of General Dentistry and Health Policy and Health Services Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA
| | - H Hernandez
- Center for Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University, 560 Harrison Avenue, 3rd Floor, Boston, MA, 02118, USA
| | - E Jones
- Center for Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University, 560 Harrison Avenue, 3rd Floor, Boston, MA, 02118, USA
| | - J Ospina
- Center for Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University, 560 Harrison Avenue, 3rd Floor, Boston, MA, 02118, USA
| | - H J Cabral
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA, 02118, USA
| | - L M Quintiliani
- Section of General Internal Medicine, School of Medicine, Boston University, Boston Medical Center, Boston, MA, 02118, USA
| | - S Werntz
- President, Agile Health, Inc, Lincolnshire, IL, 60069, USA
| |
Collapse
|
17
|
Williams RM, Eyestone E, Smith L, Philips JG, Whealan J, Webster M, Li T, Luta G, Taylor KL. Engaging Patients in Smoking Cessation Treatment within the Lung Cancer Screening Setting: Lessons Learned from an NCI SCALE Trial. Curr Oncol 2022; 29:2211-2224. [PMID: 35448154 PMCID: PMC9027703 DOI: 10.3390/curroncol29040180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/16/2022] [Accepted: 03/19/2022] [Indexed: 11/16/2022] Open
Abstract
Offering smoking cessation treatment at lung cancer screening (LCS) will maximize mortality reduction associated with screening, but predictors of treatment engagement are not well understood. We examined participant characteristics of engagement in an NCI SCALE cessation trial. Eligible LCS patients (N = 818) were randomized to the Intensive arm (8 phone counseling sessions +8 weeks of nicotine replacement therapy (NRT)) vs. Minimal arm (3 sessions + 2 weeks of NRT). Engagement was measured by number of sessions completed (none, some, or all) and NRT mailed (none vs. any) in each arm. In the Intensive arm, those with ≥some college (OR = 2.1, 95% CI = 1.1, 4.0) and undergoing an annual scan (OR = 2.1, 95% CI = 1.1, 4.2) engaged in some counseling vs. none. Individuals with higher nicotine dependence were more likely (OR = 2.8, 95% CI = 1.3, 6.2) to request NRT. In the Minimal arm, those with higher education (OR = 2.1, 95% CI = 1.1, 3.9) and undergoing an annual scan (OR = 2.0, 95% CI = 1.04, 3.8) completed some sessions vs. none. Requesting NRT was associated with more pack-years (OR = 1.9, 95% CI = 1.1, 3.5). Regardless of treatment intensity, additional strategies are needed to engage those with lower education, less intensive smoking histories, and undergoing a first scan. These efforts will be important given the broader 2021 LCS guidelines.
Collapse
Affiliation(s)
- Randi M. Williams
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA; (E.E.); (L.S.); (J.G.P.); (J.W.); (M.W.); (K.L.T.)
- Correspondence: ; Tel.: +1-202-687-7036
| | - Ellie Eyestone
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA; (E.E.); (L.S.); (J.G.P.); (J.W.); (M.W.); (K.L.T.)
| | - Laney Smith
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA; (E.E.); (L.S.); (J.G.P.); (J.W.); (M.W.); (K.L.T.)
| | - Joanna G. Philips
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA; (E.E.); (L.S.); (J.G.P.); (J.W.); (M.W.); (K.L.T.)
| | - Julia Whealan
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA; (E.E.); (L.S.); (J.G.P.); (J.W.); (M.W.); (K.L.T.)
| | - Marguerite Webster
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA; (E.E.); (L.S.); (J.G.P.); (J.W.); (M.W.); (K.L.T.)
| | - Tengfei Li
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, DC 20007, USA; (T.L.); (G.L.)
| | - George Luta
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, DC 20007, USA; (T.L.); (G.L.)
| | - Kathryn L. Taylor
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA; (E.E.); (L.S.); (J.G.P.); (J.W.); (M.W.); (K.L.T.)
| | | |
Collapse
|
18
|
Hanly G, Campbell E, Bartlem K, Dray J, Fehily C, Bradley T, Murray S, Lecathelinais C, Wiggers J, Wolfenden L, Reid K, Reynolds T, Bowman J. Effectiveness of referral to a population-level telephone coaching service for improving health risk behaviours in people with a mental health condition: study protocol for a randomised controlled trial. Trials 2022; 23:49. [PMID: 35039058 PMCID: PMC8762844 DOI: 10.1186/s13063-021-05971-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 12/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with a mental health condition have a shorter life expectancy than the general population. This is largely attributable to higher rates of chronic disease and a higher prevalence of modifiable health risk behaviours including tobacco smoking, alcohol consumption, poor nutrition, and physical inactivity. Telephone support services offer a viable option to provide support to reduce these health risk behaviours at a population-level; however, whilst there is some research pertaining to Quitlines, there is limited other research investigating whether telephone services may offer effective support for people with a mental health condition. This protocol describes a randomised controlled trial that aims to evaluate the referral of people with a mental health condition to a population-level telephone coaching service to increase physical activity, healthy eating, or weight management, and increase attempts to do so. METHODS A parallel-group randomised controlled trial will be conducted recruiting participants with a mental health condition through community mental health services and advertisement on social media. Participants will be randomly assigned to receive either a health information pack only (control) or a health information pack and a proactive referral to a free, government-funded telephone coaching service, the NSW Get Healthy Coaching and Information Service® (intervention), which offers up to 13 telephone coaching calls with a University Qualified Health Coach to assist with client-identified goals relating to physical activity, healthy eating, weight management, or alcohol reduction. Data will be collected via telephone surveys at baseline and 6 months post-recruitment. Primary outcomes are as follows: (1) minutes of moderate to vigorous physical activity per week, (2) serves of fruit consumed per day, (3) serves of vegetables consumed per day, and (4) a composite measure assessing attempts to change at least one health risk behaviour (any attempts to change physical activity, fruit consumption, vegetable consumption, or other parts of nutrition). Secondary outcomes include weight and body mass index. DISCUSSION This study is the first to evaluate the effectiveness of referral to a population-level telephone support service for reducing health risk behaviours relating to physical activity, healthy eating, and weight in people with a mental health condition. Results will inform future policy and practice regarding the delivery of telephone-based behaviour change coaching services and the management of physical health for this population to reduce health inequity and the burden of chronic disease. TRIAL REGISTRATION The Australian New Zealand Clinical Trials Registry ACTRN12620000351910 . Retrospectively registered on 12 March 2020.
Collapse
Affiliation(s)
- Grace Hanly
- School of Psychological Sciences, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Elizabeth Campbell
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
- Population Health, Hunter New England Local Health District, Wallsend, NSW Australia
| | - Kate Bartlem
- School of Psychological Sciences, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Julia Dray
- School of Psychological Sciences, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Caitlin Fehily
- School of Psychological Sciences, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Tegan Bradley
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Sonya Murray
- School of Psychological Sciences, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
| | - Christophe Lecathelinais
- School of Psychological Sciences, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
| | - John Wiggers
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
- Population Health, Hunter New England Local Health District, Wallsend, NSW Australia
| | - Luke Wolfenden
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
- Population Health, Hunter New England Local Health District, Wallsend, NSW Australia
| | - Kate Reid
- NSW Office of Preventive Health, Liverpool, NSW Australia
| | | | - Jenny Bowman
- School of Psychological Sciences, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
| |
Collapse
|
19
|
Mullen KA, Garg A, Gagnon F, Wells G, Kapur A, Hawken S, Pipe AL, Walker K, Thiruganasambandamoorthy V, Klepaczek M, Reid RD. The INITIATE trial protocol: a randomized controlled trial testing the effectiveness of a "quit card" intervention on long-term abstinence among tobacco smokers presenting to the emergency department. Trials 2021; 22:733. [PMID: 34688291 PMCID: PMC8541807 DOI: 10.1186/s13063-021-05693-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 10/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Smoking cessation interventions implemented in emergency department (ED) settings have resulted in limited success, owing to factors such as lack of time, motivation, and incentives. A dynamic yet simple and effective approach that addresses the fast-paced nature of acute-care ED settings is needed. This study proposes a multi-center randomized controlled trial (RCT) to compare the effectiveness of an easy to deliver proactive, multi-component tobacco treatment intervention to usual care in the ED setting. METHODS This will be a prospective four-site, single-blind, blinded-endpoint (PROBE) RCT. Participants will be recruited directly in the ED and will be approached strictly in order of arrival time. Those randomized to the Quit Card Intervention (QCI) group will receive a "quit kit" which will include: a "Quit Card" worth $300 that can be used at any Canadian pharmacy to purchase any form of nicotine replacement therapy (NRT); a self-help booklet; and proactive enrolment in 6 months of telephone follow-up counseling. The usual care (UC) group will receive a "quit kit" which will include a brochure for a local smoking cessation program. Quit kits for both groups will be delivered in opaque, sealed envelopes, and identical in size and weight so to conceal group allocation from the blinded research coordinator. Randomization will be stratified by site and by the Canadian Triage Acuity Scale (CTAS), a value assigned to each ED patient based on the severity of the condition. An equal number of quit kits will be prepared for each CTAS level. The primary outcome will be bio-chemically verified smoking abstinence at 26 weeks. Secondary outcomes include smoking behavior at weeks 4, 52, and 104 as well as mortality and health care utilization outcomes. Investigators, outcome assessors, and data analysts will be blinded to group allocation until after primary analyses are completed. It is hypothesized that the QCI group will have higher a abstinence rate, improved health outcomes, and decreased healthcare utilization. DISCUSSION There are few examples of hospital EDs in Canada that systematically initiate tobacco cessation interventions for patients who smoke. Given the high smoking prevalence among ED patients and the relation of tobacco smoking to the majority of ambulatory care sensitive conditions, EDs are a missed opportunity in the initiation of tobacco treatment interventions. We have designed and will test an evidence-based tobacco treatment intervention that is simple and highly scalable. TRIAL REGISTRATION ClinicalTrials.gov NCT04163081 . Registered on November 14, 2019.
Collapse
Affiliation(s)
- Kerri A. Mullen
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7 Canada
| | - Aditi Garg
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7 Canada
| | - Frederick Gagnon
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7 Canada
| | - George Wells
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7 Canada
- Faculty of Medicine, University of Ottawa, 75 Laurier Ave. E, Ottawa, Ontario K1N 6N5 Canada
| | - Atul Kapur
- Faculty of Medicine, University of Ottawa, 75 Laurier Ave. E, Ottawa, Ontario K1N 6N5 Canada
- Ottawa Hospital Research Institute (OHRI), 501 Smyth Box 511, Ottawa, Ontario K1H 8L6 Canada
| | - Steven Hawken
- Ottawa Hospital Research Institute (OHRI), 501 Smyth Box 511, Ottawa, Ontario K1H 8L6 Canada
- Institute for Clinical Evaluative Sciences (ICES), Ottawa, Canada
| | - Andrew L. Pipe
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7 Canada
- Faculty of Medicine, University of Ottawa, 75 Laurier Ave. E, Ottawa, Ontario K1N 6N5 Canada
| | - Kathryn Walker
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7 Canada
| | - Venkatesh Thiruganasambandamoorthy
- Faculty of Medicine, University of Ottawa, 75 Laurier Ave. E, Ottawa, Ontario K1N 6N5 Canada
- Ottawa Hospital Research Institute (OHRI), 501 Smyth Box 511, Ottawa, Ontario K1H 8L6 Canada
| | - Marta Klepaczek
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7 Canada
| | - Robert D. Reid
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7 Canada
- Faculty of Medicine, University of Ottawa, 75 Laurier Ave. E, Ottawa, Ontario K1N 6N5 Canada
| |
Collapse
|
20
|
Bradley T, Hansen V, Wye P, Campbell E, Bartlem K, Reid K, Bowman J. Telephone-delivered health behaviour change support for people with a mental health condition: the coaches' perspective. BMC Health Serv Res 2021; 21:1130. [PMID: 34670561 PMCID: PMC8529807 DOI: 10.1186/s12913-021-07126-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/27/2021] [Indexed: 11/10/2022] Open
Abstract
Background People with a mental health condition experience a greater prevalence of chronic disease and reduced life expectancy compared to the general population. Modifiable health risk behaviours, such as physical inactivity and poor nutrition are major contributing factors. Population-level health coaching delivering behavioural change support via telephone for healthy eating, physical activity, and weight management is an opportunity utilised by this group to support improvement in healthy lifestyle behaviours. Health coaches offer a valuable perspective into the provision of services to this high-risk group. This study aims to qualitatively explore coaches’ experiences in providing support to these participants, consider factors which may contribute to engagement and outcomes; and potentially inform future service improvement. Method A qualitative study design was employed involving semi-structured telephone interviews with six coaches employed in a telephone-based behaviour change support service in New South Wales, Australia, between April and July 2019. Interview data was analysed using an inductive thematic analysis. Results Coaches believed that the service was of benefit to people with a mental health condition, however making changes to health risk behaviours was potentially more difficult for this group of service users. Coaches indicated that in supporting this group there was a greater focus on building confidence and readiness to change. They noted that improvement in mental health as a result of physical health changes was an additional ‘measure of success’ of particular relevance. Coaches expressed a desire to receive more mental health training to better deliver coaching to participants with a mental health condition. Program variables such as limited call length were posed as possible barriers to care. Conclusion Further training and additional support for coaches, in additon to considering variations to aspects of service delivery may assist in improving engagement and outcomes for participants with mental health conditions. Examining mental health consumers’ experiences when engaging with telephone coaching services would be an important area to address in further research.
Collapse
Affiliation(s)
- Tegan Bradley
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW, 2305, Australia.
| | - Vibeke Hansen
- Southern Cross University, Hogbin Dr, Coffs Harbour, NSW, 2450, Australia
| | - Paula Wye
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Elizabeth Campbell
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia
| | - Kate Bartlem
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW, 2305, Australia
| | - Kate Reid
- NSW Office of Preventive Health, Liverpool Hospital, Don Everett Building, Locked Bag 7103, Liverpool, NSW, BC1871, Australia
| | - Jenny Bowman
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW, 2305, Australia
| |
Collapse
|
21
|
Greenberg JA, Zwiep TM, Sadek J, Malcolm JC, Mullen KA, McIsaac DI, Musselman RP, Moloo H. Clinical practice guideline: evidence, recommendations and algorithm for the preoperative optimization of anemia, hyperglycemia and smoking. Can J Surg 2021; 64:E491-E509. [PMID: 34598927 PMCID: PMC8526150 DOI: 10.1503/cjs.011519] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2020] [Indexed: 12/13/2022] Open
Abstract
Preoperative optimization has not been explored comprehensively in the surgical literature, as this responsibility has often been divided among surgery, anesthesia and medicine. We developed an evidence-based clinical practice guideline to summarize existing evidence and present diagnostic and treatment algorithms for use by surgeons caring for patients scheduled to undergo major elective surgery. We focus on 3 common comorbid conditions seen across surgical specialties - anemia, hyperglycemia and smoking - as these conditions increase complication rates in patients undergoing major surgery and can be optimized successfully as soon as 6-8 weeks before surgery. With the ability to address these conditions earlier in the patient journey, surgeons can positively affect patient outcomes. The aim of this guideline is to bring optimization in the preoperative period under the existing umbrella of evidence-based surgical care.
Collapse
Affiliation(s)
- Joshua A Greenberg
- From the Department of Surgery, The Ottawa Hospital, Ottawa, Ont. (Greenberg, Zwiep, Sadek, Musselman, Moloo); the Department of Medicine, The Ottawa Hospital, Ottawa, Ont. (Saidenberg, Malcolm); the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Saidenberg, McIsaac, Moloo); the University of Ottawa Heart Institute, Ottawa, Ont. (Mullen); and the Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ont. (McIsaac)
| | - Terry M Zwiep
- From the Department of Surgery, The Ottawa Hospital, Ottawa, Ont. (Greenberg, Zwiep, Sadek, Musselman, Moloo); the Department of Medicine, The Ottawa Hospital, Ottawa, Ont. (Saidenberg, Malcolm); the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Saidenberg, McIsaac, Moloo); the University of Ottawa Heart Institute, Ottawa, Ont. (Mullen); and the Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ont. (McIsaac)
| | - Joseph Sadek
- From the Department of Surgery, The Ottawa Hospital, Ottawa, Ont. (Greenberg, Zwiep, Sadek, Musselman, Moloo); the Department of Medicine, The Ottawa Hospital, Ottawa, Ont. (Saidenberg, Malcolm); the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Saidenberg, McIsaac, Moloo); the University of Ottawa Heart Institute, Ottawa, Ont. (Mullen); and the Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ont. (McIsaac)
| | - Janine C Malcolm
- From the Department of Surgery, The Ottawa Hospital, Ottawa, Ont. (Greenberg, Zwiep, Sadek, Musselman, Moloo); the Department of Medicine, The Ottawa Hospital, Ottawa, Ont. (Saidenberg, Malcolm); the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Saidenberg, McIsaac, Moloo); the University of Ottawa Heart Institute, Ottawa, Ont. (Mullen); and the Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ont. (McIsaac)
| | - Kerri A Mullen
- From the Department of Surgery, The Ottawa Hospital, Ottawa, Ont. (Greenberg, Zwiep, Sadek, Musselman, Moloo); the Department of Medicine, The Ottawa Hospital, Ottawa, Ont. (Saidenberg, Malcolm); the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Saidenberg, McIsaac, Moloo); the University of Ottawa Heart Institute, Ottawa, Ont. (Mullen); and the Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ont. (McIsaac)
| | - Daniel I McIsaac
- From the Department of Surgery, The Ottawa Hospital, Ottawa, Ont. (Greenberg, Zwiep, Sadek, Musselman, Moloo); the Department of Medicine, The Ottawa Hospital, Ottawa, Ont. (Saidenberg, Malcolm); the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Saidenberg, McIsaac, Moloo); the University of Ottawa Heart Institute, Ottawa, Ont. (Mullen); and the Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ont. (McIsaac)
| | - Reilly P Musselman
- From the Department of Surgery, The Ottawa Hospital, Ottawa, Ont. (Greenberg, Zwiep, Sadek, Musselman, Moloo); the Department of Medicine, The Ottawa Hospital, Ottawa, Ont. (Saidenberg, Malcolm); the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Saidenberg, McIsaac, Moloo); the University of Ottawa Heart Institute, Ottawa, Ont. (Mullen); and the Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ont. (McIsaac)
| | - Husein Moloo
- From the Department of Surgery, The Ottawa Hospital, Ottawa, Ont. (Greenberg, Zwiep, Sadek, Musselman, Moloo); the Department of Medicine, The Ottawa Hospital, Ottawa, Ont. (Saidenberg, Malcolm); the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Saidenberg, McIsaac, Moloo); the University of Ottawa Heart Institute, Ottawa, Ont. (Mullen); and the Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ont. (McIsaac)
| |
Collapse
|
22
|
Vickerman KA, Carpenter KM, Miles LN, Hsu JM, Watt KA, Brandon TH, Hart JT, Javitz HS, Wagener TL. Treatment development, implementation, and participant baseline characteristics: A randomized pilot study of a tailored quitline intervention for individuals who smoke and vape. Contemp Clin Trials Commun 2021; 24:100845. [PMID: 34568637 PMCID: PMC8449159 DOI: 10.1016/j.conctc.2021.100845] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/23/2021] [Accepted: 09/06/2021] [Indexed: 01/08/2023] Open
Abstract
Background Approximately 57,000 dual users of cigarettes and e-cigarettes call state tobacco quitlines in the U.S. each year. Methods This paper describes a behavioral intervention for dual users of cigarettes and e-cigarettes designed to increase cigarette abstinence. It also presents baseline data from a randomized pilot comparing the Enhanced E-cigarette Coaching (EEC) intervention with quitline treatment as usual (TAU). Oklahoma Tobacco Helpline callers were recruited at registration and randomized to EEC (n = 46) or TAU (n = 50). Treatment included 5 coaching calls and free nicotine replacement therapy (NRT). EEC treatment included enhanced e-cigarette assessment, education, a shared decision-making quit plan development approach, and tailored behavioral support. Results Participants averaged 40.6 years of age and 19.2 cigarettes per day; 85% smoked daily, 48% vaped daily, and 53% reported medium to high e-cigarette dependence. Most reported using e-cigarettes to quit (43%) or to cut down (26%) on smoking. Most had previously tried to quit smoking (91%) and had tried FDA-approved cessation medications (79%). Beliefs about vaping, NRT, and smoking included misinformation. After discussing the relative risks of NRT, vaping, and smoking, most EEC participants (89%) selected a quit plan that incorporated both NRT and vaping. Conclusions At baseline, most participants reported a history of failed quit attempts with NRT and were vaping to quit or cut down on smoking, but they may need more support to completely quit smoking. If the EEC improves smoking outcomes, it would provide needed guidance on behavioral support best practices for individuals who vape and want to quit smoking.
Collapse
Affiliation(s)
| | | | - Lyndsay N Miles
- Optum Health, 11000 Optum Circle; Eden Prairie, MN, 55344, USA
| | - Johnathan M Hsu
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, USA
| | - Karen A Watt
- Optum Health, 11000 Optum Circle; Eden Prairie, MN, 55344, USA
| | - Thomas H Brandon
- H Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612-9497, USA
| | - Jonathan T Hart
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, USA
| | - Harold S Javitz
- SRI International, 333 Ravenswood Avenue, Menlo Park, CA, 94025, USA
| | - Theodore L Wagener
- University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, USA
| |
Collapse
|
23
|
Barriers and Facilitators to the Uptake of Online and Telephone Services Targeting Health Risk Behaviours among Vocational Education Students: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179336. [PMID: 34501922 PMCID: PMC8430979 DOI: 10.3390/ijerph18179336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 11/25/2022]
Abstract
Uptake of online and telephone services targeting health behaviours is low among vocational education students and barriers and facilitators are unknown. This study aimed to explore barriers and facilitators to uptake of online and telephone services for smoking, nutrition, alcohol, and physical activity (SNAP) risk behaviours via semi-structured individual telephone interviews with fifteen vocational education students. Two authors independently completed thematic analysis, classified themes according to the COM-B (Capability, Opportunity, Motivation, Behaviour) framework, and discussed disagreements until consensus was reached. Facilitators to uptake of online (e.g., desire to learn something new, cost-free, accessible) and telephone services (e.g., prefer to talk to provider, complements online support) primarily related to capability and opportunity. For telephone services, difficulty understanding accent/language was a capability-related barrier. Opportunity-related barriers for online and telephone services were preference for face-to-face interaction and lack of time, while preference for apps/online programs was a barrier for telephone services. For online and telephone services, not wanting to change SNAP behaviours was a motivation-related barrier and being able to change SNAP risk behaviours themselves was a motivation-related barrier for online services. Barriers and facilitators to online and telephone services are relevant for designing interventions vocational education students are more likely to use.
Collapse
|
24
|
AlMulla A, Kouyoumjian SP. Telephone counseling and quitline service: An opportunity for tobacco use cessation during the COVID-19 pandemic. Qatar Med J 2021; 2021:25. [PMID: 34405091 PMCID: PMC8353532 DOI: 10.5339/qmj.2021.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/18/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- Ahmad AlMulla
- , Tobacco Control Center, WHO Collaborative Center, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
- Hamad Medical Corporation
| | - Silva P Kouyoumjian
- , Tobacco Control Center, WHO Collaborative Center, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
- Hamad Medical Corporation
| |
Collapse
|
25
|
Piñeiro B, Vidrine DJ, Wetter DW, Hoover DS, Frank-Pearce SG, Nguyen N, Zbikowski SM, Vidrine JI. Implementation of Ask-Advise-Connect in a safety net healthcare system: quitline treatment engagement and smoking cessation outcomes. Transl Behav Med 2021; 10:163-167. [PMID: 30476236 PMCID: PMC7295694 DOI: 10.1093/tbm/iby108] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Ask-Advise-Connect (AAC) was designed to link smokers in primary care settings with evidence-based tobacco treatment delivered via state quitlines. AAC involves training medical staff to Ask about smoking status, Advise smokers to quit, and offer to immediately Connect smokers with quitlines through an automated link within the electronic health record. We evaluated the efficacy of AAC in facilitating treatment engagement and smoking abstinence in a 34 month implementation trial conducted in a large, safety-net health care system. AAC was implemented from April 2013 through February 2016 in 13 community clinics that provided care to low-income, predominantly racial/ethnic minority smokers. Licensed vocational nurses were trained to implement AAC as part of standard care. Outcomes included (a) treatment engagement (i.e., proportion of identified smokers that enrolled in treatment) and (b) self-reported and biochemically confirmed abstinence at 6 months. Smoking status was recorded for 218,915 unique patients, and 40,888 reported current smoking. The proportion of all identified smokers who enrolled in treatment was 11.8%. Self-reported abstinence at 6 months was 16.6%, and biochemically confirmed abstinence was 4.5%. AAC was successfully implemented as part of standard care. Treatment engagement was high compared with rates of engagement for more traditional referral-based approaches reported in the literature. Although self-reported abstinence was in line with other quitline-delivered treatment studies, biochemically confirmed abstinence, which is not routinely captured in quitline studies, was dramatically lower. This discrepancy challenges the adequacy of self-report for large, population-based studies. A more detailed and comprehensive investigation is warranted.
Collapse
Affiliation(s)
- Bárbara Piñeiro
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Damon J Vidrine
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - David W Wetter
- Huntsman Cancer Institute and the Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Diana S Hoover
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Summer G Frank-Pearce
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Nga Nguyen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jennifer I Vidrine
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| |
Collapse
|
26
|
Stich C, Lasnier B, Lo E. Improving smoking cessation support for Quebec's smokers: an evaluation of Quebec's telephone quitline. Health Promot Chronic Dis Prev Can 2021; 41:222-229. [PMID: 34427420 PMCID: PMC8428720 DOI: 10.24095/hpcdp.41.7/8.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Quitlines are an important and widespread intervention that support smokers in their efforts to quit smoking and engage them into treatment services. Quebec's quitline, called "la ligne J'ARRÊTE", has been in operation since 2002. The objectives of this study were to evaluate treatment reach, provide a description of caller characteristics and to provide results on cessation outcome measures for Quebec's smoking cessation quitline. METHODS We collected data at intake, assessing new caller volume, caller characteristics and treatment reach. We used a one-group quasi-experimental design to assess 30-day and six-month quit rates, at six-month follow-up. Intake data were collected for 1292 new quitline callers, 18 years of age and older, over a one-year period. RESULTS Results indicated that the service reached 9 in 10 000 Quebec smokers. With respect to the total population of smokers in Quebec, the quitline reached proportionately higher numbers of smokers who were women, were 55 years of age and older and had a high school diploma or less. At follow-up, the 30-day point prevalence abstinence rate was 26.7%, while the six-month prolonged abstinence rate was 18.8%. CONCLUSION These results indicate that the quitline contributed to helping callers quit smoking. They are in line with findings for other quitlines in Canada and the United States. However, quitline reach is comparatively limited, suggesting that additional investment in promotional efforts and research into ways of recruiting underserved populations into the service would increase public health impact.
Collapse
Affiliation(s)
| | - Benoit Lasnier
- Institut national de santé publique du Québec, Montréal, Quebec, Canada
| | - Ernest Lo
- McGill University, Montréal, Quebec, Canada
- Institut national de santé publique du Québec, Montréal, Quebec, Canada
| |
Collapse
|
27
|
Luo T, Li M, Williams D, Fritz J, Phillippi S, Yu Q, Kantrow S, Chen L, Chen Y, Beiter K, Tseng TS. Urban and Rural Disparities in a WeChat-Based Smoking Cessation Intervention among Chinese Smokers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136731. [PMID: 34201450 PMCID: PMC8268404 DOI: 10.3390/ijerph18136731] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Tobacco use, which is directly responsible for 10% of total deaths per year globally, remains consistently high, with approximately 20% of the population reporting regular consumption globally. Moreover, health disparities regarding tobacco consumption and smoking cessation are growing between rural and urban populations worldwide. Social media interventions for tobacco cessation may effectively reach both groups. The objective of this study was to evaluate the efficacy of a WeChat-delivered smoking cessation intervention among rural and urban Chinese smokers, and to assess moderating variables that may contribute to differential intervention efficacy. METHODS WeChat was used to recruit smokers into this intervention study between 1 July and 5 August 2019. Participants were randomized to one of three intervention schedules: participants in the Standard Group and the Enhanced Group received 20 smoking-related messages over 2 weeks, whereas participants in the Enhanced Group received an extra 6 oral health-related messages for one week. Participants in the control group received 20 smoking-related messages after the post-intervention assessment. Participants completed questionnaires at baseline and at 4 weeks follow-up. Our primary outcome was smoking cessation stage of change and secondary outcome was 24-h point prevalence abstinence (PPA). Urban and rural areas were based on self-reported living areas. Chi-squared test, Fisher's exact test, ANOVA test, linear regression, and logistic regression were used for analysis. RESULTS Overall, 403 participants completed the intervention (233 rural, 107 suburban, 63 urban). Compared to urban participants, rural participants were more likely to have progressed to a later stage of change (β = 0.40, 95% CI: 0.13, 0.67) and to report higher 24-h PPA rates at follow-up (aOR = 3.23, 95% CI: 1.36, 7.68). After stratification by living area, the intervention effects in stage of change and 24-h PPA rate at follow-up were only found in the urban subgroup. DISCUSSION Smokers who lived in rural areas reported better smoking cessation outcomes compared with urban smokers; however, the efficacy of a WeChat-based smoking cessation intervention was only found for participants living in an urban area. WeChat based smoking cessation interventions should be used to promote smoking cessation in urban, suburban, and rural areas.
Collapse
Affiliation(s)
- Ting Luo
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, CA 92122, USA; (M.L.); (K.B.)
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA 70122, USA; (D.W.); (S.P.); (T.-S.T.)
- Correspondence:
| | - Mirandy Li
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, CA 92122, USA; (M.L.); (K.B.)
- School of Medicine, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA 70122, USA; (J.F.); (S.K.)
| | - Donna Williams
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA 70122, USA; (D.W.); (S.P.); (T.-S.T.)
| | - Jackson Fritz
- School of Medicine, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA 70122, USA; (J.F.); (S.K.)
| | - Stephen Phillippi
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA 70122, USA; (D.W.); (S.P.); (T.-S.T.)
| | - Qingzhao Yu
- Biostatistics, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA 70122, USA;
| | - Stephen Kantrow
- School of Medicine, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA 70122, USA; (J.F.); (S.K.)
| | - Liwei Chen
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA 90095, USA;
| | - Yongchun Chen
- Department of Clinical Nutrition, Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, Zhengzhou 450003, China;
| | - Kaylin Beiter
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, CA 92122, USA; (M.L.); (K.B.)
- School of Medicine, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA 70122, USA; (J.F.); (S.K.)
| | - Tung-Sung Tseng
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA 70122, USA; (D.W.); (S.P.); (T.-S.T.)
| |
Collapse
|
28
|
Khodadadi AB, Carroll W, Lee EL, Hansen B, Scarinci IC. It Takes Two to Tango: Patients' and Providers' Perspectives in Tobacco Cessation and Head/Neck Cancer. Oncologist 2021; 26:761-770. [PMID: 34105215 DOI: 10.1002/onco.13856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 05/26/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Tobacco cessation among patients with head/neck cancer continues to be challenging despite evidence that cessation improves treatment outcomes. The purpose of this study was to understand barriers/facilitators to tobacco cessation among patients with head/neck cancer and health care providers and to obtain perspectives toward the development of a patient-centered tobacco cessation intervention. MATERIALS AND METHODS In-depth qualitative interviews with 10 health care providers and 21 patients with head/neck cancer (12 inpatients and 9 outpatients) who were current or former smokers. RESULTS Health was a common motivator to quit among patients. Although most patients indicated that their health care provider asked and advised them to quit, they were unaware of cessation resources. Suggestions for a tobacco cessation program included involvement of former smokers, health care provider involvement/counseling, supporting written materials, and incorporating follow-up and family support. Health care providers identified patients' anger/frustration associated with the disease, social/demographic issues, and poor quality of life as the three most frequent challenges in treating patients. Although all providers reported asking about tobacco use, 70% emphasized a lack of formal training in tobacco cessation and lack of time. Their suggestions for a cessation program included having a "quarterback" responsible for this component with support from the entire health care team and continuity between outpatient and inpatient services to promote cessation, prevent relapse, and highlight the importance of follow-up and social support. CONCLUSION There is great interest and need, both from patients and providers, for tobacco cessation services in the oncology setting tailored for patients with head/neck cancer in the context of cancer care. IMPLICATIONS FOR PRACTICE Although the combination of pharmacotherapy and cognitive-behavioral intervention is the standard evidence-based treatment for tobacco dependence, it must be adapted to meet the needs and wants of patients and providers to be effective. This study provides an in-depth examination of such needs among patients with head and neck cancer and providers in the context of cancer care. Providers and patients emphasized the need of having a trained health care provider dedicated to providing tobacco cessation through seamless integration between outpatient and inpatient services as well as follow-up with an emphasis on family involvement throughout the process.
Collapse
Affiliation(s)
| | - William Carroll
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Erica L Lee
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Barbara Hansen
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Isabel C Scarinci
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| |
Collapse
|
29
|
Matthay EC, Hagan E, Gottlieb LM, Tan ML, Vlahov D, Adler N, Glymour MM. Powering population health research: Considerations for plausible and actionable effect sizes. SSM Popul Health 2021; 14:100789. [PMID: 33898730 PMCID: PMC8059081 DOI: 10.1016/j.ssmph.2021.100789] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/25/2021] [Accepted: 03/30/2021] [Indexed: 11/23/2022] Open
Abstract
Evidence for Action (E4A), a signature program of the Robert Wood Johnson Foundation, funds investigator-initiated research on the impacts of social programs and policies on population health and health inequities. Across thousands of letters of intent and full proposals E4A has received since 2015, one of the most common methodological challenges faced by applicants is selecting realistic effect sizes to inform calculations of power, sample size, and minimum detectable effect (MDE). E4A prioritizes health studies that are both (1) adequately powered to detect effect sizes that may reasonably be expected for the given intervention and (2) likely to achieve intervention effects sizes that, if demonstrated, correspond to actionable evidence for population health stakeholders. However, little guidance exists to inform the selection of effect sizes for population health research proposals. We draw on examples of five rigorously evaluated population health interventions. These examples illustrate considerations for selecting realistic and actionable effect sizes as inputs to calculations of power, sample size and MDE for research proposals to study population health interventions. We show that plausible effects sizes for population health interventions may be smaller than commonly cited guidelines suggest. Effect sizes achieved with population health interventions depend on the characteristics of the intervention, the target population, and the outcomes studied. Population health impact depends on the proportion of the population receiving the intervention. When adequately powered, even studies of interventions with small effect sizes can offer valuable evidence to inform population health if such interventions can be implemented broadly. Demonstrating the effectiveness of such interventions, however, requires large sample sizes.
Collapse
Affiliation(s)
- Ellicott C. Matthay
- Center for Health and Community, University of California, San Francisco, 3333 California St., Suite 465, Campus Box 0844, San Francisco, CA, 94143-0844, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, 2nd Floor, Campus Box 0560, San Francisco, CA, 94143, USA
| | - Erin Hagan
- Center for Health and Community, University of California, San Francisco, 3333 California St., Suite 465, Campus Box 0844, San Francisco, CA, 94143-0844, USA
| | - Laura M. Gottlieb
- Center for Health and Community, University of California, San Francisco, 3333 California St., Suite 465, Campus Box 0844, San Francisco, CA, 94143-0844, USA
| | - May Lynn Tan
- Center for Health and Community, University of California, San Francisco, 3333 California St., Suite 465, Campus Box 0844, San Francisco, CA, 94143-0844, USA
| | - David Vlahov
- Yale School of Nursing at Yale University, 400 West Campus Drive, Room 32306, Orange, CT, 06477, USA
| | - Nancy Adler
- Center for Health and Community, University of California, San Francisco, 3333 California St., Suite 465, Campus Box 0844, San Francisco, CA, 94143-0844, USA
| | - M. Maria Glymour
- Center for Health and Community, University of California, San Francisco, 3333 California St., Suite 465, Campus Box 0844, San Francisco, CA, 94143-0844, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, 2nd Floor, Campus Box 0560, San Francisco, CA, 94143, USA
| |
Collapse
|
30
|
Brady BR, O'Connor PA, Martz MP, Grogg T, Nair US. Medicaid-Insured Client Characteristics and Quit Outcomes at the Arizona Smokers' Helpline. J Behav Health Serv Res 2021; 49:61-75. [PMID: 33948874 DOI: 10.1007/s11414-021-09756-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 11/29/2022]
Abstract
Medicaid-insured individuals who smoke experience disparities in quitting and are a priority population for assistance. This retrospective cohort study of Arizona Smokers' Helpline clients (Jan 2014-Mar 2019) examined the association between insurance status, treatment, and smoking cessation. When compared to clients with non-Medicaid insurance or no insurance, clients with Medicaid (26%) were more likely to be female, referred directly to the ASHLine by a healthcare or community partner, smoke in the home, and report having a mental health condition. They also were less likely to utilize cessation medication and reported receiving less social support to quit. Controlling for these and other theoretically relevant variables, insurance status was stratified (Medicaid, non-Medicaid, and uninsured), and quit outcomes were compared by level of treatment (4 treatment groups: more and less than 3 coaching sessions and cessation medication use yes/no). Compared to clients who received 3+ coaching sessions, those who had less than 3 coaching sessions had significantly lower adjusted odds of quitting. Results were similar regardless of cessation medication use or insurance status. There is no indication that treatment effects differ by insurance status. While insurance status appears to proxy for other important factors like low social and economic status and higher comorbidity prevalence, in a quitline setting, quitting is associated with additional, high-quality coaching. Where coaching sessions may offset social and economic barriers to quitting, quitlines may consider focusing on assisting Medicaid-insured clients to connect and engage with treatment.
Collapse
Affiliation(s)
- Benjamin R Brady
- Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., P.O. Box 245210, Tucson, AZ, 85724, USA.
| | - Patrick A O'Connor
- Arizona Center for Tobacco Cessation in the Department of Health Promotion Science, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Mark P Martz
- Arizona Center for Tobacco Cessation in the Department of Health Promotion Science, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Taylor Grogg
- Arizona Center for Tobacco Cessation in the Department of Health Promotion Science, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Uma S Nair
- Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA
| |
Collapse
|
31
|
Colston DC, Simard BJ, Xie Y, McLeod MC, Elliott MR, Thrasher JF, Fleischer NL. The Association between Quitline Characteristics and Smoking Cessation by Educational Attainment, Income, Race/Ethnicity, and Sex. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3297. [PMID: 33806747 PMCID: PMC8005103 DOI: 10.3390/ijerph18063297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/12/2021] [Accepted: 03/18/2021] [Indexed: 11/22/2022]
Abstract
Little research examines how tobacco quitlines affect disparities in smoking cessation in the United States. Our study utilized data from the Tobacco Use Supplement to the Current Population Survey (2010, 2011, 2012, 2015, 2018) (TUS-CPS) and state-level quitline data from the North American Quitline Consortium and National Quitline Data Warehouse. We ran multilevel logistic regression models assessing a state-run quitline's budget, reach, number of counseling sessions offered per caller, and hours of operation on 90-day smoking cessation. Multiplicative interactions between all exposures and sex, race/ethnicity, income, and education were tested to understand potential effect modification. We found no evidence that budget, reach, number of counseling sessions, or hours available for counseling were associated with cessation in the main effects analyses. However, when looking at effect modification by sex, we found that higher budgets were associated with greater cessation in males relative to females. Further, higher budgets and offering more sessions had a stronger association with cessation among individuals with lower education, while available counseling hours were more strongly associated with cessation among those with higher education. No quitline characteristics examined were associated with smoking cessation. We found evidence for effect modification by sex and education. Despite proven efficacy at the individual-level, current resource allocation to quitlines may not be sufficient to improve rates of cessation.
Collapse
Affiliation(s)
- David C. Colston
- Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; (B.J.S.); (N.L.F.)
| | - Bethany J. Simard
- Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; (B.J.S.); (N.L.F.)
| | - Yanmei Xie
- Biostatistics Core, Rogel Cancer Center, University of Michigan, Ann Arbor, MI 48109, USA; (Y.X.); (M.C.M.)
| | - Marshall Chandler McLeod
- Biostatistics Core, Rogel Cancer Center, University of Michigan, Ann Arbor, MI 48109, USA; (Y.X.); (M.C.M.)
| | - Michael R. Elliott
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA;
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI 48104, USA
| | - James F. Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA;
- Center for Population Health Research, Department of Tobacco Research, National Institute of Public Health, Cuernavaca 62100, Mexico
| | - Nancy L. Fleischer
- Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; (B.J.S.); (N.L.F.)
| |
Collapse
|
32
|
Gordon JS, Bell ML, Armin JS, Giacobbi PR, Nair US. A telephone-based guided imagery tobacco cessation intervention: results of a randomized feasibility trial. Transl Behav Med 2021; 11:516-529. [PMID: 32542352 PMCID: PMC7963280 DOI: 10.1093/tbm/ibaa052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Evidence supports the use of guided imagery for smoking cessation; however, scalable delivery methods are needed to make it a viable approach. Telephone-based tobacco quitlines are a standard of care, but reach is limited. Adding guided imagery to quitline services might increase reach by offering an alternative approach. PURPOSE To develop and test the feasibility and potential impact of a guided imagery-based tobacco cessation intervention delivered using a quitline model. METHODS Participants for this randomized feasibility trial were recruited statewide through a quitline or community-based methods. Participants were randomized to guided imagery Intervention Condition (IC) or active behavioral Control Condition (CC). After withdrawals, there were 105 participants (IC = 56; CC = 49). The IC consisted of six sessions in which participants created guided imagery audio files. The CC used a standard six-session behavioral protocol. Feasibility measures included recruitment rate, retention, and adherence to treatment. We also assessed 6-month quit rates and consumer satisfaction. RESULTS Both the IC and CC protocols were feasible to deliver. We finalized protocols and materials for participants, coaches and study staff, and delivered the protocols with fidelity. We developed successful recruitment methods, and experienced high retention (6 months = 81.9%) and adherence (all sessions = 66.7%). Long-term quit rates (IC = 27.9%; CC = 38.1%) compared favorably to those of quitlines, and program satisfaction was high, suggesting that the protocols are acceptable to smokers and may contribute to smoking abstinence. CONCLUSIONS The guided imagery intervention is feasible and promising, suggesting that a fully powered RCT to test the efficacy of the intervention is warranted. TRIAL REGISTRATION NUMBER NCT02968381.
Collapse
Affiliation(s)
| | - Melanie L Bell
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Julie S Armin
- Department of Family and Community Medicine, University of Arizona, Tucson, AZ, USA
| | - Peter R Giacobbi
- College of Physical Activity and Sport Sciences and School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Uma S Nair
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| |
Collapse
|
33
|
Bayoumy AB, Veugen CCAFM, van der Veen EL, Bok JWM, de Ru JA, Thomeer HGXM. Management of tympanic membrane retractions: a systematic review. Eur Arch Otorhinolaryngol 2021; 279:723-737. [PMID: 33689022 PMCID: PMC8794915 DOI: 10.1007/s00405-021-06719-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 02/23/2021] [Indexed: 12/14/2022]
Abstract
Importance Tympanic membrane retraction (TMR) is a relatively common otological finding. However, no consensus on its management exists. We are looking especially for a treatment strategy in the military population who are unable to attend frequent follow-up visits, and who experience relatively more barotrauma at great heights and depths and easily suffer from otitis externa from less hygienic circumstances. Objective To assess and summarize the available evidence for the effectiveness of surgical interventions and watchful waiting policy in patients with a tympanic membrane retraction. Evidence review The protocol for this systematic review was published at Prospero (207859). PubMed, Embase, and the Cochrane Database of Systematic Reviews were systematically searched from inception up to September 2020 for published and unpublished studies. We included randomized trials and observational studies that investigated surgical interventions (tympanoplasty, ventilation tube insertion) and wait-and-see policy. The primary outcomes of this study were clinical remission of the tympanic membrane retraction, tympanic membrane perforations and cholesteatoma development. Findings In total, 27 studies were included, consisting of 1566 patients with TMRs. We included data from 2 randomized controlled trials (76 patients) and 25 observational studies (1490 patients). Seven studies (329 patients) investigated excision of the TMR with and without ventilation tube placement, 3 studies (207 patients) investigated the wait-and-see policy and 17 studies (1030 patients) investigated tympanoplasty for the treatment of TMRs. Conclusions and relevance This study provides all the studies that have been published on the surgical management and wait-and-policy for tympanic membrane retractions. No high level of evidence comparative studies has been performed. The evidence for the management of tympanic membrane retractions is heterogenous and depends on many factors such as the patient population, location and severity of the TMR and presence of other ear pathologies (e.g., perforation, risk of cholesteatoma and serous otitis media). Supplementary Information The online version contains supplementary material available at 10.1007/s00405-021-06719-3.
Collapse
Affiliation(s)
- Ahmed B Bayoumy
- Department of Otolaryngology, Ministry of Defense, Central Military Hospital, Utrecht, The Netherlands.
| | - Christianne C A F M Veugen
- Department of Otolaryngology-Head and Neck Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Erwin L van der Veen
- Department of Otolaryngology, Ministry of Defense, Central Military Hospital, Utrecht, The Netherlands
| | - Jan-Willem M Bok
- Department of Otolaryngology, Flevoziekenhuis, Almere, The Netherlands
| | - Jacob A de Ru
- Department of Otolaryngology, Ministry of Defense, Central Military Hospital, Utrecht, The Netherlands.,Department of Otolaryngology-Head and Neck Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Hans G X M Thomeer
- Department of Otolaryngology-Head and Neck Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.,UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
34
|
Kazan AS, Perry LM, Atiya WF, Voss HM, Kim S, Easwar S, Mercorella HN, Lewson A, Rogers JL, Arnold D, Raines AM, Brown L, Moore T, Hoerger M. Development and acceptability of an educational video about a smoking cessation quitline for use in adult outpatient mental healthcare. Transl Behav Med 2021; 11:1579-1584. [PMID: 33647990 DOI: 10.1093/tbm/ibaa145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Tobacco use is a leading preventable cause of early mortality and is prevalent among adults with mental health diagnoses, especially in the southern USA. Increasing cessation resources in outpatient mental health care and targeting individuals most receptive to changing their behavior may improve cessation. Drawing on the transtheoretical model, our goals were to develop an educational video about the Louisiana Tobacco Quitline and evaluate its acceptability. We designed the video with knowledge derived from Louisiana-specific data (2016 Louisiana Adult Tobacco Survey, N = 6,469) and stakeholder feedback. Bivariate associations between demographic/tobacco-use characteristics and participants' stage of quitting (preparation phase vs. nonpreparation phase) were conducted, which informed design elements of the video. Four stakeholder advisory board meetings involving current smokers, mental health clinicians, and public health advocates convened to provide iterative feedback on the intervention. Our stakeholder advisory board (n = 10) and external stakeholders (n = 20) evaluated intervention acceptability. We found that 17.9% of Louisiana adults were current smokers, with 46.9% of them in the preparation phase of quitting. Using insights from data and stakeholders, we succeeded in producing a 2-min video about the Louisiana Tobacco Quitline which incorporated three themes identified as important by stakeholders: positivity, relatability, and approachability. Supporting acceptability, 96.7% of stakeholders rated the video as helpful and engaging. This study demonstrates the acceptability of combining theory, existing data, and iterative stakeholder feedback to develop a quitline educational video. Future research should examine whether the video can be used to reduce tobacco use.
Collapse
Affiliation(s)
- Adina S Kazan
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Laura M Perry
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Wasef F Atiya
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Hallie M Voss
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Seowoo Kim
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Sanjana Easwar
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Hannah N Mercorella
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Ashley Lewson
- Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - James L Rogers
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Dodie Arnold
- Louisiana Public Health Institute, New Orleans, LA, USA
| | - Amanda M Raines
- Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA.,School of Medicine, Louisiana State University, New Orleans, LA, USA
| | - Lisanne Brown
- Louisiana Public Health Institute, New Orleans, LA, USA
| | - Tonia Moore
- Louisiana Public Health Institute, New Orleans, LA, USA
| | - Michael Hoerger
- Department of Psychology, Tulane University, New Orleans, LA, USA.,Tulane Cancer Center, Tulane University, New Orleans, LA, USA
| |
Collapse
|
35
|
Cobos-Campos R, Mar J, Apiñaniz A, de Lafuente AS, Parraza N, Aizpuru F, Orive G. Cost-effectiveness analysis of text messaging to support health advice for smoking cessation. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:9. [PMID: 33588885 PMCID: PMC7885425 DOI: 10.1186/s12962-021-00262-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 02/01/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Smoking in one of the most serious public health problems. It is well known that it constitutes a major risk factor for chronic diseases and the leading cause of preventable death worldwide. Due to high prevalence of smokers, new cost-effective strategies seeking to increase smoking cessation rates are needed. METHODS We performed a Markov model-based cost-effectiveness analysis comparing two treatments: health advice provided by general practitioners and nurses in primary care, and health advice reinforced by sending motivational text messages to smokers' mobile phones. A Markov model was used in which smokers transitioned between three mutually exclusive health states (smoker, former smoker and dead) after 6-month cycles. We calculated the cost-effectiveness ratio associated with the sending of motivational messages. Health care and society perspectives (separately) was adopted. Costs taken into account were direct health care costs and direct health care cost and costs for lost productivity, respectively. Additionally, deterministic sensitivity analysis was performed modifying the probability of smoking cessation with each option. RESULTS Sending of text messages as a tool to support health advice was found to be cost-effective as it was associated with increases in costs of €7.4 and €1,327 per QALY gained (ICUR) for men and women respectively from a healthcare perspective, significantly far from the published cost-effectiveness threshold. From a societal perspective, the combined programmed was dominant. CONCLUSIONS Sending text messages is a cost-effective approach. These findings support the implantation of the combined program across primary care health centres.
Collapse
Affiliation(s)
- Raquel Cobos-Campos
- Bioaraba Health Research Institute, Epidemiology and Public Health Research group, Vitoria-Gasteiz, Spain.
| | - Javier Mar
- Osakidetza Basque Health Service, Primary Care Research Unit of Gipuzkoa, Alto Deba Hospital, Arrasate-Mondragón, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Bilbao, Spain
- Biodonostia Health Research Institute, San Sebastián, Spain
| | - Antxon Apiñaniz
- Bioaraba Health Research Institute, Epidemiology and Public Health Research group, Vitoria-Gasteiz, Spain
- Osakidetza Basque Health Service, Lakuabizkarra Health Centre, Vitoria-Gasteiz, Spain
- Preventive Medicine and Public Health Department, University of Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Arantza Sáez de Lafuente
- Bioaraba Health Research Institute, Epidemiology and Public Health Research group, Vitoria-Gasteiz, Spain
| | - Naiara Parraza
- Bioaraba Health Research Institute, Epidemiology and Public Health Research group, Vitoria-Gasteiz, Spain
| | - Felipe Aizpuru
- Preventive Medicine and Public Health Department, University of Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
- Osakidetza Basque Health Service, Subdirectorate of Health Care, Vitoria-Gasteiz, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Vitoria-Gasteiz, Spain
| | - Gorka Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain.
- Bioaraba Health Research Institute, Nanobiocel Research group, Vitoria-Gasteiz, Spain.
- University Institute for Regenerative Medicine and Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria-Gasteiz, Spain.
- Singapore Eye Research Institute, Singapore, Singapore.
- CIBER Bioengineering, Biomaterials and Nanomedicine (CIBERBBN), Institute of Health Carlos III, Madrid, Spain.
| |
Collapse
|
36
|
How Has Intervention Fidelity Been Assessed in Smoking Cessation Interventions? A Systematic Review. J Smok Cessat 2021; 2021:6641208. [PMID: 34306228 PMCID: PMC8279202 DOI: 10.1155/2021/6641208] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/14/2020] [Accepted: 11/24/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction Intervention fidelity concerns the degree to which interventions are implemented as intended. Fidelity frameworks propose fidelity is a multidimensional concept relevant at intervention designer, provider, and recipient levels; yet the extent to which it is assessed multidimensionally is unclear. Smoking cessation interventions are complex, including multiple components, often delivered over multiple sessions and/or at scale in clinical practice; this increases susceptibility variation in the fidelity with which they are delivered. This review examined the extent to which five dimensions from the Behaviour Change Consortium fidelity framework (design, training, delivery, receipt, and enactment) were assessed in fidelity assessments of smoking cessation interventions (randomised control trials (RCTs)). Methods Five electronic databases were searched using terms “smoking cessation,” “interventions,” “fidelity,” and “randomised control trials.” Eligible studies included RCTs of smoking cessation behavioural interventions, published post 2006 after publication of the framework, reporting assessment of fidelity. The data extraction form was structured around the framework, which specifies a number of items regarding assessment and reporting of each dimension. Data extraction included study characteristics, dimensions assessed, data collection, and analysis strategies. A score per dimension was calculated, indicating its presence. Results 55 studies were reviewed. There was a wide variability in data collection approaches used to assess fidelity. Fidelity of delivery was the most commonly assessed and linked to the intervention outcomes (73% of the studies). Fidelity of enactment scored the highest according to the framework (average of 92.7%), and fidelity of training scored the lowest (average of 37.1%). Only a quarter of studies linked fidelity data to outcomes (27%). Conclusion There is wide variability in methodological and analytical approaches that precludes comparison and synthesis. In order to realise the potential of fidelity investigations to increase scientific confidence in the interpretation of observed trial outcomes, studies should include analyses of the association between fidelity data and outcomes. Findings have highlighted recommendations for improving fidelity evaluations and reporting practices.
Collapse
|
37
|
Fiore M, Adsit R, Zehner M, McCarthy D, Lundsten S, Hartlaub P, Mahr T, Gorrilla A, Skora A, Baker T. An electronic health record-based interoperable eReferral system to enhance smoking Quitline treatment in primary care. J Am Med Inform Assoc 2021; 26:778-786. [PMID: 31089727 DOI: 10.1093/jamia/ocz044] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/11/2019] [Accepted: 03/19/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The study sought to determine whether interoperable, electronic health record-based referral (eReferral) produces higher rates of referral and connection to a state tobacco quitline than does fax-based referral, thus addressing low rates of smoking treatment delivery in health care. MATERIALS AND METHODS Twenty-three primary care clinics from 2 healthcare systems (A and B) in Wisconsin were randomized, unblinded, over 2016-2017, to 2 smoking treatment referral methods: paper-based fax-to-quit (system A =6, system B = 6) or electronic (eReferral; system A = 5, system B = 6). Both methods referred adult patients who smoked to the Wisconsin Tobacco Quitline. A total of 14 636 smokers were seen in the 2 systems (system A: 54.5% women, mean age 48.2 years; system B: 53.8% women, mean age 50.2 years). RESULTS Clinics with eReferral, vs fax-to-quit, referred a higher percentage of adult smokers to the quitline: system A clinic referral rate = 17.9% (95% confidence interval [CI], 17.2%-18.5%) vs 3.8% (95% CI, 3.5%-4.2%) (P < .001); system B clinic referral rate = 18.9% (95% CI, 18.3%-19.6%) vs 5.2% (95% CI, 4.9%-5.6%) (P < .001). Average rates of quitline connection were higher in eReferral than F2Q clinics: system A = 5.4% (95% CI, 5.0%-5.8%) vs 1.3% (95% CI, 1.1%-1.5%) (P < .001); system B = 5.3% (95% CI, 5.0%-5.7%) vs 2.0% (95% CI, 1.8%-2.2%) (P < .001). DISCUSSION Electronic health record-based eReferral provided an effective, closed-loop, interoperable means of referring patients who smoke to telephone quitline services, producing referral rates 3-4 times higher than the current standard of care (fax referral), including especially high rates of referral of underserved individuals. CONCLUSIONS eReferral may help address the challenge of providing smokers with treatment for tobacco use during busy primary care visits.ClinicalTrials.gov; No. NCT02735382.
Collapse
Affiliation(s)
- Michael Fiore
- Center for Tobacco Research and Intervention and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Rob Adsit
- Center for Tobacco Research and Intervention and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Mark Zehner
- Center for Tobacco Research and Intervention and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Danielle McCarthy
- Center for Tobacco Research and Intervention and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Susan Lundsten
- Department of Community and Preventive Care Services, Gundersen Health System, La Crosse, Wisconsin, USA
| | - Paul Hartlaub
- Family and Preventive Medicine, Brown Deer, Quality and Safety, Primary Care, Ascension Medical Group, Brown Deer, Wisconsin, USA
| | - Todd Mahr
- Department of Community and Preventive Care Services, Gundersen Health System, La Crosse, Wisconsin, USA
| | - Allison Gorrilla
- Center for Tobacco Research and Intervention and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Amy Skora
- Center for Tobacco Research and Intervention and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Timothy Baker
- Center for Tobacco Research and Intervention and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| |
Collapse
|
38
|
Atorkey P, Paul C, Bonevski B, Wiggers J, Mitchell A, Byrnes E, Lecathelinais C, Tzelepis F. Uptake of Proactively Offered Online and Telephone Support Services Targeting Multiple Health Risk Behaviors Among Vocational Education Students: Process Evaluation of a Cluster Randomized Controlled Trial. J Med Internet Res 2021; 23:e19737. [PMID: 33404504 PMCID: PMC7817359 DOI: 10.2196/19737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/22/2020] [Accepted: 11/11/2020] [Indexed: 01/21/2023] Open
Abstract
Background A high proportion of vocational education students smoke tobacco, have inadequate nutrition (ie, low fruit and vegetable intake), drink alcohol at risky levels, or are physically inactive. The extent to which vocational education students will sign up for proactively offered online and telephone support services for multiple health risk behaviors is unknown. Objective The aim of this study is to examine the uptake of proactively offered online and telephone support services for smoking, nutrition, alcohol consumption, and physical activity risk behaviors, individually and in combination, among vocational education students in the Technical and Further Education (TAFE) setting. The characteristics associated with the uptake of online or telephone services for smoking, nutrition, alcohol consumption, and physical activity risk behaviors were also examined. Methods Vocational education students enrolled in a TAFE class in New South Wales, Australia, which ran for 6 months or more, were recruited to participate in a cluster randomized controlled trial from May 2018 to May 2019. In the intervention arm, participants who did not meet the Australian health guidelines for each of the smoking, nutrition, alcohol consumption, and physical activity risk behaviors were provided electronic feedback and proactively offered online and telephone support services. Uptake of support was measured by whether participants signed up for the online and telephone services they were offered. Results Vocational education students (N=551; mean age 25.7 years, SD 11.1; 310/551, 56.3% male) were recruited into the intervention arm. Uptake of the proactive offer of either online or telephone services was 14.5% (59/406) for fruit and vegetables, 12.7% (29/228) for physical activity, 6.8% (13/191) for smoking, and 5.5% (18/327) for alcohol use. Uptake of any online or telephone service for at least two health behaviors was 5.8% (22/377). Participants who were employed (odds ratio [OR] 0.10, 95% CI 0.01-0.72) and reported not being anxious (OR 0.11, 95% CI 0.02-0.71) had smaller odds of signing up for online or telephone services for smoking, whereas participants who reported not being depressed had greater odds (OR 10.25, 95% CI 1.30-80.67). Participants who intended to change their physical activity in the next 30 days had greater odds (OR 4.01, 95% CI 1.33-12.07) of signing up for online or telephone services for physical activity. Employed participants had smaller odds (OR 0.18, 95% CI 0.06-0.56) of signing up for support services for at least two behaviors. Conclusions Although the uptake of proactively offered online and telephone support services is low, these rates appear to be higher than the self-initiated use of some of these services in the general population. Scaling up the proactive offer of online and telephone services may produce beneficial health outcomes. Trial Registration Australian New Zealand Clinical Trials Registry: ACTRN12618000723280; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375001.
Collapse
Affiliation(s)
- Prince Atorkey
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia.,Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Christine Paul
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia.,Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Billie Bonevski
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - John Wiggers
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia.,Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Aimee Mitchell
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia
| | - Emma Byrnes
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Christophe Lecathelinais
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia.,Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| |
Collapse
|
39
|
Bustamante-Troncoso C, Herrera-López LM, Sánchez H, Pérez JC, Márquez-Doren F, Leiva S. [Effect of a multidimensional intervention for prevention of falls in the eldery]. Aten Primaria 2020; 52:722-730. [PMID: 31740074 PMCID: PMC8054286 DOI: 10.1016/j.aprim.2019.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 05/30/2019] [Accepted: 07/29/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To evaluate the effect of a multidimensional intervention on the perception and management of risk factors and frequency of falls in independent elderly people living in the community. DESIGN Randomised clinical trial. SETTING Family health centre, primary care. PARTICIPANTS Independent elderly people living in the community. INTERVENTION For intervention group (IG) a multidimensional intervention, consisting of home visits and telephone follow-up was carried out for 5 months (n=77), and those assigned to the control group (CG, n=77) received usual care in the family health centre. MAIN MEASUREMENTS Perception of risk of falls, number of risk factors and number of falls in the study period. RESULTS In both groups there were increases in the perception of risk factors for falling associated with walking (IG: P<.001 and CG: P<.001). Belonging to the IG was significantly associated with a decrease in the risk factors associated with surfaces (r=0.25) and shoes (r=0.24), as well as an increase in the perception of risk of falls associated with walking (r=0.21) and the presence of objects or furniture (r=0.36). In the IG, 5 participants (7.9%) suffered at least one fall in the 5-month period and 18 (27.7%) patients in the CG (P=.004). CONCLUSIONS The multidimensional intervention was effective in reducing the frequency of falls and in the management of extrinsic risk factors associated with surfaces, lighting, and support devices.
Collapse
Affiliation(s)
| | | | - Hugo Sánchez
- Servicio de Salud Metropolitano Sur, Santiago de Chile, Chile
| | - J Carola Pérez
- Facultad de Psicología, Universidad del Desarrollo, Santiago de Chile, Chile
| | | | - Sara Leiva
- Centro de Salud Familiar Félix de Amesti, Departamento de Salud Municipalidad de Macul, Santiago de Chile, Chile
| |
Collapse
|
40
|
Mak YW, Leung DYP, Loke AY. Effectiveness of an individual acceptance and commitment therapy for smoking cessation, delivered face-to-face and by telephone to adults recruited in primary health care settings: a randomized controlled trial. BMC Public Health 2020; 20:1719. [PMID: 33198700 PMCID: PMC7667813 DOI: 10.1186/s12889-020-09820-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 11/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to examine the effectiveness of delivering an individual Acceptance and Commitment Therapy (ACT) for smoking cessation among a Chinese population. Methods Participants were recruited from six primary health care centers. A total of 144 were eligible to take part in the study and agreed to be randomized to the intervention (ACT) group (n = 70) and control group (n = 74), respectively. Both groups received self-help materials on smoking cessation. The ACT group also underwent an initial face-to-face session and two telephone ACT sessions at 1 week and 1 month following the first session. They were re-contacted through telephone follow-ups at 3, 6, and 12 months by research assistants. The primary outcome was self-reported 7-day point-prevalence abstinence at the 12-month follow-up session. Other outcomes included biochemically validated quitting, quitting attempts, the intention to quit, the self-perception of quitting, and psychological flexibility. Results There was no significant difference in the self-reported 7-day point prevalence quit rate at the 12-month follow-up between the intervention group (24.3%) and the control group (21.6%) (risk ratio = 1.12; 95%CI = (0.62, 2.05); p = 0.704). Greater improvements in secondary outcomes from baseline to the 12-month follow-up were observed in the ACT group than in the control group, including a forward progression in the participants’ readiness to quit smoking (p = 0.014) and increased psychological flexibility (p = 0.022). Conclusions This study is the first evidence of a randomized-controlled trial on the adoption of an individual ACT for smoking cessation, delivered initially in primary health care settings and subsequently by telephone within a Chinese population. The present study found that the brief ACT intervention could not produce a significant quit rate but was promising in terms of bringing about cognitive changes, including greater psychological flexibility, and more confidence about quitting, when compared to the use of self-help materials only among the general population. Trial registration This trial was registered prospectively with the U.S. National Library of Medicine: (NCT01652508) on 26th July 2012.
Collapse
Affiliation(s)
- Yim Wah Mak
- School of Nursing, The Hong Kong Polytechnic University, Yuk Choi Road, Hung Hom, Kowloon, Hong Kong, Special Administrative Region of China.
| | - Doris Y P Leung
- School of Nursing, The Hong Kong Polytechnic University, Yuk Choi Road, Hung Hom, Kowloon, Hong Kong, Special Administrative Region of China
| | - Alice Yuen Loke
- School of Nursing, The Hong Kong Polytechnic University, Yuk Choi Road, Hung Hom, Kowloon, Hong Kong, Special Administrative Region of China
| |
Collapse
|
41
|
Sohlberg T, Bergmark KH. Lifestyle and Long-Term Smoking Cessation. Tob Use Insights 2020; 13:1179173X20963062. [PMID: 33132704 PMCID: PMC7576910 DOI: 10.1177/1179173x20963062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/04/2020] [Indexed: 12/17/2022] Open
Abstract
Background: Since smoking is the leading cause of preventable death, discouraging smoking initiation, encouraging smoking cessation, and exploring factors that help individuals to stay smoke free are immensely important. One such relevant factor may be the impact of lifestyle for long-term smoking cessation. Method: A representative sample of successful quitters was recruited for a study about smoking cessation. These respondents are now part of a 7-year follow-up with the overall aim of revealing factors affecting long-term smoking cessation. Descriptive analyses were carried out at baseline and at follow-up, as well as a further two-step cluster analysis to explore profiles of long-term smoke-free individuals. Results: A majority did not make any particular lifestyle changes, but among those who did, most adopted a healthier lifestyle and/or increased their quota of physical training, where permanent changes in this direction seem to promote a more enduring smoke-free life. Conclusions: Individuals who want to quit smoking should be encouraged to increase their level of physical activity. Swedish health care institutions should be able to provide support for this both initially and over time to promote the long-term maintenance of a smoke-free lifestyle.
Collapse
Affiliation(s)
- Tove Sohlberg
- Department of Sociology, Stockholm University, Stockholm, Sweden
| | | |
Collapse
|
42
|
Flocke SA, Seeholzer E, Lewis SA, Gill IJ, Rose JC, Albert E, Love TE, Kaelber D. 12-Month Evaluation of an EHR-Supported Staff Role Change for Provision of Tobacco Cessation Care in 8 Primary Care Safety-Net Clinics. J Gen Intern Med 2020; 35:3234-3242. [PMID: 32705473 PMCID: PMC7661631 DOI: 10.1007/s11606-020-06030-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
SIGNIFICANCE Guidelines urge primary care practices to routinely provide tobacco cessation care (i.e., assess tobacco use, provide brief cessation advice, and refer to cessation support). This study evaluates the impact of a systems-based strategy to provide tobacco cessation care in eight primary care clinics serving low-income patients. METHODS A non-randomized stepped wedge study design was used to implement an intervention consisting of (1) changes to the electronic health record (EHR) referral functionality and (2) expansion of staff roles to provide brief advice to quit; assess readiness to quit; offer a referral to tobacco cessation counseling; and sign the referral order. Outcomes assessed from the EHR include performance of tobacco cessation care tasks, referral contact, and enrollment rates for the quitline (QL) and in-house Freedom from Smoking (FFS) program. Generalized estimating equations (GEE) methods were used to compute odds ratios contrasting the pre-implementation vs. 1-, 3-, 6-, and 12-month post-implementation periods. RESULTS Of the 176,061 visits, 26.1% were by identified tobacco users. All indicators significantly increased at each time period evaluated post-implementation. In comparison with the pre-intervention period, assessing smoking status (26.6% vs. 55.7%; OR = 3.7, CI = 3.6-3.9), providing advice (44.8% vs. 88.7%; OR = 7.8, CI = 6.6-9.1), assessing readiness to quit (15.8% vs. 55.0%; OR = 6.2, CI = 5.4-7.0), and acceptance of a referral to tobacco cessation counseling (0.5% vs. 30.9%; OR = 81.0, CI = 11.4-575.8) remained significantly higher 12 months post-intervention. For the QL and FFS, respectively, there were 1223 and 532 referrals; 324 (31.1%) and 103 (24.7%) were contacted; 241 (74.4%) and 72 (69.6%) enrolled; and 195 (80.9%) and 14 (19.4%) received at least one counseling session. CONCLUSIONS This system change intervention that includes an EHR-supported role expansion substantially increased the provision of tobacco cessation care and improvements were sustained beyond 1 year. This approach has the potential to greatly increase the number of individuals referred for tobacco cessation counseling.
Collapse
Affiliation(s)
- Susan A Flocke
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA.
- Center for Community Health Integration, Case Western Reserve University, Cleveland, OH, USA.
| | - Eileen Seeholzer
- Center for Health Care Research and Policy, The MetroHealth System, Cleveland, OH, USA
| | - Steven A Lewis
- Center for Health Care Research and Policy, The MetroHealth System, Cleveland, OH, USA
| | - India J Gill
- Center for Community Health Integration, Case Western Reserve University, Cleveland, OH, USA
- Departments of Medicine and Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Jeanmarie C Rose
- Center for Community Health Integration, Case Western Reserve University, Cleveland, OH, USA
| | - Elizabeth Albert
- Center for Community Health Integration, Case Western Reserve University, Cleveland, OH, USA
| | - Thomas E Love
- Center for Health Care Research and Policy, The MetroHealth System, Cleveland, OH, USA
- Departments of Medicine and Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - David Kaelber
- Center for Health Care Research and Policy, The MetroHealth System, Cleveland, OH, USA
- Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH, USA
| |
Collapse
|
43
|
Collins BN, Lepore SJ, Winickoff JP, Sosnowski DW. Parents' Self-efficacy for Tobacco Exposure Protection and Smoking Abstinence Mediate Treatment Effects on Child Cotinine at 12-Month Follow-up: Mediation Results from the Kids Safe and Smokefree Trial. Nicotine Tob Res 2020; 22:1981-1988. [PMID: 31536116 DOI: 10.1093/ntr/ntz175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 09/10/2019] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Compared with the general smoking population, low-income smokers face elevated challenges to success in evidence-based smoking cessation treatment. Moreover, their children bear increased disease burden. Understanding behavioral mechanisms related to successful reduction of child tobacco smoke exposure (TSE) could inform future smoking interventions in vulnerable, underserved populations. METHODS Smoking parents were recruited from pediatric clinics in low-income communities and randomized into a multilevel intervention including a pediatric clinic intervention framed in best clinical practice guidelines ("Ask, Advise, Refer" [AAR]) plus individualized telephone counseling (AAR + counseling), or AAR + control. Mediation analysis included treatment condition (independent variable), 12-month child cotinine (TSE biomarker, criterion), and four mediators: 3-month end-of-treatment self-efficacy to protect children from TSE and smoking urge coping skills, and 12-month perceived program (intra-treatment) support and bioverified smoking abstinence. Analyses controlled for baseline nicotine dependence, depressive symptoms, child age, and presence of other residential smokers. RESULTS Participants (n = 327) included 83% women and 83% African Americans. Multilevel AAR + counseling was associated with significantly higher levels of all four mediators (ps < .05). Baseline nicotine dependence (p < .05), 3-month self-efficacy (p < .05) and 12-month bioverified smoking abstinence (p < .001) related significantly to 12-month child cotinine outcome. The indirect effects of AAR + counseling intervention on cotinine via self-efficacy for child TSE protection and smoking abstinence (ps < .05) suggested mediation through these pathways. CONCLUSIONS Compared with AAR + control, multilevel AAR + counseling improved all putative mediators. Findings suggest that fostering TSE protection self-efficacy during intervention and encouraging parental smoking abstinence may be key to promoting long-term child TSE-reduction in populations of smokers with elevated challenges to quitting smoking. IMPLICATIONS Pediatric harm reduction interventions to protect children of smokers from tobacco smoke have emerged to address tobacco-related health disparities in underserved populations. Low-income smokers experience greater tobacco-related disease burden and more difficulty with smoking behavior change in standard evidence-based interventions than the general population of smokers. Therefore, improving knowledge about putative behavioral mechanisms of smoking behavior change that results in lower child exposure risk could inform future intervention improvements.
Collapse
Affiliation(s)
- Bradley N Collins
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA
| | - Stephen J Lepore
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA
| | - Jonathan P Winickoff
- Department of Pediatrics, Harvard Medical School, Massachusetts General Hospital for Children, Boston MA
| | - David W Sosnowski
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
| |
Collapse
|
44
|
Byaruhanga J, Atorkey P, McLaughlin M, Brown A, Byrnes E, Paul C, Wiggers J, Tzelepis F. Effectiveness of Individual Real-Time Video Counseling on Smoking, Nutrition, Alcohol, Physical Activity, and Obesity Health Risks: Systematic Review. J Med Internet Res 2020; 22:e18621. [PMID: 32915156 PMCID: PMC7519427 DOI: 10.2196/18621] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/18/2020] [Accepted: 07/26/2020] [Indexed: 12/11/2022] Open
Abstract
Background Real-time video communication technology allows virtual face-to-face interactions between the provider and the user, and can be used to modify risk factors for smoking, nutrition, alcohol consumption, physical activity, and obesity. No systematic reviews have examined the effectiveness of individual real-time video counseling for addressing each of the risk factors for smoking, nutrition, alcohol consumption, physical activity, and obesity. Objective This systematic review aims to examine the effectiveness of individually delivered real-time video counseling on risk factors for smoking, nutrition, alcohol consumption, physical activity, and obesity. Methods The MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica Database), PsycINFO, Cochrane Register of Controlled Trials, and Scopus databases were searched for eligible studies published up to November 21, 2019. Eligible studies were randomized or cluster randomized trials that tested the effectiveness of individual real-time video communication interventions on smoking, nutrition, alcohol, physical activity, and obesity in any population or setting; the comparator was a no-intervention control group or any other mode of support (eg, telephone); and an English-language publication. Results A total of 13 studies were eligible. Four studies targeted smoking, 3 alcohol, 3 physical activity, and 3 obesity. In 2 of the physical activity studies, real-time video counseling was found to significantly increase physical activity when compared with usual care at week 9 and after 5 years. Two obesity studies found a significant change in BMI between a video counseling and a documents group, with significantly greater weight loss in the video counseling group than the in-person as well as the control groups. One study found that those in the video counseling group were significantly more likely than those in the telephone counseling group to achieve smoking cessation. The remaining studies found no significant differences between video counseling and telephone counseling or face-to-face counseling for smoking cessation, video counseling and face-to-face treatment on alcohol consumption, video counseling and no counseling for physical activity, and video counseling and face-to-face treatment on BMI. The global methodological quality rating was moderate in 1 physical activity study, whereas 12 studies had a weak global rating. Conclusions Video counseling is potentially more effective than a control group or other modes of support in addressing physical inactivity and obesity and is not less effective in modifying smoking and alcohol consumption. Further research is required to determine the relative benefits of video counseling in terms of other policy and practice decision-making factors such as costs and feasibility.
Collapse
Affiliation(s)
- Judith Byaruhanga
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Health Behaviour, Faculty of Health & Medicine, University of Newcastle, Callaghan, Australia
| | - Prince Atorkey
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Health Behaviour, Faculty of Health & Medicine, University of Newcastle, Callaghan, Australia
| | - Matthew McLaughlin
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Health Behaviour, Faculty of Health & Medicine, University of Newcastle, Callaghan, Australia
| | - Alison Brown
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Health Behaviour, Faculty of Health & Medicine, University of Newcastle, Callaghan, Australia
| | - Emma Byrnes
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Christine Paul
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Health Behaviour, Faculty of Health & Medicine, University of Newcastle, Callaghan, Australia
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Health Behaviour, Faculty of Health & Medicine, University of Newcastle, Callaghan, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Health Behaviour, Faculty of Health & Medicine, University of Newcastle, Callaghan, Australia
| |
Collapse
|
45
|
Carpenter KM, Torres AJ, Salmon EE, Carlini BH, Vickerman KA, Schauer GL, Bush T. Marijuana Use and Adherence to Smoking Cessation Treatment Among Callers to Tobacco Quitlines. Prev Chronic Dis 2020; 17:E102. [PMID: 32915131 PMCID: PMC7553215 DOI: 10.5888/pcd17.200110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Tobacco kills over half a million adults annually in the United States. Most smokers want to quit, and over 400,000 call state-funded quitlines for help each year. Marijuana use among tobacco users is common and may impede quitting, but co-use rates among quitline callers are unknown. The purpose of our observational study was to describe marijuana use among quitline callers in states with legalized marijuana. Methods Participants were 1,059 smokers aged 21 or older from Oregon, Alaska, and Washington, DC, who called quitlines from September through December 2016. Data on quitline callers’ demographics, tobacco and marijuana use, and quitline use were collected. We used χ2 and regression analyses to compare marijuana users with nonusers on demographic characteristics and quitline use. Result Among quitline callers in our study, 24% reported using marijuana in the past 30 days: 28.9% in Alaska, 16.7% in Washington, DC, and 25.0% in Oregon (P = .009). Current users, compared with non-users (n = 772), were less likely to be women (48.4% vs 62.0%, respectively, P < .001). Current marijuana users were less likely to be given nicotine replacement therapy (68.4%) than current nonusers (74.1%) (P < .001), but more likely to complete 3 or more counseling calls (P = .005). Of those who used marijuana in the past 30 days, 62.3% used marijuana on 1 to 19 days, 9.0% used on 20 to 29 days, and 28.7% on all 30 days. Among current marijuana users, the percentage who wanted to quit or reduce marijuana use (42.6%) was higher in Alaska (54.6%) and the District of Columbia (56.8%) than in Oregon (37.9%), P = .03. Conclusion One in 4 quitline callers reported past 30-day marijuana use. Given that nearly half (43%) wanted to reduce marijuana use, addressing co-use may be an important addition to quitline treatment. Future studies should assess co-use effects on tobacco cessation outcomes and explore combined treatment or bidirectional referrals between quitlines and marijuana treatment providers.
Collapse
Affiliation(s)
- Kelly M Carpenter
- Center for Wellbeing Research, Optum, PO BOX 9472, Minneapolis, MN 55440-9472.
| | - Alula J Torres
- Center for Wellbeing Research, Optum, Minneapolis, Minnesota
| | - Erica E Salmon
- Center for Wellbeing Research, Optum, Minneapolis, Minnesota
| | - Beatriz H Carlini
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, Washington
| | | | - Gillian L Schauer
- University of Washington, School of Public Health, Seattle, Washington
| | - Terry Bush
- Center for Wellbeing Research, Optum, Minneapolis, Minnesota
| |
Collapse
|
46
|
Black N, Eisma MC, Viechtbauer W, Johnston M, West R, Hartmann‐Boyce J, Michie S, de Bruin M. Variability and effectiveness of comparator group interventions in smoking cessation trials: a systematic review and meta-analysis. Addiction 2020; 115:1607-1617. [PMID: 32043675 PMCID: PMC7496125 DOI: 10.1111/add.14969] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/08/2019] [Accepted: 01/10/2020] [Indexed: 12/22/2022]
Abstract
AIMS To examine variability and effectiveness of interventions provided to comparator (control) groups in smoking cessation trials. METHODS Systematic review with meta-analysis of randomized controlled trials (RCTs) of behavioral interventions for smoking cessation, with or without stop-smoking medication. We searched the Cochrane Tobacco Addiction Group Specialized Register for RCTs with objective outcomes measured at ≥ 6 months. Study authors were contacted to obtain comprehensive descriptions of their comparator interventions. Meta-regression analyses examined the relationships of smoking cessation rates with stop-smoking medication and behavior change techniques. RESULTS One hundred and four of 142 eligible comparator groups (n = 23 706) had complete data and were included in analyses. There was considerable variability in the number of behavior change techniques delivered [mean = 15.97, standard deviation (SD) = 13.54, range = 0-45] and the provision of smoking cessation medication (43% of groups received medication) throughout and within categories of comparator groups (e.g. usual care, brief advice). Higher smoking cessation rates were predicted by provision of medication [B = 0.334, 95% confidence interval (CI) = 0.030-0.638, P = 0.031] and number of behavior change techniques included (B = 0.020, 95% CI = 0.008-0.032, P < 0.001). Modelled cessation rates in comparator groups that received the most intensive support were 15 percentage points higher than those that received the least (23 versus 8%). CONCLUSIONS Interventions delivered to comparator groups in smoking cessation randomized controlled trials vary considerably in content, and cessation rates are strongly predicted by stop-smoking medication and number of behavior change techniques delivered.
Collapse
Affiliation(s)
- Nicola Black
- Health Psychology Group, Institute of Applied Health SciencesUniversity of Aberdeen, Health Sciences Building, ForesterhillAberdeenUK
- National Drug and Alcohol Research CentreUniversity of New South WalesSydneyNSWAustralia
| | - Maarten C. Eisma
- Health Psychology Group, Institute of Applied Health SciencesUniversity of Aberdeen, Health Sciences Building, ForesterhillAberdeenUK
- Department of Clinical Psychology and Experimental PsychopathologyUniversity of GroningenGroningenthe Netherlands
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Neuropsychology, School for Mental Health and NeuroscienceMaastricht UniversityMaastrichtthe Netherlands
| | - Marie Johnston
- Health Psychology Group, Institute of Applied Health SciencesUniversity of Aberdeen, Health Sciences Building, ForesterhillAberdeenUK
| | - Robert West
- Department of Behavioral Science and HealthUniversity College LondonLondonUK
| | | | - Susan Michie
- Centre for behavior ChangeUniversity College LondonGower StreetLondonWC1E 6BTUK
| | - Marijn de Bruin
- Health Psychology Group, Institute of Applied Health SciencesUniversity of Aberdeen, Health Sciences Building, ForesterhillAberdeenUK
- Radboud University Medical CenterRadboud Institute for Health Sciences, IQ HealthcareNijmegenthe Netherlands
| |
Collapse
|
47
|
Tedeschi GJ, Zoref LS, Cummins SE, Zhu SH. Targeting Nonsmokers to Help Smokers Quit: Features of a Large-scale Intervention. Tob Use Insights 2020; 13:1179173X20943565. [PMID: 32753992 PMCID: PMC7378709 DOI: 10.1177/1179173x20943565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/25/2020] [Indexed: 12/01/2022] Open
Abstract
Smoking continues to be a major public health problem, despite a substantial
decline in prevalence rates over the last decades. Quit smoking interventions
typically target smokers, whether through individual or group treatment or
through broader public health campaigns. Yet, nonsmokers represent a vast and
largely untapped resource to help smokers quit. This article describes an
innovative approach that targeted nonsmokers through a media-style campaign with
repeated reminders about smoking cessation. We tested the nonsmoker intervention
in a large randomized trial and showed it to be effective in helping smokers
quit. Components of the intervention included repeated mailings with relevant
cessation messages over a 10-week period, 2 brief check-in telephone calls, and
access to a study Web site. In this article, we discuss details of the
intervention development, content, and implementation.
Collapse
Affiliation(s)
- Gary J Tedeschi
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - Leslie S Zoref
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - Sharon E Cummins
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - Shu-Hong Zhu
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA.,Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| |
Collapse
|
48
|
Allen AM, Yuan NP, Wertheim BC, Krupski L, Bell ML, Nair U. Gender differences in utilization of services and tobacco cessation outcomes at a state quitline. Transl Behav Med 2020; 9:663-668. [PMID: 30099557 DOI: 10.1093/tbm/iby083] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Research suggests that women may have poorer tobacco cessation outcomes than men; however, the literature is somewhat mixed. Less is known about gender differences in cessation within quitline settings. This study examined gender differences in the utilization of services (i.e., coaching sessions, pharmacotherapy) and tobacco cessation among callers to the Arizona Smokers' Helpline (ASHLine). The study sample included callers enrolled in ASHLine between January 2011 and June 2016. We tracked number of completed coaching sessions. At the 7-month follow-up, callers retrospectively reported use of cessation pharmacotherapy (gum, patch, or lozenge), as well as current tobacco use. Associations between gender and tobacco cessation were tested using logistic regression models. At month 7, 36.4% of women (3,277/9,004) and 40.3% of men (2,960/7,341) self-reported 30-day point prevalence abstinence. Compared to men, fewer women reported using pharmacotherapy (women: 71.4% vs. men: 73.6%, p = .01) and completed at least five coaching sessions (women: 35.1% vs. men: 38.5%, p < .01). After adjusting for baseline characteristics, women had significantly lower odds of reporting tobacco cessation than men (OR = 0.91, 95% CI: 0.84 to 0.99). However, after further adjustment for use of pharmacotherapy and coaching, there was no longer a significant relationship between gender and tobacco cessation (OR: 0.96, 95% CI: 0.87 to 1.06). Fewer women than men reported tobacco cessation. Women also had lower utilization of quitline cessation services. Although the magnitude of these differences were small, future research on improving the utilization of quitline services among women may be worth pursuing given the large-scale effects of tobacco.
Collapse
Affiliation(s)
- Alicia M Allen
- Department of Family & Community Medicine, College of Medicine, University of Arizona, Tucson, USA
| | - Nicole P Yuan
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA
| | | | - Laurie Krupski
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA
| | - Melanie L Bell
- Department of Epidemiology & Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA
| | - Uma Nair
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA
| |
Collapse
|
49
|
Client Experiences of a Telephone-Delivered Intervention for Alcohol Use: a Qualitative Study. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-020-00381-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
50
|
Jiang S, Yang T, Bullen C, Chen J, Yu L, Peng S, Rockett IRH. Real-world unassisted quit success and related contextual factors: a population-based study of Chinese male smokers. Tob Control 2020; 30:498-504. [PMID: 32675250 DOI: 10.1136/tobaccocontrol-2019-055594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 05/12/2020] [Accepted: 05/12/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To examine the association of exposure to secondhand smoke (SHS) and tobacco advertising with unassisted smoking cessation among Chinese male smokers. METHODS A questionnaire was administered to 6500 male adult smokers from six cities in China selected in a cross-sectional multistage sampling design. The survey collected self-reported demographic characteristics, smoking and cessation status, SHS exposure and tobacco advertising exposure, with 5782 valid questionnaires included in this study. Multiple logistic regression analysis was used to assess the association of unassisted smoking cessation with exposure to SHS and tobacco advertising. RESULTS 42.1% of smokers who made unassisted quit attempts achieved abstinence (95% CI 32.5% to 51.7%). SHS (adjusted OR (aOR) 0.36; 95% CI 0.18 to 0.71; p=0.033) and tobacco advertising exposure (aOR 0.63; 95% CI 0.37 to 0.95; p=0.039) were negatively associated with unassisted smoking cessation. CONCLUSION The vast majority of Chinese male smokers rely on unassisted methods to quit smoking. Success prevalence is high, which is very beneficial to health. This study suggests that exposure to secondhand smoking and tobacco advertising hinders the success of unassisted cessation. These findings speak to the need for environmental tobacco control measures to promote unassisted smoking cessation among Chinese adult male smokers.
Collapse
Affiliation(s)
- Shuhan Jiang
- School of Humanities and Management, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Tingzhong Yang
- Children's Hospital/Center for Tobacco Control Research, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Christopher Bullen
- National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
| | - Jinsong Chen
- National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
| | - Lingwei Yu
- Center for Tobacco Control Research, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Sihui Peng
- Center for Tobacco Control Research, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ian R H Rockett
- Department of Epidemiology, West Virginia University School of Public Health, Morgantown, West Virginia, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| |
Collapse
|