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Colston DC, Cruz JL, Simard BJ, Fleischer NL. A Systematic Review Evaluating Disparities in State-Run Quitline Utilization and Effectiveness in the U.S. AJPM FOCUS 2023; 2:100042. [PMID: 37789942 PMCID: PMC10546598 DOI: 10.1016/j.focus.2022.100042] [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] [Indexed: 10/05/2023]
Abstract
Context Cigarette smoking is a public health problem in the U.S. and is marked by pervasive sociodemographic disparities. State-run quitlines may offer greater access to cessation services that could in turn help to reduce smoking disparities. The aim of this review was to synthesize the body of literature regarding sociodemographic disparities in the utilization and effectiveness of state-run quitlines. Evidence acquisition The PRISMA guidelines were followed in conducting this review. Included articles were published between January 1, 1992 and May 28, 2019 and sourced from PubMed and Web of Science. Studies that evaluated state-run quitline utilization or effectiveness (cessation) by sex, race/ethnicity, sexual or gender identity, or SES (income, education, insurance) were included. Evidence synthesis Our search yielded 2,091 unique articles, 17 of which met the criteria for inclusion. This review found that quitline utilization was higher among Black and Asian/Pacific Islander individuals than among White individuals and among people with lower income and lower education than among people with higher income and higher education. Quitline use was associated with less smoking cessation among females than among males, among American Indian/Alaskan Native individuals than among individuals from all other races and ethnicities, and among individuals of lower than among those of higher income and education. Conclusions This review found that although communities disproportionately affected by smoking utilize quitlines more commonly than their White and more affluent peers, disparities in cessation persist for American Indian/Alaskan Native and individuals from lower SES groups who use quitlines.
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Affiliation(s)
- David C. Colston
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Jennifer L. Cruz
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Bethany J. Simard
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Nancy L. Fleischer
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
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Hartmann‐Boyce J, Hong B, Livingstone‐Banks J, Wheat H, Fanshawe TR. Additional behavioural support as an adjunct to pharmacotherapy for smoking cessation. Cochrane Database Syst Rev 2019; 6:CD009670. [PMID: 31166007 PMCID: PMC6549450 DOI: 10.1002/14651858.cd009670.pub4] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Pharmacotherapies for smoking cessation increase the likelihood of achieving abstinence in a quit attempt. It is plausible that providing support, or, if support is offered, offering more intensive support or support including particular components may increase abstinence further. OBJECTIVES To evaluate the effect of adding or increasing the intensity of behavioural support for people using smoking cessation medications, and to assess whether there are different effects depending on the type of pharmacotherapy, or the amount of support in each condition. We also looked at studies which directly compare behavioural interventions matched for contact time, where pharmacotherapy is provided to both groups (e.g. tests of different components or approaches to behavioural support as an adjunct to pharmacotherapy). SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register, clinicaltrials.gov, and the ICTRP in June 2018 for records with any mention of pharmacotherapy, including any type of nicotine replacement therapy (NRT), bupropion, nortriptyline or varenicline, that evaluated the addition of personal support or compared two or more intensities of behavioural support. SELECTION CRITERIA Randomised or quasi-randomised controlled trials in which all participants received pharmacotherapy for smoking cessation and conditions differed by the amount or type of behavioural support. The intervention condition had to involve person-to-person contact (defined as face-to-face or telephone). The control condition could receive less intensive personal contact, a different type of personal contact, written information, or no behavioural support at all. We excluded trials recruiting only pregnant women and trials which did not set out to assess smoking cessation at six months or longer. DATA COLLECTION AND ANALYSIS For this update, screening and data extraction followed standard Cochrane methods. The main outcome measure was abstinence from smoking after at least six months of follow-up. We used the most rigorous definition of abstinence for each trial, and biochemically-validated rates, if available. We calculated the risk ratio (RR) and 95% confidence interval (CI) for each study. Where appropriate, we performed meta-analysis using a random-effects model. MAIN RESULTS Eighty-three studies, 36 of which were new to this update, met the inclusion criteria, representing 29,536 participants. Overall, we judged 16 studies to be at low risk of bias and 21 studies to be at high risk of bias. All other studies were judged to be at unclear risk of bias. Results were not sensitive to the exclusion of studies at high risk of bias. We pooled all studies comparing more versus less support in the main analysis. Findings demonstrated a benefit of behavioural support in addition to pharmacotherapy. When all studies of additional behavioural therapy were pooled, there was evidence of a statistically significant benefit from additional support (RR 1.15, 95% CI 1.08 to 1.22, I² = 8%, 65 studies, n = 23,331) for abstinence at longest follow-up, and this effect was not different when we compared subgroups by type of pharmacotherapy or intensity of contact. This effect was similar in the subgroup of eight studies in which the control group received no behavioural support (RR 1.20, 95% CI 1.02 to 1.43, I² = 20%, n = 4,018). Seventeen studies compared interventions matched for contact time but that differed in terms of the behavioural components or approaches employed. Of the 15 comparisons, all had small numbers of participants and events. Only one detected a statistically significant effect, favouring a health education approach (which the authors described as standard counselling containing information and advice) over motivational interviewing approach (RR 0.56, 95% CI 0.33 to 0.94, n = 378). AUTHORS' CONCLUSIONS There is high-certainty evidence that providing behavioural support in person or via telephone for people using pharmacotherapy to stop smoking increases quit rates. Increasing the amount of behavioural support is likely to increase the chance of success by about 10% to 20%, based on a pooled estimate from 65 trials. Subgroup analysis suggests that the incremental benefit from more support is similar over a range of levels of baseline support. More research is needed to assess the effectiveness of specific components that comprise behavioural support.
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Affiliation(s)
- Jamie Hartmann‐Boyce
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
| | - Bosun Hong
- Birmingham Dental HospitalOral Surgery Department5 Mill Pool WayBirminghamUKB5 7EG
| | - Jonathan Livingstone‐Banks
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
| | - Hannah Wheat
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
| | - Thomas R Fanshawe
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
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Abstract
BACKGROUND Telephone services can provide information and support for smokers. Counselling may be provided proactively or offered reactively to callers to smoking cessation helplines. OBJECTIVES To evaluate the effect of telephone support to help smokers quit, including proactive or reactive counselling, or the provision of other information to smokers calling a helpline. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register, clinicaltrials.gov, and the ICTRP for studies of telephone counselling, using search terms including 'hotlines' or 'quitline' or 'helpline'. Date of the most recent search: May 2018. SELECTION CRITERIA Randomised or quasi-randomised controlled trials which offered proactive or reactive telephone counselling to smokers to assist smoking cessation. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We pooled studies using a random-effects model and assessed statistical heterogeneity amongst subgroups of clinically comparable studies using the I2 statistic. In trials including smokers who did not call a quitline, we used meta-regression to investigate moderation of the effect of telephone counselling by the planned number of calls in the intervention, trial selection of participants that were motivated to quit, and the baseline support provided together with telephone counselling (either self-help only, brief face-to-face intervention, pharmacotherapy, or financial incentives). MAIN RESULTS We identified 104 trials including 111,653 participants that met the inclusion criteria. Participants were mostly adult smokers from the general population, but some studies included teenagers, pregnant women, and people with long-term or mental health conditions. Most trials (58.7%) were at high risk of bias, while 30.8% were at unclear risk, and only 11.5% were at low risk of bias for all domains assessed. Most studies (100/104) assessed proactive telephone counselling, as opposed to reactive forms.Among trials including smokers who contacted helplines (32,484 participants), quit rates were higher for smokers receiving multiple sessions of proactive counselling (risk ratio (RR) 1.38, 95% confidence interval (CI) 1.19 to 1.61; 14 trials, 32,484 participants; I2 = 72%) compared with a control condition providing self-help materials or brief counselling in a single call. Due to the substantial unexplained heterogeneity between studies, we downgraded the certainty of the evidence to moderate.In studies that recruited smokers who did not call a helpline, the provision of telephone counselling increased quit rates (RR 1.25, 95% CI 1.15 to 1.35; 65 trials, 41,233 participants; I2 = 52%). Due to the substantial unexplained heterogeneity between studies, we downgraded the certainty of the evidence to moderate. In subgroup analysis, we found no evidence that the effect of telephone counselling depended upon whether or not other interventions were provided (P = 0.21), no evidence that more intensive support was more effective than less intensive (P = 0.43), or that the effect of telephone support depended upon whether or not people were actively trying to quit smoking (P = 0.32). However, in meta-regression, telephone counselling was associated with greater effectiveness when provided as an adjunct to self-help written support (P < 0.01), or to a brief intervention from a health professional (P = 0.02); telephone counselling was less effective when provided as an adjunct to more intensive counselling. Further, telephone support was more effective for people who were motivated to try to quit smoking (P = 0.02). The findings from three additional trials of smokers who had not proactively called a helpline but were offered telephone counselling, found quit rates were higher in those offered three to five telephone calls compared to those offered just one call (RR 1.27, 95% CI 1.12 to 1.44; 2602 participants; I2 = 0%). AUTHORS' CONCLUSIONS There is moderate-certainty evidence that proactive telephone counselling aids smokers who seek help from quitlines, and moderate-certainty evidence that proactive telephone counselling increases quit rates in smokers in other settings. There is currently insufficient evidence to assess potential variations in effect from differences in the number of contacts, type or timing of telephone counselling, or when telephone counselling is provided as an adjunct to other smoking cessation therapies. Evidence was inconclusive on the effect of reactive telephone counselling, due to a limited number studies, which reflects the difficulty of studying this intervention.
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Affiliation(s)
| | - José M. Ordóñez‐Mena
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
| | - Jamie Hartmann‐Boyce
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
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Shahani S, Korenblit P, Thomas P, Passannante MR, Carr R, Davis L. Targeted Secure Messages to Facilitate Access to Tobacco Treatment Counseling for Veterans: Feasibility Study. JMIR Ment Health 2018; 5:e18. [PMID: 29506969 PMCID: PMC5859788 DOI: 10.2196/mental.7957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/26/2017] [Accepted: 02/12/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Studies show that combining nicotine replacement therapy (NRT) with tobacco treatment counseling is most effective for smoking cessation. However, tobacco treatment counseling has been underutilized across the nation. A secure email message sent to patients already taking NRT was hypothesized to increase the utilization of tobacco treatment counseling among Veterans in New Jersey. Secure messaging for communication between patients and providers was implemented through a web-based password-protected, secure messaging account, where veterans get notified through their personal email when they have a message awaiting them. OBJECTIVE The main objective of this project was to determine if there was a significant increase in adoption of tobacco treatment counseling among Veterans who received a secure message describing the options for tobacco treatment counseling available to them. Secondary objectives were to demographically characterize Veterans who were and were not enrolled in secure messaging, as well as those who opened or did not open a message. Finally, because the language and content of the messages were changed across project phases, this project also sought to determine (by analysis of response rates) the type of language that was most effective at eliciting a response. METHODS Over two phases, messages were sent to two samples of Veterans prescribed NRT within the prior 90 days of each phase. In phase 1, one message was sent in December 2015 (message 1). In phase 2, one message was sent in July 2016 (message 2) and the same message (message 3) was resent in August 2016 to persons who did not open message 2. Messages 2 and 3 were more directive than message 1. Response rates to message 1 versus message 2 were compared. A logistic regression analysis determined effect of age and gender on enrollment in secure messaging across both phases. The effectiveness of each phase at increasing tobacco treatment counseling was analyzed using a McNemar test. RESULTS Message 2, sent to 423 Veterans, had a significantly higher response rate than message 1, sent to 348 Veterans (18%, 17/93 vs 8%, 6/78, P=.04). Phase 2 (ie, messages 2 and 3) significantly increased utilization of tobacco treatment counseling (net increase of six tobacco treatment counseling adopters, P=.04), whereas phase 1 (ie, message 1) did not (net increase of two tobacco treatment counseling adopters, P=.48). Women (odds ratio [OR] 1.6, 95% CI 1.1-2.3) and those aged 30 to 49 years (compared to other age groups) were more likely to be enrolled in secure messaging. Gender and age were not significant predictors of opening or replying to either message. CONCLUSIONS Although the effect was small, secure messaging was a useful modality to increase tobacco treatment counseling. Directive content with a follow-up message appeared useful. Female Veterans and/or Veterans aged between 30 and 49 years are more likely to use secure messaging.
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Affiliation(s)
- Shaun Shahani
- Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Pearl Korenblit
- Veterans Affairs New Jersey Health Care System, East Orange, NJ, United States
| | - Pauline Thomas
- Rutgers New Jersey Medical School, Newark, NJ, United States
| | | | - Richard Carr
- Veterans Affairs New Jersey Health Care System, East Orange, NJ, United States
| | - Lynn Davis
- Veterans Affairs New Jersey Health Care System, East Orange, NJ, United States
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Sherman SE, Krebs P, York LS, Cummins SE, Kuschner W, Guvenc-Tuncturk S, Zhu SH. Telephone care co-ordination for tobacco cessation: randomised trials testing proactive versus reactive models. Tob Control 2017; 27:78-82. [PMID: 28190003 DOI: 10.1136/tobaccocontrol-2016-053327] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 12/28/2016] [Accepted: 01/04/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVES We conducted two parallel studies evaluating the effectiveness of proactive and reactive engagement approaches to telephone treatment for smoking cessation. METHODS Patients who smoked and were interested in quitting were referred to this study and were eligible if they were current smokers and had an address and a telephone number. The data were collected at 35 Department of Veterans Affairs (VA) sites, part of four VA medical centres in both California and Nevada. In study 1, participants received multisession counselling from the California Smokers' Helpline (quitline). In study 2, they received self-help materials only. Patients were randomly assigned by week to either proactive or reactive engagement, and primary care staff were blind to this assignment. Providers gave brief advice and referred them via the electronic health record to a tobacco co-ordinator. All patients were offered cessation medications. OUTCOME Using complete case analysis, in study 1 (quitline), patients in the proactive condition were more likely than those in the reactive condition to report abstinence at 6 months (21.0% vs 16.4%, p=0.03). No difference was found between conditions in study 2 (self-help) (16.9% vs 16.5%, p=0.88). Proactive outreach resulted in increased use of cessation medications in both the quitline (70.1% vs 57.6%, p<0.0001) and the self-help studies (74.5% vs 48.2%, p<0.0001). CONCLUSION Proactive outreach with quitline intervention was associated with greater long-term abstinence. Both studies resulted in high rates of medication use. Sites should use a proactive outreach approach and provide counselling whenever possible. TRIAL REGISTRATION NUMBER NCT00123682.
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Affiliation(s)
- Scott E Sherman
- VA NY Harbor Healthcare System, New York, New York, USA.,Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Paul Krebs
- VA NY Harbor Healthcare System, New York, New York, USA.,Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Laura S York
- Department of Veterans Affairs, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Sharon E Cummins
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, San Diego, California, USA
| | - Ware Kuschner
- VA Palo Alto Healthcare System, Palo Alto, California, USA.,Department of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Sebnem Guvenc-Tuncturk
- Department of Pulmonary and Critical Care Medicine, VA Palo Alto Healthcare System, Palo Alto, California, USA
| | - Shu-Hong Zhu
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, San Diego, California, USA
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Richter KP, Faseru B, Shireman TI, Mussulman LM, Nazir N, Bush T, Scheuermann TS, Preacher KJ, Carlini BH, Magnusson B, Ellerbeck EF, Cramer C, Cook DJ, Martell MJ. Warm Handoff Versus Fax Referral for Linking Hospitalized Smokers to Quitlines. Am J Prev Med 2016; 51:587-96. [PMID: 27647059 PMCID: PMC5031370 DOI: 10.1016/j.amepre.2016.04.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 03/29/2016] [Accepted: 04/04/2016] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Few hospitals treat patients' tobacco dependence. To be effective, hospital-initiated cessation interventions must provide at least 1 month of supportive contact post-discharge. STUDY DESIGN Individually randomized clinical trial. Recruitment commenced July 2011; analyses were conducted October 2014-June 2015. SETTING/PARTICIPANTS The study was conducted in two large Midwestern hospitals. Participants included smokers who were aged ≥18 years, planned to stay quit after discharge, and spoke English or Spanish. INTERVENTION Hospital-based cessation counselors delivered the intervention. For patients randomized to warm handoff, staff immediately called the quitline from the bedside and handed the phone to participants for enrollment and counseling. Participants randomized to fax were referred on the day of hospital discharge. MAIN OUTCOME MEASURES Outcomes at 6 months included quitline enrollment/adherence, medication use, biochemically verified cessation, and cost effectiveness. RESULTS Significantly more warm handoff than fax participants enrolled in quitline (99.6% vs 59.6%; relative risk, 1.67; 95% CI=1.65, 1.68). One in four (25.4% warm handoff, 25.3% fax) were verified to be abstinent at 6-month follow-up; this did not differ significantly between groups (relative risk, 1.02; 95% CI=0.82, 1.24). Cessation medication use in the hospital and receipt of a prescription for medication at discharge did not differ between groups; however, significantly more fax participants reported using cessation medication post-discharge (32% vs 25%, p=0.01). The average incremental cost-effectiveness ratio of enrolling participants into warm handoff was $0.14. Hospital-borne costs were significantly lower in warm handoff than in fax ($5.77 vs $9.41, p<0.001). CONCLUSIONS One in four inpatient smokers referred to quitline by either method were abstinent at 6 months post-discharge. Among motivated smokers, fax referral and warm handoff are efficient and comparatively effective ways to link smokers with evidence-based care. For hospitals, warm handoff is a less expensive and more effective method for enrolling smokers in quitline services.
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Affiliation(s)
- Kimber P Richter
- Department of Preventive Medicine and Public Health and The University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, Kansas.
| | - Babalola Faseru
- Department of Preventive Medicine and Public Health and The University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, Kansas
| | - Theresa I Shireman
- Department of Health Services, Policy, and Practice, Brown University, Providence, Rhode Island
| | - Laura M Mussulman
- Department of Preventive Medicine and Public Health and The University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, Kansas
| | - Niaman Nazir
- Department of Preventive Medicine and Public Health and The University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, Kansas
| | | | - Taneisha S Scheuermann
- Department of Preventive Medicine and Public Health and The University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, Kansas
| | - Kristopher J Preacher
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee
| | - Beatriz H Carlini
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, Washington
| | | | - Edward F Ellerbeck
- Department of Preventive Medicine and Public Health and The University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, Kansas
| | - Carol Cramer
- Tobacco Use Prevention, Kansas Department of Health and Environment, Topeka, Kansas
| | - David J Cook
- Department of Health Policy and Management, University of Kansas Medical Center, Kansas City, Kansas
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Bush T, Lovejoy J, Javitz H, Magnusson B, Torres AJ, Mahuna S, Benedict C, Wassum K, Spring B. Comparative effectiveness of adding weight control simultaneously or sequentially to smoking cessation quitlines: study protocol of a randomized controlled trial. BMC Public Health 2016; 16:615. [PMID: 27443485 PMCID: PMC4957297 DOI: 10.1186/s12889-016-3231-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 05/10/2016] [Indexed: 11/18/2022] Open
Abstract
Background Prevalence of multiple health risk behaviors is growing, and obesity and smoking are costly. Weight gain associated with quitting smoking is common and can interfere with quit success. Efficacy of adding weight management to tobacco cessation treatment has been tested with women in group sessions over an extended period of time, but has never been tested in real-world settings with men and women seeking help to quit. This paper describes the Best Quit study which tests the effectiveness of delivering tobacco and weight control interventions via existing quitline infrastructures. Methods Eligible and consenting smokers (n = 2550) who call a telephone quitline will be randomized to one of three groups; the standard quitline or standard quitline plus a weight management program added either simultaneously or sequentially to the tobacco program. The study aims to test: 1) the effectiveness of the combined intervention on smoking cessation and weight, 2) the cost-effectiveness of the combined intervention on cessation and weight and 3) theoretically pre-specified mediators of treatment effects on cessation: reduced weight concerns, increased outcome expectancies about quitting and improved self-efficacy about quitting without weight gain. Baseline, 6 month and 12 month data will be analyzed using multivariate statistical analyses and groups will be compared on treatment adherence, quit rates and change in weight among abstinent participants. To determine if the association between group assignment and primary outcomes (30-day abstinence and change in weight at 6 months) is moderated by pre-determined baseline and process measures, interaction terms will be included in the regression models and their significance assessed. Discussion This study will generate information to inform whether adding weight management to a tobacco cessation intervention delivered by phone, mail and web for smokers seeking help to quit will help or harm quit rates and whether a simultaneous or sequential approach is better at increasing abstinence and reducing weight gain post quit. If proven effective, the combined intervention could be disseminated across the U.S. through quitlines and could encourage additional smokers who have not sought cessation treatment for fear of gaining weight to make quit attempts. Trial registration Clinicaltrials.gov NCT01867983. Registered: May 30, 2013 Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3231-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Terry Bush
- Alere Wellbeing (now Optum), 999 3rd Ave, Seattle, WA, 98104-1139, USA.
| | - Jennifer Lovejoy
- Arivale, Inc. and University of Washington School of Public Health, 616 First Ave, Suite 700, Seattle, WA, 98104, USA
| | - Harold Javitz
- SRI International, 333 Ravenswood Ave, Menlo Park, CA, 94025-3493, USA
| | - Brooke Magnusson
- Alere Wellbeing (now Optum), 999 3rd Ave, Seattle, WA, 98104-1139, USA
| | | | - Stacey Mahuna
- Alere Wellbeing (now Optum), 999 3rd Ave, Seattle, WA, 98104-1139, USA
| | - Cody Benedict
- Bill and Melinda Gates Foundation, 440 5th Ave N, Seattle, WA, 98109, USA
| | - Ken Wassum
- Alere Wellbeing (now Optum), 999 3rd Ave, Seattle, WA, 98104-1139, USA
| | - Bonnie Spring
- Center for Behavior and Health, Feinberg School of Medicine, Northwestern University, 680 N. Lakeshore Drive, Suite 1220, Chicago, IL, 0611-8708, USA
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Abstract
This article reviews the online-counseling literature with an emphasis on current applications and considerations for future research. It focuses on primary themes of counseling psychology including the history of process-outcome research and multiculturalism. It explores current gaps in the literature from a counseling psychology framework, including the field’s focus on normal and developmental challenges and tasks, client strength and resilience, education and career development, prevention and wellness, and multiculturalism. In general, current evidence indicates that online counseling may be a viable service option for some clients, especially those who are typically isolated; however, questions remain regarding the effectiveness and appropriateness of online counseling.
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Unrod M, Simmons VN, Sutton SK, Cummings KM, Celestino P, Craig BM, Lee JH, Meltzer LR, Brandon TH. Relapse-Prevention Booklets as an Adjunct to a Tobacco Quitline: A Randomized Controlled Effectiveness Trial. Nicotine Tob Res 2016; 18:298-305. [PMID: 25847293 PMCID: PMC4757931 DOI: 10.1093/ntr/ntv079] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 03/26/2015] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Relapse prevention (RP) remains a major challenge to smoking cessation. Previous research found that a set of self-help RP booklets significantly reduced smoking relapse. This study tested the effectiveness of RP booklets when added to the existing services of a telephone quitline. METHODS Quitline callers (N = 3458) were enrolled after their 2-week quitline follow-up call and randomized to one of three interventions: (1) Usual Care: standard intervention provided by the quitline, including brief counseling and nicotine replacement therapy; (2) Repeated Mailings (RM): eight Forever Free RP booklets sent to participants over 12 months; and (3) Massed Mailings: all eight Forever Free RP booklets sent upon enrollment. Follow-ups were conducted at 6-month intervals, through 24 months. The primary outcome measure was 7-day-point-prevalence-abstinence. RESULTS Overall abstinence rates were 61.0% at baseline, and 41.9%, 42.7%, 44.0%, and 45.9% at the 6-, 12-, 18- and 24-month follow-ups, respectively. Although RM produced higher abstinence rates, the differences did not reach significance for the full sample. Post-hoc analyses of at-risk subgroups revealed that among participants with high nicotine dependence (n = 1593), the addition of RM materials increased the abstinence rate at 12 months (42.2% vs. 35.2%; OR = 1.38; 95% CI = 1.03% to 1.85%; P = .031) and 24 months (45% vs. 38.8%; OR = 1.31; 95% CI = 1.01% to 1.73%; P = .046). CONCLUSIONS Sending self-help RP materials to all quitline callers appears to provide little benefit to deterring relapse. However, selectively sending RP booklets to callers explicitly seeking assistance for RP and those identified as highly dependent on nicotine might still prove to be worthwhile.
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Affiliation(s)
- Marina Unrod
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Department of Psychology, University of South Florida, Tampa, FL
| | - Vani N Simmons
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Department of Psychology, University of South Florida, Tampa, FL
| | - Steven K Sutton
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Paula Celestino
- Department of Health Behavior Roswell Park Cancer Institute, Buffalo, NY
| | - Benjamin M Craig
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Department of Psychology, University of South Florida, Tampa, FL
| | - Ji-Hyun Lee
- Department of Internal Medicine University of New Mexico Cancer Center, Albuquerque, NM
| | - Lauren R Meltzer
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Department of Psychology, University of South Florida, Tampa, FL
| | - Thomas H Brandon
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Department of Psychology, University of South Florida, Tampa, FL;
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Piper ME, Fiore MC, Smith SS, Fraser D, Bolt DM, Collins LM, Mermelstein R, Schlam TR, Cook JW, Jorenby DE, Loh WY, Baker TB. Identifying effective intervention components for smoking cessation: a factorial screening experiment. Addiction 2016; 111:129-41. [PMID: 26582269 PMCID: PMC4699315 DOI: 10.1111/add.13162] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 04/21/2015] [Accepted: 09/08/2015] [Indexed: 11/30/2022]
Abstract
AIMS To identify promising intervention components intended to help smokers to attain and maintain abstinence in their quit smoking attempts. DESIGN A fully crossed, six-factor randomized fractional factorial experiment. SETTING Eleven primary care clinics in southern Wisconsin, USA. PARTICIPANTS A total of 637 adult smokers (55% women, 88% white) motivated to quit smoking who visited primary care clinics. INTERVENTIONS Six intervention components designed to prepare smokers to quit, and achieve and maintain abstinence (i.e. for the preparation, cessation and maintenance phases of smoking treatment): (1) preparation nicotine patch versus none; (2) preparation nicotine gum versus none; (3) preparation counseling versus none; (4) intensive cessation in-person counseling versus minimal; (5) intensive cessation telephone counseling versus minimal; and (6) 16 versus 8 weeks of combination nicotine replacement therapy (nicotine patch + nicotine gum). MEASUREMENTS Seven-day self-reported point-prevalence abstinence at 16 weeks. FINDINGS Preparation counseling significantly improved week 16 abstinence rates (P = .04), while both forms of preparation nicotine replacement therapy interacted synergistically with intensive cessation in-person counseling (P < 0.05). Conversely, intensive cessation phone counseling and intensive cessation in-person counseling interacted antagonistically (P < 0.05)-these components produced higher abstinence rates by themselves than in combination. CONCLUSIONS Preparation counseling and the combination of intensive cessation in-person counseling with preparation nicotine gum or patch are promising intervention components for smoking and should be evaluated as an integrated treatment package.
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Affiliation(s)
- Megan E Piper
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, Madison, WI, USA
| | - Michael C Fiore
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, Madison, WI, USA
| | - Stevens S Smith
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, Madison, WI, USA
| | - David Fraser
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Daniel M Bolt
- University of Wisconsin, Department of Educational Psychology, Madison, WI, USA
| | - Linda M Collins
- The Methodology Center, The Pennsylvania State University, University Park, PA, USA
| | - Robin Mermelstein
- University of Illinois at Chicago, Institute for Health Research and Policy, Chicago, IL, USA
| | - Tanya R Schlam
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, Madison, WI, USA
| | - Jessica W Cook
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, Madison, WI, USA
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Douglas E Jorenby
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, Madison, WI, USA
| | - Wei-Yin Loh
- University of Wisconsin, Department of Statistics, Madison, WI, USA
| | - Timothy B Baker
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, Madison, WI, USA
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Stead LF, Koilpillai P, Lancaster T. Additional behavioural support as an adjunct to pharmacotherapy for smoking cessation. Cochrane Database Syst Rev 2015:CD009670. [PMID: 26457723 DOI: 10.1002/14651858.cd009670.pub3] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Effective pharmacotherapies are available to help people who are trying to stop smoking, but quitting can still be difficult and providing higher levels of behavioural support may increase success rates further. OBJECTIVES To evaluate the effect of increasing the intensity of behavioural support for people using smoking cessation medications, and to assess whether there are different effects depending on the type of pharmacotherapy, or the amount of support in each condition. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register in May 2015 for records with any mention of pharmacotherapy, including any type of nicotine replacement therapy (NRT), bupropion, nortriptyline or varenicline that evaluated the addition of personal support or compared two or more intensities of behavioural support. SELECTION CRITERIA Randomized or quasi-randomized controlled trials in which all participants received pharmacotherapy for smoking cessation and conditions differed by the amount of behavioural support. The intervention condition had to involve person-to-person contact. The control condition could receive less intensive personal contact, or just written information. We did not include studies that used a contact-matched control to evaluate differences between types or components of support. We excluded trials recruiting only pregnant women, trials recruiting only adolescents, and trials with less than six months follow-up. DATA COLLECTION AND ANALYSIS One author prescreened search results and two authors agreed inclusion or exclusion of potentially relevant trials. One author extracted data and another checked them.The main outcome measure was abstinence from smoking after at least six months of follow-up. We used the most rigorous definition of abstinence for each trial, and biochemically-validated rates if available. We calculated the risk ratio (RR) and 95% confidence interval (CI) for each study. Where appropriate, we performed meta-analysis using a Mantel-Haenszel fixed-effect model. MAIN RESULTS Forty-seven studies met the inclusion criteria with over 18,000 participants in the relevant arms. There was little evidence of statistical heterogeneity (I² = 18%) so we pooled all studies in the main analysis. There was evidence of a small but statistically significant benefit from more intensive support (RR 1.17, 95% CI 1.11 to 1.24) for abstinence at longest follow-up. All but four of the included studies provided four or more sessions of support to the intervention group. Most trials used NRT. We did not detect significant effects for studies where the pharmacotherapy was nortriptyline (two trials) or varenicline (one trial), but this reflects the absence of evidence.In subgroup analyses, studies that provided at least four sessions of personal contact for the intervention and no personal contact for the control had slightly larger estimated effects (RR 1.25, 95% CI 1.08 to 1.45; 6 trials, 3762 participants), although a formal test for subgroup differences was not significant. Studies where all intervention counselling was via telephone (RR 1.28, 95% CI 1.17 to 1.41; 6 trials, 5311 participants) also had slightly larger effects, and the test for subgroup differences was significant, but this subgroup analysis was not prespecified. In this update, the benefit of providing additional behavioural support was similar for the subgroup of trials in which all participants, including controls, had at least 30 minutes of personal contact (RR 1.18, 95% CI 1.06 to 1.32; 21 trials, 5166 participants); previously the evidence of benefit in this subgroup had been weaker. This subgroup was not prespecified and a test for subgroup differences was not significant. We judged the quality of the evidence to be high, using the GRADE approach. We judged a small number of trials to be at high risk of bias on one or more domains, but findings were not sensitive to their exclusion. AUTHORS' CONCLUSIONS Providing behavioural support in person or via telephone for people using pharmacotherapy to stop smoking has a small but important effect. Increasing the amount of behavioural support is likely to increase the chance of success by about 10% to 25%, based on a pooled estimate from 47 trials. Subgroup analysis suggests that the incremental benefit from more support is similar over a range of levels of baseline support.
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Affiliation(s)
- Lindsay F Stead
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, UK, OX2 6GG
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Shelley D, VanDevanter N, Cleland CC, Nguyen L, Nguyen N. Implementing tobacco use treatment guidelines in community health centers in Vietnam. Implement Sci 2015; 10:142. [PMID: 26453554 PMCID: PMC4600252 DOI: 10.1186/s13012-015-0328-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 09/18/2015] [Indexed: 11/29/2022] Open
Abstract
Background Vietnam has a smoking prevalence that is the second highest among Southeast Asian countries (SEACs). According to the World Health Organization (WHO), most reductions in mortality from tobacco use in the near future will be achieved through helping current users quit. Yet, largely due to a lack of research on strategies for implementing WHO-endorsed treatment guidelines in primary care settings, services to treat tobacco dependence are not readily available to smokers in low middle-income countries (LMICs) like Vietnam. The objective of this study is to conduct a cluster randomized controlled trial that compares the effectiveness of two system-level strategies for implementing evidence-based guidelines for the treatment of tobacco use in 26 public community health centers (CHCs) in Vietnam. Methods/Design The current study will use a cluster-randomized design and multiple data sources (patient exit interviews, provider and village health worker (VHW) surveys, and semi-structured provider/VHW interviews) to study the process of adapting and implementing clinical practice guidelines in Vietnam and theory-driven mechanisms hypothesized to explain the comparative effectiveness of the two strategies for implementation. CHCs will be randomly assigned to either of the following: (1) training plus clinical reminder system (TC) or (2) TC + referral to a VHW (TCR) for three in person counseling sessions. The primary outcome is provider adherence to tobacco use treatment guidelines. The secondary outcome is 6-month biochemically verified smoking abstinence. Discussion The proposed implementation strategies draw on evidence-based approaches and a growing literature that supports the effectiveness of integrating community health workers as members of the health care team to improve access to preventive services. We hypothesize that the value of these implementation strategies is additive and that incorporating a referral resource that allows providers to delegate the task of offering counseling (TCR) will be superior to TC alone in improving delivery of cessation assistance to smokers. The findings of this research have potential to guide large-scale adoption of promising strategies for implementing and disseminating tobacco use treatment guidelines throughout the public health system in Vietnam and will serve as a model for similar action in other LMICs. Trial registration NCT01967654 Electronic supplementary material The online version of this article (doi:10.1186/s13012-015-0328-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Donna Shelley
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, 7th floor, New York, NY, 10016, USA.
| | - Nancy VanDevanter
- New York University College of Nursing, 433 First Ave, New York, NY, 10010, USA.
| | - Charles C Cleland
- Center for Drug Use and HIV Research, New York University College of Nursing, 433 First Ave, New York, NY, 10010, USA.
| | - Linh Nguyen
- Institute of Social Medical Studies, No. 18, Lot 12B, Trung Yen 10, Trung Hoa, Cau Giay District, Hanoi, Vietnam.
| | - Nam Nguyen
- Institute of Social Medical Studies, No. 18, Lot 12B, Trung Yen 10, Trung Hoa, Cau Giay District, Hanoi, Vietnam.
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Abstract
BACKGROUND Telephone services can provide information and support for smokers. Counselling may be provided proactively or offered reactively to callers to smoking cessation helplines. OBJECTIVES To evaluate the effect of proactive and reactive telephone support via helplines and in other settings to help smokers quit. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register for studies of telephone counselling, using search terms including 'hotlines' or 'quitline' or 'helpline'. Date of the most recent search: May 2013. SELECTION CRITERIA randomized or quasi-randomised controlled trials in which proactive or reactive telephone counselling to assist smoking cessation was offered to smokers or recent quitters. DATA COLLECTION AND ANALYSIS One author identified and data extracted trials, and a second author checked them. The main outcome measure was the risk ratio for abstinence from smoking after at least six months follow-up. We selected the strictest measure of abstinence, using biochemically validated rates where available. We considered participants lost to follow-up to be continuing smokers. Where trials had more than one arm with a less intensive intervention we used only the most similar intervention without the telephone component as the control group in the primary analysis. We assessed statistical heterogeneity amongst subgroups of clinically comparable studies using the I² statistic. We considered trials recruiting callers to quitlines separately from studies recruiting in other settings. Where appropriate, we pooled studies using a fixed-effect model. We used a meta-regression to investigate the effect of differences in planned number of calls, selection for motivation, and the nature of the control condition (self help only, minimal intervention, pharmacotherapy) in the group of studies recruiting in non-quitline settings. MAIN RESULTS Seventy-seven trials met the inclusion criteria. Some trials were judged to be at risk of bias in some domains but overall we did not judge the results to be at high risk of bias. Among smokers who contacted helplines, quit rates were higher for groups randomized to receive multiple sessions of proactive counselling (nine studies, > 24,000 participants, risk ratio (RR) for cessation at longest follow-up 1.37, 95% confidence interval (CI) 1.26 to 1.50). There was mixed evidence about whether increasing the number of calls altered quit rates but most trials used more than two calls. Three studies comparing different counselling approaches during a single quitline contact did not detect significant differences. Of three studies that tested the provision of access to a hotline two detected a significant benefit and one did not.Telephone counselling not initiated by calls to helplines also increased quitting (51 studies, > 30,000 participants, RR 1.27; 95% CI 1.20 to 1.36). In a meta-regression controlling for other factors the effect was estimated to be slightly larger if more calls were offered, and in trials that specifically recruited smokers motivated to try to quit. The relative extra benefit of counselling was smaller when it was provided in addition to pharmacotherapy (usually nicotine replacement therapy) than when the control group only received self-help material or a brief intervention.A further eight studies were too diverse to contribute to meta-analyses and are discussed separately. Two compared different intensities of counselling, both of which detected a dose response; one of these detected a benefit of multiple counselling sessions over a single call for people prescribed bupropion. The others tested a variety of interventions largely involving offering telephone counselling as part of a referral or systems change and none detected evidence of effect. AUTHORS' CONCLUSIONS Proactive telephone counselling aids smokers who seek help from quitlines. Telephone quitlines provide an important route of access to support for smokers, and call-back counselling enhances their usefulness. There is limited evidence about the optimal number of calls. Proactive telephone counselling also helps people who receive it in other settings. There is some evidence of a dose response; one or two brief calls are less likely to provide a measurable benefit. Three or more calls increase the chances of quitting compared to a minimal intervention such as providing standard self-help materials, or brief advice, or compared to pharmacotherapy alone.
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Affiliation(s)
- Lindsay F Stead
- Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, UK, OX2 6GG
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Vidrine JI, Shete S, Cao Y, Greisinger A, Harmonson P, Sharp B, Miles L, Zbikowski SM, Wetter DW. Ask-Advise-Connect: a new approach to smoking treatment delivery in health care settings. JAMA Intern Med 2013; 173:458-64. [PMID: 23440173 PMCID: PMC3858085 DOI: 10.1001/jamainternmed.2013.3751] [Citation(s) in RCA: 181] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Several national health care-based smoking cessation initiatives have been recommended to facilitate the delivery of evidence-based treatments, such as quitline (telephone-based tobacco cessation services) assistance. The most notable examples are the 5 As (Ask, Advise, Assess, Assist, Arrange) and Ask. Advise. Refer. (AAR) programs. Unfortunately, rates of primary care referrals to quitlines are low, and most referred smokers fail to call for assistance. OBJECTIVE To evaluate a new approach--Ask-Advise-Connect (AAC)--designed to address barriers to linking smokers with treatment. DESIGN A pair-matched, 2-treatment-arm, group-randomized design in 10 family practice clinics in a single metropolitan area. Five clinics were randomized to the AAC (intervention) and 5 to the AAR (control) conditions. In both conditions, clinic staff were trained to assess and record the smoking status of all patients at all visits in the electronic health record, and smokers were given brief advice to quit. In the AAC clinics, the names and telephone numbers of smokers who agreed to be connected were sent electronically to the quitline daily, and patients were called proactively by the quitline within 48 hours. In the AAR clinics, smokers were offered a quitline referral card and encouraged to call on their own. All data were collected from February 8 through December 27, 2011. SETTING Ten clinics in Houston, Texas. PARTICIPANTS Smoking status assessments were completed for 42,277 patients; 2052 unique smokers were identified at AAC clinics, and 1611 smokers were identified at AAR clinics. INTERVENTIONS Linking smokers with quitline-delivered treatment. MAIN OUTCOME MEASURE Impact was based on the RE-AIM (Reach, Efficacy, Adoption, Implementation, and Maintenance) conceptual framework and defined as the proportion of all identified smokers who enrolled in treatment. RESULTS In the AAC clinics, 7.8% of all identified smokers enrolled in treatment vs 0.6% in the AAR clinics (t4 = 9.19 [P < .001]; odds ratio, 11.60 [95% CI, 5.53-24.32]), a 13-fold increase in the proportion of smokers enrolling in treatment. CONCLUSIONS AND RELEVANCE The system changes implemented in the AAC approach could be adopted broadly by other health care systems and have tremendous potential to reduce tobacco-related morbidity and mortality.
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Affiliation(s)
- Jennifer Irvin Vidrine
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1440, Houston, TX 77030, USA.
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Provan KG, Beagles JE, Mercken L, Leischow SJ. Awareness of Evidence-Based Practices by Organizations in a Publicly Funded Smoking Cessation Network. JOURNAL OF PUBLIC ADMINISTRATION RESEARCH AND THEORY : J-PART 2013; 23:133-153. [PMID: 25484551 PMCID: PMC4254734 DOI: 10.1093/jopart/mus011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This research examines the awareness of evidence based practices by the public organizations that fund services in the North American Quitline Consortium (NAQC). NAQC is a large, publicly funded, goal-directed "whole network," spanning both Canada and the U.S., working to get people to quit smoking. Building on prior research on the dissemination and diffusion of innovation and evidence based practices, and considering differences between network ties that are homophilous versus instrumental, we found that awareness of evidence based practices was highest for quitline funders that were strongly connected directly to researchers and indirectly to the network administrative organization, controlling for quitline spending per capita and decision making locus of control. The findings support the importance of maintaining instrumental (a technical-rational argument) rather than homophilous ties for acquisition of evidence based practice knowledge. The findings also offer ideas for how public networks might be designed and governed to enhance the likelihood that the organizations in the network are better aware of what evidence based practices exist.
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Affiliation(s)
- Keith G Provan
- Eller College of Management and School of Government & Public Policy 1130 E. Helen Street, McClelland Hall University of Arizona Tucson, AZ 85721 ( )
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Abstract
BACKGROUND Effective pharmacotherapies are available to help people who are trying to stop smoking, but quitting can still be difficult and providing higher levels of behavioural support may increase success rates further. OBJECTIVES To evaluate the effect of increasing the intensity of behavioural support for people using smoking cessation medications, and to assess whether there are different effects depending on the type of pharmacotherapy, or the amount of support in each condition. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register in July 2012 for records with any mention of pharmacotherapy, including any type of NRT, bupropion, nortriptyline or varenicline that evaluated the addition of personal support or compared two or more intensities of behavioural support. SELECTION CRITERIA Randomized or quasi-randomized controlled trials in which all participants received pharmacotherapy for smoking cessation and conditions differed by the amount of behavioural support. Controls could receive less intensive personal contact, or just written information. We did not include studies that used a contact matched control to evaluate differences between types or components of support. We excluded trials recruiting only pregnant women, trials recruiting only adolescents, and trials with less than six months follow-up. DATA COLLECTION AND ANALYSIS Search results were prescreened by one author and inclusion or exclusion of potentially relevant trials was agreed by both authors. Data were extracted by one author and checked by the other.The main outcome measure was abstinence from smoking after at least six months of follow-up. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. We calculated the risk ratio (RR) and 95% confidence interval (CI) for each study. Where appropriate, we performed meta-analysis using a Mantel-Haenszel fixed-effect model. MAIN RESULTS Thirty-eight studies met the inclusion criteria with over 15,000 participants in the relevant arms. There was very little evidence of statistical heterogeneity (I² = 3%) so all studies were pooled in the main analysis. There was evidence of a small but statistically significant benefit from more intensive support (RR 1.16, 95% CI 1.09 to 1.24) for abstinence at longest follow-up. All but two of the included studies provided four or more sessions of support. Most trials used nicotine replacement therapy. Significant effects were not detected for studies where the pharmacotherapy was nortriptyline (two trials) or varenicline (one trial), but this reflects the absence of evidence. In subgroup analyses, studies that provided at least four sessions of personal contact for the intervention and no personal contact for the control had slightly larger effects (six trials, RR 1.25, 95% CI 1.08 to 1.45), as did studies where all intervention counselling was via telephone (six trials, RR 1.28, 95% CI 1.17 to 1.41). Weaker evidence for a benefit of providing additional behavioural support was seen in the trials where all participants, including those in the control condition, had at least 30 minutes of personal contact (18 trials, RR 1.11, 95% CI 0.99 to 1.25). None of the differences between subgroups were significant, and the last two subgroup analyses were not prespecified. No trials were judged at high risk of bias on any domain. AUTHORS' CONCLUSIONS Providing behavioural support in person or via telephone for people using pharmacotherapy to stop smoking has a small but important effect. Increasing the amount of behavioural support is likely to increase the chance of success by about 10 to 25%, based on a pooled estimate from 38 trials. A subgroup analysis of a small number of trials suggests the benefit could be a little greater when the contrast is between a no contact control and a behavioural intervention that provides at least four sessions of contact. Subgroup analysis also suggests that there may be a smaller incremental benefit from providing even more intensive support via more or longer sessions over and above some personal contact.
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Affiliation(s)
- Lindsay F Stead
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
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Enhancing dissemination of smoking cessation quitlines through T2 translational research: a unique partnership to address disparities in the delivery of effective cessation treatment. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2012; 16:304-8. [PMID: 20520368 DOI: 10.1097/phh.0b013e3181cbc500] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Burns EK, Levinson AH, Deaton EA. Factors in Nonadherence to Quitline Services. HEALTH EDUCATION & BEHAVIOR 2012; 39:596-602. [DOI: 10.1177/1090198111425186] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Quitlines offer evidence-based, multisession coaching support for smoking cessation in the 50 U.S. states, Canada, and several other countries. Smokers who enroll in quitline services have, ipso facto, shown readiness to attempt to quit, but noncompletion of coaching services appears widespread and has not been widely investigated. The current study explored the magnitude and correlates of quitline service abandonment. Method. A state’s quitline intake, coaching, and nicotine patch/gum utilization data were obtained for smokers who enrolled during the period July 2007 to June 2008 ( n = 20,882). Analyses examined demographic, socioeconomic status, nicotine dependence-related, and nicotine replacement therapy—utilization factors associated with completion of only one coaching session (of five offered). Results. Almost half of enrollees (47.8%) completed only one session. All significant predictors together explained less than 4% of variance; not being sent nicotine replacement therapy was most strongly correlated with completion of only one session. A framework is proposed for directing research toward reducing quitline service nonadherence. Conclusions. Premature user abandonment of coaching calls is widespread within a quitline. Further research should determine the extent of the problem in national quitline systems, increase knowledge of mediators of nonadherence, and develop strategies for increasing coaching completion.
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Reese RJ, Conoley CW, Brossart DF. The Attractiveness of Telephone Counseling: An Empirical Investigation of Client Perceptions. JOURNAL OF COUNSELING AND DEVELOPMENT 2011. [DOI: 10.1002/j.1556-6678.2006.tb00379.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Sussman S, Sun P, Rohrbach LA, Spruijt-Metz D. One-year outcomes of a drug abuse prevention program for older teens and emerging adults: evaluating a motivational interviewing booster component. Health Psychol 2011; 31:476-85. [PMID: 21988096 DOI: 10.1037/a0025756] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The present study tested the efficacy of motivational interviewing-based booster sessions for Project Toward No Drug Abuse (TND), a 12-session school-based curriculum targeting youth at risk for drug abuse. In addition, generalization of effects to risky sexual behavior was assessed. The 1-year outcomes evaluation of the project is presented. METHOD A total of 24 schools were randomized to one of three conditions: standard care control (SCC), TND classroom program only (TND-only), and TND plus motivational interviewing booster (TND + MI). A total of 1186 participants completed baseline and 1-year follow-up surveys. Following the classroom program, youth in the TND + MI condition received up to 3 sessions of MI in person or by telephone. Effects were examined on 30-day cigarette, alcohol, marijuana, and hard drug use, as well as measures of risky sexual behavior (number of sex partners, condom use, having sex while using drugs or alcohol). RESULTS Collapsed across the 2 program conditions, results showed significant reductions in alcohol use, hard drug use, and cigarette smoking relative to controls. These effects held for an overall substance use index. The MI booster component failed to achieve significant incremental effects above and beyond the TND classroom program. No effects were found on risky sexual behavior. CONCLUSIONS While the program effects of previous studies were replicated, the study failed to demonstrate that an adequately implemented MI booster was of incremental value at 1-year follow-up.
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Affiliation(s)
- Steve Sussman
- Department of Preventive Medicine and Psychology, University of Southern California, Los Angeles 90033-9045, USA.
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Collins LM, Baker TB, Mermelstein RJ, Piper ME, Jorenby DE, Smith SS, Christiansen BA, Schlam TR, Cook JW, Fiore MC. The multiphase optimization strategy for engineering effective tobacco use interventions. Ann Behav Med 2011; 41:208-26. [PMID: 21132416 PMCID: PMC3053423 DOI: 10.1007/s12160-010-9253-x] [Citation(s) in RCA: 198] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The multiphase optimization strategy (MOST) is a new methodological approach for building, optimizing, and evaluating multicomponent interventions. Conceptually rooted in engineering, MOST emphasizes efficiency and careful management of resources to move intervention science forward steadily and incrementally. MOST can be used to guide the evaluation of research evidence, develop an optimal intervention (the best set of intervention components), and enhance the translation of research findings, particularly type II translation. This article uses an ongoing study to illustrate the application of MOST in the evaluation of diverse intervention components derived from the phase-based framework reviewed in the companion article by Baker et al. (Ann Behav Med, in press, 2011). The article also discusses considerations, challenges, and potential benefits associated with using MOST and similar principled approaches to improving intervention efficacy, effectiveness, and cost-effectiveness. The applicability of this methodology may extend beyond smoking cessation to the development of behavioral interventions for other chronic health challenges.
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Willemsen MC, van der Meer RM, Schippers GM. Smoking cessation quitlines in Europe: matching services to callers' characteristics. BMC Public Health 2010; 10:770. [PMID: 21167063 PMCID: PMC3020686 DOI: 10.1186/1471-2458-10-770] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 12/18/2010] [Indexed: 11/16/2022] Open
Abstract
Background Telephone quitlines offer a wide range of services to callers, including advice and counsel, and information on pharmacotherapy for smoking cessation. But, little is known about what specific quitline services are offered to smokers and whether these services are appropriately matched to characteristics of smokers. This study examines how quitline services are matched to callers' level of addiction, educational level, stage-of-change with quitting, and whether they are referred by a doctor or other health professional. Methods Between February 2005 and April 2006, 3,585 callers to seven European quitlines responded to our survey. During the course of and immediately after the call, quitline counsellors collected descriptive data on callers' characteristics and the services they used. We then conducted four logistic regression analyses to examine the relationship between quitline services and the four caller characteristics. Results Forty three percent of all callers received information on pharmacotherapy - most often nicotine patches and nicotine gum - from the counsellor. As we predicted, these callers were the heavy smokers. There was a direct correlation between the length of the conversations between the counsellor and the educational level of the smoker: the lower the education of the smoker, the shorter the call. However, we found no significant association between any other type of service and the educational level of caller. We also found a correlation between the smoker's stage of quitting and the type of advice a counsellor gives. Smokers in the action stage of quitting were more likely to receive advice (in two quitlines) or counselling (in two quitlines) than those in the preparation stage, who were less likely to be referred (in three quitlines). Very few of the total number of calls (10.7%) were from referrals by health professionals. Referred callers were more likely to receive counselling, but this was found only in four of seven quitlines. Conclusion Most of the services quitlines offer to smokers favour heavy smokers and those at a more advanced stage of cessation, but not based on their educational level. Thus, we recommend that European quitlines extend and tailor their services to include less-educated smokers.
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Affiliation(s)
- Marc C Willemsen
- STIVORO, Dutch Expert Centre on Tobacco Control, The Hague, The Netherlands.
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Sheffer CE, Stitzer M, Brandon T, Bursac Z. Effectiveness of adding relapse prevention materials to telephone counseling. J Subst Abuse Treat 2010; 39:71-7. [PMID: 20682187 DOI: 10.1016/j.jsat.2010.03.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Accepted: 03/15/2010] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to examine the effectiveness of adding the Forever Free relapse prevention materials to telephone counseling provided by the Arkansas quitline. Results suggest that the addition of Forever Free materials to telephone counseling does not improve quit rates for those participants who receive at least one session of counseling and nicotine patches; however, for those participants unwilling or unable to receive nicotine patches, the addition of the Forever Free relapse prevention materials doubled the abstinence rate and increased the odds of abstinence by nearly 70% 6 months after treatment (20.9% versus 10.6%; OR = 1.69; CI = 1.02-2.78; p = .04). Given the recent proliferation of quitline services and the variety of services provided, these results can address concerns about enhancing treatment outcomes for certain groups.
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Affiliation(s)
- Christine E Sheffer
- Health Behavior and Health Education, Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
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Sood A, Andoh J, Verhulst S, Ganesh M, Edson B, Hopkins-Price P. "Real-world" effectiveness of reactive telephone counseling for smoking cessation: a randomized controlled trial. Chest 2009; 136:1229-1236. [PMID: 19225061 DOI: 10.1378/chest.08-2425] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Reactive telephone helplines for smoking cessation (where all calls to counselors are smoker initiated) are increasingly used in the United States. However, limited data from randomized controlled trials are available on their effectiveness. The study objective was to evaluate the real-world effectiveness of reactive telephone counseling for smoking cessation using a randomized controlled trial study design. METHODS The study was implemented during a period from 2003 to 2006 to evaluate a reactive telephone helpline run by the American Lung Association chapter of Illinois-Iowa. The 990 new callers, all adult current smokers who called the helpline, were randomized on their first call into one of the two following groups: a control group that received only mailed self-help literature (n = 496); and a study group that received supplemental live reactive telephone counseling (n = 494). Telephone follow-up was completed at 1, 3, 6, and 12 months after study enrollment by interviewers blinded to group assignment. Seven-day point prevalence rates of self-reported abstinence at follow-up evaluations were compared between the two groups using an intent-to-treat design. RESULTS The two groups did not differ significantly in baseline demographics and smoking-related behavior. The abstinence rates (ranging between 0.09 and 0.15) were not significantly different between the two groups at 1-, 3-, 6-, and 12-month follow-up evaluations. Post hoc subgroup analysis showed that black callers had lower abstinence rates at the 3- and 12-month follow-up evaluations as compared with white callers. CONCLUSION Supplemental live, reactive telephone counseling does not provide greater success in smoking cessation than self-help educational materials alone.
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Affiliation(s)
- Akshay Sood
- Department of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM.
| | - Jennifer Andoh
- Department of Medicine, Southern Illinois University School of Medicine, Springfield, IL
| | - Steven Verhulst
- Department of Medicine, Southern Illinois University School of Medicine, Springfield, IL
| | - Mathany Ganesh
- Department of Medicine, Southern Illinois University School of Medicine, Springfield, IL
| | - Billie Edson
- Department of Medicine, Southern Illinois University School of Medicine, Springfield, IL
| | - Patricia Hopkins-Price
- Department of Medicine, Southern Illinois University School of Medicine, Springfield, IL
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McAfee TA, Bush T, Deprey TM, Mahoney LD, Zbikowski SM, Fellows JL, McClure JB. Nicotine patches and uninsured quitline callers. A randomized trial of two versus eight weeks. Am J Prev Med 2008; 35:103-10. [PMID: 18617079 DOI: 10.1016/j.amepre.2008.04.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Revised: 03/05/2008] [Accepted: 04/03/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND State-level tobacco quitlines are integrating nicotine replacement therapy (NRT) into service. Because of funding limitations some provide short courses of NRT. No randomized trial has evaluated the relative benefit of short versus standard treatment. DESIGN A two-cell randomized trial comparing 2 weeks of NRT to 8 weeks. SETTING/PARTICIPANTS Uninsured callers to the Oregon Quit Line during a free-patch initiative from October 18, 2004, to May 5, 2005, who were 18 years or older, smoked five or more cigarettes per day, did not have a medical contraindication to NRT use, and were interested in quitting in 30 days. Data were collected from April to November 2005, and analyzed in 2006--2007. INTERVENTION Participants were eligible for two phone counseling sessions. 1154 participants were randomized to receive via the mail either 2 or 8 weeks of nicotine patches. MEASURES Primary outcome was self-reported complete abstinence from tobacco for 30 or more days at the 6-month phone survey. Secondary outcomes were 7-day point prevalence and 90-day abstinence, satisfaction, and patch use. ORs and CIs were computed. Cost per quit and incremental cost per additional quit were computed based on program costs. RESULTS Intent-to-treat 30-day abstinence was 14.3% in the 2-week group, and 19.6% in the 8-week group (OR 1.45 [CI=1.01, 2.12]). Average cost per quit was $1156 for 2 weeks and $1405 for 8 weeks, with an incremental cost effectiveness of $2068. Satisfaction increased from 90% to 97% with 8 weeks. Those receiving 8 weeks of NRT took more calls (2.0 vs 1.6) and used more patches (6.3 weeks vs 4.3 weeks), but were less likely to purchase patches (16.2% vs 39.3%). CONCLUSIONS Eight weeks of patches improved quit rates compared with 2 weeks, and was cost effective.
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Affiliation(s)
- Timothy A McAfee
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington, USA.
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Hollis JF, McAfee TA, Fellows JL, Zbikowski SM, Stark M, Riedlinger K. The effectiveness and cost effectiveness of telephone counselling and the nicotine patch in a state tobacco quitline. Tob Control 2007; 16 Suppl 1:i53-9. [PMID: 18048633 DOI: 10.1136/tc.2006.019794] [Citation(s) in RCA: 158] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES State and national tobacco quitlines have expanded rapidly and offer a range of services. We examined the effectiveness and cost effectiveness of offering callers single session versus multisession counselling, with or without free nicotine patches. METHODS This 3x2 randomised trial included 4614 Oregon tobacco quitline callers and compared brief (one 15-minute call), moderate (one 30-minute call and a follow-up call) and intensive (five proactive calls) intervention protocols, with or without offers of free nicotine patches (nicotine replacement therapy, NRT). Blinded staff assessed tobacco use by phone at 12 months. RESULTS Abstinence odds ratios were significant for moderate (OR = 1.22, CI = 1.01 to 1.48) and intensive (OR = 1.29, CI = 1.07 to 1.56) intervention, and for NRT (OR = 1.58, CI = 1.35 to 1.85). Intent to treat quit rates were as follows: brief no NRT (12%); brief NRT (17%); moderate no NRT (14%); moderate NRT (20%); intensive no NRT (14%); and intensive NRT (21%). Relative to brief no NRT, the added costs for each additional quit was $2467 for brief NRT, $1912 for moderate no NRT, $2109 for moderate NRT, $2641 for intensive no NRT, and $2112 for intensive NRT. CONCLUSION Offering free NRT and multisession telephone support within a state tobacco quitline led to higher quit rates, and similar costs per incremental quit, than less intensive protocols.
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Affiliation(s)
- Jack F Hollis
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR 97227, USA.
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McAfee TA. Quitlines a tool for research and dissemination of evidence-based cessation practices. Am J Prev Med 2007; 33:S357-67. [PMID: 18021911 DOI: 10.1016/j.amepre.2007.09.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Revised: 08/02/2007] [Accepted: 09/18/2007] [Indexed: 11/27/2022]
Abstract
Quitlines in the United States have grown dramatically over the past 15 years, from one state and a handful of health plans to all 50 states and over 200 health plans and employers. Over half a million tobacco users received help from state quitlines alone in 2005. Research to confirm and improve quitline effectiveness also has burgeoned, with multiple meta-analyses confirming a dose-related treatment effect. Quitlines are increasing the depth and breadth of services offered, including the integration of medication support and other electronic communication mediums such as web and e-mail. Quitlines have the capacity to serve a larger fraction of the population than they currently serve. Accomplishing this is dependent on creating ambitious, multi-institution funding and delivery mechanisms, as well as further research and development to improve reach, effectiveness, and efficiency.
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Affiliation(s)
- Timothy A McAfee
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington, USA.
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Schiebel NEE, Ebbert JO. Quitline referral vs. self-help manual for tobacco use cessation in the Emergency Department: a feasibility study. BMC Emerg Med 2007; 7:15. [PMID: 17868444 PMCID: PMC2008199 DOI: 10.1186/1471-227x-7-15] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Accepted: 09/14/2007] [Indexed: 11/10/2022] Open
Abstract
Background Tobacco use counseling interventions delivered in the primary care setting are efficacious, but limited evidence exists regarding their feasibility or efficacy in the Emergency Department (ED). ED randomized controlled trials evaluating referral for outpatient tobacco use counseling have not had a single subject in the intervention groups attend scheduled clinic appointments. Telephone counseling potentially affords the opportunity to provide this population with individual counseling more conveniently than traditional clinic counseling. The purpose of this preliminary study was to evaluate the intervention completion rate among cigarette smokers enrolled through the ED in a tobacco quitline (QL) and to assess the feasibility of a randomized controlled trial assessing the efficacy of this intervention. Methods We conducted a prospective, randomized, controlled, un-blinded pilot study enrolling cigarette smokers presenting to a tertiary-care ED. Patients indicating a desire to quit smoking were randomized to receive either proactive telephone counseling through a QL (intervention) or a self-help manual (control). Results Of 212 smokers who indicated an interest in quitting, 20 subjects were randomized to the QL and 19 to control. Twenty-one did not meet inclusion criteria and 152 refused to participate. A total of 10 patients (50%) enrolled in the QL completed the full intervention. However, only a total of 20 patients (51%) were reached for follow-up at 3 or 6 months (10 in each arm). At 6-month follow-up a total of six subjects had either disconnected their phone, no longer lived at the provided phone number or had provided an incorrect number. Two declined to provide follow-up and the remainder could not be reached. Assuming all patients unavailable for follow-up were still smoking, the 7-day point prevalence smoking abstinence rate at 6 months was 20% (95% CI: 6 to 44%) for the QL group and 0% (95% CI: 0 to 15%) for the control group (p = 0.11). Conclusion Compliance with the QL intervention was encouraging and may hold promise for providing needed tobacco use counseling to ED patients. Future studies are required, and should focus on more effective mechanisms to obtain outcome measures and a larger sample size. Trial Registration NCT00394420
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Affiliation(s)
- Nicola EE Schiebel
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jon O Ebbert
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Ebbert JO, Carr AB, Patten CA, Morris RA, Schroeder DR. Tobacco use quitline enrollment through dental practices. J Am Dent Assoc 2007; 138:595-601. [PMID: 17473036 DOI: 10.14219/jada.archive.2007.0229] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Time and resource constraints limit the ability of oral health care professionals to help patients quit smoking. Opportunities exist for dental providers to help patients who smoke by enrolling them in tobacco use quitlines. The authors conducted a pilot study to investigate whether such referrals were feasible and effective. METHODS The authors randomly assigned eight general dental practices to provide either brief counseling regarding smoking cessation or brief counseling along with referrals to a tobacco use quitline for patients receiving routine dental hygiene care who reported that they were currently smoking cigarettes. RESULTS The authors enrolled 82 patients (60 in the tobacco use quitline group, 22 in the brief counseling group). At six months, the self-reported, seven-day point prevalence tobacco use abstinence rates were 25.0 percent (15 of 60 patients) in the tobacco use quitline group and 27.3 percent (six of 22 patients) in the brief-counseling group (P approximately 1.0). Twenty-eight (47 percent) of 60 subjects in the tobacco use quitline group completed the initial tobacco use quitline consultation. Abstinence rates among subjects in the quitline group were higher if they completed more telephone consultations. CONCLUSIONS Referral to a tobacco use quitline by dental practices is a feasible strategy for helping patients quit smoking if efficient links between the dental practice and the tobacco use quitline can be established. Research is needed to evaluate whether it is more effective than standard clinical interventions for tobacco use cessation. CLINICAL IMPLICATIONS Dental practitioners with limited time and other resources can assist patients who smoke by referring them to a tobacco use quitline.
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Affiliation(s)
- Jon O Ebbert
- Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
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Carreras Castellet JM, Fletes Dóniga I, Quesada Laborda M, Sánchez Torrecilla B, Sánchez Agudo L. Diseño y primera evaluación de un programa de tratamiento de tabaquismo por teléfono. Comparación con un modelo estándar. Med Clin (Barc) 2007; 128:247-50. [PMID: 17335736 DOI: 10.1157/13099238] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE To assess an intensive proactive telephone smoking cessation program and compare it with a similar group in face to face treatment. DESIGN A prospective, controlled, observational study performed during daily clinical practice. PATIENTS AND METHOD PARTICIPANTS 383 smokers, 176 in telephone treatment and 207 in face to face group treatment, aged greater than 18 years old. They smoked more than 10 cigarettes per day and both groups were recruited between April and November 2003. The study was performed between April 2003 and May 2004. Treatment technique: 11 congnitive-behavioral interventions for six months plus 24 hour nicotine patches in standard doses and 2 mg nicotine gum on demand. Main variable: Prolonged abstinence self-professed at 24 hours, 1 week, 2 weeks, 4 weeks, 6 weeks, 8 weeks, 12, weeks, 16 weeks, 20 weeks and 24 weeks. RESULTS In the first and second week, abstinence was significantly higher in the face to face group than in telephone treatment (1st. week 80.2% vs. 65.9% p = .001; 2nd. week 77.3% vs 65.3% p = .007). Subsequently, the difference was not significant, and at 24 weeks abstinence remained similar for the two treatment methods, 54.6% in the face to face group treatment and 54.5% in telephone treatment. CONCLUSIONS Intensive smoking cessation treatment programs, with nicotine replacement therapy, are equally effective if performed by proactive telephone or in face to face treatment sessions.
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An LC, Schillo BA, Kavanaugh AM, Lachter RB, Luxenberg MG, Wendling AH, Joseph AM. Increased reach and effectiveness of a statewide tobacco quitline after the addition of access to free nicotine replacement therapy. Tob Control 2006; 15:286-93. [PMID: 16885577 PMCID: PMC2563594 DOI: 10.1136/tc.2005.014555] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2005] [Accepted: 04/20/2006] [Indexed: 11/04/2022]
Abstract
BACKGROUND Tobacco users receiving behavioural and pharmacological assistance are more likely to quit. Although telephone quitlines provide population access to counselling, few offer pharmacotherapy. OBJECTIVE To assess change in cessation rates and programme impact after the addition of free nicotine replacement therapy (NRT) to statewide quitline services. DESIGN, SETTING, PARTICIPANTS An observational study of cohorts of callers to the Minnesota QUITPLAN(SM) Helpline before (n = 380) and after (n = 373) the addition of access to free NRT. INTERVENTION Mailing of NRT (patch or gum) to callers enrolling in multi-session counselling. MAIN OUTCOME MEASURE Thirty-day abstinence six months after programme registration. RESULTS The number of callers increased from 155 (SD 75) to 679 (180) per month pre-NRT to post-NRT (difference 524, 95% confidence interval (CI) 323 to 725). Post-NRT, the proportion of callers enrolling in multi-session counselling (23.4% v 90.1%, difference 66.6%, 95% CI 60.8% to 71.6%) and using pharmacotherapy (46.8% v 86.8%, difference 40.0%, 95% CI 31.3% to 47.9%) increased. Thirty-day abstinence at six months increased from 10.0% pre-NRT to 18.2% post-NRT (difference 8.2%, 95% CI 3.1% to 13.4%). Post-NRT the average number of new ex-smokers per month among registrants increased from 15.5 to 123.6 (difference 108.1, 95% CI 61.1 to 155.0). The cost per quit pre-NRT was 1362 dollars (SD 207 dollars). The cost per quit post-NRT was 1934 dollars (215 dollars) suggesting a possible increase in cost per quit (difference 572 dollars, 95% CI -12 dollars to 1157 dollars). CONCLUSION The addition of free NRT to a state quitline is followed by increases in participation and abstinence rates resulting in an eightfold increase in programme impact. These findings support the addition of access to pharmacological therapy as part of state quitline services.
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Affiliation(s)
- Lawrence C An
- University of Minnesota, Department of Internal Medicine, Division of General Medicine, Minneapolis, Minnesota 55455, USA.
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Abstract
BACKGROUND Telephone services can provide information and support for smokers. Counselling may be provided proactively or offered reactively to callers to smoking cessation helplines. OBJECTIVES To evaluate the effect of proactive and reactive telephone support to help smokers quit. SEARCH STRATEGY We searched the Cochrane Tobacco Addiction Group trials register for studies using free text term 'telephone*' or the keywords 'telephone counselling' or 'Hotlines' or 'Telephone' . Date of the most recent search: January 2006. SELECTION CRITERIA Randomized or quasi-randomized controlled trials in which proactive or reactive telephone counselling to assist smoking cessation was offered to smokers or recent quitters. DATA COLLECTION AND ANALYSIS Trials were identified and data extracted by one person (LS) and checked by a second (TL). The main outcome measure was the odds ratio for abstinence from smoking after at least six months follow up. We selected the strictest measure of abstinence, using biochemically validated rates where available. We considered participants lost to follow-up to be continuing smokers. Where trials had more than one arm with a less intensive intervention we used only the most similar intervention without the telephone component as the control group in the primary analysis. We assessed statistical heterogeneity amongst sub groups of clinically comparable studies using the I(2) statistic. Where appropriate, we pooled studies using a fixed-effect model. A meta-regression was used to investigate the effect of differences in planned number of calls. MAIN RESULTS Forty-eight trials met the inclusion criteria. Among smokers who contacted helplines, quit rates were higher for groups randomised to receive multiple sessions of call-back counselling (eight studies, >18,000 participants, odds ratio (OR) for long term cessation 1.41, 95% confidence interval (CI) 1.27 to 1.57). Two of these studies showed a significant benefit of more intensive compared to less intensive intervention. Telephone counselling not initiated by calls to helplines also increased quitting (29 studies, >17,000 participants, OR 1.33, 95% CI 1.21 to 1.47). A meta-regression detected a significant association between the maximum number of planned calls and the effect size. There was clearer evidence of benefit in the subgroup of trials recruiting smokers motivated to quit. Of two studies that provided access to a hotline one showed a significant benefit and one did not. Two studies comparing different counselling approaches during a single session did not detect significant differences. A further seven studies were too diverse to contribute to meta-analyses and are discussed separately. AUTHORS' CONCLUSIONS Proactive telephone counselling helps smokers interested in quitting. There is evidence of a dose response; one or two brief calls are less likely to provide a measurable benefit. Three or more calls increases the odds of quitting compared to a minimal intervention such as providing standard self-help materials, brief advice, or compared to pharmacotherapy alone. Telephone quitlines provide an important route of access to support for smokers, and call-back counselling enhances their usefulness.
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Affiliation(s)
- L F Stead
- Oxford University, Department of Primary Health Care, Old Road Campus, Headington, Oxford, UK OX3 7LF.
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Miller M, Wood L. Effectiveness of smoking cessation interventions: review of evidence and implications for best practice in Australian health care settings. Aust N Z J Public Health 2004; 27:300-9. [PMID: 14705286 DOI: 10.1111/j.1467-842x.2003.tb00399.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To review the evidence of the effectiveness of various smoking cessation methods and appropriateness for use in Australian health care settings. METHODS Cochrane and other existing reviews and meta-analyses of evidence were the basis for the review. Systematic literature searches were also conducted to identify relevant controlled trials published internationally between January 1999 and May 2002. The main inclusion criteria for studies were use of a controlled evaluation design and an outcome measure of continuous abstinence from smoking for at least five months. A three-tiered grading system for strength of evidence was used. RESULTS Clinic and hospital systems to assess and document tobacco use and routine provision of cessation advice can double long-term quit rates. While brief intervention can achieve a significant effect at population level, at individual level there is a strong dose response between the number and length of sessions of tobacco cessation counselling and its effectiveness. Effective behavioural interventions can increase cessation rates by 50-100% compared with no intervention. Some pharmacotherapies are safe and also help to substantially increase cessation rates. CONCLUSIONS Effective behavioural and pharmacological methods of tobacco cessation are available. IMPLICATIONS Every smoker should be offered evidence-based advice and treatment to quit smoking. This includes pharmacotherapy, unless contra-indicated. Health professionals and health care settings can play a significant role in motivating and assisting smokers to quit.
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Affiliation(s)
- Margaret Miller
- Marg Miller Health Consulting, 16 Rudwick Street, Mosman Park, Western Australia 6012.
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Aquilino ML, Lowe JB. Approaches to tobacco control: the evidence base. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2004; 8 Suppl 4:11-7. [PMID: 14725648 DOI: 10.1111/j.1399-5863.2004.00317.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Tobacco production, distribution, and use are international issues with significant health and economic implications. This paper provides an overview of the effective approaches to tobacco control including decreasing demand for tobacco products through taxation, consumer education, research, bans on advertising and promotion, warning labels, and restrictions on public smoking. The effectiveness of reducing the supply of tobacco products through prohibition, restrictions on youth access, crop substitution, trade restrictions, and control of smuggling, will also be discussed. Decreasing smoking, particularly among young people, by preventing or delaying initiation, preventing regular use, and increasing cessation through behavioural approaches for all ages is reviewed. Cessation methods including pharmacological approaches, 'quitlines', Internet programmes, and the targeting of specific populations are discussed. Internet availability of tobacco products and sustainability of current efforts are presented as continuing challenges to tobacco control.
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Abstract
Quitlines provide a model for the translation of research findings to public health application. Quitlines are currently in operation in more than half of US states, in Canada, and in multiple countries globally. Overall, when implemented correctly, quitlines have been shown to be efficacious and effective. Multiple quitline models are in use, but there is no evidence on the relative effectiveness of one over the other. Differences have been demonstrated for the efficacy of quitlines for specific applications, with the strongest evidence base for application as a primary intervention or as follow-up for hospitalized patients and particularly for cardiac patients. The evidence base for both reactive and proactive services is reviewed, and future directions to continue to advance the field are discussed.
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Affiliation(s)
- Deborah J Ossip-Klein
- James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, New York 14642, USA.
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Borland R, Balmford J, Segan C, Livingston P, Owen N. The effectiveness of personalized smoking cessation strategies for callers to a Quitline service. Addiction 2003; 98:837-46. [PMID: 12780372 DOI: 10.1046/j.1360-0443.2003.00389.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM To assess the effectiveness of a program of computer-generated tailored advice for callers to a telephone helpline, and to assess whether it enhanced a series of callback telephone counselling sessions in aiding smoking cessation. DESIGN Randomized controlled trial comparing: (1) untailored self-help materials; (2) computer-generated tailored advice only, and (3) computer-generated tailored advice plus callback telephone counselling. Assessment surveys were conducted at baseline, 3, 6 and 12 months. SETTING Victoria, Australia. PARTICIPANTS A total of 1578 smokers who called the Quitline service and agreed to participate. MEASUREMENTS Smoking status at follow-up; duration of cessation, if quit; use of nicotine replacement therapy; and extent of participation in the callback service. FINDINGS At the 3-month follow-up, significantly more (chi2(2) = 16.9; P < 0.001) participants in the computer-generated tailored advice plus telephone counselling condition were not smoking (21%) than in either the computer-generated advice only (12%) or the control condition (12%). Proportions reporting not smoking at the 12-month follow-up were 26%, 23% and 22%, respectively (NS) for point prevalence, and for 9 months sustained abstinence; 8.2, 6.0, and 5.0 (NS). In the telephone counselling group, those receiving callbacks were more likely than those who did not to have sustained abstinence at 12 months (10.2 compared with 4.0, P < 0.05). Logistic regression on 3-month data showed significant independent effects on cessation of telephone counselling and use of NRT, but not of computer-generated tailored advice. CONCLUSION Computer-generated tailored advice did not enhance telephone counselling, nor have any independent effect on cessation. This may be due to poor timing of the computer-generated tailored advice and poor integration of the two modes of advice.
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Affiliation(s)
- Ron Borland
- VicHealth Centre for Tobacco Control, Victoria, Australia.
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Roski J, Jeddeloh R, An L, Lando H, Hannan P, Hall C, Zhu SH. The impact of financial incentives and a patient registry on preventive care quality: increasing provider adherence to evidence-based smoking cessation practice guidelines. Prev Med 2003; 36:291-9. [PMID: 12634020 DOI: 10.1016/s0091-7435(02)00052-x] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND This study tested the effects of two organizational support processes, the provision of financial incentives for superior clinical performance and the availability of a patient (smoker) registry and proactive telephone support system for smoking cessation, on provider adherence to accepted practice guidelines and associated patient outcomes. METHODS Forty clinics of a large multispecialty medical group practice providing primary care services were randomly allocated to study conditions. Fifteen clinics each were assigned to the experimental conditions "control" (distribution of printed versions of smoking cessation guidelines) and "incentive" (financial incentive pay-out for reaching preset clinical performance targets). Ten clinics were randomized to receive financial incentives combined with access to a centralized patient registry and intervention system ("registry"). Main outcome measures were adherence to smoking cessation clinical practice guidelines and patients' smoking cessation behaviors. RESULTS Patients' tobacco use status was statistically significant (P < 0.01) more frequently identified in clinics with the opportunity for incentives and access to a registry than in clinics in the control condition. Patients visiting registry clinics accessed counseling programs statistically significantly more often (P < 0.001) than patients receiving care in the control condition. Other endpoints did not statistically significantly differ between the experimental conditions. CONCLUSIONS The impact of financial incentives and a patient registry/intervention system in improving smoking cessation clinical practices and patient behaviors was mixed. Additional research is needed to identify conditions under which such organizational support processes result in significant health care quality improvement and warrant the investment.
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Affiliation(s)
- Joachim Roski
- National Committee for Quality Assurance, Washington, DC 20036, USA.
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Abstract
BACKGROUND Telephone services can provide information and support for smokers. Counselling may be provided proactively or offered reactively to callers to smoking cessation helplines. OBJECTIVES To evaluate the effect of proactive and reactive telephone support to help smokers quit. SEARCH STRATEGY We searched the Cochrane Tobacco Addiction Group trials register for studies using free text term 'telephone*' or the keywords 'telephone counselling' or 'Hotlines' or 'Telephone'. Date of the most recent search: September 2002. SELECTION CRITERIA Randomised or quasi-randomised controlled trials in which proactive or reactive telephone counselling to assist smoking cessation was offered to smokers or recent quitters. DATA COLLECTION AND ANALYSIS Trials were identified and data extracted by one person and checked by a second. The main outcome measure was abstinence from smoking after at least six months follow-up. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. Participants lost to follow-up were considered to be continuing smokers. Where trials had more than one arm with a less intensive intervention we used only the most similar intervention as the control group in the primary analysis. Where interventions were similar, we performed meta-analysis using a fixed effects model (Peto method) to give an odds ratio. MAIN RESULTS Twenty seven trials met inclusion criteria. Thirteen trials compared proactive counselling to a minimal intervention control. There was statistical heterogeneity, with five trials showing a significant benefit, and eight showing non significant differences. The heterogeneity was associated with trials that provided tailored self-help materials to the control group. Meta-analysis using all less intensive intervention arms as the control removed the heterogeneity and suggests that telephone counselling compared to less intensive intervention increases quit rates (OR 1.56, 1.38 - 1.77). Four trials adding telephone support to a face to face intervention control failed to detect a significant effect on long term quit rates. Four trials failed to detect an additional effect of telephone support in users of nicotine replacement therapy. Providing access to a hotline showed a significant benefit in one trial and no significant difference in two. No differences in outcome were detected in trials that compared different types of telephone counselling. REVIEWER'S CONCLUSIONS Proactive telephone counselling can be effective compared to an intervention without personal contact. Successful interventions generally involve multiple contacts timed around a quit attempt. The available evidence neither confirms nor rules out a benefit of telephone counselling as an adjunct to face to face counselling or pharmacotherapy. Further trials randomising access to helplines are unlikely to be done but indirect evidence suggests they can be a useful part of a smoking cessation service.
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Affiliation(s)
- L F Stead
- Department of Primary Health Care, Institute of Health Sciences, Old Road, Headington, Oxford, UK, OX3 7LF.
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DataBase: Research and Evaluation Results. Am J Health Promot 2002. [DOI: 10.4278/0890-1171-16.4.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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DataBase: Research and Evaluation Results. Am J Health Promot 2002. [DOI: 10.4278/0890-1171-16.3.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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DataBase: Research and Evaluation Results. Am J Health Promot 2001. [DOI: 10.4278/0890-1171-16.2.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Database: Research and Evaluation Results. Am J Health Promot 2001. [DOI: 10.4278/0890-1171-16.1.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Zhu S, Melcer T, Sun J, Rosbrook B, Pierce JP. Smoking cessation with and without assistance: a population-based analysis. Am J Prev Med 2000; 18:305-11. [PMID: 10788733 DOI: 10.1016/s0749-3797(00)00124-0] [Citation(s) in RCA: 304] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine usage rates of smoking-cessation assistance and to compare the success rate of those who used assistance with the success rate of those who did not. METHODS The data come from the 1996 California Tobacco Survey, a random sample of 4480 individuals (18 years or older) who tried to quit smoking in the 12 months before the survey. We calculated population estimates for demographics, smoking histories, rate of using assistance, and abstinence rates. RESULTS One fifth (19.9%) of those who attempted to quit smoking used one or more forms of assistance: self-help, counseling, and/or nicotine replacement therapy (NRT). Heavy smokers were more likely to use assistance than were light smokers. Women were more likely to use assistance than were men, and usage increased with age. Whites were more likely to use NRT than were other ethnic groups. Overall, those who used assistance had a higher success rate than those who did not; the 12-month abstinence rates were 15.2% and 7.0%, respectively. CONCLUSIONS Use of assistance for smoking cessation has increased over recent years, from 7.9% in 1986 to 19.9% in 1996. The use of assistance is associated with a greater success rate. Anti-tobacco campaigns in California and increased availability of multiple forms of assistance probably facilitated the use of assistance and successful quitting for those using assistance.
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Affiliation(s)
- S Zhu
- University of California, San Diego, Cancer Center, La Jolla, California 92093-0905, USA
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