1
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Burris JL, Borger TN, Baker TB, Bernstein SL, Ostroff JS, Rigotti NA, Joseph AM. Proposing a Model of Proactive Outreach to Advance Clinical Research and Care Delivery for Patients Who Use Tobacco. J Gen Intern Med 2022; 37:2548-2552. [PMID: 35474504 PMCID: PMC9360368 DOI: 10.1007/s11606-022-07553-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/30/2022] [Indexed: 11/25/2022]
Abstract
There are evidence-based treatments for tobacco dependence, but inequities exist in the access to and reach of these treatments. Traditional models of tobacco treatment delivery are "reactive" and typically provide treatment only to patients who are highly motivated to quit and seek out tobacco treatment. Newer models involve "proactive" outreach, with benefits that include increasing access to tobacco treatment, prompting quit attempts among patients with low motivation, addressing health disparities, and improving population-level quit rates. However, the definition of "proactive" is not clear, and adoption has been slow. This commentary introduces a comprehensive yet flexible model of proactive outreach and describes how proactive outreach can optimize clinical research and care delivery in these domains: (1) identifying the population, (2) offering treatment, and (3) delivering treatment. Dimensions relevant to each domain are the intensity of proactive outreach (low to high) and the extent to which proactive outreach activities rely on human interaction or are facilitated by information technology (IT). Adoption of the proposed proactive outreach model could improve the precision and rigor with which tobacco cessation research and tobacco treatment programs report data, which could have a positive effect on care delivery and patient outcomes.
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Affiliation(s)
- Jessica L Burris
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Tia N Borger
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Timothy B Baker
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Steven L Bernstein
- Department of Emergency Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Jamie S Ostroff
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nancy A Rigotti
- Department of Medicine, Harvard Medical School, MB, Boston, USA
| | - Anne M Joseph
- Department of Medicine and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
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2
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Selby K, Marti J, Durand MA. We are all choice architects: using behavioral economics to improve smoking cessation in primary care. J Gen Intern Med 2022; 37:1783-1785. [PMID: 35018565 PMCID: PMC9130388 DOI: 10.1007/s11606-021-07322-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Kevin Selby
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
| | - Joachim Marti
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Marie-Anne Durand
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.,University of Toulouse III Paul Sabatier, Toulouse, France.,Dartmouth University, Lebanon, New Hampshire, USA
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3
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From planning to action in smoking cessation: Demographic and psychological symptom dimensions related to readiness to quit smoking. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-020-00271-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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4
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Bastian LA, Driscoll M, DeRycke E, Edmond S, Mattocks K, Goulet J, Kerns RD, Lawless M, Quon C, Selander K, Snow J, Casares J, Lee M, Brandt C, Ditre J, Becker W. Pain and smoking study (PASS): A comparative effectiveness trial of smoking cessation counseling for veterans with chronic pain. Contemp Clin Trials Commun 2021; 23:100839. [PMID: 34485755 PMCID: PMC8391053 DOI: 10.1016/j.conctc.2021.100839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 08/11/2021] [Accepted: 08/18/2021] [Indexed: 11/08/2022] Open
Abstract
Introduction Smoking is associated with greater pain intensity and pain-related functional interference in people with chronic pain. Interventions that teach smokers with chronic pain how to apply adaptive coping strategies to promote both smoking cessation and pain self-management may be effective. Methods The Pain and Smoking Study (PASS) is a randomized clinical trial of a telephone-delivered, cognitive behavioral intervention among Veterans with chronic pain who smoke cigarettes. PASS participants are randomized to a standard telephone counseling intervention that includes five sessions focusing on motivational interviewing, craving and relapse management, rewards, and nicotine replacement therapy versus the same components with the addition of a cognitive behavioral intervention for pain management. Participants are assessed at baseline, 6, and 12 months. The primary outcome is smoking cessation. Results The 371 participants are 88% male, a median age of 60 years old (range 24–82), and smoke a median of 15 cigarettes per day. Participants are mainly white (61%), unemployed (70%), 33% had a high school degree or less, and report their overall health as “Fair” (40%) to “Poor” (11%). Overall, pain was moderately high (mean pain intensity in past week = 5.2 (Standard Deviation (SD) = 1.6) and mean pain interference = 5.5 (SD = 2.2)). Pain-related anxiety was high (mean = 47.0 (SD = 22.2)) and self-efficacy was low (mean = 3.8 (SD = 1.6)). Conclusions PASS utilizes an innovative smoking and pain intervention to promote smoking cessation among Veterans with chronic pain. Baseline characteristics reflect a socioeconomically vulnerable population with a high burden of mental health comorbidities.
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Affiliation(s)
- Lori A Bastian
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States.,Yale University School of Medicine, New Haven, CT, United States
| | - Mary Driscoll
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States.,Yale University School of Medicine, New Haven, CT, United States
| | - Eric DeRycke
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Sara Edmond
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States.,Yale University School of Medicine, New Haven, CT, United States
| | - Kristin Mattocks
- University of Massachusetts Medical School, Worcester, MA, United States.,VA Central Western Massachusetts Healthcare System, Leeds, MA, United States
| | - Joe Goulet
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States.,Yale University School of Medicine, New Haven, CT, United States
| | - Robert D Kerns
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States.,Yale University School of Medicine, New Haven, CT, United States
| | - Mark Lawless
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Caroline Quon
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Kim Selander
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Jennifer Snow
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Jose Casares
- VA Central Western Massachusetts Healthcare System, Leeds, MA, United States
| | - Megan Lee
- Yale University School of Medicine, New Haven, CT, United States
| | - Cynthia Brandt
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States.,Yale University School of Medicine, New Haven, CT, United States
| | - Joseph Ditre
- Department of Psychology, Syracuse University, Syracuse, NY, United States
| | - William Becker
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States.,Yale University School of Medicine, New Haven, CT, United States
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5
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McRobbie H, Kwan B. Tobacco use disorder and the lungs. Addiction 2021; 116:2559-2571. [PMID: 33140508 DOI: 10.1111/add.15309] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/17/2020] [Accepted: 10/23/2020] [Indexed: 12/22/2022]
Abstract
This narrative review provides a summary of the impact of tobacco smoking on the respiratory system and the benefits of smoking cessation. Tobacco smoking is one of the leading preventable causes of death world-wide and a major risk factor for lung cancer and chronic obstructive pulmonary disease. Smoking is also associated with an increased risk of respiratory infections and appears to be related to poorer outcomes among those with COVID-19. Non-smokers with second-hand smoke exposure also experience significant adverse respiratory effects. Smoking imposes enormous health- and non-health-related costs to societies. The benefits of smoking cessation, in both prevention and management of respiratory disease, have been known for decades and, to this day, cessation support remains one of the most important cost-effective interventions that health professionals can provide to people who smoke. Cessation at any age confers substantial health benefits, even in smokers with established morbidities. As other treatments for chronic respiratory disease advance and survival rates increase, smoking cessation treatment will become even more relevant. While smoking cessation interventions are available, the offer of these by clinicians and uptake by patients remain limited.
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Affiliation(s)
- Hayden McRobbie
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, Australia.,Lakes District Health Board, Rotorua, New Zealand
| | - Benjamin Kwan
- Department of Respiratory and Sleep Medicine, Sutherland Hospital, Sydney, Australia.,St George and Sutherland Clinical School, University of New South Wales, Sydney, Australia
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6
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Zeliadt SB. Smoking Cessation Resources Can and Should Be Integrated in Lung Cancer Screening. Chest 2021; 160:413-414. [PMID: 34366030 DOI: 10.1016/j.chest.2021.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/10/2021] [Indexed: 10/20/2022] Open
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Kruse GR, Park ER, Chang Y, Haberer JE, Abroms LC, Shahid NN, Howard S, Haas JS, Rigotti NA. Proactively Offered Text Messages and Mailed Nicotine Replacement Therapy for Smokers in Primary Care Practices: A Pilot Randomized Trial. Nicotine Tob Res 2020; 22:1509-1514. [PMID: 32198520 PMCID: PMC7443591 DOI: 10.1093/ntr/ntaa050] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/17/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Proactive, population health cessation programs can guide efforts to reach smokers outside of the clinic to encourage quit attempts and treatment use. AIMS AND METHODS This study aimed to measure trial feasibility and preliminary effects of a proactive intervention offering text messages (TM) and/or mailed nicotine replacement therapy (NRT) to smokers in primary care clinics. From 2017 to 2019 we performed a pilot randomized trial comparing brief telephone advice (control: BA), TM, 2 weeks of mailed NRT, or both interventions (TM + NRT). Patients were identified using electronic health records and contacted proactively by telephone to assess interest in the study. We compared quit attempts, treatment use, and cessation in the intervention arms with BA. RESULTS Of 986 patients contacted, 153 (16%) enrolled (mean age 53 years, 57% female, 76% white, 11% black, 8% Hispanic, 52% insured by Medicaid) and 144 (94%) completed the 12-week assessment. On average, patients in the TM arms received 159 messages (99.4% sent, 0.6% failed), sent 19 messages, and stayed in the program for 61 days. In all groups, a majority of patients reported quit attempts (BA 67% vs. TM 86% [p = .07], NRT 81% [p = .18], TM + NRT 79% [p = .21]) and NRT use (BA 51% vs. NRT 83% [p = .007], TM 65% [p = .25], TM + NRT 76% [p = .03]). Effect estimates for reported 7-day abstinence were BA 10% versus TM 26% (p = .09), NRT 28% (p = .06), and TM + NRT 23% (p = .14). CONCLUSIONS Proactively offering TM or mailed nicotine medications was feasible among primary care smokers and a promising approach to promote quit attempts and short-term abstinence. IMPLICATIONS Proactive intervention programs to promote quit attempts outside of office visits among smokers enrolled in primary care practices are needed. TM have potential to engage smokers not planning to quit or to support smokers to make a planned quit attempt. This pilot study demonstrates the feasibility of testing a proactive treatment model including TM and/or mailed NRT to promote quit attempts, treatment use, and cessation among nontreatment-seeking smokers in primary care. CLINICALTRIALS.GOV IDENTIFIER NCT03174158.
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Affiliation(s)
- Gina R Kruse
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Elyse R Park
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Yuchiao Chang
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Jessica E Haberer
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- Center for Global Health, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Naysha N Shahid
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Sydney Howard
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Jennifer S Haas
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Nancy A Rigotti
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
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Ozga-Hess JE, Felicione NJ, Ferguson SG, Dino G, Elswick D, Whitworth C, Turiano N, Blank MD. Piloting a clinical laboratory method to evaluate the influence of potential modified risk tobacco products on smokers' quit-related motivation, choice, and behavior. Addict Behav 2019; 99:106105. [PMID: 31470240 DOI: 10.1016/j.addbeh.2019.106105] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/15/2019] [Accepted: 08/19/2019] [Indexed: 11/28/2022]
Abstract
Research methods are needed that can predict whether the availability of potential modified risk tobacco products (MRTPs) may influence smokers' quit-related motivation, choice, and behavior. This pilot study assessed the primary outcomes of feasibility and adherence to address this need using an electronic cigarette (ECIG) as a model MRTP. Cigarette smokers were randomly assigned to use only their own brand of cigarettes (OB-only) or a second-generation ECIG (18 ng/ml nicotine) plus their OB cigarettes (ECIG+OB) ad libitum for four weeks. Participants logged products using a mobile device, collected used cigarette filters, and provided saliva samples every day for analysis of cotinine. They returned to the lab once per week to provide a breath sample and accept or decline a choice to quit all tobacco products (i.e., cigarettes and/or ECIGs). They also returned for a one-month follow-up visit. Of those participants randomized (n = 60), 56.7% completed the 4-week intervention and 40.0% completed the follow-up visit. The primary reason for withdrawal was poor adherence with mobile device use. Comparable numbers of participants in each group chose to make a quit attempt, although more OB-only participants chose to quit during the first two weeks and more ECIG+OB participants during the last two weeks. With protocol modifications to reduce participation burden, the current method might ultimately be used by regulators to predict how smokers' quit-related motivation, choice, and behavior are influenced by current and future MRTPs.
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Affiliation(s)
- Jenny E Ozga-Hess
- Department of Psychology, West Virginia University, Morgantown, WV, USA
| | | | | | - Geri Dino
- WV Prevention Research Center, West Virginia University, Morgantown, WV, USA; Department of Social and Behavioral Sciences, West Virginia University, Morgantown, WV, USA
| | - Daniel Elswick
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV, USA
| | - Catherine Whitworth
- WV Prevention Research Center, West Virginia University, Morgantown, WV, USA
| | - Nicholas Turiano
- Department of Psychology, West Virginia University, Morgantown, WV, USA
| | - Melissa D Blank
- Department of Psychology, West Virginia University, Morgantown, WV, USA.
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9
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Comparative Effectiveness of Proactive Tobacco Treatment among Smokers with and without Chronic Lower Respiratory Disease. Ann Am Thorac Soc 2019; 15:341-347. [PMID: 29144886 DOI: 10.1513/annalsats.201707-582oc] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Adults with chronic lower respiratory disease differ in their barriers to smoking cessation but also suffer from tobacco-related health concerns, which may motivate quit attempts. Few studies have examined differences in tobacco treatment response between smokers with and without chronic lower respiratory disease. OBJECTIVE We examined the effectiveness of a proactive outreach program for cessation among smokers with and without chronic lower respiratory disease. METHODS Subgroup analysis of the Veterans Victory over Tobacco Study, a pragmatic randomized controlled trial that demonstrated the effectiveness of proactive outreach and the choice of tobacco treatments compared with usual care. Smokers identified via the electronic medical record were proactively offered phone-based counseling and care coordination to receive medication from their Veterans Affairs providers or in-person care. We compared the response among those with and without an International Classification of Diseases, 9th Revision diagnosis of a chronic lower respiratory disease (chronic obstructive pulmonary disease, chronic bronchitis, emphysema, asthma). We used stratification by propensity scores to adjust for imbalanced covariates between groups with and without chronic lower respiratory disease within each treatment arm, using complete case analysis accounting for the stratified sampling by site. RESULTS The study participants were predominantly older, white, male smokers. Overall, 19.6% had chronic lower respiratory disease. A total of 3,307 had outcome data with the following assignments to the intervention: proactive care: n = 1,272 without chronic lower respiratory disease, n = 301 with chronic lower respiratory disease; usual care: n = 1,387 without chronic lower respiratory disease, n = 347 with chronic lower respiratory disease. A total of 1,888 had both complete baseline and outcome data and were included in the primary analysis. In unadjusted analyses (n = 3,307), among individuals with chronic lower respiratory disease, 13.1% in the proactive group reported 6-month prolonged abstinence compared with 8.7% of those in the usual care group (odds ratio, 1.57; 95% confidence interval, 0.93-2.65). Among individuals without chronic lower respiratory disease, 13.1% quit in the proactive group compared with 11.0% in the usual care group (odds ratio, 1.22; 95% confidence interval, 0.95-1.55). In adjusted analyses (n = 1,888), the association between treatment arm and quit rate varied by the presence of chronic lower respiratory disease, with a stronger association between allocation to the proactive group and quit rate among those with chronic lower respiratory disease (odds ratio, 3.45; 95% confidence interval, 1.59-7.47) than those without chronic lower respiratory disease (odds ratio, 1.34; 95% confidence interval, 0.95-1.88; P for interaction with chronic lower respiratory disease = 0.03). CONCLUSIONS Smokers with chronic lower respiratory disease may be more likely to respond to a proactive outreach intervention for tobacco cessation treatment than those without chronic lower respiratory disease. Clinical trial registered with www.clinicaltrials.gov (NCT 00608426).
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Joseph AM, Rothman AJ, Almirall D, Begnaud A, Chiles C, Cinciripini PM, Fu SS, Graham AL, Lindgren BR, Melzer AC, Ostroff JS, Seaman EL, Taylor KL, Toll BA, Zeliadt SB, Vock DM. Lung Cancer Screening and Smoking Cessation Clinical Trials. SCALE (Smoking Cessation within the Context of Lung Cancer Screening) Collaboration. Am J Respir Crit Care Med 2019; 197:172-182. [PMID: 28977754 DOI: 10.1164/rccm.201705-0909ci] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
National recommendations for lung cancer screening for former and current smokers aged 55-80 years with a 30-pack-year smoking history create demand to implement efficient and effective systems to offer smoking cessation on a large scale. These older, high-risk smokers differ from participants in past clinical trials of behavioral and pharmacologic interventions for tobacco dependence. There is a gap in knowledge about how best to design systems to extend reach and treatments to maximize smoking cessation in the context of lung cancer screening. Eight clinical trials, seven funded by the National Cancer Institute and one by the Veterans Health Administration, address this gap and form the SCALE (Smoking Cessation within the Context of Lung Cancer Screening) collaboration. This paper describes methodological issues related to the design of these clinical trials: clinical workflow, participant eligibility criteria, screening indication (baseline or annual repeat screen), assessment content, interest in stopping smoking, and treatment delivery method and dose, all of which will affect tobacco treatment outcomes. Tobacco interventions consider the "teachable moment" offered by lung cancer screening, how to incorporate positive and negative screening results, and coordination of smoking cessation treatment with clinical events associated with lung cancer screening. Unique data elements, such as perceived risk of lung cancer and costs of tobacco treatment, are of interest. Lung cancer screening presents a new and promising opportunity to reduce morbidity and mortality resulting from lung cancer that can be amplified by effective smoking cessation treatment. SCALE teamwork and collaboration promise to maximize knowledge gained from the clinical trials.
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Affiliation(s)
| | | | - Daniel Almirall
- 3 Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | | | - Caroline Chiles
- 4 Department of Radiology, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Paul M Cinciripini
- 5 Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Amanda L Graham
- 6 Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC
| | | | | | - Jamie S Ostroff
- 8 Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elizabeth L Seaman
- 9 Tobacco Control Research Branch, National Cancer Institute, Rockville, Maryland
| | - Kathryn L Taylor
- 10 Department of Oncology, Georgetown University Medical Center, Washington, DC
| | - Benjamin A Toll
- 11 Department of Public Health Sciences and Psychiatry, Medical University of South Carolina, Charleston, South Carolina; and
| | - Steven B Zeliadt
- 12 VA Center of Innovation for Veteran-Centered and Value-Driven Care, School of Public Health, University of Washington, Seattle, Washington
| | - David M Vock
- 13 Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota
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11
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Smoking Cessation for Smokers Not Ready to Quit: Meta-analysis and Cost-effectiveness Analysis. Am J Prev Med 2018; 55:253-262. [PMID: 29903568 PMCID: PMC6055474 DOI: 10.1016/j.amepre.2018.04.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 03/20/2018] [Accepted: 04/10/2018] [Indexed: 11/23/2022]
Abstract
CONTEXT To provide a systematic review and cost-effectiveness analysis on smoking interventions targeting smokers not ready to quit, a population that makes up approximately 32% of current smokers. EVIDENCE ACQUISITION Twenty-two studies on pharmacological, behavioral, and combination smoking-cessation interventions targeting smokers not ready to quit (defined as those who reported they were not ready to quit at the time of the study) published between 2000 and 2017 were analyzed. The effectiveness (measured by the number needed to treat) and cost effectiveness (measured by costs per quit) of interventions were calculated. All data collection and analyses were performed in 2017. EVIDENCE SYNTHESIS Smoking interventions targeting smokers not ready to quit can be as effective as similar interventions for smokers ready to quit; however, costs of intervening on this group may be higher for some intervention types. The most cost-effective interventions identified for this group were those using varenicline and those using behavioral interventions. CONCLUSIONS Updating clinical recommendations to provide cessation interventions for this group is recommended. Further research on development of cost-effective treatments and effective strategies for recruitment and outreach for this group are needed. Additional studies may allow for more nuanced comparisons of treatment types among this group.
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12
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Predicting Engagement in Smoking Cessation Treatment Following a Brief Telephone Evaluation and Referral Session. J Smok Cessat 2018. [DOI: 10.1017/jsc.2018.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction: Smoking cessation treatment combining medication and counselling yields the best outcomes; however, few smokers employ both modalities.Aims: The purpose of this study was to examine variables predicting treatment attendance.Methods: This was a chart review of US military Veterans (N = 340; 89% male, 59% non-Hispanic white) referred for smoking cessation, who completed a telephone call to encourage treatment utilization. Treatment engagement was defined as attending a smoking cessation session within 30 days following telephone contact. A logistic regression analysis examined predictors (demographics, smoking variables, and psychiatric diagnoses) of treatment engagement.Results/Findings: Greater age (Odds Ratio [OR] = 1.04, 95% confidence interval [CI] 1.01–1.06), more cigarettes (OR = 1.03, 95% CI 1.00–1.06), and higher perceived importance of quitting (OR = 1.11, 95% CI 1.00–1.23) predicted engaging in treatment within 30 days (all p values < 0.05).Conclusion: Veterans who attended treatment were older, smoked more cigarettes, and perceived quitting as more important than those who did not attend. These findings are consistent with prior studies examining factors associated with treatment utilization. Results highlight the need to identify strategies for engaging into treatment smokers who are younger, smoke fewer cigarettes, and view quitting as less important.
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13
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Kathuria H. Proactively Engaging Smokers with Chronic Respiratory Disease in Tobacco Treatment. Ann Am Thorac Soc 2018; 15:308-309. [PMID: 29493333 DOI: 10.1513/annalsats.201711-905ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hasmeena Kathuria
- The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
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14
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Borrelli B, Endrighi R, Hammond SK, Dunsiger S. Smokers who are unmotivated to quit and have a child with asthma are more likely to quit with intensive motivational interviewing and repeated biomarker feedback. J Consult Clin Psychol 2017; 85:1019-1028. [PMID: 29083219 PMCID: PMC5678980 DOI: 10.1037/ccp0000238] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Smokers who are not motivated to quit are an important group for intervention, particularly if they have children with asthma. Research indicates that unmotivated smokers are less responsive to intensive interventions, although motivation-by-treatment interactions have not been tested. This study examines whether motivation to quit moderates the effect of a cessation induction intervention. METHOD Parents had an asthmatic child requiring urgent care, and did not have to want to quit smoking to be eligible for the study. Two home visits included asthma education, motivational interviewing (MI) for cessation, and feedback on child's secondhand smoke exposure (SHSe). Participants were then randomized (n = 339, 79.6% female) to receive Enhanced-PAM (Precaution Adoption Model; 6 MI calls including SHSe feedback) or PAM (6 contact control calls). Motivation to quit was assessed at baseline and point-prevalence abstinence (ppa) and SHSe outcomes were objectively measured. RESULTS At baseline, 38.9% were not motivated to quit. Those who were not motivated to quit were 3 to 4 times more likely to be abstinent at 6 months in Enhanced-PAM versus PAM (7-day ppa: OR = 3.71, 95% CI = [1.06, 12.99]; 30-day: OR = 4.15, 95% CI [1.20, 14.35]); those receiving Enhanced-PAM achieved quit rates comparable to motivated smokers. Those who were not motivated to quit were more than 4 times as likely to have very low/undetectable SHSe at follow-up in Enhanced-PAM versus PAM (OR = 4.46, 95% CI [1.31, 15.15]). Among motivated smokers, neither outcome significantly differed by treatment arm. CONCLUSION It cannot be assumed that smokers who are unmotivated to quit will not be responsive to intensive interventions. (PsycINFO Database Record
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Affiliation(s)
- Belinda Borrelli
- Boston University, Henry M. Goldman School of Dental Medicine, Department of Health Policy and Health Services Research, Division of Behavioral Science Research, Boston, MA
| | - Romano Endrighi
- Boston University, Henry M. Goldman School of Dental Medicine, Department of Health Policy and Health Services Research, Division of Behavioral Science Research, Boston, MA
| | - S. Katharine Hammond
- Environmental Health Science Division, School of Public Health, University of California at Berkeley
| | - Shira Dunsiger
- Centers for Behavioral and Preventive Medicine, Alpert Medical School of Brown University and The Miriam Hospital
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15
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Association of the Affordable Care Act With Smoking and Tobacco Treatment Utilization Among Adults Newly Enrolled in Health Care. Med Care 2017; 55:535-541. [PMID: 28288073 DOI: 10.1097/mlr.0000000000000712] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine rates of smoking and tobacco treatment utilization by insurance coverage status (Medicaid, commercial, exchange) among newly enrolled patients in the post Affordable Care Act (ACA) era. METHODS We examined new members who enrolled in Kaiser Permanente Northern California through Medicaid, the California exchange, or nonexchange commercial plans (N=122,298) in the first 6 months of 2014 following ACA implementation. We compared these groups on smoking prevalence and tested whether smokers in each group differed on sociodemographic characteristics and in their utilization of tobacco treatment (pharmacotherapy and counseling) in 2014. RESULTS Smoking prevalence was higher among Medicaid (22%) than exchange (13%) or commercial (12%) patients (P<0.0001). Controlling for key sociodemographic and clinical characteristics, Medicaid (odds ratio, 1.49; 95% confidence interval, 1.29-1.73) smokers had greater odds of tobacco treatment use than commercial smokers. Other groups at risk for underuse included men, younger patients, Asians, and Latinos. CONCLUSIONS In this cohort of newly enrolled patients after ACA implementation, Medicaid patients were more likely to be smokers compared with exchange and commercial patients, but they were also more likely to use tobacco treatment. Low tobacco treatment use among exchange and commercial plan smokers, as well as younger men, Asians and Latinos poses a significant obstacle to improving public health and additional targeted outreach strategies may be needed to engage these patients with available health services.
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16
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McClure JB, Heffner J, Hohl S, Klasnja P, Catz SL. Design Considerations for mHealth Programs Targeting Smokers Not Yet Ready to Quit: Results of a Sequential Mixed-Methods Study. JMIR Mhealth Uhealth 2017; 5:e31. [PMID: 28283465 PMCID: PMC5381767 DOI: 10.2196/mhealth.6845] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/12/2016] [Accepted: 02/11/2017] [Indexed: 11/18/2022] Open
Abstract
Background Mobile health (mHealth) smoking cessation programs are typically designed for smokers who are ready to quit smoking. In contrast, most smokers want to quit someday but are not yet ready to quit. If mHealth apps were designed for these smokers, they could potentially encourage and assist more people to quit smoking. No prior studies have specifically examined the design considerations of mHealth apps targeting smokers who are not yet ready to quit. Objective To inform the user-centered design of mHealth apps for smokers who were not yet ready to quit by assessing (1) whether these smokers were interested in using mHealth tools to change their smoking behavior; (2) their preferred features, functionality, and content of mHealth programs addressing smoking; and (3) considerations for marketing or distributing these programs to promote their uptake. Methods We conducted a sequential exploratory, mixed-methods study. Qualitative interviews (phase 1, n=15) were completed with a demographically diverse group of smokers who were smartphone owners and wanted to quit smoking someday, but not yet. Findings informed a Web-based survey of smokers from across the United States (phase 2, n=116). Data were collected from April to September, 2016. Results Findings confirmed that although smokers not yet ready to quit are not actively seeking treatment or using cessation apps, most would be interested in using these programs to help them reduce or change their smoking behavior. Among phase 2 survey respondents, the app features, functions, and content rated most highly were (1) security of personal information; (2) the ability to track smoking, spending, and savings; (3) content that adaptively changes with one’s needs; (4) the ability to request support as needed; (5) the ability to earn and redeem awards for program use; (6) guidance on how to quit smoking; and (7) content specifically addressing management of nicotine withdrawal, stress, depression, and anxiety. Results generally did not vary by stage of change for quitting smoking (precontemplation vs contemplation). The least popular feature was the ability to share progress via social media. Relevant to future marketing or distribution considerations, smokers were price-sensitive and valued empirically validated programs. Program source, expert recommendations, and user ratings were also important considerations. Conclusions Smokers who are not yet ready to quit represent an important target group for intervention. Study findings suggest that many of these individuals are receptive to using mHealth tools to reduce or quit smoking, despite not having made a commitment to quit yet. The preferences for specific mHealth intervention features, functionality, and content outlined in this paper can aid addiction treatment experts, design specialists, and software developers interested in creating engaging interventions for smokers who want to quit in the future but are not yet committed to this important health goal.
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Affiliation(s)
- Jennifer B McClure
- Kaiser Permanente Washington Health Research Institute (formerly, Group Health Research Institute), Seattle, WA, United States
| | - Jaimee Heffner
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Sarah Hohl
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States.,School of Public Health, University of Washington, Seattle, WA, United States
| | - Predrag Klasnja
- Kaiser Permanente Washington Health Research Institute (formerly, Group Health Research Institute), Seattle, WA, United States
| | - Sheryl L Catz
- Betty Irene School of Nursing, University of California, Davis, Sacramento, CA, United States
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Mohammad A. Capsule Commentary on Danan et al., Does Motivation Matter? Analysis of a Randomized Trial of Proactive Outreach to VA Smokers. J Gen Intern Med 2016; 31:927. [PMID: 27130620 PMCID: PMC4945572 DOI: 10.1007/s11606-016-3715-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Amir Mohammad
- Yale University School of Medicine, New Haven, CT, USA. .,VA Connecticut Healthcare System, New Haven, CT, USA.
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18
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Feldman MD. Getting to the 'Why' of Behavior Change. J Gen Intern Med 2016; 31:819-20. [PMID: 27229001 PMCID: PMC4945577 DOI: 10.1007/s11606-016-3752-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Mitchell D Feldman
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, 1545 Divisadero, San Francisco, CA, 94143-0320, USA.
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