1
|
Non-Pharmacologic Approaches to Tobacco Cessation. Respir Med 2023. [DOI: 10.1007/978-3-031-24914-3_5] [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: 03/04/2023]
|
2
|
Hitsman B, Matthews PA, Papandonatos GD, Cameron KA, Rittner SS, Mohanty N, Long T, Ackermann RT, Ramirez E, Carr J, Cordova E, Bridges C, Flowers-Carson C, Giachello AL, Hamilton A, Ciecierski CC, Simon MA. An EHR-automated and theory-based population health management intervention for smoking cessation in diverse low-income patients of safety-net health centers: a pilot randomized controlled trial. Transl Behav Med 2022; 12:892-899. [PMID: 36205472 PMCID: PMC9540977 DOI: 10.1093/tbm/ibac026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This study tested the preliminary effectiveness of an electronic health record (EHR)-automated population health management (PHM) intervention for smoking cessation among adult patients of a federally qualified health center in Chicago. Participants (N = 190; 64.7% women, 82.1% African American/Black, 8.4% Hispanic/Latino) were self-identified as smokers, as documented in the EHR, who completed the baseline survey of a longitudinal "needs assessment of health behaviors to strengthen health programs and services." Four weeks later, participants were randomly assigned to the PHM intervention (N = 97) or enhanced usual care (EUC; N = 93). PHM participants were mailed a single-page self-determination theory (SDT)-informed letter that encouraged smoking cessation or reduction as an initial step. The letter also addressed low health literacy and low income. PHM participants also received automated text messages on days 1, 5, 8, 11, and 20 after the mailed letter. Two weeks after mailing, participants were called by the Illinois Tobacco Quitline. EUC participants were e-referred following a usual practice. Participants reached by the quitline were offered behavioral counseling and nicotine replacement therapy. Outcome assessments were conducted at weeks 6, 14, and 28 after the mailed letter. Primary outcomes were treatment engagement, utilization, and self-reported smoking cessation. In the PHM arm, 25.8% of participants engaged in treatment, 21.6% used treatment, and 16.3% were abstinent at 28 weeks. This contrasts with no quitline engagement among EUC participants, and a 6.4% abstinence rate. A PHM approach that can reach all patients who smoke and address unique barriers for low-income individuals may be a critical supplement to clinic-based care.
Collapse
Affiliation(s)
- Brian Hitsman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL 60611, USA
| | - Phoenix A Matthews
- Department of Population Health Nursing Science, College of Nursing, The University of Illinois at Chicago, Chicago, IL 60612, USA
| | | | - Kenzie A Cameron
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL 60611, USA
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | | | - Nivedita Mohanty
- Alliance-Chicago, Chicago, IL 60654, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Timothy Long
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Alliance-Chicago, Chicago, IL 60654, USA
- Near North Health Service Corporation, Chicago, IL 60610, USA
| | - Ronald T Ackermann
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Edgardo Ramirez
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | | | - Emmanuel Cordova
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | | | | | - Aida Luz Giachello
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | | | | | - Melissa A Simon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL 60611, USA
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| |
Collapse
|
3
|
Bartels CM, Johnson L, Ramly E, Panyard DJ, Gilmore-Bykovskyi A, Johnson HM, McBride P, Li Z, Sampene E, Lauver DR, Lewicki K, Piper ME. Impact of a Rheumatology Clinic Protocol on Tobacco Cessation Quit Line Referrals. Arthritis Care Res (Hoboken) 2022; 74:1421-1429. [PMID: 33825349 PMCID: PMC8492788 DOI: 10.1002/acr.24589] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 12/23/2020] [Accepted: 03/02/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Smoking increases cardiopulmonary and rheumatic disease risk, yet tobacco cessation intervention is rare in rheumatology clinics. This study aimed to implement a rheumatology staff-driven protocol, Quit Connect, to increase the rate of electronic referrals (e-referrals) to free, state-run tobacco quit lines. METHODS We conducted a quasi-experimental cohort study of Quit Connect at 3 rheumatology clinics comparing tobacco quit line referrals from 4 baseline years to referrals during a 6-month intervention period. Nurses and medical assistants were trained to use 2 standardized electronic health record (EHR) prompts to check readiness to quit smoking within 30 days, advise cessation, and connect patients using tobacco quit line e-referral orders. Our objective was to use EHR data to examine the primary outcome of tobacco quit line referrals using pre/post design. RESULTS Across 54,090 pre- and post-protocol rheumatology clinic visits, 4,601 were with current smokers. We compared outcomes between 4,078 eligible pre-implementation visits and 523 intervention period visits. Post-implementation, the odds of tobacco quit line referral were 26-fold higher compared to our pre-implementation rate (unadjusted odds ratio [OR] 26 [95% confidence interval (95% CI) 6-106]). Adjusted odds of checking readiness to quit in the next 30 days increased over 100-fold compared to pre-implementation (adjusted OR 132 [95% CI 99-177]). Intervention led to e-referrals for 71% of quit-ready patients in <90 seconds; 24% of referred patients reported a quit attempt. CONCLUSION Implementing Quit Connect in rheumatology clinics was feasible and improved referrals to a state-run tobacco quit line. Given the importance of smoking cessation to reduce cardiopulmonary and rheumatic disease risk, future studies should investigate disseminating cessation protocols like Quit Connect that leverage tobacco quit lines.
Collapse
Affiliation(s)
| | - Lauren Johnson
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Edmond Ramly
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Daniel J Panyard
- University of Wisconsin School of Medicine and Public Health, Madison
| | | | - Heather M Johnson
- Charles E. Schmidt College of Medicine, Florida Atlantic University and Boca Raton Regional Hospital/Baptist Health South Florida, Boca Raton
| | - Patrick McBride
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Zhanhai Li
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Emmanuel Sampene
- University of Wisconsin School of Medicine and Public Health, Madison
| | | | - Kristin Lewicki
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Megan E Piper
- University of Wisconsin School of Medicine and Public Health, Madison
| |
Collapse
|
4
|
Japuntich SJ, Adkins-Hempel M, Lundtvedt C, Becker SJ, Helseth SA, Fu SS, Tidey J, Evins AE, Pratt R. Implementing Chronic Care Model Treatments for Cigarette Dependence in Community Mental Health Clinics. J Dual Diagn 2022; 18:153-164. [PMID: 35763554 PMCID: PMC9472099 DOI: 10.1080/15504263.2022.2090647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: Tobacco use is rarely addressed in community mental healthcare settings, despite its high prevalence among people with serious mental illness. The aim of the current study was to gather stakeholder feedback regarding the feasibility of chronic care management strategies for tobacco dependence in community mental health centers (CMHCs). Chronic care strategies evaluated included the 5 As (Ask about tobacco use, Advise users of tobacco to quit, Assess interest in cessation, Assist with cessation, and Arrange for follow-up) and proactive telephone outreach (reaching out to all users of tobacco to offer connection to tobacco cessation treatment). Methods: Using a semi-structured interview guide informed by the Practical Robust Implementation and Sustainability Model, we conducted individual semi-structured interviews with providers, leaders, and clients across two CMHCs. Our objectives were to capture their attitudes toward smoking cessation treatment, two chronic care model interventions (i.e., proactive outreach, the 5 As), and to determine the infrastructure needed to implement such interventions in their CMHCs. Thematic analysis was conducted by two independent coders to uncover pertinent themes. Results: Participants (n = 20) included nine providers, six leaders, and five clients. Thematic analysis revealed three major themes: (1) characteristics of recipients, (2) characteristics of the intervention, and (3) infrastructure needed for implementation and sustainability. Providers, leaders, and clients all reported that tobacco cessation treatment was rarely provided in CMHCs and expressed an interest in such treatments becoming more available. The 5 As and proactive outreach were viewed as feasible and acceptable to deliver and receive. Providers, leaders, and clients wanted support to connect clients with smoking cessation treatment. Providers and leaders requested a range of implementation supports, including didactic trainings, decision aids, performance feedback, and coaching on evidence-based tobacco cessation treatments for people with serious mental illness. Clients requested tobacco cessation resources, such as a cessation counseling provided at the CMHC and prescriptions for cessation medication. Conclusions: CMHC providers, leaders, and clients are interested in making tobacco cessation services more widely accessible and available. The feedback gathered in this study can be used to inform the delivery and implementation of guideline-adherent tobacco dependence care in CMHCs.
Collapse
Affiliation(s)
- Sandra J. Japuntich
- Department of Clinical Pharmacology and Toxicology, Hennepin Healthcare, Minneapolis, Minnesota, USA
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | | | - Carina Lundtvedt
- Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
| | - Sara J. Becker
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, the Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Sarah A. Helseth
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Steven S. Fu
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- VA HSR&D Center for Care Delivery and Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| | - Jennifer Tidey
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, the Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - A. Eden Evins
- Center for Addiction Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Psychiatry Department, Harvard Medical School, Boston, Massachusetts, USA
| | - Rebekah Pratt
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
5
|
Cook JW, Baker TB, Fiore MC, Collins LM, Piper ME, Schlam TR, Bolt DM, Smith SS, Zwaga D, Jorenby DE, Mermelstein R. Evaluating four motivation-phase intervention components for use with primary care patients unwilling to quit smoking: a randomized factorial experiment. Addiction 2021; 116:3167-3179. [PMID: 33908665 PMCID: PMC8492501 DOI: 10.1111/add.15528] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/15/2020] [Accepted: 04/14/2021] [Indexed: 11/27/2022]
Abstract
AIMS To assess the effectiveness of intervention components designed to increase quit attempts and promote abstinence in patients initially unwilling to quit smoking. DESIGN A four-factor, randomized factorial experiment. SETTING Sixteen primary care clinics in southern Wisconsin. PARTICIPANTS A total of 577 adults who smoke (60% women, 80% White) recruited during primary care visits who were currently willing to reduce their smoking but unwilling to try to quit. Interventions Four factors contrasted intervention components administered over a 1-year period: (i) nicotine mini-lozenge versus none; (ii) reduction counseling versus none; (iii) behavioral activation (BA) counseling versus none; and (iv) motivational 5Rs counseling versus none. Participants could request cessation treatment at any time. MEASUREMENTS The primary outcome was 7-day point-prevalence abstinence at 52 weeks post enrollment; secondary outcomes were point-prevalence abstinence at 26 weeks and making a quit attempt by weeks 26 and 52. FINDINGS No abstinence main effects were found but a mini-lozenge × reduction counseling × BA interaction was found at 52 weeks; P = 0.03. Unpacking this interaction showed that the mini-lozenge alone produced the highest abstinence rate (16.7%); combining it with reduction counseling produced an especially low abstinence rate (4.1%). Reduction counseling decreased the likelihood of making a quit attempt by 52 weeks relative to no reduction counseling (P = 0.01). CONCLUSIONS Nicotine mini-lozenges may increase smoking abstinence in people initially unwilling to quit smoking, but their effectiveness declines when used with smoking reduction counseling or other behavioral interventions. Reduction counseling decreases the likelihood of making a quit attempt in people initially unwilling to quit smoking.
Collapse
Affiliation(s)
- Jessica W Cook
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Timothy B Baker
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Michael C Fiore
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Linda M Collins
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - Megan E Piper
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Tanya R Schlam
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Daniel M Bolt
- Department of Educational Psychology, University of Wisconsin, WI, USA
| | - Stevens S Smith
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Deejay Zwaga
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Douglas E Jorenby
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Robin Mermelstein
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
6
|
Ramsey AT, Chiu A, Baker T, Smock N, Chen J, Lester T, Jorenby DE, Colditz GA, Bierut LJ, Chen LS. Care-paradigm shift promoting smoking cessation treatment among cancer center patients via a low-burden strategy, Electronic Health Record-Enabled Evidence-Based Smoking Cessation Treatment. Transl Behav Med 2021; 10:1504-1514. [PMID: 31313808 DOI: 10.1093/tbm/ibz107] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Tobacco smoking is an important risk factor for cancer incidence, an effect modifier for cancer treatment, and a negative prognostic factor for disease outcomes. Inadequate implementation of evidence-based smoking cessation treatment in cancer centers, a consequence of numerous patient-, provider-, and system-level barriers, contributes to tobacco-related morbidity and mortality. This study provides data for a paradigm shift from a frequently used specialist referral model to a point-of-care treatment model for tobacco use assessment and cessation treatment for outpatients at a large cancer center. The point-of-care model is enabled by a low-burden strategy, the Electronic Health Record-Enabled Evidence-Based Smoking Cessation Treatment program, which was implemented in the cancer center clinics on June 2, 2018. Five-month pre- and post-implementation data from the electronic health record (EHR) were analyzed. The percentage of cancer patients assessed for tobacco use significantly increased from 48% to 90% (z = 126.57, p < .001), the percentage of smokers referred for cessation counseling increased from 0.72% to 1.91% (z = 3.81, p < .001), and the percentage of smokers with cessation medication significantly increased from 3% to 17% (z = 17.20, p < .001). EHR functionalities may significantly address barriers to point-of-care treatment delivery, improving its consistent implementation and thereby increasing access to and quality of smoking cessation care for cancer center patients.
Collapse
Affiliation(s)
- Alex T Ramsey
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Ami Chiu
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Timothy Baker
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Nina Smock
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Jingling Chen
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Tina Lester
- Information Systems, BJC Healthcare, St. Louis, MO, USA
| | - Douglas E Jorenby
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.,Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
| | - Laura J Bierut
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.,Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
| | - Li-Shiun Chen
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.,Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
7
|
Flocke SA, Albert EL, Lewis SA, Love TE, Rose JC, Kaelber DC, Seeholzer EL. A cluster randomized trial evaluating a teachable moment communication process for tobacco cessation support. BMC FAMILY PRACTICE 2021; 22:85. [PMID: 33947346 PMCID: PMC8097804 DOI: 10.1186/s12875-021-01423-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/12/2021] [Indexed: 12/30/2022]
Abstract
Introduction This study examines the uptake of a clinician-focused teachable moment communication process (TMCP) and its impact on patient receipt of tobacco cessation support. The TMCP is a counseling method that uses patient concerns to help clinicians guide behavior change discussions about tobacco. We evaluate the added value of the TMCP training in a health system that implemented an Ask-Advise-Connect (AAC) systems-based approach. Methods A stepped wedge cluster randomized trial included eight community health centers. Training involved a web module and onsite skill development with standardized patients and coaching. Main outcome measures included contact and enrollment in cessation services among patients referred for counseling, prescription of cessation medications and quit attempts. Results Forty-four of 60 eligible clinicians received the TMCP training. Among TMCP-trained clinicians 68% used a TMCP approach (documented by flowsheet use) one or more times, with the median number of uses being 15 (IQR 2–33). Overall, the TMCP was used in 661 out of 8198 visits by smokers (8%). There was no improvement in any of the tobacco cessation assistance outcomes for the AAC + TMCP vs. the AAC only period. Visits where clinicians used the TMCP approach were associated with increased ordering of tobacco cessation medications, (OR = 2.6; 95% CI = 1.9, 3.5) and providing advice to quit OR 3.2 (95% CI 2.2, 4.7). Conclusions Despite high fidelity to the training, uptake of the TMCP approach in routine practice was poor, making it difficult to evaluate the impact on patient outcomes. When the TMCP approach was used, ordering tobacco cessation medications increased. Implications Tobacco cessation strategies in primary care have the potential to reach a large portion of the population and deliver advice tailored to the patient. The poor uptake of the approach despite high training fidelity suggests that additional implementation support strategies, are needed to increase sustainable adoption of the TMCP approach. Trial Registration clinicaltrials.gov #NCT02764385, registration date 06/05/2016.
Collapse
Affiliation(s)
- Susan A Flocke
- Department of Family Medicine, Oregon Health & Science, University, 3800 SW Sam Jackson Park Rd, Portland, OR, 97239, USA. .,Kaiser Permanente Center for Health Research Northwest, Portland, OR, USA.
| | - Elizabeth L Albert
- Center for Community Health Integration, Case Western Reserve University, Cleveland, OH, USA
| | - Steven A Lewis
- Population Health Research Institute, MetroHealth System, OH, Cleveland, USA.,Center for Health Care Research and Policy, MetroHealth System, OH, Cleveland, USA
| | - Thomas E Love
- Population Health Research Institute, MetroHealth System, OH, Cleveland, USA.,Center for Health Care Research and Policy, MetroHealth System, OH, Cleveland, USA.,Department of Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA.,Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Jeanmarie C Rose
- Center for Community Health Integration, Case Western Reserve University, Cleveland, OH, USA
| | - David C Kaelber
- Population Health Research Institute, MetroHealth System, OH, Cleveland, USA.,Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.,Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA.,Center for Clinical Informatics Research and Education, MetroHealth System, Cleveland, OH, USA
| | - Eileen L Seeholzer
- Population Health Research Institute, MetroHealth System, OH, Cleveland, USA.,Center for Health Care Research and Policy, MetroHealth System, OH, Cleveland, USA.,Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|
8
|
Baker TB, Berg KM, Adsit RT, Skora AD, Swedlund MP, Zehner ME, McCarthy DE, Glasgow RE, Fiore MC. Closed-Loop Electronic Referral From Primary Care Clinics to a State Tobacco Cessation Quitline: Effects Using Real-World Implementation Training. Am J Prev Med 2021; 60:S113-S122. [PMID: 33663698 PMCID: PMC7939019 DOI: 10.1016/j.amepre.2019.12.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 12/04/2019] [Accepted: 12/18/2019] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Patients who use tobacco are too rarely connected with tobacco use treatment during healthcare visits. Electronic health record enhancements may increase such referrals in primary care settings. This project used the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework to assess the implementation of a healthcare system change carried out in an externally valid manner (executed by the healthcare system). METHODS The healthcare system used their standard, computer-based training approach to implement the electronic health record and clinic workflow changes for electronic referral in 30 primary care clinics that previously used faxed quitline referral. Electronic health record data captured rates of assessment of readiness to quit and quitline referral 4 months before implementation and 8 months (May-December 2017) after implementation. Data, analyzed from October 2018 to June 2019, also reflected intervention reach, adoption, and maintenance. RESULTS For reach and effectiveness, from before to after implementation for electronic referral, among adult patients who smoked, assessment of readiness to quit increased from 24.8% (2,126 of 8,569) to 93.2% (11,163 of 11,977), quitline referrals increased from 1.7% (143 of 8,569) to 11.3% (1,351 of 11,977), and 3.6% were connected with the quitline after implementation. For representativeness of reach, electronic referral rates were especially high for women, African Americans, and Medicaid patients. For adoption, 52.6% of staff who roomed at least 1 patient who smoked referred to the quitline. For maintenance, electronic referral rates fell by approximately 60% over 8 months but remained higher than pre-implementation rates. CONCLUSIONS Real-world implementation of an electronic health record-based electronic referral system markedly increased readiness to quit assessment and quitline referral rates in primary care patients. Future research should focus on implementation methods that produce more consistent implementation and better maintenance of electronic referral.
Collapse
Affiliation(s)
- Timothy B Baker
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
| | - Kristin M Berg
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
| | - Robert T Adsit
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Amy D Skora
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Matthew P Swedlund
- University of Wisconsin Hospitals and Clinics, Madison, Wisconsin; Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Mark E Zehner
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Danielle E McCarthy
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
| | - Russell E Glasgow
- Department of Family Medicine, University of Colorado, Denver, Colorado
| | - Michael C Fiore
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
| |
Collapse
|
9
|
Fiore M, Adsit R, Zehner M, McCarthy D, Lundsten S, Hartlaub P, Mahr T, Gorrilla A, Skora A, Baker T. An electronic health record-based interoperable eReferral system to enhance smoking Quitline treatment in primary care. J Am Med Inform Assoc 2021; 26:778-786. [PMID: 31089727 DOI: 10.1093/jamia/ocz044] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/11/2019] [Accepted: 03/19/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The study sought to determine whether interoperable, electronic health record-based referral (eReferral) produces higher rates of referral and connection to a state tobacco quitline than does fax-based referral, thus addressing low rates of smoking treatment delivery in health care. MATERIALS AND METHODS Twenty-three primary care clinics from 2 healthcare systems (A and B) in Wisconsin were randomized, unblinded, over 2016-2017, to 2 smoking treatment referral methods: paper-based fax-to-quit (system A =6, system B = 6) or electronic (eReferral; system A = 5, system B = 6). Both methods referred adult patients who smoked to the Wisconsin Tobacco Quitline. A total of 14 636 smokers were seen in the 2 systems (system A: 54.5% women, mean age 48.2 years; system B: 53.8% women, mean age 50.2 years). RESULTS Clinics with eReferral, vs fax-to-quit, referred a higher percentage of adult smokers to the quitline: system A clinic referral rate = 17.9% (95% confidence interval [CI], 17.2%-18.5%) vs 3.8% (95% CI, 3.5%-4.2%) (P < .001); system B clinic referral rate = 18.9% (95% CI, 18.3%-19.6%) vs 5.2% (95% CI, 4.9%-5.6%) (P < .001). Average rates of quitline connection were higher in eReferral than F2Q clinics: system A = 5.4% (95% CI, 5.0%-5.8%) vs 1.3% (95% CI, 1.1%-1.5%) (P < .001); system B = 5.3% (95% CI, 5.0%-5.7%) vs 2.0% (95% CI, 1.8%-2.2%) (P < .001). DISCUSSION Electronic health record-based eReferral provided an effective, closed-loop, interoperable means of referring patients who smoke to telephone quitline services, producing referral rates 3-4 times higher than the current standard of care (fax referral), including especially high rates of referral of underserved individuals. CONCLUSIONS eReferral may help address the challenge of providing smokers with treatment for tobacco use during busy primary care visits.ClinicalTrials.gov; No. NCT02735382.
Collapse
Affiliation(s)
- Michael Fiore
- Center for Tobacco Research and Intervention and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Rob Adsit
- Center for Tobacco Research and Intervention and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Mark Zehner
- Center for Tobacco Research and Intervention and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Danielle McCarthy
- Center for Tobacco Research and Intervention and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Susan Lundsten
- Department of Community and Preventive Care Services, Gundersen Health System, La Crosse, Wisconsin, USA
| | - Paul Hartlaub
- Family and Preventive Medicine, Brown Deer, Quality and Safety, Primary Care, Ascension Medical Group, Brown Deer, Wisconsin, USA
| | - Todd Mahr
- Department of Community and Preventive Care Services, Gundersen Health System, La Crosse, Wisconsin, USA
| | - Allison Gorrilla
- Center for Tobacco Research and Intervention and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Amy Skora
- Center for Tobacco Research and Intervention and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Timothy Baker
- Center for Tobacco Research and Intervention and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| |
Collapse
|
10
|
Schlam TR, Baker TB, Smith SS, Bolt DM, McCarthy DE, Cook JW, Hayes-Birchler T, Fiore MC, Piper ME. Electronically Monitored Nicotine Gum Use Before and After Smoking Lapses: Relationship With Lapse and Relapse. Nicotine Tob Res 2020; 22:2051-2058. [PMID: 32598468 DOI: 10.1093/ntr/ntaa116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 06/22/2020] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Greater use of nicotine replacement therapy (NRT) is related to smoking cessation success, but the causal direction is unclear. This study characterized the relationship between NRT use and smoking lapse and relapse. METHODS Participants (N = 416 smokers; 57% female, 85% White) were recruited from primary care for a smoking cessation factorial experiment and analyzed if abstaining ≥1 day in the first 2 weeks post-target quit day (TQD). Participants were randomized to counseling and 8 versus 26 weeks of nicotine patch plus nicotine gum post-TQD. Participants carried electronic dispensers that timestamped each gum use. Participants who lapsed (smoked after abstaining) within 6 weeks post-TQD were matched with nonlapsers (n = 146 pairs) on multiple variables. We compared lapsers' versus matched nonlapsers' gum use in the 5 days before and after the lapsers' first lapse. RESULTS By week 6 post-TQD, 63% of participants lapsed. Compared with nonlapsers, lapsers used less gum 1 and 2 days pre-"lapse" and on the 5 days post-lapse. Lapsers used less gum during the 5 days post-lapse than the 5 days pre-lapse. Univariate survival analyses with lapsers showed greater gum use during both pre- and post-lapse periods predicted longer latency to relapse in the first 6 weeks. CONCLUSIONS In a smoking cessation attempt using nicotine patch plus gum, lapsers versus matched nonlapsers used less gum immediately preceding and following their first lapse. Lower mean gum use before and after lapses predicted a more rapid escalation to relapse. Decreased nicotine gum use both precedes and follows returns to smoking during cessation attempts. IMPLICATIONS This research examined electronically monitored nicotine gum use collected in real time and found that among smokers engaged in a quit attempt, lapsers (vs. matched nonlapsers) tended to decrease their gum use 1-2 days prior to lapsing and to further decrease their gum use from pre- to post-lapse. Decreased gum use pre-lapse may signal heightened lapse risk in 1-2 days, with lower level of gum use predicting a more precipitous course of relapse. These results encourage further exploration of objective measures of smoking medication use patterns to examine their signaling properties and to inform understanding of cessation failure. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT01120704.
Collapse
Affiliation(s)
- Tanya R Schlam
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI.,Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Timothy B Baker
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI.,Division of General Internal Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Stevens S Smith
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI.,Division of General Internal Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Daniel M Bolt
- Department of Educational Psychology, University of Wisconsin-Madison, Madison, WI
| | - Danielle E McCarthy
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI.,Division of General Internal Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Jessica W Cook
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI.,Division of General Internal Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.,William S. Middleton Memorial Veterans Hospital, Madison, WI
| | - Todd Hayes-Birchler
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Michael C Fiore
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI.,Division of General Internal Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Megan E Piper
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI.,Division of General Internal Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| |
Collapse
|
11
|
Li J, Chung S, Martinez MC, Luft HS. Smoking-Cessation Interventions After Lung Cancer Screening Guideline Change. Am J Prev Med 2020; 59:88-97. [PMID: 32417022 DOI: 10.1016/j.amepre.2020.01.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Recent guideline changes for lung cancer screening with low-dose computed tomography recommend smoking-cessation interventions be done in parallel with screening. The purpose of this study is to determine the post-guideline rates of smoking-cessation interventions among patients eligible and ineligible for lung cancer screening. METHODS Using electronic health records collected from a large ambulatory care system in northern California between 2010 and 2017, authors identified new patients who were current smokers aged 55-80 years visiting a primary care provider, and grouped patients into lung cancer screening-eligible heavy smokers, screening-ineligible moderate smokers, and screening-ineligible light smokers. Screening-eligible smokers versus screening-ineligible smokers were compared in receipt of smoking-cessation interventions before (2010-2013) and after (2014-2017) the guideline change, overall and by intervention type (formal counseling, informal counseling, pharmacotherapy) using hierarchical generalized linear models. Analyses were conducted in 2018-2019. RESULTS After the guideline change, the likelihood of receiving any smoking-cessation intervention (OR=1.44, 95% CI=1.28, 1.61, p<0.05), informal counseling (OR=1.29, 95% CI=1.15, 1.46, p<0.05), and pharmacotherapy (OR=1.24, 95% CI=1.02, 1.50, p<0.05) during a new patient visit significantly increased, with the increase not varying by level of smoking. For formal counseling, the post-guideline increase was greater for screening-eligible heavy smokers (OR=3.15, 95% CI=1.18, 8.36, p<0.05) and moderate smokers (OR=3.58, 95% CI=1.29, 9.95, p<0.05) relative to light smokers. CONCLUSIONS Smoking-cessation interventions increased after new lung cancer screening guidelines. Given the sizable adverse impacts of smoking on morbidity and mortality, small increases in the implementation of smoking-cessation interventions could have substantial public health benefits.
Collapse
Affiliation(s)
- Jiang Li
- Center for Health Systems Research, Sutter Health, Palo Alto Medical Foundation Research Institute, Palo Alto, California.
| | - Sukyung Chung
- Center for Health Systems Research, Sutter Health, Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Meghan C Martinez
- Center for Health Systems Research, Sutter Health, Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Harold S Luft
- Center for Health Systems Research, Sutter Health, Palo Alto Medical Foundation Research Institute, Palo Alto, California
| |
Collapse
|
12
|
Fernandez ME, Schlechter CR, Del Fiol G, Gibson B, Kawamoto K, Siaperas T, Pruhs A, Greene T, Nahum-Shani I, Schulthies S, Nelson M, Bohner C, Kramer H, Borbolla D, Austin S, Weir C, Walker TW, Lam CY, Wetter DW. QuitSMART Utah: an implementation study protocol for a cluster-randomized, multi-level Sequential Multiple Assignment Randomized Trial to increase Reach and Impact of tobacco cessation treatment in Community Health Centers. Implement Sci 2020; 15:9. [PMID: 32000812 PMCID: PMC6993416 DOI: 10.1186/s13012-020-0967-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 01/13/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Tobacco use remains the leading cause of death and disability in the USA and is disproportionately concentrated among low socioeconomic status (SES) populations. Community Health Centers (CHCs) are a key venue for reaching low SES populations with evidence-based tobacco cessation treatment such as Quitlines. Electronic health record (EHR)-based interventions at the point-of-care, text messaging (TM), and phone counseling have the potential to increase Quitline reach and are feasible to implement within CHCs. However, there is a lack of data to inform how, when, and in what combination these strategies should be implemented. The aims of this cluster-randomized trial are to evaluate multi-level implementation strategies to increase the Reach (i.e., proportion of tobacco-using patients who enroll in the Quitline) and Impact (i.e., Reach × Efficacy [efficacy is defined as the proportion of tobacco-using patients who enroll in Quitline treatment that successfully quit]) and to evaluate characteristics of healthcare system, providers, and patients that may influence tobacco-use outcomes. METHODS This study is a multilevel, three-phase, Sequential Multiple Assignment Randomized Trial (SMART), conducted in CHCs (N = 33 clinics; N = 6000 patients). In the first phase, clinics will be randomized to two different EHR conditions. The second and third phases are patient-level randomizations based on prior treatment response. Patients who enroll in the Quitline receive no further interventions. In phase two, patients who are non-responders (i.e., patients who do not enroll in Quitline) will be randomized to receive either TM or continued-EHR. In phase three, patients in the TM condition who are non-responders will be randomized to receive either continued-TM or TM + phone coaching. DISCUSSION This project will evaluate scalable, multi-level interventions to directly address strategic national priorities for reducing tobacco use and related disparities by increasing the Reach and Impact of evidence-based tobacco cessation interventions in low SES populations. TRIAL REGISTRATION This trial was registered at ClinicalTrials.gov (NCT03900767) on April 4th, 2019.
Collapse
Affiliation(s)
- Maria E Fernandez
- Center for Health Promotion and Prevention Research, Department of Health Promotion & Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin St, Houston, TX, 77030, USA
| | - Chelsey R Schlechter
- Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr, Salt Lake City, UT, 84112, USA.
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, USA
| | - Bryan Gibson
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, USA
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, USA
| | - Tracey Siaperas
- Association for Utah Community Health, 860 E 4500 S, Murray, UT, 84107, USA
| | - Alan Pruhs
- Association for Utah Community Health, 860 E 4500 S, Murray, UT, 84107, USA
| | - Tom Greene
- Department of Population Health Sciences, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, 426 Thompson St, Ann Arbor, MI, 48104, USA
| | - Sandra Schulthies
- Utah Department of Health, 288 N 1460 W, Salt Lake City, UT, 84116, USA
| | - Marci Nelson
- Utah Department of Health, 288 N 1460 W, Salt Lake City, UT, 84116, USA
| | - Claudia Bohner
- Utah Department of Health, 288 N 1460 W, Salt Lake City, UT, 84116, USA
| | - Heidi Kramer
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, USA
| | - Damian Borbolla
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, USA
| | - Sharon Austin
- Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr, Salt Lake City, UT, 84112, USA
| | - Charlene Weir
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, USA
| | - Timothy W Walker
- Center for Health Promotion and Prevention Research, Department of Health Promotion & Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin St, Houston, TX, 77030, USA
| | - Cho Y Lam
- Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr, Salt Lake City, UT, 84112, USA
- Department of Population Health Sciences, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - David W Wetter
- Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr, Salt Lake City, UT, 84112, USA
- Department of Population Health Sciences, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| |
Collapse
|
13
|
Engle JL, Mermelstein R, Baker TB, Smith SS, Schlam TR, Piper ME, Jorenby DE, Collins LM, Cook JW. Effects of motivation phase intervention components on quit attempts in smokers unwilling to quit: A factorial experiment. Drug Alcohol Depend 2019; 197:149-157. [PMID: 30825795 PMCID: PMC6573018 DOI: 10.1016/j.drugalcdep.2019.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 01/12/2019] [Accepted: 01/14/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Smoking reduction treatment is a promising approach to increase abstinence amongst smokers initially unwilling to quit. However, little is known about which reduction treatment elements increase quit attempts and the uptake of cessation treatment amongst such smokers. METHODS This study is a secondary analysis of a 4-factor randomized factorial experiment conducted amongst primary care patients (N = 517) presenting for regular healthcare visits in Southern Wisconsin who were unwilling to quit smoking but willing to cut down. We evaluated the main and interactive effects of Motivation-phase intervention components on whether participants: 1) made a quit attempt (intentional abstinence ≥24 h) by 6- and 26-weeks post-study enrollment and, 2) used cessation treatment. We also evaluated the relations of quit attempts with abstinence. The four intervention components evaluated were: 1) Nicotine Patch vs. None; 2) Nicotine Gum vs. None; 3) Motivational Interviewing (MI) vs. None; and 4) Behavioral Reduction Counseling (BR) vs. None. Intervention components were administered over 6 weeks, with an option to repeat treatment; participants could request cessation treatment at any point. RESULTS Nicotine gum significantly increased the likelihood of making a quit attempt by 6 weeks (23% vs. 15% without gum; p < .05). Conversely, nicotine patch reduced quit attempts when used with BR. Patch also discouraged use of cessation treatment (15.8% vs. 23% without patch; p < .05). Aided vs. unaided quit attempts produced abstinence in 42% vs. 10% of participants, respectively. CONCLUSION Nicotine gum is a promising Motivation-phase intervention that may spur quit attempts amongst smokers initially unwilling to quit.
Collapse
Affiliation(s)
- Jessica L. Engle
- William S. Middleton Memorial Veterans Hospital, Addictive Disorders Treatment Program, 2500 Overlook Terrace, Madison, WI, 53705, USA
| | - Robin Mermelstein
- Institute for Health Research and Policy, University of Illinois at Chicago (MC 275), 544 Westside Research Office Bldg., 1747 West Roosevelt Road, Chicago, IL, 60608, USA
| | - Timothy B. Baker
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, 1930 Monroe St. Suite 200, Madison, WI, 53711, USA
| | - Stevens S. Smith
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, 1930 Monroe St. Suite 200, Madison, WI, 53711, USA
| | - Tanya R. Schlam
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, 1930 Monroe St. Suite 200, Madison, WI, 53711, USA
| | - Megan E. Piper
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, 1930 Monroe St. Suite 200, Madison, WI, 53711, USA
| | - Douglas E. Jorenby
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, 1930 Monroe St. Suite 200, Madison, WI, 53711, USA
| | - Linda M. Collins
- The Pennsylvania State University, The Methodology Center and Department of Human Development & Family Studies, 404 Health and Human Development Building, University Park, PA 16802
| | - Jessica W. Cook
- William S. Middleton Memorial Veterans Hospital, Addictive Disorders Treatment Program, 2500 Overlook Terrace, Madison, WI, 53705, USA.,Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, 1930 Monroe St. Suite 200, Madison, WI, 53711, USA
| |
Collapse
|
14
|
Barua RS, Rigotti NA, Benowitz NL, Cummings KM, Jazayeri MA, Morris PB, Ratchford EV, Sarna L, Stecker EC, Wiggins BS. 2018 ACC Expert Consensus Decision Pathway on Tobacco Cessation Treatment: A Report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2018; 72:3332-3365. [PMID: 30527452 DOI: 10.1016/j.jacc.2018.10.027] [Citation(s) in RCA: 188] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
15
|
Fagnano M, Thorsness S, Butz A, Halterman JS. Provider Counseling About Secondhand Smoke Exposure for Urban Children With Persistent or Poorly Controlled Asthma. J Pediatr Health Care 2018; 32:612-619. [PMID: 30064929 PMCID: PMC6341479 DOI: 10.1016/j.pedhc.2018.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 05/08/2018] [Indexed: 11/21/2022]
Abstract
Urban children continue to be exposed to secondhand smoke (SHS), and this is particularly concerning for children with asthma. The objective of this study is to describe SHS exposure among urban children with asthma and assess SHS counseling delivered at primary care visits. We interviewed caregivers of 318 children (2-12 years) with persistent asthma at the time of a health care visit and reviewed medical records. We found that one third (32%) of children lived with a caregiver who smoked and that 15% lived with other smokers. Children whose caregivers smoked had the lowest prevalence of home smoking bans compared with homes with other smokers and no smokers (65% vs. 72% vs. 95%, respectively). Overall, 67% of caregivers received some SHS counseling. Providers most often counseled caregiver smokers; counseling occurred less frequently for caregivers in homes with other or no smokers. Further efforts to improve provider SHS counseling for all children with asthma are needed.
Collapse
|
16
|
Papadakis S, Cole AG, Reid RD, Assi R, Gharib M, Tulloch HE, Mullen KA, Wells G, Pipe AL. From Good to Great: The Role of Performance Coaching in Enhancing Tobacco-Dependence Treatment Rates. Ann Fam Med 2018; 16:498-506. [PMID: 30420364 PMCID: PMC6231943 DOI: 10.1370/afm.2312] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/20/2018] [Accepted: 09/01/2018] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The purpose of this study was to examine the incremental effect of performance coaching, delivered as part of a multicomponent intervention (Ottawa Model for Smoking Cessation [OMSC]), in increasing rates of tobacco-dependence treatment by primary care clinicians. METHODS In a cluster-randomized controlled trial, 15 primary care practices were randomly assigned to 1 of the following active-treatment conditions: OMSC or OMSC plus performance coaching (OMSC+). All practices received support to implement the OMSC. In addition, clinicians in the OMSC+ group participated in a 1.5-hour skills-based coaching session and received an individualized performance report. All clinicians and a cross-sectional sample of their patients were surveyed before and 4 months after introduction of the interventions. The primary outcome measure was rates of tobacco-dependence treatment strategy (Ask, Advise, Assist, Arrange) delivery. Secondary outcomes were patient quit attempts and smoking abstinence measured at 6 months' follow-up. RESULTS Primary care clinicians (166) and patients (1,990) were enrolled in the trial. Clinicians in the OMSC+ group had statistically greater rates of delivery for Ask (adjusted odds ratio [AOR] = 1.69; 95% CI, 1.05-2.72), Assist (AOR = 1.64; 95% CI, 1.08-2.49), and Arrange (AOR = 2.01; 95% CI, 1.22-3.31). Sensitivity analysis found that the rate of delivery for Advise was greater only among those clinicians who attended the coaching session (AOR = 1.65; 95% CI, 1.10-2.49; P = .02). No differences were documented between groups for cessation outcomes. CONCLUSIONS Performance coaching significantly increased rates of tobacco-dependence treatment by primary care clinicians when delivered as part of a multicomponent intervention.
Collapse
Affiliation(s)
- Sophia Papadakis
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada .,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinic of Social and Family Medicine, University of Crete, Rethymnon, Crete, Greece
| | - Adam G Cole
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Robert D Reid
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Roxane Assi
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marie Gharib
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Heather E Tulloch
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kerri-Anne Mullen
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - George Wells
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Andrew L Pipe
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
17
|
Schlam TR, Cook JW, Baker TB, Hayes-Birchler T, Bolt DM, Smith SS, Fiore MC, Piper ME. Can we increase smokers' adherence to nicotine replacement therapy and does this help them quit? Psychopharmacology (Berl) 2018; 235:2065-2075. [PMID: 29696311 PMCID: PMC6141024 DOI: 10.1007/s00213-018-4903-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 04/10/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To examine the effects of five intervention components on smokers' adherence to combined nicotine patch and nicotine gum during a quit attempt and assess whether adherence is related to cessation. METHOD Smokers interested in quitting (N = 513; 59% female; 87% White) received nicotine patch plus nicotine gum and participated in a 2x2x2x2x2 randomized factorial experiment (i.e., 32 treatment conditions) evaluating five intervention components: (1) medication adherence counseling versus none; (2) automated medication adherence calls versus none; (3) electronic medication monitoring with feedback and counseling versus e-monitoring alone; (4) 26 versus 8 weeks of nicotine patch plus nicotine gum; and (5) maintenance counseling versus none. Adherence was assessed over the first 6 weeks post-target quit day via timeline follow-back (nicotine patch) and electronic medication dispenser (gum). RESULTS In the first 6 weeks post-quit day, 12% of participants used no patches or gum, and 40% used the patch every day. Only 1.4% used both patch and gum adherently every day in the 6 weeks post-target quit day. E-monitoring counseling increased gum use (from 1.9 to 2.6 pieces/day; p < .001) but did not increase abstinence. More adherent patch and gum use in the first 6 weeks were each associated with higher point-prevalence abstinence rates through 1 year. CONCLUSIONS This large experiment with electronic monitoring of nicotine gum adherence showed that e-monitoring counseling increased gum use but not abstinence. Adherence to nicotine patch and to gum were each strongly related to abstinence, but it is unclear whether adherence increases abstinence, or relapse causes medication discontinuation. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT01120704.
Collapse
Affiliation(s)
- Tanya R Schlam
- Center for Tobacco Research and Intervention, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, 1930 Monroe Street, Suite 200, Madison, WI, 53711, USA.
| | - Jessica W Cook
- Center for Tobacco Research and Intervention, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, 1930 Monroe Street, Suite 200, Madison, WI, 53711, USA
- Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Timothy B Baker
- Center for Tobacco Research and Intervention, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, 1930 Monroe Street, Suite 200, Madison, WI, 53711, USA
- Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Todd Hayes-Birchler
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Daniel M Bolt
- Department of Educational Psychology, University of Wisconsin-Madison, Madison, WI, USA
| | - Stevens S Smith
- Center for Tobacco Research and Intervention, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, 1930 Monroe Street, Suite 200, Madison, WI, 53711, USA
- Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Michael C Fiore
- Center for Tobacco Research and Intervention, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, 1930 Monroe Street, Suite 200, Madison, WI, 53711, USA
- Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Megan E Piper
- Center for Tobacco Research and Intervention, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, 1930 Monroe Street, Suite 200, Madison, WI, 53711, USA
- Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| |
Collapse
|
18
|
Abstract
BACKGROUND People with a severe and persistent mental illness are far more likely to smoke than others. While a large portion would like to quit, they are less likely to make quit attempts and succeed. OBJECTIVE This study used an Randomized Controlled Trial (RCT) to test an intervention designed to increase engagement in cessation treatment, quit attempts, and quitting in smokers who did not want to quit in the next 30 days. It also compared these smokers with those who were motivated to quit in the next 30 days. METHODS Participants (N = 222), were smokers with significant mental illness receiving intensive outpatient care from Wisconsin Community Support Programs who were not interested in quitting in the next 30 days. They were randomly assigned to either an intervention group or an attention control group. The intervention, administered during four weekly sessions, included a motivational element, components designed to prepare the smoker for a quit attempt, and pre-quit nicotine patch. Additionally, 48 smokers motivated to quit in the next 30 days served as a comparison group. RESULTS Compared to control participants, smokers receiving the intervention were more likely to be abstinent at the three month follow-up (biochemically verified, intent to treat, 8.5% vs. 1.0%, respectively, p = .01). They were also more likely to accept four more quitting preparation sessions (intent to treat, 50.8% vs 29.2%, respectively, p < .001) but were not more likely to call a telephone tobacco quit line. Conclusion/Importance: Brief motivational interventions increased engagement in cessation treatment and abstinence among smokers with signification mental illness.
Collapse
Affiliation(s)
- Bruce A Christiansen
- a Center for Tobacco Research and Intervention , University of Wisconsin School of Medicine and Public Health , Madison , Wisconsin , USA
| | | | - Erin TerBeek
- c Greater Milwaukee Foundation , Milwaukee , Wisconsin , USA
| | - Michael C Fiore
- a Center for Tobacco Research and Intervention , University of Wisconsin School of Medicine and Public Health , Madison , Wisconsin , USA
| |
Collapse
|
19
|
Petersen A, Mermelstein R, Berg KM, Baker TB, Smith SS, Jorenby D, Piper ME, Schlam TR, Cook JW. Offering smoking treatment to primary care patients in two Wisconsin healthcare systems: Who chooses smoking reduction versus cessation? Prev Med 2017; 105:332-336. [PMID: 28988997 PMCID: PMC6211191 DOI: 10.1016/j.ypmed.2017.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 10/03/2017] [Accepted: 10/04/2017] [Indexed: 01/30/2023]
Abstract
Smokers unwilling to make a quit attempt can still benefit from smoking intervention. However, it is unclear what proportion of smokers will enter such a Motivation phase intervention, and whether such an intervention attracts different types of smokers than does abstinence oriented treatment. We conducted a study from June 2010 to October 2013 based on a chronic care model of tobacco treatment among study eligible primary care patients (N=1579; 58% women, 89% White) presenting for regular health care visits in southern Wisconsin, U.S. Medical assistants, prompted via the electronic health record (EHR), invited smokers (n=10,242) to learn more about treatment options to help them either reduce their smoking or quit. Of those invited to learn more who were then reached by study staff, 10.2% (n=1046) reported interest in reduction treatment and 24% (n=2465) reported interest in cessation treatment. Patients who selected and ultimately entered reduction (n=492) versus cessation (n=1087) were more likely to report: older age; a history of anxiety; lower motivation to quit; lower primary dependence motives; more close friends or family who smoke; and a greater interval since their last quit attempt. Results suggest that Motivation phase treatment aimed at smoking reduction may increase the proportion and range of smokers inducted into tobacco treatment.
Collapse
Affiliation(s)
- Angela Petersen
- VA San Diego Healthcare System, 8950 Villa La Jolla Dr. Ste B109, La Jolla, CA 92037, United States; University of California, San Diego, La Jolla, CA 92093, United States.
| | - Robin Mermelstein
- University of Illinois at Chicago, Institute for Health Research and Policy, 544 Westside Research Office Bldg., 1747 West Roosevelt Rd., Chicago, IL 60608, United States
| | - Kristin M Berg
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, and William S. Middleton Memorial Veterans Hospital, Madison, WI 53792, United States
| | - Timothy B Baker
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, and William S. Middleton Memorial Veterans Hospital, Madison, WI 53792, United States
| | - Stevens S Smith
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, and William S. Middleton Memorial Veterans Hospital, Madison, WI 53792, United States
| | - Doug Jorenby
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, and William S. Middleton Memorial Veterans Hospital, Madison, WI 53792, United States
| | - Megan E Piper
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, and William S. Middleton Memorial Veterans Hospital, Madison, WI 53792, United States
| | - Tanya R Schlam
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, and William S. Middleton Memorial Veterans Hospital, Madison, WI 53792, United States
| | - Jessica W Cook
- Center for Tobacco Research and Intervention, Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, and William S. Middleton Memorial Veterans Hospital, Madison, WI 53792, United States; William S. Middleton Memorial Veterans Hospital, 2500 Overlook Way, Madison, WI 53792, United States
| |
Collapse
|
20
|
Chen LS, Baker T, Brownson RC, Carney RM, Jorenby D, Hartz S, Smock N, Johnson M, Ziedonis D, Bierut LJ. Smoking Cessation and Electronic Cigarettes in Community Mental Health Centers: Patient and Provider Perspectives. Community Ment Health J 2017; 53:695-702. [PMID: 27900650 PMCID: PMC5449258 DOI: 10.1007/s10597-016-0065-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 11/22/2016] [Indexed: 01/15/2023]
Abstract
Little is known about patients' electronic cigarette use, interest in and use of smoking cessation treatments, and providers' attitude towards such treatment. We assessed patients (N = 231) and providers (45 psychiatrists, 97 case workers) in four Community Mental Health Centers. Interestingly, 50% of smokers reported interest in using electronic cigarettes to quit smoking, and 22% reported current use. While 82% of smokers reported wanting to quit or reduce smoking, 91% of psychiatrists and 84% of case workers reported that patients were not interested in quitting as the lead barrier, limiting the provision of cessation interventions. Providers' assumption of low patient interest in treatment may account for the low rate of smoking cessation treatment. In contrast, patients report interest and active use of electronic cigarettes to quit smoking. This study highlights the need for interventions targeting different phases of smoking cessation in these patients suffering disproportionately from tobacco dependence.
Collapse
Affiliation(s)
- Li-Shiun Chen
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave., Box 8134, St. Louis, MO, 63110, USA.
- BJC Behavioral Health, BJC Healthcare, St. Louis, MO, USA.
| | - Timothy Baker
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Robert M Carney
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave., Box 8134, St. Louis, MO, 63110, USA
| | - Douglas Jorenby
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Sarah Hartz
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave., Box 8134, St. Louis, MO, 63110, USA
| | - Nina Smock
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave., Box 8134, St. Louis, MO, 63110, USA
| | - Mark Johnson
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave., Box 8134, St. Louis, MO, 63110, USA
- BJC Behavioral Health, BJC Healthcare, St. Louis, MO, USA
| | - Douglas Ziedonis
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Laura J Bierut
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave., Box 8134, St. Louis, MO, 63110, USA
| |
Collapse
|
21
|
Baker TB. The 2016 Ferno Award Address: Three Things. Nicotine Tob Res 2017; 19:891-900. [PMID: 28201626 PMCID: PMC5896548 DOI: 10.1093/ntr/ntx039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/08/2017] [Indexed: 12/11/2022]
Abstract
Researchers may optimize smoking treatment by addressing three research topics that have been relatively neglected. First, researchers have neglected to intensively explore how counseling contents affect smoking cessation success. Worldwide, millions of smokers are exposed to different smoking cessation contents and messages, yet existing research evidence does not permit strong inference about the value of particular counseling contents or strategies. Research in this area could enhance smoking outcomes and yield new insights into smoking motivation. Second, researchers have focused great attention on inducing smokers to make quit attempts when they contact healthcare systems; the success of such efforts may have plateaued. Also, the vast majority of quit attempts are self-quit attempts, largely unsuccessful, that occur outside such contacts. Researchers should explore strategies for using healthcare systems as conduits for digital- and other population-based interventions independent of healthcare visits. Such resources should be used to graft timely access to evidence-based intervention onto self-quitting, yielding evidence-based, patient-managed quit attempts. Third, most smoking treatments are assembled via selection of components based on informal synthesis of empirical and impressionistic evidence and are evaluated as a package. However, recent factorial experiments show that components of smoking treatments often interact meaningfully; for example, some components may interfere with the effectiveness of other components. Many extant treatments likely comprise suboptimal sets of components; future treatment development should routinely use factorial experiments to permit the assembly of components that yield additive or synergistic effects.Research in the above three areas should significantly advance our understanding of tobacco use and its treatment. IMPLICATIONS A lack of relevant research, and the likely prospect of significant clinical and public health benefit, underscore the importance of performing research on three topics related to smoking intervention: (1) researchers need to identify which contents of smoking counseling are effective; (2) researchers need to devise innovative strategies that use healthcare systems as conduits of smoking treatment delivery outside of clinical contacts; and (3) researchers need to use factorial designs to guide their development of smoking treatments. Research on these topics should yield complementary evidence that guides the development of more effective smoking treatments.
Collapse
Affiliation(s)
- Timothy B Baker
- Department of Medicine, University of Wisconsin School of Medicine and Public
Health, Madison, WI
| |
Collapse
|
22
|
Hesse BW. System Changes for Tracking Performance Measures in Tobacco Control: Can Health Information Technology Serve as an Accelerant for Moonshot Success in Cancer? Jt Comm J Qual Patient Saf 2017; 43:232-233. [PMID: 28434456 DOI: 10.1016/j.jcjq.2017.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
23
|
Duffy SA, Ronis DL, Ewing LA, Waltje AH, Hall SV, Thomas PL, Olree CM, Maguire KA, Friedman L, Klotz S, Jordan N, Landstrom GL. Implementation of the Tobacco Tactics intervention versus usual care in Trinity Health community hospitals. Implement Sci 2016; 11:147. [PMID: 27814722 PMCID: PMC5097410 DOI: 10.1186/s13012-016-0511-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 10/17/2016] [Indexed: 01/24/2023] Open
Abstract
Background Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) implementation framework, a National Institutes of Health-sponsored study compared the nurse-administered Tobacco Tactics intervention to usual care. A prior paper describes the effectiveness of the Tobacco Tactics intervention. This subsequent paper provides data describing the remaining constructs of the RE-AIM framework. Methods This pragmatic study used a mixed methods, quasi-experimental design in five Michigan community hospitals of which three received the nurse-administered Tobacco Tactics intervention and two received usual care. Nurses and patients were surveyed pre- and post-intervention. Measures included reach (patient participation rates, characteristics, and receipt of services), adoption (nurse participation rates and characteristics), implementation (pre-to post-training changes in nurses' attitudes, delivery of services, barriers to implementation, opinions about training, documentation of services, and numbers of volunteer follow-up phone calls), and maintenance (continuation of the intervention once the study ended). Results Reach: Patient participation rates were 71.5 %. Compared to no change in the control sites, there were significant pre- to post-intervention increases in self-reported receipt of print materials in the intervention hospitals (n = 1370, p < 0.001). Adoption: In the intervention hospitals, all targeted units and several non-targeted units participated; 76.0 % (n = 1028) of targeted nurses and 317 additional staff participated in the training, and 92.4 % were extremely or somewhat satisfied with the training. Implementation: Nurses in the intervention hospitals reported increases in providing advice to quit, counseling, medications, handouts, and DVD (all p < 0.05) and reported decreased barriers to implementing smoking cessation services (p < 0.001). Qualitative comments were very positive (“user friendly,” “streamlined,” or “saves time”), although problems with showing patients the DVD and charting in the electronic medical record were noted. Maintenance: Nurses continued to provide the intervention after the study ended. Conclusions Given that nurses represent the largest group of front-line providers, this intervention, which meets Joint Commission guidelines for treating inpatient smokers, has the potential to have a wide reach and to decrease smoking, morbidity, and mortality among inpatient smokers. As we move toward more population-based interventions, the RE-AIM framework is a valuable guide for implementation. Trial registration ClinicalTrials.gov, NCT01309217 Electronic supplementary material The online version of this article (doi:10.1186/s13012-016-0511-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sonia A Duffy
- College of Nursing, Ohio State University, Newton Hall, 1585 Neil Ave, Columbus, OH, 43210, USA. .,Veterans Affairs (VA) Center for Clinical Management Research, HSR&D Center of Excellence, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.
| | - David L Ronis
- University of Michigan School of Nursing, 400 North Ingalls Building Room 4330, Ann Arbor, MI, 48109-0482, USA
| | - Lee A Ewing
- VA Center for Clinical Management Research, HSR&D Center of Excellence, 2215 Fuller Road, Ann Arbor, MI, 48105, USA
| | - Andrea H Waltje
- Internal Medicine, Brehm Tower, University of Michigan, Room 6115, 1000 Wall Street, Ann Arbor, MI, 48109-5714, USA
| | - Stephanie V Hall
- VA Center for Clinical Management Research, HSR&D Center of Excellence, 2215 Fuller Road, Ann Arbor, MI, 48105, USA
| | | | - Christine M Olree
- The Lacks Cancer Center, Mercy Health Saint Mary's, 200 Jefferson SE, Grand Rapids, MI, 49503, USA
| | | | - Lisa Friedman
- Saint Joseph Mercy Health System, 5305 E. Huron River Dr., Ann Arbor, MI, 48106-0995, USA
| | - Sue Klotz
- Saint Mary Mercy Hospital, 36475 Five Mile Road, Livonia, MI, 48154-1988, USA
| | - Neil Jordan
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Abbott Hall 710 North Lake Shore Drive, Suite 904, Chicago, IL, 60611, USA.,Center for Management of Complex Chronic Care, Hines VA Hospital, 5000 S 5th Ave., Hines, IL, 60141, USA
| | - Gay L Landstrom
- Dartmouth-Hitchcock Medical Center, One Medical Center Dr., Lebanon, NH, 03756, USA
| |
Collapse
|
24
|
Cook JW, Collins LM, Fiore MC, Smith SS, Fraser D, Bolt DM, Baker TB, Piper ME, Schlam TR, Jorenby D, Loh WY, Mermelstein R. Comparative effectiveness of motivation phase intervention components for use with smokers unwilling to quit: a factorial screening experiment. Addiction 2016; 111:117-28. [PMID: 26582140 PMCID: PMC4681585 DOI: 10.1111/add.13161] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 09/03/2015] [Accepted: 09/08/2015] [Indexed: 11/28/2022]
Abstract
AIMS To screen promising intervention components designed to reduce smoking and promote abstinence in smokers initially unwilling to quit. DESIGN A balanced, four-factor, randomized factorial experiment. SETTING Eleven primary care clinics in southern Wisconsin, USA. PARTICIPANTS A total of 517 adult smokers (63.4% women, 91.1% white) recruited during primary care visits who were willing to reduce their smoking but not quit. INTERVENTIONS Four factors contrasted intervention components designed to reduce smoking and promote abstinence: (1) nicotine patch versus none; (2) nicotine gum versus none; (3) motivational interviewing (MI) versus none; and (4) behavioral reduction counseling (BR) versus none. Participants could request cessation treatment at any point during the study. MEASUREMENTS The primary outcome was percentage change in cigarettes smoked per day at 26 weeks post-study enrollment; the secondary outcomes were percentage change at 12 weeks and point-prevalence abstinence at 12 and 26 weeks post-study enrollment. FINDINGS There were few main effects, but a significant four-way interaction at 26 weeks post-study enrollment (P = 0.01, β = 0.12) revealed relatively large smoking reductions by two component combinations: nicotine gum combined with BR and BR combined with MI. Further, BR improved 12-week abstinence rates (P = 0.04), and nicotine gum, when used without MI, increased 26-week abstinence after a subsequent aided quit attempt (P = 0.01). CONCLUSIONS Motivation-phase nicotine gum and behavioral reduction counseling are promising intervention components for smokers who are initially unwilling to quit.
Collapse
Affiliation(s)
- Jessica W. Cook
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705,William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705
| | - Linda M. Collins
- The Pennsylvania State University, The Methodology Center and Department of Human Development & Family Studies, 404 Health and Human Development Building, University Park, PA 16802
| | - Michael C. Fiore
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| | - Stevens S. Smith
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| | - David Fraser
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| | - Daniel M. Bolt
- University of Wisconsin, Department of Educational Psychology, 1025 W. Johnson St., Madison, WI 53706
| | - Timothy B. Baker
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| | - Megan E. Piper
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| | - Tanya R. Schlam
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| | - Douglas Jorenby
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| | - Wei-Yin Loh
- University of Wisconsin, Department of Statistics, 1220 Medical Sciences Center, 1300 University Ave., Madison, WI 53706
| | - Robin Mermelstein
- University of Illinois at Chicago, Institute for Health Research and Policy, 544 Westside Research Office Bldg., 1747 West Roosevelt Rd., Chicago, IL 60608
| |
Collapse
|
25
|
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.
Collapse
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
| |
Collapse
|
26
|
Schlam TR, Fiore MC, Smith SS, Fraser D, Bolt DM, Collins LM, Mermelstein R, Piper ME, Cook JW, Jorenby DE, Loh WY, Baker TB. Comparative effectiveness of intervention components for producing long-term abstinence from smoking: a factorial screening experiment. Addiction 2016; 111:142-55. [PMID: 26581819 PMCID: PMC4692280 DOI: 10.1111/add.13153] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [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: 11/28/2022]
Abstract
AIMS To identify promising intervention components that help smokers attain and maintain abstinence during a quit attempt. DESIGN A 2 × 2 × 2 × 2 × 2 randomized factorial experiment. SETTING Eleven primary care clinics in Wisconsin, USA. PARTICIPANTS A total of 544 smokers (59% women, 86% white) recruited during primary care visits and motivated to quit. INTERVENTIONS Five intervention components designed to help smokers attain and maintain abstinence: (1) extended medication (26 versus 8 weeks of nicotine patch + nicotine gum); (2) maintenance (phone) counseling versus none; (3) medication adherence counseling versus none; (4) automated (medication) adherence calls versus none; and (5) electronic medication monitoring with feedback and counseling versus electronic medication monitoring alone. MEASUREMENTS The primary outcome was 7-day self-reported point-prevalence abstinence 1 year after the target quit day. FINDINGS Only extended medication produced a main effect. Twenty-six versus 8 weeks of medication improved point-prevalence abstinence rates (43 versus 34% at 6 months; 34 versus 27% at 1 year; P = 0.01 for both). There were four interaction effects at 1 year, showing that an intervention component's effectiveness depended upon the components with which it was combined. CONCLUSIONS Twenty-six weeks of nicotine patch + nicotine gum (versus 8 weeks) and maintenance counseling provided by phone are promising intervention components for the cessation and maintenance phases of smoking treatment.
Collapse
Affiliation(s)
- Tanya R Schlam
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, Madison, WI, USA
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, Madison, WI, USA
| | - Michael C Fiore
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, Madison, WI, USA
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, Madison, WI, USA
| | - Stevens S Smith
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, Madison, WI, USA
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, Madison, WI, USA
| | - David Fraser
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, Madison, WI, USA
| | - Daniel M Bolt
- University of Wisconsin, Department of Educational Psychology, Madison, WI, USA
| | - Linda M Collins
- The Pennsylvania State University, The Methodology Center and Department of Human Development and Family Studies, State College, PA, USA
| | - Robin Mermelstein
- University of Illinois at Chicago, Institute for Health Research and Policy, Chicago, IL, USA
| | - Megan E Piper
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, Madison, WI, USA
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, Madison, WI, USA
| | - Jessica W Cook
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 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
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 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
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, Madison, WI, USA
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, Madison, WI, USA
| |
Collapse
|
27
|
Baker TB, Collins LM, Mermelstein R, Piper ME, Schlam TR, Cook JW, Bolt DM, Smith SS, Jorenby DE, Fraser D, Loh WY, Theobald WE, Fiore MC. Enhancing the effectiveness of smoking treatment research: conceptual bases and progress. Addiction 2016; 111:107-16. [PMID: 26581974 PMCID: PMC4681592 DOI: 10.1111/add.13154] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 04/21/2015] [Accepted: 09/08/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIMS A chronic care strategy could potentially enhance the reach and effectiveness of smoking treatment by providing effective interventions for all smokers, including those who are initially unwilling to quit. This paper describes the conceptual bases of a National Cancer Institute-funded research program designed to develop an optimized, comprehensive, chronic care smoking treatment. METHODS This research is grounded in three methodological approaches: (1) the Phase-Based Model, which guides the selection of intervention components to be experimentally evaluated for the different phases of smoking treatment (motivation, preparation, cessation, and maintenance); (2) the Multiphase Optimization Strategy (MOST), which guides the screening of intervention components via efficient experimental designs and, ultimately, the assembly of promising components into an optimized treatment package; and (3) pragmatic research methods, such as electronic health record recruitment, that facilitate the efficient translation of research findings into clinical practice. Using this foundation and working in primary care clinics, we conducted three factorial experiments (reported in three accompanying papers) to screen 15 motivation, preparation, cessation and maintenance phase intervention components for possible inclusion in a chronic care smoking treatment program. RESULTS This research identified intervention components with relatively strong evidence of effectiveness at particular phases of smoking treatment and it demonstrated the efficiency of the MOST approach in terms both of the number of intervention components tested and of the richness of the information yielded. CONCLUSIONS A new, synthesized research approach efficiently evaluates multiple intervention components to identify promising components for every phase of smoking treatment. Many intervention components interact with one another, supporting the use of factorial experiments in smoking treatment development.
Collapse
Affiliation(s)
- Timothy B. Baker
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| | - Linda M. Collins
- The Pennsylvania State University, The Methodology Center and Department of Human Development & Family Studies, 404 Health and Human Development Building, University Park, PA 16802
| | - Robin Mermelstein
- University of Illinois at Chicago Institute for Health Research and Policy 544, Westside Research Office Bldg., 1747 West Roosevelt Rd., Chicago, IL 60608
| | - Megan E. Piper
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| | - Tanya R. Schlam
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| | - Jessica W. Cook
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705,William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705
| | - Daniel M. Bolt
- University of Wisconsin, Department of Educational Psychology, 1025 W. Johnson St., Madison, WI 53706
| | - Stevens S. Smith
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| | - Douglas E. Jorenby
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| | - David Fraser
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| | - Wei-Yin Loh
- University of Wisconsin, Department of Statistics, 1220 Medical Sciences Center 1300 University Ave., Madison, WI 53706
| | - Wendy E. Theobald
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| | - Michael C. Fiore
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Suite 200, Madison, WI 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| |
Collapse
|
28
|
Baker TB, Fiore MC. Treating more smokers, more of the time, more successfully. Addiction 2015; 110:388-9. [PMID: 25678285 PMCID: PMC4466910 DOI: 10.1111/add.12801] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 10/30/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Timothy B. Baker
- Center for Tobacco Research and Intervention; University of Wisconsin School of Medicine and Public Health; 1930 Monroe Street, Suite 200 Madison WI 53711 USA
| | - Michael C. Fiore
- Center for Tobacco Research and Intervention; University of Wisconsin School of Medicine and Public Health; 1930 Monroe Street, Suite 200 Madison WI 53711 USA
| |
Collapse
|
29
|
Caraballo RS, Kruger J, Asman K, Pederson L, Widome R, Kiefe CI, Hitsman B, Jacobs DR. Relapse among cigarette smokers: the CARDIA longitudinal study - 1985-2011. Addict Behav 2014; 39:101-6. [PMID: 24172753 DOI: 10.1016/j.addbeh.2013.08.030] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 08/06/2013] [Accepted: 08/30/2013] [Indexed: 11/16/2022]
Abstract
RATIONALE There is little information about long-term relapse patterns for cigarette smokers. OBJECTIVE To describe long-term prevalence of relapse and related smoking patterns by sex, race, age, and education level among a community-based cohort of young adults followed for 25 years. METHODS We examined 25 years of data from Coronary Artery Risk Development in Young Adults (CARDIA), an ongoing study of a community-based cohort of 5115 men and women aged 18 to 30 years at baseline with periodic re-examinations. At each examination smoking, quitting, and relapse were queried. We examined prevalence of smoking relapse among 3603 participants who attended at least 6 of the 8 examinations. RESULTS About 53% of 3603 participants never reported smoking on a regular basis. Among the remaining 1682 ever smokers, 52.8% of those who reported current smoking at baseline were still smoking by the end of the study, compared to 10.7% of those who initiated smoking by year 5. Among those classified as former smokers at baseline, 39% relapsed at least once; of these, 69.5% had quit again by the end of the study. Maximum education level attained, age at study baseline, and race were associated with failure to quit smoking by the end of the study and relapse among those who did quit. Maximum education level attained and age at study baseline were also associated with ability to successfully quit after a relapse. CONCLUSIONS Smoking relapse after quitting is common, especially in those with lower education level. Education was the strongest predictor of all three outcomes. Improvements in access to treatment and treatment options, especially for underserved populations, are needed to prevent relapse when smokers quit.
Collapse
Affiliation(s)
- Ralph S Caraballo
- Office on Smoking and Health, Epidemiology Branch, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA 30341-3717, USA.
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Abstract
Around 19% of US adults smoke cigarettes, and smoking remains the leading avoidable cause of death in this country. Without treatment only ~5% of smokers who try to quit achieve long-term abstinence, but evidence-based cessation treatment increases this figure to 10% to 30%. The process of smoking cessation comprises different pragmatically defined phases, and these can help guide smoking treatment development and evaluation. This review evaluates the effectiveness of smoking interventions for smokers who are unwilling to make a quit attempt (motivation phase), who are willing to make a quit attempt (cessation phase), who have recently quit (maintenance phase), and who have recently relapsed (relapse recovery phase). Multiple effective treatments exist for some phases (cessation), but not others (relapse recovery). A chronic care approach to treating smoking requires effective interventions for every phase, especially interventions that exert complementary effects both within and across phases and that can be disseminated broadly and cost-effectively.
Collapse
Affiliation(s)
- Tanya R Schlam
- Center for Tobacco Research and Intervention, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53711, USA.
| | | |
Collapse
|