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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.
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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
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Körkel J. Treating patients with multiple substance use in accordance with their personal treatment goals: a new paradigm for addiction treatment. DRUGS AND ALCOHOL TODAY 2021. [DOI: 10.1108/dat-10-2020-0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to present the theoretical foundation and practical approach of “open-target addiction treatment” (OTAT). Traditional treatment programmes are usually-oriented towards fixed predefined goals (abstinence, reduced consumption and harm reduction) and often focus on one substance only (e.g. alcohol). However, as a rule, people who use drugs consume several substances and sometimes additionally exhibit behavioural addictions. For many of these addictions, there is more or less motivation for change, but commonly it is not abstinence as a consistent goal. The paradigm of OTAT systematically considers multi-substance use, expects high readiness to change and is aware that commonly clients lack the willingness to abstain permanently.
Design/methodology/approach
The theory and practice of OTAT involve three components, namely, first, to create a systematic inventory of all psychoactive substances consumed and addictive behaviours performed, second, to clarify, which substance-related change goals clients pursue and third, to choose adequate treatment options matching the substance-specific goals of the clients. Furthermore, OTAT includes didactic tools to support working along with these three steps (e.g. a set of cards to gain an overview over the psychoactive substances used and addictive behaviours performed).
Findings
The systematic implementation of OTAT requires fundamentally different concepts about addiction and its treatment, specific competencies of the staff and a corresponding portfolio of interventions within the treatment facilities.
Research limitations/implications
Future research should focus more on patients’ goal preferences and their impact on their willingness to take up treatment and its outcomes.
Practical implications
To implement OTAT treatment, institutions have to undergo a systematic process of team and organizational development.
Social implications
OTAT has the potential to reduce the treatment gap and to serve severely addicted individuals in a more comprehensive way.
Originality/value
The OTAT approach has not been described in the addiction treatment literature so far.
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Shaw RB, Sweet SN, McBride CB, Adair WK, Martin Ginis KA. Operationalizing the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework to evaluate the collective impact of autonomous community programs that promote health and well-being. BMC Public Health 2019; 19:803. [PMID: 31234804 PMCID: PMC6591988 DOI: 10.1186/s12889-019-7131-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/09/2019] [Indexed: 12/13/2022] Open
Abstract
Background The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework is a useful tool for evaluating the impact of programs in community settings. RE-AIM has been applied to evaluate individual programs but seldom used to evaluate the collective impact of community-based, public health programming developed and delivered by multiple autonomous organizations. The purposes of this paper were to (a) demonstrate how RE-AIM can be operationalized and applied to evaluate the collective impact of similar autonomous programs that promote health and well-being and (b) provide preliminary data on the collective impact of Canadian spinal cord injury (SCI) peer mentorship programs on the delivery of peer mentorship services. Methods Criteria from all five RE-AIM dimensions were operationalized to evaluate multiple similar community-based programs. For this study, nine provincial organizations that serve people with SCI were recruited from across Canada. Organizations completed a structured self-report questionnaire and participated in a qualitative telephone interview to examine different elements of their peer mentorship program. Data were analyzed using summary statistics. Results Having multiple indicators to assess RE-AIM dimensions provided a broad evaluation of the impact of Canadian SCI peer mentorship programs. Peer mentorship programs reached 1.63% of the estimated Canadian SCI population. The majority (67%) of organizations tracked the effectiveness of peer mentorship through testimonials and reports. Setting-level adoption rates were high with 100% of organizations offering peer mentorship in community and hospital settings. On average, organizations allocated 10.4% of their operating budget and 9.8% of their staff to implement peer mentorship and 89% had maintained their programming for over 10 years. Full interpretation of the collective impact of peer mentorship programs was limited as complete data were only collected for 52% of survey questions. Conclusions The lack of available organizational data highlights a significant challenge when using RE-AIM to evaluate the collective impact of multiple programs that promote health and well-being. Although researchers are encouraged to use RE-AIM to evaluate the collective impact of programs delivered by different organizations, documenting limitations and providing recommendations should be done to further the understanding of how best to operationalize RE-AIM in these contexts. Electronic supplementary material The online version of this article (10.1186/s12889-019-7131-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Robert B Shaw
- School of Health & Exercise Sciences, University of British Columbia, 1147 Research Rd, Kelowna, British Columbia, V1V 1V7, Canada. .,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, British Columbia, V5Z 1M9, Canada.
| | - Shane N Sweet
- Department of Kinesiology and Physical Education, McGill University, 475 Pine Ave W, Montreal, Quebec, H2W 1S4, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, 6363 Chemin Hudson (Pavillon Lindsay) suite 061, Montreal, Quebec, H3S 1M9, Canada
| | - Christopher B McBride
- Spinal Cord Injury BC, 780 SW Marine Drive, Vancouver, British Columbia, V6P 5Y7, Canada
| | - William K Adair
- Spinal Cord Injury Canada, 520 Sutherland Drive, Toronto, Ontario, M4G 3V9, Canada
| | - Kathleen A Martin Ginis
- School of Health & Exercise Sciences, University of British Columbia, 1147 Research Rd, Kelowna, British Columbia, V1V 1V7, Canada.,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, British Columbia, V5Z 1M9, Canada.,Department of Medicine, Division of Physical Medicine & Rehabilitation, University of British Columbia, 2329 West Mall, Vancouver, British Columbia, V6T1Z4, Canada
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Rüther T, Kiss A, Eberhardt K, Linhardt A, Kröger C, Pogarell O. Evaluation of the cognitive behavioral smoking reduction program "Smoke_less": a randomized controlled trial. Eur Arch Psychiatry Clin Neurosci 2018; 268:269-277. [PMID: 28616772 DOI: 10.1007/s00406-017-0818-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 06/06/2017] [Indexed: 11/26/2022]
Abstract
UNLABELLED The vast majority of smokers are unable or unwilling to quit, but many are open to reducing smoking. No treatment options exist for these smokers besides medication-based therapies. Thus, this study investigated the efficacy of a cognitive behavioral therapy (CBT) smoking reduction program, Smoke_less. A sample of 155 outpatient smokers aged 18-70 years was recruited at the Tobacco Dependence Outpatient Clinic of the Medical Center of the University of Munich, Germany, and randomly assigned to the experimental group (Smoke_less: four weekly CBT group sessions and two telephone calls over 5 weeks, n = 51), active comparator group (one 15-minute counseling session, n = 49), or waiting control group (no intervention during the study, n = 55). The primary endpoint was a ≥50% smoking reduction in the intention-to-treat group 1 week and 6 months after the intervention. We evaluated also abstinence rates at follow-up. Significantly more participants in the Smoke_less group had reduced smoking ≥50% compared to the waiting group at 1 week [OR 7.59 (2.59-22.19)] and 6 months [OR 5.00 (1.68-14.84)] and compared to the active comparison group at 1 week [OR 8.58 (2.67-27.31)] but not at 6 months [OR 1.73 (0.71-4.20)]. We found no significant effects on abstinence rates. The CBT smoking reduction program Smoke_less is effective for smoking reduction but is superior to brief counseling only in the short term. Further research is required to improve its efficacy in long-term smoking reduction to provide a valid, non-medication-based alternative to smokers unable or unwilling to quit. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT02337400.
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Affiliation(s)
- Tobias Rüther
- Department of Psychiatry and Psychotherapy, Medical Center of the University of Munich, Nussbaumstrasse 7, 80336, Munich, Germany.
| | - Alexa Kiss
- Department of Psychiatry and Psychotherapy, Medical Center of the University of Munich, Nussbaumstrasse 7, 80336, Munich, Germany
| | - Kerstin Eberhardt
- Department of Psychiatry and Psychotherapy, Medical Center of the University of Munich, Nussbaumstrasse 7, 80336, Munich, Germany
| | - Andrea Linhardt
- Department of Psychiatry and Psychotherapy, Medical Center of the University of Munich, Nussbaumstrasse 7, 80336, Munich, Germany
| | - Christoph Kröger
- IFT Gesundheitsförderung Gesellschaft mbH, Montsalvatstrasse 14, 80804, Munich, Germany
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, Medical Center of the University of Munich, Nussbaumstrasse 7, 80336, Munich, Germany
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Bridging the gap between research and practice: an assessment of external validity of community-based physical activity programs in Bogotá, Colombia, and Recife, Brazil. Transl Behav Med 2015; 5:1-11. [PMID: 25729448 DOI: 10.1007/s13142-014-0275-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
For more than a decade, physical activity classes have been offered in public places at no cost to the participants in some Latin American cities, however, internal and external validity evidence of these programs is limited. The goals of this study were to assess, report, and compare the external validity of the Recreovia program (RCP) in Colombia, and the Academia da Cidade program (ACP) in Brazil. Interviews to assess external validity of the RCP and ACP were conducted in 2012. The interview guide was developed based on the RE-AIM framework. Seventeen key informants were selected to participate in the study. Interviews were recorded and transcribed verbatim. Transcripts were analyzed using a constant comparative qualitative method and experts validated common themes. RCP and ACP key informants reported that both programs reach underserved population. There is no information available about effectiveness. Both programs take place in public spaces (e.g., parks and plazas), which are selected for adoption mainly based on community demand. RCP and ACP offer free physical activity classes with educational and cultural components, have a strong organizational structure for implementation, and differ on schedule and content of classes. Funding sources were reported to play an important role on long-term maintenance. Facilitators and barriers were identified. Programs are similar in the reach and adoption elements; the main differences were found on implementation and maintenance, whereas information on effectiveness was not found. Reporting external validity of these programs is useful to bridge the gap between research and practice.
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Abstract
In the United States, the rate of cigarette smoking has significantly declined over the past 2 decades, but much more work is needed, as almost 20% of adults still smoke and smoking continues to be the leading preventable cause of death. Furthermore, rates of smoking in certain subpopulations have remained relatively stable and have historically been neglected in smoking cessation research. Pharmacotherapy (both prescription and over-the-counter) and behavioral support are known to aid cessation, and their combination is more effective than either alone. There are significant barriers to access, use, and adherence, however, especially with pharmacotherapy. Therefore, the purpose of this review is to provide an update and overview of the numerous behavioral approaches that have been used to enhance smoking cessation. The research described can be classified into the type of approach used, the setting in which it is delivered, and the population targeted. Regardless of the classification, all the approaches attempt to provide smokers with the information, motivation, and behavioral skills thought to be necessary for achieving initial cessation and sustained abstinence. Recommendations for future research on behavioral smoking cessation are also included.
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Affiliation(s)
- Joseph T. Ciccolo
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York (JTC)
- Department of Psychiatry and Human Behavior, Centers for Behavioral & Preventive Medicine, Alpert Medical School of Brown University and The Miriam Hospital, Providence, Rhode Island (AMB)
| | - Andrew M. Busch
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York (JTC)
- Department of Psychiatry and Human Behavior, Centers for Behavioral & Preventive Medicine, Alpert Medical School of Brown University and The Miriam Hospital, Providence, Rhode Island (AMB)
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Thompson TP, Greaves CJ, Ayres R, Aveyard P, Warren FC, Byng R, Taylor RS, Campbell JL, Ussher M, Michie S, West R, Taylor AH. Lessons learned from recruiting socioeconomically disadvantaged smokers into a pilot randomized controlled trial to explore the role of Exercise Assisted Reduction then Stop (EARS) smoking. Trials 2015; 16:1. [PMID: 25971836 PMCID: PMC4429914 DOI: 10.1186/1745-6215-16-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 11/24/2014] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Research is needed on what influences recruitment to smoking reduction trials, and how to increase their reach. The present study aimed to i) assess the feasibility of recruiting a disadvantaged population, ii) examine the effects of recruitment methods on participant characteristics, iii) identify resource requirements for different recruitment methods, and iv) to qualitatively assess the acceptability of recruitment. This was done as part of a pilot two-arm trial of the effectiveness of a novel behavioral support intervention focused on increasing physical activity and reducing smoking, among disadvantaged smokers not wishing to quit. METHODS Smokers were recruited through mailed invitations from three primary care practices (62 participants) and one National Health Stop Smoking Service (SSS) database (31 participants). Six other participants were recruited via a variety of other community-based approaches. Data were collected through questionnaires, field notes, work sampling, and databases. Chi-squared and t-tests were used to compare baseline characteristics of participants. RESULTS We randomized between 5.1 and 11.1% of those invited through primary care and SSS, with associated researcher time to recruit one participant varying from 18 to 157 minutes depending on time and intensity invested.Only six participants were recruited through a wide variety of other community-based approaches, with an associated researcher time of 469 minutes to recruit one participant. Targets for recruiting a disadvantaged population were met, with 91% of the sample in social classes C2 to E (NRS social grades, UK), and 41% indicating mental health problems. Those recruited from SSS were more likely to respond to an initial letter, had used cessation aids before, and had attempted to quit in the past year. Overall, initial responders were more likely to be physically active than those who were recruited via follow-up telephone calls. No other demographics or behaviour characteristics were associated with recruitment approach or intensity of effort. Qualitative feedback indicated that participants had been attracted by the prospect of support that focused on smoking reduction rather than abrupt quitting. CONCLUSIONS Mailed invitations, and follow-up, from health professionals was an effective method of recruiting disadvantaged smokers into a trial of an exercise intervention to aid smoking reduction. Recruitment via community outreach approaches was largely ineffective. TRIAL REGISTRATION ISRCTN identifier: 13837944 , registered on 6 July 2010.
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Affiliation(s)
- Tom P Thompson
- Plymouth University Peninsula School of Medicine and Dentistry, ITTC Building, Plymouth Science Park, Plymouth, PL6 8BX, UK.
| | - Colin J Greaves
- University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Richard Ayres
- Plymouth University Peninsula School of Medicine and Dentistry, ITTC Building, Plymouth Science Park, Plymouth, PL6 8BX, UK.
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Walton Street, Jericho, Oxford, OX2 6NW, UK.
| | - Fiona C Warren
- University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Richard Byng
- Plymouth University Peninsula School of Medicine and Dentistry, ITTC Building, Plymouth Science Park, Plymouth, PL6 8BX, UK.
| | - Rod S Taylor
- University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - John L Campbell
- University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Michael Ussher
- Institute of Population Health Research, St George's University of London, Cranmer Terrace, London, SW17 ORE, UK.
| | - Susan Michie
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
| | - Robert West
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Adrian H Taylor
- Plymouth University Peninsula School of Medicine and Dentistry, ITTC Building, Plymouth Science Park, Plymouth, PL6 8BX, UK.
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Gaglio B, Shoup JA, Glasgow RE. The RE-AIM framework: a systematic review of use over time. Am J Public Health 2013; 103:e38-46. [PMID: 23597377 DOI: 10.2105/ajph.2013.301299] [Citation(s) in RCA: 559] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
We provided a synthesis of use, summarized key issues in applying, and highlighted exemplary applications in the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. We articulated key RE-AIM criteria by reviewing the published literature from 1999 to 2010 in several databases to describe the application and reporting on various RE-AIM dimensions. After excluding nonempirical articles, case studies, and commentaries, 71 articles were identified. The most frequent publications were on physical activity, obesity, and disease management. Four articles reported solely on 1 dimension compared with 44 articles that reported on all 5 dimensions of the framework. RE-AIM was broadly applied, but several criteria were not reported consistently.
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Affiliation(s)
- Bridget Gaglio
- Bridget Gaglio is with the Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD 20852, USA.
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Beard E, Bruguera C, Brown J, McNeill A, West R. Was the expansion of the marketing license for nicotine replacement therapy in the United kingdom to include smoking reduction associated with changes in use and incidence of quit attempts? Nicotine Tob Res 2013; 15:1777-81. [PMID: 23576630 DOI: 10.1093/ntr/ntt044] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND In December 2009 and January 2010, the UK Medicines and Healthcare Products Regulatory Agency expanded the marketing license for a number of nicotine replacement therapies (NRTs) to include smoking reduction without an intention to stop completely. This study examined whether this was associated with a change in incidence of use of NRT for harm reduction (i.e., smoking reduction and/or temporary abstinence) and in smoking cessation activity. METHODS Data were taken from 10,497 smokers who took part in the Smoking Toolkit Study, which involves monthly representative household surveys of adults aged 16+ in England. Incidence of use of NRT for smoking reduction and/or temporary abstinence and attempts to stop smoking in 2009 was compared with the 2 years following the expansion of the marketing license. RESULTS Expansion of the license was not associated with an increase in incidence of NRT use for harm reduction, which was already substantial prior to the change. The odds of a quit attempt were lower in the second year following the license change relative to the year before, but there was no change in the success of quit attempts. CONCLUSIONS Expansion of the UK marketing license for NRT to include smoking reduction without the intention of quitting was not associated with an increase in use of NRT for this purpose. It was followed by a reduction in the incidence of quit attempts (but not their success) although this may have been a continuation of a pre-existing decline.
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Affiliation(s)
- Emma Beard
- Cancer Research UK Health Behaviour Research Centre, University College London
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Szklo AS, Sampaio MMA, Fernandes EM, Almeida LMD. [Smoking of non-cigarette tobacco products by students in three Brazilian cities: should we be worried?]. CAD SAUDE PUBLICA 2012; 27:2271-5. [PMID: 22124504 DOI: 10.1590/s0102-311x2011001100020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 09/08/2011] [Indexed: 11/22/2022] Open
Abstract
Smoking of non-cigarette tobacco products is increasing worldwide because of their high social acceptability, misperceptions about their purported harmlessness, and globalization of the tobacco industry. In Brazil, tobacco control experts have recently focused their attention on the importance of monitoring the use of such products. We analyzed data from the Global Youth Tobacco Survey (2009) in three cities. Prevalence rates of non-cigarette tobacco smoking in the previous 30 days among students 13 to 15 years of age were high in Campo Grande (18.3%; 95%CI: 14.4%-22.9%) and São Paulo (22.1%; 95%CI: 19.0%-25.6%), while Vitória showed comparatively lower prevalence (4.3%; 95%CI: 3.1%-5.7%). No statistical differences were observed in prevalence rates according to gender. Water pipes were the most frequent form of non-cigarette tobacco smoking. The decline in cigarette smoking in Brazil in recent years may have contributed to other forms of tobacco smoking, especially among students.
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Affiliation(s)
- André Salem Szklo
- Instituto Nacional de Câncer, Rua Marquês de Pombal 125, Rio de Janeiro, RJ, Brazil.
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Do smoking reduction interventions promote cessation in smokers not ready to quit? Addict Behav 2011; 36:764-8. [PMID: 21420791 DOI: 10.1016/j.addbeh.2011.02.003] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 12/28/2010] [Accepted: 02/08/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Limited treatment options exist for smokers who are not ready to make a quit attempt. Smoking reduction may be a viable treatment approach if proven to increase the rates of long-term abstinence from smoking. METHOD A systematic review of randomized, controlled trials that tested smoking-reduction interventions (pharmacological, behavioral, or both combined) among smokers who were not ready to make a quit attempt (immediately or in the next month) was conducted to assess the efficacy of these strategies in promoting future smoking abstinence. The primary outcome was the 7-day point-prevalence smoking abstinence at longest follow-up (≥6months). Ten trials were included; six tested pharmacologic interventions, one evaluated a behavioral intervention, and three evaluated combined interventions. RESULTS Pharmacologic (2732 participants; OR 2.33, 95% CI 1.43 to 3.79) and combined (638 participants; OR 2.14, 95% CI: 1.28 to 3.60) smoking-reduction interventions significantly increased long-term abstinence from smoking. Insufficient evidence was available on the efficacy of behavioral smoking-reduction interventions (320 participants; OR 1.49, 95% CI 0.56 to 3.93). CONCLUSIONS Further research to evaluate the efficacy of smoking reduction should have cessation as an endpoint, focus on clarity and consistency in patient selection, and identify the mechanism through which nicotine replacement therapy assisted smoking reduction in increasing abstinence rates.
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Ebbert JO, Edmonds A, Luo X, Jensen J, Hatsukami DK. Smokeless tobacco reduction with the nicotine lozenge and behavioral intervention. Nicotine Tob Res 2010; 12:823-7. [PMID: 20525780 DOI: 10.1093/ntr/ntq088] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Studies have evaluated smoking reduction with nicotine replacement therapy to reduce tobacco exposure and facilitate abstinence among cigarette smokers, but none have evaluated a reduction approach in smokeless tobacco (ST) users. METHODS We conducted an open-label pilot study to determine if the 4-mg nicotine lozenge with a behavioral intervention could facilitate ST use reduction among ST users compared with a behavioral intervention alone. Eligible subjects were ST users not interested in quitting. RESULTS One hundred and two subjects were randomized. Both interventions were associated with significant decreases in ST use and toxicant exposure and with increased abstinence, quit attempts, and duration of abstinence. However, no significant differences were observed between groups for these outcomes. DISCUSSION A behavioral intervention with or without the nicotine lozenge may be effective for decreasing both ST use and toxicant exposure and for increasing tobacco abstinence, quit attempts, and duration of abstinence. The use of reduction strategies for ST users not interested in quitting deserves further evaluation as an intervention strategy.
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Szklo AS. Review of strategies to recruit smokers for smoking cessation: a population impact perspective. CAD SAUDE PUBLICA 2009; 24 Suppl 4:s621-34. [PMID: 18797735 DOI: 10.1590/s0102-311x2008001600013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Accepted: 10/30/2007] [Indexed: 11/22/2022] Open
Abstract
This paper reviews published articles describing several instruments used currently to "capture" the attention of smokers for quit-smoking interventions and emphasizes the distinction between the strategies used to reach eligible individuals and those used to recruit them for the proposed smoking cessation intervention. The search for articles was conducted using MEDLINE, PsychARTICLE, and LILACS. Key words for the search included recruitment, enrollment, reach, smoking cessation, quitline, and helpline mentioned in the abstracts and titles of the articles. Articles published in English, Portuguese, and Spanish through November 2006 that emphasized capture instruments related to different populations and specific interventions were included in this review. Twenty-nine studies met the inclusion criteria. Studies that used active and mixed strategies reached, on average, a smaller and less diverse possible number of eligible individuals and had greater participation proportions than those that used reactive strategies. Future studies are needed to evaluate the effectiveness of new associations between current interventions and reactive capture strategies, in view of the potential for increasing the population impact related to reactive capture.
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Affiliation(s)
- André Salem Szklo
- Coordenação de Prevenção e Vigilância, Instituto Nacional de Câncer, Rio de Janeiro RJ 20231-020, Brasil.
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Murray RL, Bauld L, Hackshaw LE, McNeill A. Improving access to smoking cessation services for disadvantaged groups: a systematic review. J Public Health (Oxf) 2009; 31:258-77. [PMID: 19208688 DOI: 10.1093/pubmed/fdp008] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Smoking is a main contributor to health inequalities. Identifying strategies to find and support smokers from disadvantaged groups is, therefore, of key importance. METHODS A systematic review was carried out of studies identifying and supporting smokers from disadvantaged groups for smoking cessation, and providing and improving their access to smoking-cessation services. A wide range of electronic databases were searched and unpublished reports were identified from the national research register and key experts. RESULTS Over 7500 studies were screened and 48 were included. Some papers were of poor quality, most were observational studies and many did not report findings for disadvantaged smokers. Nevertheless, several methods of recruiting smokers, including proactively targeting patients on General Physician's registers, routine screening or other hospital appointments, were identified. Barriers to service use for disadvantaged groups were identified and providing cessation services in different settings appeared to improve access. We found preliminary evidence of the effectiveness of some interventions in increasing quitting behaviour in disadvantaged groups. CONCLUSIONS There is limited evidence on effective strategies to increase access to cessation services for disadvantaged smokers. While many studies collected socioeconomic data, very few analysed its contribution to the results. However, some potentially promising interventions were identified which merit further research.
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Affiliation(s)
- Rachael L Murray
- Division of Epidemiology and Public Health, UK Centre for Tobacco Control Studies, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Nottingham, UK.
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Gaglio B, Smith TL, Estabrooks PA, Ritzwoller DP, Ferro EF, Glasgow RE. Using theory and technology to design a practical and generalizable smoking reduction intervention. Health Promot Pract 2008; 11:675-84. [PMID: 19116418 DOI: 10.1177/1524839908324778] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this article is to describe the process of using theory to form strategies for a generalizable smoking reduction intervention delivered through multiple intervention modalities. This report describes the process of integrating theory, data from diverse sources, staff from three different organizations, and different intervention modalities into an efficient, large-scale smoking reduction program featuring automated data from electronic medical records, computer-assisted telephone interviews, and tailored newsletters. The authors successfully developed a program that was consistently implemented as planned for 320 smokers in a managed care organization. The mapping of theory to intervention, data transfer and security procedures, and processes and strategies used to overcome challenges to intervention implementation should provide lessons learned for similar health promotion projects. Few intervention studies discuss details of how they translate theory into practice or how they integrate different modalities and collaborating institutions, but such integration is critical for project success.
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Affiliation(s)
- Bridget Gaglio
- Kaiser Permanente-Colorado, Institute for Health Research, Denver, CO 80237-8066, USA.
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17
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Glasgow RE. eHealth evaluation and dissemination research. Am J Prev Med 2007; 32:S119-26. [PMID: 17466816 DOI: 10.1016/j.amepre.2007.01.023] [Citation(s) in RCA: 182] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2006] [Revised: 01/26/2007] [Accepted: 01/30/2007] [Indexed: 11/30/2022]
Abstract
This paper reviews key challenges in evaluating eHealth intervention and behavior change programs, and makes recommendations for the types of designs, measures, and methods needed to accelerate the integration of proven eHealth programs into practice. Key issues discussed include evaluation approaches that answer questions that consumers, potential adoptees, and policymakers have. These include measures of participation and representativeness at both patient and healthcare setting levels, consistency of outcomes across different subgroups, tendency of an eHealth program to ameliorate versus exacerbate health disparities, implementation and program adaptation, cost, and quality-of-life outcomes. More practical eHealth trials are needed that use rigorous but creative designs compatible with eHealth interventions and theory. These evaluations should address key dissemination issues, such as appeal, use, and robustness of eHealth programs across different subgroups, settings, conditions, outcomes, and time.
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Affiliation(s)
- Russell E Glasgow
- Clinical Research Unit, Kaiser Permanente Colorado, Denver, Colorado, USA.
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