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Thomas KH, Dalili MN, López-López JA, Keeney E, Phillippo D, Munafò MR, Stevenson M, Caldwell DM, Welton NJ. Smoking cessation medicines and e-cigarettes: a systematic review, network meta-analysis and cost-effectiveness analysis. Health Technol Assess 2021; 25:1-224. [PMID: 34668482 DOI: 10.3310/hta25590] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cigarette smoking is one of the leading causes of early death. Varenicline [Champix (UK), Pfizer Europe MA EEIG, Brussels, Belgium; or Chantix (USA), Pfizer Inc., Mission, KS, USA], bupropion (Zyban; GlaxoSmithKline, Brentford, UK) and nicotine replacement therapy are licensed aids for quitting smoking in the UK. Although not licensed, e-cigarettes may also be used in English smoking cessation services. Concerns have been raised about the safety of these medicines and e-cigarettes. OBJECTIVES To determine the clinical effectiveness, safety and cost-effectiveness of smoking cessation medicines and e-cigarettes. DESIGN Systematic reviews, network meta-analyses and cost-effectiveness analysis informed by the network meta-analysis results. SETTING Primary care practices, hospitals, clinics, universities, workplaces, nursing or residential homes. PARTICIPANTS Smokers aged ≥ 18 years of all ethnicities using UK-licensed smoking cessation therapies and/or e-cigarettes. INTERVENTIONS Varenicline, bupropion and nicotine replacement therapy as monotherapies and in combination treatments at standard, low or high dose, combination nicotine replacement therapy and e-cigarette monotherapies. MAIN OUTCOME MEASURES Effectiveness - continuous or sustained abstinence. Safety - serious adverse events, major adverse cardiovascular events and major adverse neuropsychiatric events. DATA SOURCES Ten databases, reference lists of relevant research articles and previous reviews. Searches were performed from inception until 16 March 2017 and updated on 19 February 2019. REVIEW METHODS Three reviewers screened the search results. Data were extracted and risk of bias was assessed by one reviewer and checked by the other reviewers. Network meta-analyses were conducted for effectiveness and safety outcomes. Cost-effectiveness was evaluated using an amended version of the Benefits of Smoking Cessation on Outcomes model. RESULTS Most monotherapies and combination treatments were more effective than placebo at achieving sustained abstinence. Varenicline standard plus nicotine replacement therapy standard (odds ratio 5.75, 95% credible interval 2.27 to 14.90) was ranked first for sustained abstinence, followed by e-cigarette low (odds ratio 3.22, 95% credible interval 0.97 to 12.60), although these estimates have high uncertainty. We found effect modification for counselling and dependence, with a higher proportion of smokers who received counselling achieving sustained abstinence than those who did not receive counselling, and higher odds of sustained abstinence among participants with higher average dependence scores. We found that bupropion standard increased odds of serious adverse events compared with placebo (odds ratio 1.27, 95% credible interval 1.04 to 1.58). There were no differences between interventions in terms of major adverse cardiovascular events. There was evidence of increased odds of major adverse neuropsychiatric events for smokers randomised to varenicline standard compared with those randomised to bupropion standard (odds ratio 1.43, 95% credible interval 1.02 to 2.09). There was a high level of uncertainty about the most cost-effective intervention, although all were cost-effective compared with nicotine replacement therapy low at the £20,000 per quality-adjusted life-year threshold. E-cigarette low appeared to be most cost-effective in the base case, followed by varenicline standard plus nicotine replacement therapy standard. When the impact of major adverse neuropsychiatric events was excluded, varenicline standard plus nicotine replacement therapy standard was most cost-effective, followed by varenicline low plus nicotine replacement therapy standard. When limited to licensed interventions in the UK, nicotine replacement therapy standard was most cost-effective, followed by varenicline standard. LIMITATIONS Comparisons between active interventions were informed almost exclusively by indirect evidence. Findings were imprecise because of the small numbers of adverse events identified. CONCLUSIONS Combined therapies of medicines are among the most clinically effective, safe and cost-effective treatment options for smokers. Although the combined therapy of nicotine replacement therapy and varenicline at standard doses was the most effective treatment, this is currently unlicensed for use in the UK. FUTURE WORK Researchers should examine the use of these treatments alongside counselling and continue investigating the long-term effectiveness and safety of e-cigarettes for smoking cessation compared with active interventions such as nicotine replacement therapy. STUDY REGISTRATION This study is registered as PROSPERO CRD42016041302. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 59. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kyla H Thomas
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael N Dalili
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - José A López-López
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Edna Keeney
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - David Phillippo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marcus R Munafò
- Faculty of Life Sciences, School of Psychological Science, University of Bristol, Bristol, UK.,MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,UK Centre for Tobacco and Alcohol Studies, University of Bristol, Bristol, UK
| | - Matt Stevenson
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Deborah M Caldwell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicky J Welton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Abstract
The impact of tobacco smoking treatment is determined by its reach into the smoking population and the effectiveness of its interventions. This review evaluates the reach and effectiveness of pharmacotherapy and psychosocial interventions for smoking. Historically, the reach of smoking treatment has been low, and therefore its impact has been limited, but new reach strategies such as digital interventions and health care system changes offer great promise. Pharmacotherapy tends to be more effective than psychosocial intervention when used clinically, and newer pharmacotherapy strategies hold great promise of further enhancing effectiveness. However, new approaches are needed to advance psychosocial interventions; progress has stagnated because research and dissemination efforts have focused too narrowly on skill training despite evidence that its core content may be inconsequential and the fact that its mechanisms are either unknown or inconsistent with supporting theory. Identifying effective psychosocial content and its mechanisms of action could greatly enhance the effectiveness of counseling, digital, and web interventions.
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Affiliation(s)
- Timothy B Baker
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53711, USA;
| | - Danielle E McCarthy
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53711, USA;
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Free, easy and effective: how young adults used 8 weeks of mailed nicotine patches and to what effect. J Smok Cessat 2020. [DOI: 10.1017/jsc.2020.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AbstractIntroductionResearch shows the mass distribution of free nicotine replacement therapy (NRT) is a high-impact, population-level strategy for smoking cessation; but underrepresentation of younger, and/or lighter, smokers challenges generalisability of findings to young adult smokers.AimsThis naturalistic study examined how and with what effect young adult smokers used free nicotine patches provided through a mass mailout programme.MethodsIn total, 5,025 eligible 18–29 year-old smokers who accessed an online ordering platform received self-help materials and an 8-week course of patches matched to their consumption level (<10 cigarettes per day (cpd); ≥10 cpd). No other behavioural support occurred. Whether participants used patches correctly and achieved 30-day continuous abstinence at 6-month follow-up were assessed.ResultsAmong 694 participants with complete data: 89% used some patches; 8% used the patches correctly for 8 weeks; 31.0% (95% confidence interval (CI) = 27.6, 34.7) achieved abstinence. Adjusted logistic regression analysis showed the highest odds of abstinence was associated with the correct use of patches (odds ratio = 2.8, 95% CI = 1.5, 5.1).ConclusionsMass distribution of free patches may be an effective public health measure for supporting younger, lighter smokers to attempt cessation, reduce consumption, or achieve abstinence. Emphasising why and how to use NRT for the entire treatment course may enhance outcomes.
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Abstract
BACKGROUND Cancer prevention and screening is a significant part of the cancer care continuum. Nurses are trusted professionals who can bring stakeholders together and serve diverse groups. OBJECTIVES This article describes how nurses can advance cancer prevention and screening initiatives in industry, education, legislative advocacy, research, survivorship, and program development and support. METHODS An online search and collaborative knowledge revealed examples of nurses leading the way in cancer prevention and screening efforts. FINDINGS Nurse-driven cancer prevention and screening collaborations advance care farther and faster. By creating maximum impact and mobilizing individual passion for a project, any nurse can find collaborative niche opportunities in clinical practice.
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Rosel JF, Elipe-Miravet M, Elósegui E, Flor-Arasil P, Machancoses FH, Pallarés J, Puchol S, Canales JJ. Pooled Time Series Modeling Reveals Smoking Habit Memory Pattern. Front Psychiatry 2020; 11:49. [PMID: 32153437 PMCID: PMC7045040 DOI: 10.3389/fpsyt.2020.00049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 01/21/2020] [Indexed: 11/16/2022] Open
Abstract
Smoking is a habit that is hard to break because nicotine is highly addictive and smoking behavior is strongly linked to multiple daily activities and routines. Here, we explored the effect of gender, age, day of the week, and previous smoking on the number of cigarettes smoked on any given day. Data consisted of daily records of the number of cigarettes participants smoked over an average period of 84 days. The sample included smokers (36 men and 26 women), aged between 18 and 26 years, who smoked at least five cigarettes a day and had smoked for at least 2 years. A panel data analysis was performed by way of multilevel pooled time series modeling. Smoking on any given day was a function of the number of cigarettes smoked on the previous day, and 2, 7, 14, 21, 28, 35, 42, 49, and 56 days previously, and the day of the week. Neither gender nor age influenced this pattern, with no multilevel effects being detected, thus the behavior of all participants fitted the same smoking model. These novel findings show empirically that smoking behavior is governed by firmly established temporal dependence patterns and inform temporal parameters for the rational design of smoking cessation programs.
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Affiliation(s)
- Jesús F Rosel
- Department of Evolutionary Psychology, Educative, Social Studies and Methodology, Universitat Jaume I, Castellón, Spain
| | - Marcel Elipe-Miravet
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
| | - Eduardo Elósegui
- Department of Theory and History of Education and Methods of Research and Diagnosis in Education, Universidad de Málaga, Málaga, Spain
| | - Patricia Flor-Arasil
- Department of Health Science, Valencian International University, Castelló de la Plana, Spain
| | | | - Jacinto Pallarés
- Department of Evolutionary Psychology, Educative, Social Studies and Methodology, Universitat Jaume I, Castellón, Spain
| | - Sara Puchol
- IATS, Consejo Superior de Investigaciones Científicas, Castellón, Spain
| | - Juan J Canales
- School of Psychological Sciences, University of Tasmania, Hobart, TAS, Australia
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Reisinger SA, Kamel S, Seiber E, Klein EG, Paskett ED, Wewers ME. Cost-Effectiveness of Community-Based Tobacco Dependence Treatment Interventions: Initial Findings of a Systematic Review. Prev Chronic Dis 2019; 16:E161. [PMID: 31831106 PMCID: PMC6936666 DOI: 10.5888/pcd16.190232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction Scientific literature evaluating the cost-effectiveness of tobacco dependence treatment programs delivered in community-based settings is scant, which limits evidence-based tobacco control decisions. The aim of this review was to systematically assess the cost-effectiveness and quality of the economic evaluations of community-based tobacco dependence treatment interventions conducted as randomized controlled trials in the United States. Methods We searched 8 electronic databases and gray literature from their beginning to February 2018. Inclusion criteria were economic evaluations of community-based tobacco dependence treatments conducted as randomized controlled trials in the United States. Two independent researchers extracted data on study design and outcomes. Study quality was assessed by using Drummond and Jefferson’s economic evaluations checklist. Nine of 3,840 publications were eligible for inclusion. Heterogeneity precluded formal meta-analyses. We synthesized a qualitative narrative of outcomes. Results All 9 studies used cost-effectiveness analysis and a payer/provider/program perspective, but several study components, such as abstinence measures, were heterogeneous. Study participants were predominantly English speaking, middle aged, white, motivated to quit, and highly nicotine dependent. Overall, the economic evaluations met most of Drummond and Jefferson’s recommendations; however, some studies provided limited details. All studies had a cost per quit at or below $2,040 or an incremental cost-effectiveness ratio (ICER) at or below $3,781. When we considered biochemical verification, sensitivity analysis, and subgroups, the costs per quit were less than $2,050 or the ICERs were less than $6,800. Conclusion All community-based interventions included in this review were cost-effective. When economic evaluation results are extrapolated to future savings, the low cost per quit or ICER indicates that the cost-effectiveness of community-based tobacco dependence treatments is similar to the cost-effectiveness of clinic-based programs and that community-based interventions are a valuable approach to tobacco control. Additional research that more fully characterizes the cost-effectiveness of community-based tobacco dependence treatments is needed to inform future decisions in tobacco control policy.
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Affiliation(s)
- Sarah A Reisinger
- Division of Health Behavior and Health Promotion, College of Public Health, Ohio State University, Columbus, Ohio.,Comprehensive Cancer Center, Ohio State University, Columbus, Ohio.,420 W 12th Ave, Ste 390, Columbus, OH 43210.
| | - Sahar Kamel
- Comprehensive Cancer Center, Ohio State University, Columbus, Ohio
| | - Eric Seiber
- Division of Health Services Management and Policy, College of Public Health, Ohio State University, Columbus, Ohio
| | - Elizabeth G Klein
- Division of Health Behavior and Health Promotion, College of Public Health, Ohio State University, Columbus, Ohio
| | - Electra D Paskett
- Comprehensive Cancer Center, Ohio State University, Columbus, Ohio.,Division of Cancer Prevention and Control, College of Medicine, Ohio State University, Columbus, Ohio.,Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio
| | - Mary Ellen Wewers
- Division of Health Behavior and Health Promotion, College of Public Health, Ohio State University, Columbus, Ohio
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Abstract
BACKGROUND Telephone services can provide information and support for smokers. Counselling may be provided proactively or offered reactively to callers to smoking cessation helplines. OBJECTIVES To evaluate the effect of telephone support to help smokers quit, including proactive or reactive counselling, or the provision of other information to smokers calling a helpline. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register, clinicaltrials.gov, and the ICTRP for studies of telephone counselling, using search terms including 'hotlines' or 'quitline' or 'helpline'. Date of the most recent search: May 2018. SELECTION CRITERIA Randomised or quasi-randomised controlled trials which offered proactive or reactive telephone counselling to smokers to assist smoking cessation. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We pooled studies using a random-effects model and assessed statistical heterogeneity amongst subgroups of clinically comparable studies using the I2 statistic. In trials including smokers who did not call a quitline, we used meta-regression to investigate moderation of the effect of telephone counselling by the planned number of calls in the intervention, trial selection of participants that were motivated to quit, and the baseline support provided together with telephone counselling (either self-help only, brief face-to-face intervention, pharmacotherapy, or financial incentives). MAIN RESULTS We identified 104 trials including 111,653 participants that met the inclusion criteria. Participants were mostly adult smokers from the general population, but some studies included teenagers, pregnant women, and people with long-term or mental health conditions. Most trials (58.7%) were at high risk of bias, while 30.8% were at unclear risk, and only 11.5% were at low risk of bias for all domains assessed. Most studies (100/104) assessed proactive telephone counselling, as opposed to reactive forms.Among trials including smokers who contacted helplines (32,484 participants), quit rates were higher for smokers receiving multiple sessions of proactive counselling (risk ratio (RR) 1.38, 95% confidence interval (CI) 1.19 to 1.61; 14 trials, 32,484 participants; I2 = 72%) compared with a control condition providing self-help materials or brief counselling in a single call. Due to the substantial unexplained heterogeneity between studies, we downgraded the certainty of the evidence to moderate.In studies that recruited smokers who did not call a helpline, the provision of telephone counselling increased quit rates (RR 1.25, 95% CI 1.15 to 1.35; 65 trials, 41,233 participants; I2 = 52%). Due to the substantial unexplained heterogeneity between studies, we downgraded the certainty of the evidence to moderate. In subgroup analysis, we found no evidence that the effect of telephone counselling depended upon whether or not other interventions were provided (P = 0.21), no evidence that more intensive support was more effective than less intensive (P = 0.43), or that the effect of telephone support depended upon whether or not people were actively trying to quit smoking (P = 0.32). However, in meta-regression, telephone counselling was associated with greater effectiveness when provided as an adjunct to self-help written support (P < 0.01), or to a brief intervention from a health professional (P = 0.02); telephone counselling was less effective when provided as an adjunct to more intensive counselling. Further, telephone support was more effective for people who were motivated to try to quit smoking (P = 0.02). The findings from three additional trials of smokers who had not proactively called a helpline but were offered telephone counselling, found quit rates were higher in those offered three to five telephone calls compared to those offered just one call (RR 1.27, 95% CI 1.12 to 1.44; 2602 participants; I2 = 0%). AUTHORS' CONCLUSIONS There is moderate-certainty evidence that proactive telephone counselling aids smokers who seek help from quitlines, and moderate-certainty evidence that proactive telephone counselling increases quit rates in smokers in other settings. There is currently insufficient evidence to assess potential variations in effect from differences in the number of contacts, type or timing of telephone counselling, or when telephone counselling is provided as an adjunct to other smoking cessation therapies. Evidence was inconclusive on the effect of reactive telephone counselling, due to a limited number studies, which reflects the difficulty of studying this intervention.
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Affiliation(s)
| | - José M. Ordóñez‐Mena
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
| | - Jamie Hartmann‐Boyce
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
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Carpenter KM, Nash CM, Vargas-Belcher RA, Vickerman KA, Haufle V. Feasibility and Early Outcomes of a Tailored Quitline Protocol for Smokers With Mental Health Conditions. Nicotine Tob Res 2019; 21:584-591. [DOI: 10.1093/ntr/ntz023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 02/11/2019] [Indexed: 12/12/2022]
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Dahne J, Wahlquist AE, Boatright AS, Garrett-Mayer E, Fleming DO, Davis R, Egan B, Carpenter MJ. Nicotine replacement therapy sampling via primary care: Methods from a pragmatic cluster randomized clinical trial. Contemp Clin Trials 2018; 72:1-7. [PMID: 30010086 PMCID: PMC6133738 DOI: 10.1016/j.cct.2018.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 07/05/2018] [Accepted: 07/12/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Primary care is the most important point of healthcare contact for smokers. Brief physician advice to quit, based on the 5As/AAR model, offers some efficacy but is inconsistently administered and has limited population impact. Nicotine replacement therapy (NRT) sampling, defined as provision of a brief NRT starter kit, when added to the 5As/AAR, is well-suited to primary care because it is simple, brief, and can be provided to all smokers. This article describes the design and methods of an ongoing comparative effectiveness trial testing standard care vs. standard care + NRT sampling within primary care. METHODS Smokers were recruited directly from primary care practices between July 2014 and December 2017 within an established network of South Carolina clinics. Interventions were delivered randomly by clinic personnel, and phone-based follow-ups were centrally coordinated by research staff to track outcomes through six months post-intervention. Primary study aims are to examine the impact of NRT sampling on smoking, inclusive of cessation, quit attempts, and uptake of evidence-based treatment. RESULTS Twenty-two clinics were recruited. Across clinics, patient census ranged from 985 to 10,957 and number of providers ranged from 1 to 63. Average patient age across clinics was 52.9 years and smoking prevalence across ranged from 10.6% to 28.5%. CONCLUSION Improving the effectiveness and reach of brief interventions within primary care could have a considerable impact on population quit rates. We consider the advantages and disadvantages of key methodological decisions relevant to the design of future primary care-based cessation trials.
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Affiliation(s)
- Jennifer Dahne
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA; Hollings Cancer Center, MUSC, Charleston, SC, USA.
| | - Amy E Wahlquist
- Department of Public Health Sciences, MUSC, Charleston, SC, USA; Hollings Cancer Center, MUSC, Charleston, SC, USA
| | - Amy S Boatright
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA; Hollings Cancer Center, MUSC, Charleston, SC, USA
| | - Elizabeth Garrett-Mayer
- Department of Public Health Sciences, MUSC, Charleston, SC, USA; Hollings Cancer Center, MUSC, Charleston, SC, USA
| | - Douglas O Fleming
- Care Coordination Institute, Greenville, SC, USA; Spatial Sciences Institute, University of Southern California, Los Angeles, CA, USA
| | - Robert Davis
- Care Coordination Institute, Greenville, SC, USA; School of Medicine, University of South Carolina Greenville, Greenville, SC, USA
| | - Brent Egan
- Care Coordination Institute, Greenville, SC, USA; School of Medicine, University of South Carolina Greenville, Greenville, SC, USA
| | - Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA; Department of Public Health Sciences, MUSC, Charleston, SC, USA; Hollings Cancer Center, MUSC, Charleston, SC, USA.
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Kushnir V, Sproule BA, Cunningham JA. Mailed distribution of free nicotine patches without behavioral support: Predictors of use and cessation. Addict Behav 2017; 67:73-78. [PMID: 28039798 DOI: 10.1016/j.addbeh.2016.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 12/09/2016] [Accepted: 12/15/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION There is growing evidence that the mailed distribution of free nicotine replacement therapy (NRT), usually as part of smokers' helplines, can been effective in increasing the odds of cessation on a population level. However, limited information is available on the utilization of NRT when it is provided for free, and factors associated with regimen adherence have remained largely unexplored. METHODS In the context of a randomized controlled trial, 500 adult smokers across Canada hypothetically interested in free NRT were mailed a 5week supply of nicotine patches, but no other support was offered. Analyses evaluated which a priori-defined demographic and smoking characteristics predicted nicotine patch use at 8week follow-up of 421 patch recipients, as well as examined the association between patch use and smoking cessation at 6months. RESULTS At 8weeks, 10.9% had used all, 47.5% had used some but not all, and 41.6% had not used any of the provided nicotine patches. Lower age, unemployment, past NRT use and intent to quit in the next 30days at baseline (preparation stage of change) were all identified as independent predictors of some nicotine patch use. Only use of all patches was associated with greater odds of smoking cessation, compared to non-users (Adj. OR=2.96; 95%CI=1.06-8.27). CONCLUSIONS The mailed distribution of free nicotine patches to smokers at large can be effective at promoting cessation, particularly among financially disadvantaged groups, those with previous NRT experience and among individuals with already advanced intent to quit.
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Cole S, Suter C, Nash C, Pollard J. Impact of a Temporary NRT Enhancement in a State Quitline and Web-Based Program. Am J Health Promot 2016; 32:1206-1213. [DOI: 10.1177/0890117116675555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To examine the impact of a nicotine replacement therapy (NRT) enhancement on quit outcomes. Design: Observational study using an intent to treat as treated analysis. Setting: Not available. Participants: A total of 4022 Idaho tobacco users aged ≥18 years who received services from the Idaho Tobacco Quitline or Idaho’s web-based program. Intervention: One-call phone or web-based participants were sent a single 4- or 8-week NRT shipment. Multiple-call participants were sent NRT in a single 4-week shipment or two 4-week shipments (second shipment sent only to those completing a second coaching call). Measures: North American Quitline Consortium recommended Minimal Data Set items collected at registration and follow-up. Thirty-day point prevalence quit rates were assessed at 7-month follow-up. Analysis: Multiple logistic regression models were used to examine the effects of program type and amount of NRT sent to participants while controlling for demographic and tobacco use characteristics. Results: Abstinence rates were significantly higher among 8-week versus 4-week NRT recipients (42.5% vs 33.3%). The effect was only significant between multiple-call program participants who received both 4-week NRT shipments versus only the first of 2 possible 4-week shipments (51.1% vs 31.1%). Costs per quit were lowest among web-based participants who received 4 weeks of NRT (US$183 per quit) and highest among multiple-call participants who received only 1 of 2 possible NRT shipments (US$557 per quit). Conclusion: To better balance cost with clinical effectiveness, funders of state-based tobacco cessation services may want to consider (1) allowing tobacco users to choose between phone- and web-based programs while (2) limiting longer NRT benefits only to multiple-call program participants.
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Affiliation(s)
- Sam Cole
- Optum (formerly Alere Wellbeing, Inc), Seattle, WA, USA
| | - Casey Suter
- Idaho Division of Public Health, Boise, ID, USA
| | - Chelsea Nash
- Optum (formerly Alere Wellbeing, Inc), Seattle, WA, USA
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Voci SC, Zawertailo LA, Hussain S, Selby PL. Association between adherence to free nicotine replacement therapy and successful quitting. Addict Behav 2016; 61:25-31. [PMID: 27235989 DOI: 10.1016/j.addbeh.2016.05.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 04/29/2016] [Accepted: 05/12/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Providing free nicotine replacement therapy (NRT) can be a cost-effective strategy for increasing quit attempts and cessation rates at a population level. However, the optimal amount of NRT to provide is unknown. Associations between duration of NRT use and abstinence may be overestimated as a result of reverse causality due to discontinuation following relapse. We examined the association between adherence to 10weeks of cost-free NRT and quit success at 6-month follow-up, after controlling for reverse causation by excluding participants who reported nonadherence due to relapse. METHODS Individuals 18years or older who smoked at least 10 cigarettes daily and intended to quit within 30days received 10weeks of NRT at a smoking cessation workshop. There were 3922 participants who attended one of 114 workshops in 70 different localities in Ontario, Canada from 2007 to 2008. RESULTS At end of treatment participants were asked whether they had used "all" of the NRT (20%), "most" of it (28%), "some" of it (47%), or whether they "did not use any" of it (5%). After controlling for reverse causation and adjusting for potential confounding variables, poorer quit success was reported by those who used either some (AOR=0.43, 95% CI=0.26-0.69, p=0.001) or none (AOR=0.30, 95% CI=0.09-0.95, p=0.041) of the NRT versus all 10weeks. Post-estimation contrasts revealed using some versus most of the NRT was also associated with poorer quit success (p=0.026). CONCLUSIONS After controlling for reverse causation, adherence to 10weeks of cost-free NRT was associated with successful abstinence at six months post-treatment.
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Troelstra SA, Bosdriesz JR, de Boer MR, Kunst AE. Effect of Tobacco Control Policies on Information Seeking for Smoking Cessation in the Netherlands: A Google Trends Study. PLoS One 2016; 11:e0148489. [PMID: 26849567 PMCID: PMC4746073 DOI: 10.1371/journal.pone.0148489] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 01/19/2016] [Indexed: 11/20/2022] Open
Abstract
Background The impact of tobacco control policies on measures of smoking cessation behaviour has often been studied, yet there is little information on their precise magnitude and duration. This study aims to measure the magnitude and timing of the impact of Dutch tobacco control policies on the rate of searching for information on smoking cessation, using Google Trends search query data. Methods An interrupted time series analysis was used to examine the effect of two types of policies (smoke-free legislation and reimbursement of smoking cessation support (SCS)) on Google searches for ‘quit smoking’. Google Trends data were seasonally adjusted and analysed using autoregressive integrated moving average (ARIMA) modelling. Multiple effect periods were modelled as dummy variables and analysed simultaneously to examine the magnitude and duration of the effect of each intervention. The same analysis was repeated with Belgian search query data as a control group, since Belgium is the country most comparable to the Netherlands in terms of geography, language, history and culture. Results A significant increase in relative search volume (RSV) was found from one to four weeks (21–41%) after the introduction of the smoking ban in restaurants and bars in the Netherlands in 2008. The introduction of SCS reimbursement in 2011 was associated with a significant increase of RSV (16–22%) in the Netherlands after 3 to 52 weeks. The reintroduction of SCS in 2013 was associated with a significant increase of RSV (9–21%) in the Netherlands from 3 to 32 weeks after the intervention. No effects were found in the Belgian control group for the smoking ban and the reintroduction of SCS in 2013, but there was a significant increase in RSV shortly before and after the introduction of SCS in 2011. Conclusions These findings suggest that these tobacco control policies have short-term or medium-term effects on the rate of searching for information on smoking cessation, and therefore potentially on smoking cessation rates.
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Affiliation(s)
- Sigrid A. Troelstra
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- * E-mail:
| | - Jizzo R. Bosdriesz
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Michiel R. de Boer
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, the Netherlands
| | - Anton E. Kunst
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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McDaniel AM, Vickerman KA, Stump TE, Monahan PO, Fellows JL, Weaver MT, Carlini BH, Champion VL, Zbikowski SM. A randomised controlled trial to prevent smoking relapse among recently quit smokers enrolled in employer and health plan sponsored quitlines. BMJ Open 2015; 5:e007260. [PMID: 26124508 PMCID: PMC4486943 DOI: 10.1136/bmjopen-2014-007260] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To test adding an interactive voice response (IVR)-supported protocol to standard quitline treatment to prevent relapse among recently quit smokers. DESIGN Parallel randomised controlled trial with three arms: standard quitline, standard plus technology enhanced quitline with 10 risk assessments (TEQ-10), standard plus 20 TEQ assessments (TEQ-20). SETTING Quit For Life (QFL) programme. PARTICIPANTS 1785 QFL enrolees through 19 employers or health plans who were 24+ h quit. INTERVENTIONS QFL is a 5-call telephone-based cessation programme including medications and web-based support. TEQ interventions included 10 or 20 IVR-delivered relapse risk assessments over 8 weeks with automated transfer to counselling for those at risk. MAIN OUTCOME MEASURES Self-reported 7-day and 30-day abstinence assessed at 6-month and 12-month post-enrolment (response rates: 61% and 59%, respectively). Missing data were imputed. RESULTS 1785 were randomised (standard n=592, TEQ-10 n=602, TEQ-20 n=591). Multiple imputation-derived, intent-to-treat 30-day quit rates (95% CI) at 6 months were 59.4% (53.7% to 63.8%) for standard, 62.3% (57.7% to 66.9%) for TEQ-10, 59.4% (53.7% to 65.1%) for TEQ-20 and 30-day quit rates at 12 months were 61.2% (55.6% to 66.8%) for standard, 60.6% (56.0% to 65.2%) for TEQ-10, 54.9% (49.0% to 60.9%) for TEQ-20. There were no significant differences in quit rates. 73.3% of TEQ participants were identified as at-risk by IVR assessments; on average, participants completed 0.41 IVR-transferred counselling calls. Positive risk assessments identified participants less likely (OR=0.56, 95% CI 0.42 to 0.76) to be abstinent at 6 months. CONCLUSIONS Standard treatment was highly effective, with 61% remaining abstinent at 12 months using multiple imputation intent-to-treat (intent-to-treat missing=smoking quit rate: 38%). TEQ assessments identified quitters at risk for relapse. However, adding IVR-transferred counselling did not yield higher quit rates. Research is needed to determine if alternative designs can improve outcomes. TRIAL REGISTRATION NUMBER NCT00888992.
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Affiliation(s)
- Anna M McDaniel
- College of Nursing, University of Florida, Gainesville, Florida, USA
| | | | - Timothy E Stump
- Department of Biostatistics, Indiana University, School of Medicine, Indianapolis, Indiana, USA
| | - Patrick O Monahan
- Department of Biostatistics, Indiana University, School of Medicine, Indianapolis, Indiana, USA
| | | | - Michael T Weaver
- College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Beatriz H Carlini
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, Washington, USA
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Duke JC, Mann N, Davis KC, MacMonegle A, Allen J, Porter L. The impact of a state-sponsored mass media campaign on use of telephone quitline and web-based cessation services. Prev Chronic Dis 2014; 11:E225. [PMID: 25539129 PMCID: PMC4279867 DOI: 10.5888/pcd11.140354] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Most US smokers do not use evidence-based interventions as part of their quit attempts. Quitlines and Web-based treatments may contribute to reductions in population-level tobacco use if successfully promoted. Currently, few states implement sustained media campaigns to promote services and increase adult smoking cessation. This study examines the effects of Florida's tobacco cessation media campaign and a nationally funded media campaign on telephone quitline and Web-based registrations for cessation services from November 2010 through September 2013. METHODS We conducted multivariable analyses of weekly media-market-level target rating points (TRPs) and weekly registrations for cessation services through the Florida Quitline (1-877-U-CAN-NOW) or its Web-based cessation service, Web Coach (www.quitnow.net/florida). RESULTS During 35 months, 141,221 tobacco users registered for cessation services through the Florida Quitline, and 53,513 registered through Web Coach. An increase in 100 weekly TRPs was associated with an increase of 7 weekly Florida Quitline registrants (β = 6.8, P < .001) and 2 Web Coach registrants (β = 1.7, P = .003) in an average media market. An increase in TRPs affected registrants from multiple demographic subgroups similarly. When state and national media campaigns aired simultaneously, approximately one-fifth of Florida's Quitline registrants came from the nationally advertised portal (1-800-QUIT-NOW). CONCLUSION Sustained, state-sponsored media can increase the number of registrants to telephone quitlines and Web-based cessation services. Federally funded media campaigns can further increase the reach of state-sponsored cessation services.
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Affiliation(s)
- Jennifer C Duke
- RTI International, 3040 East Cornwallis Rd, Research Triangle Park, NC 27709. E-mail:
| | - Nathan Mann
- RTI International, Research Triangle Park, North Carolina
| | - Kevin C Davis
- RTI International, Research Triangle Park, North Carolina
| | | | - Jane Allen
- RTI International, Research Triangle Park, North Carolina
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Abstract
Introduction: Although smoking prevalence has declined dramatically among adults in the past 40 years, 19.3% of adults still smoke, including 20.1% of adults aged 18–24 years. Quitlines are effective, population-based interventions that increase successful cessation.Aims: This study aims to describe the characteristics of young adult smokers aged 18–24 years who used telephone cessation counselling for assistance with quitting, to assess self-reported quit rates, and to examine predictors of quitting, compared to older adults.Methods: We examined data from 4,542 young adult smokers aged 18–24 years and 46,094 smokers aged ≥25 years who enrolled in the American Cancer Society's quitline services during 2006–2008.Results: Young adult smokers aged 18–24 years who called quitlines differed slightly from older adults in demographics and tobacco-use behaviours. There were no age-related differences in self-reported seven-day quit rates or 30-day quit rates at the seven-month follow-up. Predictors of quitting were mostly similar for the young adults and the older adults, although the odds of quitting were lower among young adults for living with vs. not living with a smoker.Conclusions: Although young adult smokers under-utilise telephone cessation quitlines for assistance with quitting, those who do use these services have quit rates similar to older adults.
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Burns EK, Hood NE, Goforth E, Levinson AH. Randomised trial of two nicotine patch protocols distributed through a state quitline. Tob Control 2014; 25:218-23. [PMID: 25416755 DOI: 10.1136/tobaccocontrol-2014-051843] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 11/03/2014] [Indexed: 11/04/2022]
Abstract
BACKGROUND Most telephone quitlines provide free nicotine replacement therapy (NRT). An 8-week course is recommended, but few users complete it. Information is needed to help quitlines distribute NRT cost-effectively. DESIGN Randomised two-group trial. SETTING/PARTICIPANTS Colorado QuitLine callers who smoked 16-20 cigarettes per day at enrolment and who were eligible for and agreed to receive free NRT. INTERVENTION Provision of 4-week versus 8-week NRT supply; the 8-week supply was shipped in halves and required participants to request the second half (split-shipment protocol). Enrolment occurred during March 2010-February 2011, follow-up concluded in November 2011, and analysis was performed in 2012. MAIN OUTCOME MEASURES Point abstinence (7 and 30 day) and prolonged abstinence (6 month) from tobacco use. RESULTS Overall, 1495 study participants were enrolled and 57.7% completed follow-up. Abstinence rates did not differ significantly between study conditions: 13.8% versus 12.4% in 4-week versus 8-week arms, respectively, (30-day point abstinence, non-respondents treated as smokers). NRT duration was similar in both groups, due in part to purchase of additional patches in the 4-week group. About one-third of the 8-week group requested the full 8-week supply and had higher abstinence rates. Cost per quit was lower in the 4-week (compared to 8-week) group. CONCLUSIONS A randomised trial did not find worse cessation outcomes among quitline users who received half the minimum recommended course of NRT, but offering the full recommended course using a split-shipment protocol may be reasonably cost-effective and supportive of NRT adherers. TRIAL REGISTRATION NUMBER NCT01889771.
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Affiliation(s)
- Emily K Burns
- Mercy Family Medicine, Mercy Regional Medical Center, Centura Health, Durango, Colorado, USA
| | - Nancy E Hood
- Community Properties of Ohio Management Services, Columbus, Ohio, USA
| | - Emma Goforth
- Colorado Department of Public Health and Environment, Prevention Services Division, Denver, Colorado, USA
| | - Arnold H Levinson
- Department of Community & Behavioral Health, Colorado School of Public Health, Aurora, Colorado, USA University of Colorado Cancer Center, Aurora, Colorado, USA
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Cost and Effectiveness of Combination Nicotine Replacement Therapy Among Heavy Smokers Contacting a Quitline. J Smok Cessat 2014. [DOI: 10.1017/jsc.2014.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Varghese M, Sheffer C, Stitzer M, Landes R, Brackman SL, Munn T. Socioeconomic disparities in telephone-based treatment of tobacco dependence. Am J Public Health 2014; 104:e76-84. [PMID: 24922165 DOI: 10.2105/ajph.2014.301951] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined socioeconomic disparities in tobacco dependence treatment outcomes from a free, proactive telephone counseling quitline. METHODS We delivered cognitive-behavioral treatment and nicotine patches to 6626 smokers and examined socioeconomic differences in demographic, clinical, environmental, and treatment use factors. We used logistic regressions and generalized estimating equations (GEE) to model abstinence and account for socioeconomic differences in the models. RESULTS The odds of achieving long-term abstinence differed by socioeconomic status (SES). In the GEE model, the odds of abstinence for the highest SES participants were 1.75 times those of the lowest SES participants. Logistic regression models revealed no treatment outcome disparity at the end of treatment, but significant disparities 3 and 6 months after treatment. CONCLUSIONS Although quitlines often increase access to treatment for some lower SES smokers, significant socioeconomic disparities in treatment outcomes raise questions about whether current approaches are contributing to tobacco-related socioeconomic health disparities. Strategies to improve treatment outcomes for lower SES smokers might include novel methods to address multiple factors associated with socioeconomic disparities.
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Affiliation(s)
- Merilyn Varghese
- Merilyn Varghese and Christine Sheffer are with the Department of Community Health and Social Medicine, Sophie Davis School of Biomedical Education, City College of New York, New York, NY. Maxine Stitzer is with Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD. Reid Landes is with the Department of Biostatistics, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock. S. Laney Brackman and Tiffany Munn are with the Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences
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Bush T, Levine MD, Beebe LA, Cerutti B, Deprey M, McAfee T, Boeckman L, Zbikowski S. Addressing weight gain in smoking cessation treatment: a randomized controlled trial. Am J Health Promot 2013; 27:94-102. [PMID: 23113779 DOI: 10.4278/ajhp.110603-quan-238] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the effectiveness of a cognitive behavioral treatment (CBT) addressing cessation-related weight concerns delivered via a tobacco quitline that does not address weight concerns. DESIGN Randomized controlled trial, blinded 6-month follow-up. SETTING The Oklahoma Tobacco Helpline (OKHL). SUBJECTS All 7998 smokers who called the OKHL were screened; 4240 were eligible; 2000 were randomized to the standard quitline (STD) or the brief version of the CBT weight concerns program (WCP). INTERVENTION Telephone counseling to help people quit smoking and address concerns about cessation-related weight gain. MEASURES Demographics, weight, tobacco status, weight concerns, self-efficacy in quitting, and quitting without weight gain. ANALYSIS Descriptive statistics and logistic regression. RESULTS Of those randomized, 1002 participants completed the 6-month survey (response rates = 53.2% for STD, 47% for WCP). Compared with STD, WCP led to reduced weight concerns (p < .01) and less weight gain among quitters (1.8 vs. -3.4 pounds; p = .01). Although not significant, participants in the WCP were more likely to report 30-day abstinence (33.3% vs. 36.8%, p = .24; intent to treat = 17.7 vs. 17.3). CONCLUSION The WCP was successfully delivered via a quitline and resulted in improved attitudes about weight and decreased cessation-related weight gain without harming quit rates. Promotion of a quitline focused on addressing weight in conjunction with quitline treatment for smoking cessation may improve cessation and weight outcomes. Study limitations include use of self-report and survey response.
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Affiliation(s)
- Terry Bush
- Alere Wellbeing, Seattle, Washington, USA.
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Abstract
BACKGROUND Telephone services can provide information and support for smokers. Counselling may be provided proactively or offered reactively to callers to smoking cessation helplines. OBJECTIVES To evaluate the effect of proactive and reactive telephone support via helplines and in other settings to help smokers quit. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register for studies of telephone counselling, using search terms including 'hotlines' or 'quitline' or 'helpline'. Date of the most recent search: May 2013. SELECTION CRITERIA randomized or quasi-randomised controlled trials in which proactive or reactive telephone counselling to assist smoking cessation was offered to smokers or recent quitters. DATA COLLECTION AND ANALYSIS One author identified and data extracted trials, and a second author checked them. The main outcome measure was the risk ratio for abstinence from smoking after at least six months follow-up. We selected the strictest measure of abstinence, using biochemically validated rates where available. We considered participants lost to follow-up to be continuing smokers. Where trials had more than one arm with a less intensive intervention we used only the most similar intervention without the telephone component as the control group in the primary analysis. We assessed statistical heterogeneity amongst subgroups of clinically comparable studies using the I² statistic. We considered trials recruiting callers to quitlines separately from studies recruiting in other settings. Where appropriate, we pooled studies using a fixed-effect model. We used a meta-regression to investigate the effect of differences in planned number of calls, selection for motivation, and the nature of the control condition (self help only, minimal intervention, pharmacotherapy) in the group of studies recruiting in non-quitline settings. MAIN RESULTS Seventy-seven trials met the inclusion criteria. Some trials were judged to be at risk of bias in some domains but overall we did not judge the results to be at high risk of bias. Among smokers who contacted helplines, quit rates were higher for groups randomized to receive multiple sessions of proactive counselling (nine studies, > 24,000 participants, risk ratio (RR) for cessation at longest follow-up 1.37, 95% confidence interval (CI) 1.26 to 1.50). There was mixed evidence about whether increasing the number of calls altered quit rates but most trials used more than two calls. Three studies comparing different counselling approaches during a single quitline contact did not detect significant differences. Of three studies that tested the provision of access to a hotline two detected a significant benefit and one did not.Telephone counselling not initiated by calls to helplines also increased quitting (51 studies, > 30,000 participants, RR 1.27; 95% CI 1.20 to 1.36). In a meta-regression controlling for other factors the effect was estimated to be slightly larger if more calls were offered, and in trials that specifically recruited smokers motivated to try to quit. The relative extra benefit of counselling was smaller when it was provided in addition to pharmacotherapy (usually nicotine replacement therapy) than when the control group only received self-help material or a brief intervention.A further eight studies were too diverse to contribute to meta-analyses and are discussed separately. Two compared different intensities of counselling, both of which detected a dose response; one of these detected a benefit of multiple counselling sessions over a single call for people prescribed bupropion. The others tested a variety of interventions largely involving offering telephone counselling as part of a referral or systems change and none detected evidence of effect. AUTHORS' CONCLUSIONS Proactive telephone counselling aids smokers who seek help from quitlines. Telephone quitlines provide an important route of access to support for smokers, and call-back counselling enhances their usefulness. There is limited evidence about the optimal number of calls. Proactive telephone counselling also helps people who receive it in other settings. There is some evidence of a dose response; one or two brief calls are less likely to provide a measurable benefit. Three or more calls increase the chances of quitting compared to a minimal intervention such as providing standard self-help materials, or brief advice, or compared to pharmacotherapy alone.
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Affiliation(s)
- Lindsay F Stead
- Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, UK, OX2 6GG
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Bush T, Zbikowski SM, Mahoney L, Deprey M, Mowery P, Cerutti B. State quitlines and cessation patterns among adults with selected chronic diseases in 15 states, 2005-2008. Prev Chronic Dis 2013; 9:E163. [PMID: 23137862 PMCID: PMC3498947 DOI: 10.5888/pcd9.120105] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction The death rate of people who have a chronic disease is lower among former smokers than current smokers. State tobacco cessation quitlines are available for free in every state. The objective of our study was to compare demographic characteristics, use of quitline services, and quit rates among a sample of quitline callers. Results Among 195,057 callers, 32.3% reported having 1 or more of the following chronic diseases: 17.7%, asthma; 5.9%, coronary artery disease; 11.1%, chronic obstructive pulmonary disease; and 9.3%, diabetes; 9.0% had 2 or more chronic diseases. Callers who had a chronic disease were older and better educated; more likely to be female, have Medicaid or other health insurance, and have used tobacco for 20 years or more; and less likely to quit smoking (22.3%) at 7 months than callers who had none of these chronic diseases (29.7%). Conclusion About one-third of tobacco users who call state quitlines have a chronic disease, and those who have a chronic disease are less likely to quit using tobacco. Continued efforts are needed to ensure cessation treatments are reaching tobacco users who have a chronic disease and to develop and test ways to increase quit rates among them.
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Affiliation(s)
- Terry Bush
- Alere Wellbeing, Inc, Seattle, WA 98104, USA.
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Smith SS, Keller PA, Kobinsky KH, Baker TB, Fraser DL, Bush T, Magnusson B, Zbikowski SM, McAfee TA, Fiore MC. Enhancing tobacco quitline effectiveness: identifying a superior pharmacotherapy adjuvant. Nicotine Tob Res 2013; 15:718-28. [PMID: 22992296 PMCID: PMC3611992 DOI: 10.1093/ntr/nts186] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Accepted: 07/08/2012] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Telephone tobacco quitlines are effective and are widely used, with more than 500,000 U.S. callers in 2010. This study investigated the clinical effectiveness and cost-effectiveness of 3 different quitline enhancements: combination nicotine replacement therapy (NRT), longer duration of NRT, and counseling to increase NRT adherence. METHODS In this study, 987 quitline callers were randomized to a combination of quitline treatments in a 2 × 2 × 2 factorial design: NRT duration (2 vs. 6 weeks), NRT type (nicotine patch only vs. patch plus nicotine gum), and standard 4-call counseling (SC) versus SC plus medication adherence counseling (MAC). The primary outcome was 7-day point-prevalence abstinence (PPA) at 6 months postquit in intention-to-treat (ITT) analyses. RESULTS Combination NRT for 6 weeks yielded the highest 6-month PPA rate (51.6%) compared with 2 weeks of nicotine patch (38.4%), odds ratios [OR] = 1.71 (95% confidence interval [CI]:1.20-2.45). A similar result was found for 2 weeks of combination NRT (48.2%), OR = 1.49 (95% CI: 1.04-2.14) but not for 6 weeks of nicotine patch alone (46.2%), OR = 1.38 (95% CI: 0.96-1.97). The MAC intervention effect was nonsignificant. Cost analyses showed that the 2-week combination NRT group had the lowest cost per quit ($442 vs. $464 for 2-week patch only, $505 for 6-week patch only, and $675 for 6-week combination NRT). CONCLUSIONS Combination NRT for 2 or 6 weeks increased 6-month abstinence rates by 10% and 13%, respectively, over rates produced by 2 weeks of nicotine patch when offered with quitline counseling. A 10% improvement would potentially yield an additional 50,000 quitters annually, assuming 500,000 callers to U.S. quitlines per year.
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Affiliation(s)
- Stevens S Smith
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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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.
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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.
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Bush T, Zbikowski S, Mahoney L, Deprey M, Mowery PD, Magnusson B. The 2009 US federal cigarette tax increase and quitline utilization in 16 states. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2012; 2012:314740. [PMID: 22649463 PMCID: PMC3356941 DOI: 10.1155/2012/314740] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 02/10/2012] [Accepted: 02/21/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND On April 1, 2009, the federal cigarette excise tax increased from 39 cents to $1.01 per pack. METHODS This study describes call volumes to 16 state quitlines, characteristics of callers and cessation outcomes before and after the tax. RESULTS Calls to the quitlines increased by 23.5% in 2009 and more whites, smokers ≥ 25 years of age, smokers of shorter duration, those with less education, and those who live with smokers called after (versus before) the tax. Quit rates at 7 months did not differ before versus after tax. CONCLUSIONS Descriptive analyses revealed that the federal excise tax on cigarettes was associated with increased calls to quitlines but multivariate analyses revealed no difference in quit rates. However, more callers at the same quit rate indicates an increase in total number of successful quitters. If revenue obtained from increased taxation on cigarettes is put into cessation treatment, then it is likely future excise taxes would have an even greater effect.
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Affiliation(s)
- Terry Bush
- Alere Wellbeing (Formerly Free & Clear, Inc.), Seattle, WA 98104-1139, USA.
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Ferguson J, Docherty G, Bauld L, Lewis S, Lorgelly P, Boyd KA, McEwen A, Coleman T. Effect of offering different levels of support and free nicotine replacement therapy via an English national telephone quitline: randomised controlled trial. BMJ 2012; 344:e1696. [PMID: 22446739 PMCID: PMC3311694 DOI: 10.1136/bmj.e1696] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the effects of free nicotine replacement therapy or proactive telephone counselling in addition to standard smoking cessation support offered through a telephone quitline. DESIGN Parallel group, 2 × 2 factorial, randomised controlled trial. SETTING National quitline, England. PARTICIPANTS 2591 non-pregnant smokers aged 16 or more residing in England who called the quitline between February 2009 and February 2010 and agreed to set a quit date: 648 were each randomised to standard support, proactive support, or proactive support with nicotine replacement therapy, and 647 were randomised to standard support with nicotine replacement therapy. INTERVENTIONS Two interventions were offered in addition to standard support: six weeks' nicotine replacement therapy, provided free, and proactive counselling sessions (repeat telephone calls from, and interaction with, cessation advisors). MAIN OUTCOME MEASURES The primary outcome was self reported smoking cessation for six or more months after the quit date. The secondary outcome was cessation validated by exhaled carbon monoxide measured at six or more months. RESULTS At six months, 17.7% (n = 229) of those offered nicotine replacement therapy reported smoking cessation compared with 20.1% (n = 261) not offered such therapy (odds ratio 0.85, 95% confidence interval 0.70 to 1.04), and 18.2% (n = 236) offered proactive counselling reported smoking cessation compared with 19.6% (n = 254) offered standard support (0.91, 0.75 to 1.11). Data validated by carbon monoxide readings changed the findings for nicotine replacement therapy only, with smoking cessation validated in 6.6% (85/1295) of those offered nicotine replacement therapy compared with 9.4% (122/1296) not offered such therapy (0.67, 0.50 to 0.90). CONCLUSIONS Offering free nicotine replacement therapy or additional (proactive) counselling to standard helpline support had no additional effect on smoking cessation. TRIAL REGISTRATION ClinicalTrials.gov NCT00775944.
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Affiliation(s)
- Janet Ferguson
- Division of Epidemiology and Public Health, and UK Centre for Tobacco Control Studies, University of Nottingham, Nottingham City Hospital, Nottingham, UK
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Cunningham JA, Leatherdale ST, Selby PL, Tyndale RF, Zawertailo L, Kushnir V. Randomized controlled trial of mailed Nicotine Replacement Therapy to Canadian smokers: study protocol. BMC Public Health 2011; 11:741. [PMID: 21955930 PMCID: PMC3198706 DOI: 10.1186/1471-2458-11-741] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 09/28/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Considerable public health efforts are ongoing Canada-wide to reduce the prevalence of smoking in the general population. From 1985 to 2005, smoking rates among adults decreased from 35% to 19%, however, since that time, the prevalence has plateaued at around 18-19%. To continue to reduce the number of smokers at the population level, one option has been to translate interventions that have demonstrated clinical efficacy into population level initiatives. Nicotine Replacement Therapy (NRT) has a considerable clinical research base demonstrating its efficacy and safety and thus public health initiatives in Canada and other countries are distributing NRT widely through the mail. However, one important question remains unanswered--do smoking cessation programs that involve mailed distribution of free NRT work? To answer this question, a randomized controlled trial is required. METHODS/DESIGN A single blinded, panel survey design with random assignment to an experimental and a control condition will be used in this study. A two-stage recruitment process will be employed, in the context of a general population survey with two follow-ups (8 weeks and 6 months). Random digit dialing of Canadian home telephone numbers will identify households with adult smokers (aged 18+ years) who are willing to take part in a smoking study that involves three interviews, with saliva collection for 3-HC/cotinine ratio measurement at baseline and saliva cotinine verification at 8-week and 6-month follow-ups (N = 3,000). Eligible subjects interested in free NRT will be determined at baseline (N = 1,000) and subsequently randomized into experimental and control conditions to receive versus not receive nicotine patches. The primary hypothesis is that subjects who receive nicotine patches will display significantly higher quit rates (as assessed by 30 day point prevalence of abstinence from tobacco) at 6-month follow-up as compared to subjects who do not receive nicotine patches at baseline. DISCUSSION The findings from the proposed trial are timely and highly relevant as mailed distribution of NRT require considerable resources and there are limited public health dollars available to combat this substantial health concern. In addition, findings from this randomized controlled trial will inform the development of models to engage smokers to quit, incorporating proactive recruitment and the offer of evidence based treatment. TRIAL REGISTRATION ClinicalTrials.gov: NCT01429129.
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Affiliation(s)
- John A Cunningham
- Centre for Addiction and Mental Health, 33 Russell St., Toronto, M5S 2S1, Canada
- Department of Psychology, University of Toronto, 100 St. George St., Toronto, M5S 3G3, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, M5T 3M7, Canada
| | - Scott T Leatherdale
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, M5T 3M7, Canada
- Department of Health Studies and Gerontology, University of Waterloo, 200 University Ave., Waterloo, N2L 3G1, Canada
- Department of Population Studies and Surveillance, Cancer Care Ontario, 620 University Ave., Toronto, M5G 2L7, Canada
| | - Peter L Selby
- Centre for Addiction and Mental Health, 33 Russell St., Toronto, M5S 2S1, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, M5T 3M7, Canada
- Department of Pharmaceutical Sciences, University of Toronto, 144 College St., Toronto, M5S 3M2, Canada
- Department of Family and Community Medicine, University of Toronto, 500 University Ave., Toronto, M5G 1V7, Canada
| | - Rachel F Tyndale
- Centre for Addiction and Mental Health, 33 Russell St., Toronto, M5S 2S1, Canada
- Department of Pharmacology and Toxicology, University of Toronto, 1 King's College Circle, Toronto, M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, 250 College St., Toronto, M5S 1A8, Canada
| | - Laurie Zawertailo
- Centre for Addiction and Mental Health, 33 Russell St., Toronto, M5S 2S1, Canada
- Department of Pharmacology and Toxicology, University of Toronto, 1 King's College Circle, Toronto, M5S 1A8, Canada
| | - Vladyslav Kushnir
- Centre for Addiction and Mental Health, 33 Russell St., Toronto, M5S 2S1, Canada
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Outcomes and cost-effectiveness of two nicotine replacement treatment delivery models for a tobacco quitline. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2011; 8:1547-59. [PMID: 21655136 PMCID: PMC3108126 DOI: 10.3390/ijerph8051547] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Accepted: 04/29/2011] [Indexed: 11/17/2022]
Abstract
Many tobacco cessation quitlines provide nicotine replacement therapy (NRT) in the U.S. but consensus is lacking regarding the best shipping protocol or NRT amounts. We evaluated the impact of the Minnesota QUITPLAN(®) Helpline's shift from distributing NRT using a single eight-week shipment to a two-shipment protocol. For this observational study, the eight week single-shipment cohort (n = 247) received eight weeks of NRT (patches or gum) at once, while the split-shipment cohort (n = 160) received five weeks of NRT (n = 94), followed by an additional three weeks of NRT if callers continued with counseling (n = 66). Patient satisfaction, retention, quit rates, and cost associated with the three groups were compared. A higher proportion of those receiving eight weeks of NRT, whether in one or two shipments, reported that the helpline was "very helpful" (77.2% of the single-shipment group; 81.1% of the two-shipment group) than those receiving five weeks of NRT (57.8% of the one-shipment group) (p = 0.004). Callers in the eight week two-shipment group completed significantly more calls (3.0) than callers in the five week one-shipment group (2.4) or eight week single-shipment group (1.7) (p < 0.001). Using both responder and intent-to-treat calculations, there were no significant differences in 30-day point prevalence abstinence at seven months among the three protocol groups even when controlling for demographic and tobacco use characteristics, and treatment group protocol. The mean cost per caller was greater for the single-shipment phase than the split-shipment phase ($350 vs. $326) due to the savings associated with not sending a second shipment to some participants. Assuming no difference in abstinence rates resulting from the protocol change, cost-per-quit was lowest for the five week one-shipment group ($1,155), and lower for the combined split-shipment cohort ($1,242) than for the single-shipment cohort ($1,350). Results of this evaluation indicate that while satisfaction rates increase among those receiving more counseling and NRT, quit rates do not, even when controlling for demographic and tobacco use characteristics.
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Zbikowski SM, Jack LM, McClure JB, Deprey M, Javitz HS, McAfee TA, Catz SL, Richards J, Bush T, Swan GE. Utilization of services in a randomized trial testing phone- and web-based interventions for smoking cessation. Nicotine Tob Res 2011; 13:319-27. [PMID: 21330267 DOI: 10.1093/ntr/ntq257] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Phone counseling has become standard for behavioral smoking cessation treatment. Newer options include Web and integrated phone-Web treatment. No prior research, to our knowledge, has systematically compared the effectiveness of these three treatment modalities in a randomized trial. Understanding how utilization varies by mode, the impact of utilization on outcomes, and predictors of utilization across each mode could lead to improved treatments. METHODS One thousand two hundred and two participants were randomized to phone, Web, or combined phone-Web cessation treatment. Services varied by modality and were tracked using automated systems. All participants received 12 weeks of varenicline, printed guides, an orientation call, and access to a phone supportline. Self-report data were collected at baseline and 6-month follow-up. RESULTS Overall, participants utilized phone services more often than the Web-based services. Among treatment groups with Web access, a significant proportion logged in only once (37% phone-Web, 41% Web), and those in the phone-Web group logged in less often than those in the Web group (mean = 2.4 vs. 3.7, p = .0001). Use of the phone also was correlated with increased use of the Web. In multivariate analyses, greater use of the phone- or Web-based services was associated with higher cessation rates. Finally, older age and the belief that certain treatments could improve success were consistent predictors of greater utilization across groups. Other predictors varied by treatment group. CONCLUSIONS Opportunities for enhancing treatment utilization exist, particularly for Web-based programs. Increasing utilization more broadly could result in better overall treatment effectiveness for all intervention modalities.
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Affiliation(s)
- Susan M Zbikowski
- Free & Clear, Inc., Clinical and Behavioral Sciences, Seattle, WA, USA.
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Burns EK, Tong S, Levinson AH. Reduced NRT supplies through a quitline: Smoking cessation differences. Nicotine Tob Res 2010; 12:845-9. [DOI: 10.1093/ntr/ntq094] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Cummings KM, Fix BV, Celestino P, Hyland A, Mahoney M, Ossip DJ, Bauer U. Does the number of free nicotine patches given to smokers calling a quitline influence quit rates: results from a quasi-experimental study. BMC Public Health 2010; 10:181. [PMID: 20374628 PMCID: PMC2856535 DOI: 10.1186/1471-2458-10-181] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Accepted: 04/07/2010] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The offer of free nicotine replacement therapy (NRT) can be a cost-effective marketing strategy to induce smokers to call a telephone quitline for quitting assistance. However, the most cost-effective supply of free NRT to provide to smokers who call a quitline remains unknown. This study tests the hypothesis that smokers who call a telephone quitline and are given more free nicotine patches would report higher quit rates upon follow-up 12 months later. METHODS A quasi-experimental design was used to assess nicotine patch usage patterns and quit rates among five groups of smokers who called the New York State Smokers' Quitline (NYSSQL) between April 2003 and May 2006 and were mailed 2-, 4-, 6- or 8-week supplies of free nicotine patches. The study population included 2,442 adult (aged 18 years or older) current daily smokers of 10 or more cigarettes per day, who were willing to make a quit attempt, and reported no contraindications for using the nicotine patch. Outcome variables assessed included the percentage of smokers who reported that they had not smoked for at least 7-days at the time of a 12 months telephone follow-up survey, sustained quitting, delayed quitting and nicotine patch use. RESULTS Quit rates measured at 12 months were higher for smokers in the groups who received either 2, 6, or 8 weeks of free patches. The lowest quit rate was observed among the group of Medicaid/uninsured smokers who were eligible to receive up to six weeks of free patches. The quit rate for the 4-week supply group did not differ significantly from the 6-week or 8-week groups. These patterns remained similar in an intent-to-treat analysis of 12-month quit rates and in an analysis of sustained quitting. CONCLUSION No clear cut dose response relationship was observed between the number of free nicotine patches sent to smokers and smoking outcomes. Baseline differences in the characteristics of the groups compared could account for the null findings, and a more definitive randomized trial is warranted.
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Affiliation(s)
- K Michael Cummings
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Brian V Fix
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Paula Celestino
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Martin Mahoney
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Deborah J Ossip
- Department of Community and Preventive Medicine, University of Rochester, Rochester, NY, USA
| | - Ursula Bauer
- Division of Chronic Disease Prevention and Adult Health, New York State Department of Health, New York, NY, USA
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Bricker JB, Mann SL, Marek PM, Liu J, Peterson AV. Telephone-delivered Acceptance and Commitment Therapy for adult smoking cessation: a feasibility study. Nicotine Tob Res 2010; 12:454-8. [PMID: 20142417 DOI: 10.1093/ntr/ntq002] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Quitline smoking cessation counseling results in a mere 12% success rate. Testing of new telephone-delivered cessation counseling approaches is needed. OBJECTIVE Determine the feasibility of the first telephone-delivered Acceptance and Commitment Therapy (ACT) intervention for smoking cessation. DESIGN Fourteen adults (57% racial/ethnic minority, 8/14) in a single-arm study. Counselor proactively delivered a 5-session (90-min total) ACT telephone intervention for smoking cessation. Hypothesized ACT processes were self-reported at baseline and posttreatment. Smoking status was self-reported at baseline, 20-day posttreatment (93% retention, 13/14), and 12-month posttreatment (93% retention, 13/14). RESULTS (a) Delivery length and duration: average of 3.5 calls and 81.9-min intervention duration. (b) Receptivity: 100% (14/14) felt respected by the counselor, 86% (12/14) said that intervention was a good fit, and 93% (13/14) said that intervention helped them quit. (c) ACT processes: (i) acceptance of physical cravings, emotions, and thoughts that cue smoking increased from baseline to posttreatment (p = .001, p = .038, and p = .085, respectively) and (ii) commitment to quitting increased from baseline to posttreatment (p = .01). (4) Intent-to-treat cessation outcomes: (i) at 20-day posttreatment, 43% (6/14) had not smoked the day of the survey and 29% (4/14) had not smoked in past 7 days and (ii) at 12-month posttreatment, 29% (4/14) had not smoked at all in past 12 months. These quit rates are over double the 12% quit rates of current standard telephone counseling. CONCLUSION Telephone-delivered ACT shows promise for smoking cessation and warrants future testing in a well-powered randomized trial.
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Affiliation(s)
- Jonathan B Bricker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N., M3-B232, Seattle, WA 98109, USA.
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BOTELHO RICK, WASSUM KEN, BENZIAN HABIB, SELBY PETER, CHAN SOPHIA. Address the gaps in tobacco cessation training and services: Developing professional organisational alliances to create social movements. Drug Alcohol Rev 2009; 28:558-66. [DOI: 10.1111/j.1465-3362.2009.00112.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
BACKGROUND Telephone services can provide information and support for smokers. Counselling may be provided proactively or offered reactively to callers to smoking cessation helplines. OBJECTIVES To evaluate the effect of proactive and reactive telephone support to help smokers quit. SEARCH STRATEGY We searched the Cochrane Tobacco Addiction Group trials register for studies using free text term 'telephone*' or the keywords 'telephone counselling' or 'Hotlines' or 'Telephone' . Date of the most recent search: January 2006. SELECTION CRITERIA Randomized or quasi-randomized controlled trials in which proactive or reactive telephone counselling to assist smoking cessation was offered to smokers or recent quitters. DATA COLLECTION AND ANALYSIS Trials were identified and data extracted by one person (LS) and checked by a second (TL). The main outcome measure was the odds ratio for abstinence from smoking after at least six months follow up. We selected the strictest measure of abstinence, using biochemically validated rates where available. We considered participants lost to follow-up to be continuing smokers. Where trials had more than one arm with a less intensive intervention we used only the most similar intervention without the telephone component as the control group in the primary analysis. We assessed statistical heterogeneity amongst sub groups of clinically comparable studies using the I(2) statistic. Where appropriate, we pooled studies using a fixed-effect model. A meta-regression was used to investigate the effect of differences in planned number of calls. MAIN RESULTS Forty-eight trials met the inclusion criteria. Among smokers who contacted helplines, quit rates were higher for groups randomised to receive multiple sessions of call-back counselling (eight studies, >18,000 participants, odds ratio (OR) for long term cessation 1.41, 95% confidence interval (CI) 1.27 to 1.57). Two of these studies showed a significant benefit of more intensive compared to less intensive intervention. Telephone counselling not initiated by calls to helplines also increased quitting (29 studies, >17,000 participants, OR 1.33, 95% CI 1.21 to 1.47). A meta-regression detected a significant association between the maximum number of planned calls and the effect size. There was clearer evidence of benefit in the subgroup of trials recruiting smokers motivated to quit. Of two studies that provided access to a hotline one showed a significant benefit and one did not. Two studies comparing different counselling approaches during a single session did not detect significant differences. A further seven studies were too diverse to contribute to meta-analyses and are discussed separately. AUTHORS' CONCLUSIONS Proactive telephone counselling helps smokers interested in quitting. There is evidence of a dose response; one or two brief calls are less likely to provide a measurable benefit. Three or more calls increases the odds of quitting compared to a minimal intervention such as providing standard self-help materials, brief advice, or compared to pharmacotherapy alone. Telephone quitlines provide an important route of access to support for smokers, and call-back counselling enhances their usefulness.
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Affiliation(s)
- L F Stead
- Oxford University, Department of Primary Health Care, Old Road Campus, Headington, Oxford, UK OX3 7LF.
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