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McDaniel AM, Cooley ME, Andrews JO, Bialous S, Buettner-Schmidt K, Heath J, Okoli C, Timmerman GM, Sarna L. Nursing leadership in tobacco dependence treatment to advance health equity: An American Academy of Nursing policy manuscript. Nurs Outlook 2024; 72:102236. [PMID: 39043053 DOI: 10.1016/j.outlook.2024.102236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 06/15/2024] [Accepted: 06/22/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Tobacco use remains the leading cause of preventable disease, disability, and death in the United States and is a significant cause of health disparities. PURPOSE The purpose of this paper is to update the Tobacco Control policy paper published over a decade ago by the American Academy of Nursing's Health Behavior Expert Panel Tobacco Control subcommittee. METHODS Members reviewed and synthesized published literature from 2012 to 2024 to identify the current state of the science related to nurse-led tobacco dependence treatment and implications for nursing practice, education, and research. FINDINGS The results confirmed that nurse-led tobacco dependence treatment interventions are successful in enhancing cessation outcomes across settings. DISCUSSION Recommendations for nursing leaders include: promote tobacco dependence treatment as standard care, accelerate research on implementation of evidence-based treatment guidelines, reduce health disparities by extending access to evidence-based treatment, increase nursing competency in providing tobacco treatment, and drive equity-focused tobacco control policies.
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Affiliation(s)
- Anna M McDaniel
- Health Behavior Expert Panel (Tobacco Control Sub-group), American Academy of Nursing, Washington, DC.
| | - Mary E Cooley
- Health Behavior Expert Panel (Tobacco Control Sub-group), American Academy of Nursing, Washington, DC
| | - Jeannette O Andrews
- Health Behavior Expert Panel (Tobacco Control Sub-group), American Academy of Nursing, Washington, DC
| | - Stella Bialous
- Health Behavior Expert Panel (Tobacco Control Sub-group), American Academy of Nursing, Washington, DC
| | - Kelly Buettner-Schmidt
- Health Behavior Expert Panel (Tobacco Control Sub-group), American Academy of Nursing, Washington, DC
| | - Janie Heath
- Health Behavior Expert Panel (Tobacco Control Sub-group), American Academy of Nursing, Washington, DC
| | - Chizimuzo Okoli
- Health Behavior Expert Panel (Tobacco Control Sub-group), American Academy of Nursing, Washington, DC
| | - Gayle M Timmerman
- Health Behavior Expert Panel (Tobacco Control Sub-group), American Academy of Nursing, Washington, DC
| | - Linda Sarna
- Health Behavior Expert Panel (Tobacco Control Sub-group), American Academy of Nursing, Washington, DC
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Businelle M, Becerra J, Witten C, Chen S, Kezbers K, Beebe LA, Kendzor DE. Smartphone-Based Smoking Cessation Intervention (OKquit) for Oklahoma Tobacco Helpline Users: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e56827. [PMID: 39088254 PMCID: PMC11327626 DOI: 10.2196/56827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 05/31/2024] [Accepted: 05/31/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Tobacco quitlines provide effective resources (eg, nicotine replacement therapy, smoking cessation counseling, and text and web-based support) for those who want to quit smoking in the United States. However, quitlines reach approximately only 1%-3% of people who smoke each year. Novel, smartphone-based, and low-burden interventions that offer 24/7 access to smoking cessation resources that are tailored to current readiness to quit may increase appeal, reach, and effectiveness of smoking cessation interventions. OBJECTIVE This study will examine the efficacy of OKquit, a low-burden smartphone-based app for smoking cessation. METHODS Approximately 500 people who smoke cigarettes and access the Oklahoma Tobacco Helpline (OTH) will be randomized to receive standard OTH care (SC) or SC plus the novel OKquit smartphone app for smoking cessation (OKquit). All participants will use a smartphone app to complete study surveys (ie, baseline, 27 weekly surveys, brief daily check-ins, and 27-week follow-up). Upon completion of daily check-ins and weekly surveys, participants will receive either trivia type messages (SC) or messages that are tailored to current readiness to quit smoking and currently experienced lapse triggers (OKquit). In addition, those assigned to receive the OKquit app will have access to on-demand smoking cessation content (eg, quit tips, smoking cessation medication tips). It is hypothesized that participants assigned to OKquit will be more likely to achieve biochemically verified 7-day point prevalence abstinence than those assigned to SC at 27 weeks post enrollment. In addition, participants who use more OTH resources (eg, more cessation coaching sessions completed) or more OKquit resources (eg, access more quit tips) will have greater biochemically verified smoking cessation rates. RESULTS Data collection began in September 2022 and final follow-ups are expected to be completed by May 2025. CONCLUSIONS Data from this randomized controlled trial will determine whether the OKquit smartphone app combined with OTH care will increase smoking cessation rates over standard OTH care alone. If successful, OKquit could provide tailored intervention content at a fraction of the cost of traditional interventions. Furthermore, this type of low-burden intervention may offer a way to reach underserved populations of adults who smoke and want to quit. TRIAL REGISTRATION ClinicalTrials.gov NCT05539209; https://clinicaltrials.gov/study/NCT05539209. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56827.
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Affiliation(s)
- Michael Businelle
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Jessica Becerra
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Carl Witten
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Sixia Chen
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Krista Kezbers
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Laura A Beebe
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Darla E Kendzor
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
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Shadel WG, Martino SC, Setodji CM, Dunbar M, Jenson D, Wong JC, Falgoust G. Doing more with less: A proposal to advance cigarette packaging regulations in the United States. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 124:104308. [PMID: 38184903 PMCID: PMC10939880 DOI: 10.1016/j.drugpo.2023.104308] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/12/2023] [Accepted: 12/20/2023] [Indexed: 01/09/2024]
Abstract
Cigarette packages are potent marketing tools. Following guidance from the WHO Framework Convention on Tobacco Control, many countries have sought to diminish this marketing power by mandating that (1) large graphic health warnings be affixed to the packages (i.e., text warnings combined with graphic images of the health consequences of smoking) and (2) all packages be fully "plain" in their design (i.e., all packages use the same drab/bland color and font type; no brand logos, other colors, or designs are permitted). Yet, the United States lags other countries in implementing regulations designed to blunt the marketing power of cigarette packages. This is not because of a lack of effort on the part of the Food and Drug Administration, the main governmental body charged with regulating tobacco products in the United States. Rather, it is because the regulatory options that that have been advanced in the country (e.g., graphic health warnings) have not been found - yet - to be legally feasible by its courts. This commentary works through some of the conceptual, practical, and legal issues regarding packaging regulations in the United States. It considers the political and bureaucratic risks involved with issuing new regulations. The overall intent is to prompt our field to think creatively about what is realistic in this regulatory space and to offer a novel perspective that may help move the United States tobacco control community forward in its efforts to reduce the promotional power of cigarette packages.
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Affiliation(s)
- William G Shadel
- RAND Corporation, 4570 Fifth Avenue., Suite 600, Pittsburgh, PA 15213, United States.
| | - Steven C Martino
- RAND Corporation, 4570 Fifth Avenue., Suite 600, Pittsburgh, PA 15213, United States
| | - Claude M Setodji
- RAND Corporation, 4570 Fifth Avenue., Suite 600, Pittsburgh, PA 15213, United States
| | - Michael Dunbar
- RAND Corporation, 4570 Fifth Avenue., Suite 600, Pittsburgh, PA 15213, United States
| | - Desmond Jenson
- Public Health Law Center, Mitchell Hamline School of Law, Saint Paul, MN 55105, United States
| | - Jody Cs Wong
- RAND Corporation, 4570 Fifth Avenue., Suite 600, Pittsburgh, PA 15213, United States
| | - Grace Falgoust
- RAND Corporation, 4570 Fifth Avenue., Suite 600, Pittsburgh, PA 15213, United States
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Webb Hooper M, Carpenter KM, Salmon EE, Resnicow K. Enhancing Tobacco Quitline Outcomes for African American Adults: An RCT of a Culturally Specific Intervention. Am J Prev Med 2023; 65:964-972. [PMID: 37302513 DOI: 10.1016/j.amepre.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 06/05/2023] [Accepted: 06/05/2023] [Indexed: 06/13/2023]
Abstract
INTRODUCTION This study tested the effectiveness of a culturally specific tobacco cessation video intervention among African American quitline enrollees. STUDY DESIGN This was a 3-arm semipragmatic RCT. SETTING/PARTICIPANTS African American adults (N=1,053) were recruited from the North Carolina tobacco quitline and data were collected between 2017 and 2020. INTERVENTION Participants were randomized to receive (1) quitline services only; (2) quitline services plus a standard, general audience video intervention; or (3) quitline services plus Pathways to Freedom (PTF), a culturally specific video intervention designed to promote cessation among African American persons. MAIN OUTCOME MEASURES The primary outcome was self-reported 7-day point prevalence smoking abstinence at 6 months. Secondary outcomes included 7-day and 24-hour point prevalence abstinence at 3 months, 28-day continuous abstinence, and intervention engagement. Data analyses occurred in 2020 and 2022. RESULTS At 6 months, 7-day point prevalence abstinence was significantly greater in the Pathways to Freedom Video arm compared with quitline-only (OR=1.5, CI=1.11, 2.07). Twenty four-hour point prevalence abstinence was significantly greater in the Pathways to Freedom (than in quitline-only) group at 3 (OR=1.49, 95% CI=1.03, 2.15) and 6 (OR=1.58, 95% CI=1.10, 2.28) months. At 6 months, 28-day continuous abstinence (OR=1.60, 95% CI=1.17, 2.20) was significantly greater in the Pathways to Freedom Video arm than in the quitline-only arm. Views of the Pathways to Freedom Video were 76% higher than views of the standard video. CONCLUSIONS Culturally specific tobacco interventions delivered through state quitlines can increase cessation and thus have the potential to decrease health disparities among African American adults. TRIAL REGISTRATION This study is registered at www. CLINICALTRIALS gov NCT03064971.
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Affiliation(s)
- Monica Webb Hooper
- Case Comprehensive Cancer Center, Department of Oncology, School of Medicine, Case Western Reserve University, Cleveland, Ohio.
| | | | - Erica E Salmon
- Optum Center for Wellbeing Research, Eden Prairie, Minnesota
| | - Ken Resnicow
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
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Tetlow SM, Zhang L, Borowiecki M, Kim Y, Gentzke AS, Wang TW, Cornelius ME, Hawkins NA. A Safety Net Tobacco Use Cessation Resource: Quitline Service Usage, 2019. Prev Chronic Dis 2023; 20:E84. [PMID: 37769250 PMCID: PMC10557988 DOI: 10.5888/pcd20.230033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION Quitlines are free, accessible evidence-based services that may provide an important resource for people facing barriers to clinical treatment for cessation of tobacco use. METHODS Using 2019 intake data from the National Quitline Data Warehouse, we examined quitline service usage, stratified by sociodemographic characteristics. Only US quitlines reporting service type data were included (n = 40 [of 51]). Callers (aged ≥12 years) who registered with a quitline, reported current use of a tobacco product, and received at least 1 service comprised the analytic data. Chi-square tests examined differences in quitline services received by participant characteristics. RESULTS In 2019, 182,544 people reporting current use of a tobacco product received at least 1 service from a quitline in 39 states and the District of Columbia. Among them, 80.4% had attained less than a college or university degree and 70.4% were uninsured or enrolled in Medicaid or in Medicare (aged <65 years). By educational attainment (aged ≥25 years), receipt of cessation medications ranged from 59.4% of callers with a college or university degree to 65.0% of callers with a high school diploma (P < .001). The range by insurance coverage was 59.3% of callers with private insurance to 74.7% of callers with Medicare (aged <65 years) (P < .001). CONCLUSION Quitlines served as a resource for low-SES populations in 2019, providing cessation services to many people who may face barriers to clinical cessation treatment. Strengthening and expanding quitlines may help to increase cessation among populations with a disproportionately high prevalence of tobacco product use and improve the health and well-being of people in the US.
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Affiliation(s)
- Sonia M Tetlow
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, MS S107-7, 4770 Buford Hwy, Atlanta, GA 30341
| | - Lei Zhang
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Yoonsang Kim
- NORC at the University of Chicago, Chicago, Illinois
| | - Andrea S Gentzke
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Teresa W Wang
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Monica E Cornelius
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nikki A Hawkins
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Jafry MZ, Martinez J, Chen TA, Britton M, Martinez Leal I, Rogova A, Kyburz B, Williams T, Patel M, Carter BJ, Reitzel LR. Behavioral health care provider's beliefs, confidence, and knowledge in treating cigarette smoking in relation to their use of the 5A's intervention. Addict Behav Rep 2023; 17:100493. [PMID: 37347047 PMCID: PMC10279772 DOI: 10.1016/j.abrep.2023.100493] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/29/2023] [Indexed: 06/23/2023] Open
Abstract
Introduction Evidence-based smoking cessation interventions are underused settings where behavioral health treatment is provided, contributing to smoking-related health disparities in this patient group. This study assessed the relationship of provider's beliefs about patients' smoking, perceptions of treatment capability, and knowledge of referral options and their use of the 5A's (Ask, Advise, Assess, Assist, and Arrange) intervention for smoking cessation. Methods Surveys were collected from providers in healthcare settings in Texas where patients receive behavioral health care (N = 86; 9 federally qualified health centers, 16 Local Mental Health Authorities (LMHAs), 6 substance use treatment programs in LMHAs, and 55 stand-alone substance use treatment centers). Logistic regression analyses were used to assess the association between provider's beliefs about patients' concern and desire to quit smoking; perceptions of their confidence, skills, and effectiveness in treating smoking; their knowledge of referral options; and their use of the 5A's with patients who smoked. Results Providers who believed that patients were concerned about smoking and wanted to quit; who perceived themselves as confident in providing cessation care, having the required skills, and being effective in providing advice; and/or who had greater referral knowledge were more likely to use the 5A's with patients who smoked than their (respective) provider counterparts (ps < 0.05). Conclusion Provider-level constructs affect their 5A's provision for patients with behavioral health needs. Future work should train providers to correct misconceptions about patients' interest in quitting, bolster their confidence, and provide referral options to support tobacco provision efforts.
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Affiliation(s)
- Midhat Z. Jafry
- The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Unit 1440, 1400 Pressler Street, Houston, TX 77030, USA
- University of Houston, Department of Biology and Biochemistry, Science & Research Building 2, 3455 Cullen Blvd Room 342, Houston, TX 77204, USA
- University of Houston, Department of Psychological, Health, and Learning Sciences, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA
| | - Jayda Martinez
- University of Houston, Department of Psychological, Health, and Learning Sciences, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA
- University of Houston, HEALTH Research Institute, 4349 Martin Luther King Blvd., Houston, TX 77204, USA
- The University of Texas Health Science Center, School of Public Health, 1200 Pressler St., Houston, TX 77030, USA
| | - Tzuan A. Chen
- University of Houston, Department of Psychological, Health, and Learning Sciences, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA
- University of Houston, HEALTH Research Institute, 4349 Martin Luther King Blvd., Houston, TX 77204, USA
| | - Maggie Britton
- The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Unit 1440, 1400 Pressler Street, Houston, TX 77030, USA
- University of Houston, Department of Psychological, Health, and Learning Sciences, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA
| | - Isabel Martinez Leal
- The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Unit 1440, 1400 Pressler Street, Houston, TX 77030, USA
- University of Houston, Department of Psychological, Health, and Learning Sciences, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA
| | - Anastasia Rogova
- The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Unit 1440, 1400 Pressler Street, Houston, TX 77030, USA
- University of Houston, Department of Psychological, Health, and Learning Sciences, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA
| | - Bryce Kyburz
- Integral Care, 1430 Collier St., Austin, TX 78704, USA
| | | | - Mayuri Patel
- Texas Department of State Health Services, Tobacco Prevention and Control Branch, 1100 West 49th Street, Mail Code 1965, Austin, TX 78756, USA
| | - Brian J. Carter
- The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Unit 1440, 1400 Pressler Street, Houston, TX 77030, USA
- University of Houston, Department of Psychological, Health, and Learning Sciences, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA
| | - Lorraine R. Reitzel
- The University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, Unit 1440, 1400 Pressler Street, Houston, TX 77030, USA
- University of Houston, Department of Psychological, Health, and Learning Sciences, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA
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Rojewski AM, Palmer AM, Toll BA. Treatment of Tobacco Dependence in the Inpatient Setting. Respir Med 2023. [DOI: 10.1007/978-3-031-24914-3_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Leventakou V, Al Thani M, Sofroniou A, Butt HI, Eltayeb SM, Hakim IA, Thomson C, Nair US. Feasibility and Acceptability of a Telephone-Based Smoking Cessation Intervention for Qatari Residents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16509. [PMID: 36554389 PMCID: PMC9779462 DOI: 10.3390/ijerph192416509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
The steady increase in smoking rates has led to a call for wide-reaching and scalable interventions for smoking cessation in Qatar. This study examined the feasibility and acceptability of an evidence-based smoking cessation program delivered by telephone for Qatari residents. A total of 248 participants were recruited through primary care centers and received five weekly scheduled proactive behavioral counseling calls from personnel trained in tobacco cessation and navigation to obtain cessation pharmacotherapy from clinics. Outcomes were assessed at end of treatment (EOT), and 1- and-3-month follow up. The Mann-Whitney test was used to compare the average number of participants recruited per month pre- and post-COVID. We recruited 16 participants/month, the majority (85.5%) attended at least one counselling session, and 95.4% used some of pharmacotherapy. Retention rates were 70% at EOT, 64.4% and 71.7% at 1- and 3-month follow up, respectively; 86% reported being 'extremely satisfied' by the program. Our ITT 7-day point prevalence abstinence was 41.6% at EOT, 38.4% and 39.3% at 1-and 3-month, respectively. The average number of participants recruited per month was significantly higher for pre vs. post-COVID (18.9 vs. 10.0, p-value = 0.02). Average number of participants retained at EOT per recruitment month showed a slight decrease from 8.6 pre- to 8.2 post-COVID; average number who quit smoking at EOT per recruitment month also showed a decrease from 6 to 4.6. The study results indicated that our telephone-based intervention is feasible and acceptable in this population and presents a new treatment model which can be easily disseminated to a broad population of Qatari smokers.
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Affiliation(s)
- Vasiliki Leventakou
- Health Research Governance Department, Ministry of Public Health, Doha P.O. Box 42, Qatar
| | - Mohammed Al Thani
- Public Health Department, Ministry of Public Health, Doha P.O. Box 42, Qatar
| | - Angeliki Sofroniou
- Public Health Department, Ministry of Public Health, Doha P.O. Box 42, Qatar
| | - Hamza I. Butt
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA
| | - Safa M. Eltayeb
- Public Health Department, Ministry of Public Health, Doha P.O. Box 42, Qatar
| | - Iman A. Hakim
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA
| | - Cynthia Thomson
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA
| | - Uma S. Nair
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA
- College of Nursing, University of South Florida, Tampa, FL 33612, USA
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Sheffer CE. Tobacco quitlines: Opportunities for innovation to increase reach and effectiveness. Prev Med 2022; 165:107319. [PMID: 36283486 DOI: 10.1016/j.ypmed.2022.107319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022]
Abstract
The largest tobacco treatment network in North America, Tobacco Quitlines are an effective population-based approach to increase tobacco cessation; however, overall reach has decreased significantly in the past decade. A new generation of innovations responsive to evolving shifts in communication preferences, supported by research, and focused on increasing the impact of services have the potential to reinvigorate this network. The goal of this narrative review was to identify opportunities for innovation in Quitline service delivery, synthesize evidence for these opportunities, and identify gaps in the research. Innovation was defined as significant shift in current practice by utilizing novel theoretical concepts, approaches, methodologies, or interventions. The Experimental Medicine Approach informed the identification of gaps in the research. The specific domains were selected by reviewing previous reviews, commentaries, calls for action, and a recent report on promising practices. Evidence was garnered primarily from systematic reviews. Opportunities included automated and interactive digital therapeutics, novel health communications for stigma-free media campaigns, methods to increase access to nicotine replacement therapies, novel treatment options and combinations, and methods to promote engagement with digital therapeutics. Research topics that cross multiple domains include the consideration of theoretical frameworks, the identification of therapeutic targets and mechanisms of action, and the development of adapted approaches to address specific challenges and cultural responsivity. Finally, an examination is needed to understand how to improve the speed with which innovations are developed and implemented in this network.
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Affiliation(s)
- Christine E Sheffer
- Roswell Park Comprehensive Cancer Center, Department of Health Behavior, Elm & Carlton, Buffalo, NY 14263, United States of America.
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Electronic health record closed-loop referral ("eReferral") to a state tobacco quitline: a retrospective case study of primary care implementation challenges and adaptations. Implement Sci Commun 2022; 3:107. [PMID: 36209149 PMCID: PMC9548147 DOI: 10.1186/s43058-022-00357-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/28/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Health system change can increase the reach of evidence-based smoking cessation treatments. Proactive electronic health record (EHR)-enabled, closed-loop referral ("eReferral") to state tobacco quitlines increases the rates at which patients who smoke accept cessation treatment. Implementing such system change poses many challenges, however, and adaptations to system contexts are often required, but are understudied. This retrospective case study identified adaptations to eReferral EHR tools and implementation strategies in two healthcare systems. METHODS In a large clustered randomized controlled trial (C-RCT; NCT02735382) conducted in 2016-2017, 11 primary care clinics in two healthcare systems implemented quitline eReferral, starting with 1 pilot clinic per system followed by 2 phases of implementation (an experimental phase in 5-6 test clinics per system and then a system-wide dissemination phase in both systems). Adaptations were informed by stakeholder input from live trainings, follow-up calls and meetings in the first month after eReferral launch, emails, direct observation by researchers, and clinic staff survey responses. Retrospective, descriptive analysis characterized implementation strategy modifications and adaptations using the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS). A pre- and post-implementation survey assessed staff ratings of eReferral acceptability and implementation barriers and facilitators. FINDINGS Major modifications to closed-loop eReferral implementation strategies included aligning the eReferral initiative with other high-priority health system objectives, modifying eReferral user interfaces and training in their use, modifying eReferral workflows and associated training, and maintaining and enhancing interoperability and clinician feedback functions. The two health systems both used Epic EHRs but used different approaches to interfacing with the quitline vendor and integrating eReferral into clinician workflows. Both health systems engaged in iterative refinement of the EHR alert prompting eReferral, the eReferral order, trainings, and workflows. Staff survey comments suggested moderate acceptability of eReferral processes and identified possible targets for future modifications in eReferral, including reducing clinician burden related to EHR documentation and addressing clinicians' negative beliefs about patient receptivity to cessation treatment. CONCLUSIONS System-wide implementation of tobacco quitline eReferral in primary care outpatient clinics is feasible but requires extensive coordination across stakeholders, tailoring to local health system EHR configurations, and sensitivity to system- and clinic-specific workflows. TRIAL REGISTRATION www. CLINICALTRIALS gov, NCT02735382 . Registered on 12 August 2016.
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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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12
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Siddiqi AD, Britton M, Chen TA, Carter BJ, Wang C, Martinez Leal I, Rogova A, Kyburz B, Williams T, Patel M, Reitzel LR. Tobacco Screening Practices and Perceived Barriers to Offering Tobacco Cessation Services among Texas Health Care Centers Providing Behavioral Health Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9647. [PMID: 35955001 PMCID: PMC9367734 DOI: 10.3390/ijerph19159647] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 05/11/2023]
Abstract
Tobacco use, and thus tobacco-related morbidity, is elevated amongst patients with behavioral health treatment needs. Consequently, it is important that centers providing health care to this group mandate providers' use of tobacco screenings to inform the need for tobacco use disorder intervention. This study examined the prevalence of mandated tobacco screenings in 80 centers providing health care to Texans with behavioral health needs, examined key factors that could enhance screening conduct, and delineated providers' perceived barriers to tobacco use intervention provision. The results indicated that 80% of surveyed centers mandated tobacco use screenings; those that did were significantly more likely than those that did not to have a hard stop for tobacco use status in health records and were marginally more likely to make training on tobacco screening available to providers. The most widespread barriers to tobacco use disorder care provision were relative perceived importance of competing diagnoses, lack of community resources to refer patients, perceived lack of time, lack of provider knowledge or confidence, and belief that patients do not comply with cessation treatment. Overall, the results suggest that there are opportunities for centers providing care to Texans with behavioral health needs to bolster their tobacco screening and intervention capacity to better address tobacco-related health disparities in this group. Health care centers can support their providers to intervene in tobacco use by mandating screenings, streamlining clinical workflows with hard stops in patient records, and educating providers about the importance of treating tobacco with brief evidence-based intervention strategies while providing accurate information about patients' interest in quitting and providers' potential impacts on a successful quit attempt.
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Affiliation(s)
- Ammar D. Siddiqi
- Department of Biosciences, Rice University, 6100 Main St., Houston, TX 77005, USA
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
| | - Maggie Britton
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
| | - Tzuan A. Chen
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
| | - Brian J. Carter
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
| | - Carol Wang
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Department of Health Disparities Research, MD Anderson Cancer Center, Houston, TX 77230, USA
| | - Isabel Martinez Leal
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
| | - Anastasia Rogova
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
| | - Bryce Kyburz
- Integral Care, 1430 Collier St., Austin, TX 78704, USA
| | | | - Mayuri Patel
- Department of State Health Services, Tobacco Prevention and Control Branch, Austin, TX 78714, USA
| | - Lorraine R. Reitzel
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
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13
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Delle S, Kraus L, Maspero S, Pogarell O, Hoch E, Lochbühler K. Effectiveness of the national German quitline for smoking cessation: study protocol of a randomized controlled trial. BMC Public Health 2022; 22:1386. [PMID: 35854238 PMCID: PMC9295518 DOI: 10.1186/s12889-022-13742-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/05/2022] [Indexed: 12/04/2022] Open
Abstract
Background Despite the decline in cigarette smoking prevalence during nearly the past two decades, tobacco use is still widespread in the German adult population, accounting for 125,000 deaths each year and causing tremendous social costs. To accelerate the reduction in tobacco smoking prevalence, evidence-based smoking cessation methods are pivotal to a national tobacco control strategy. The present study aims to evaluate the effectiveness of the national German Smokers Quitline offering cessation support to smokers. Methods A total sample of 910 daily smokers, who are motivated to quit, will be recruited via an online access panel and randomly assigned to either the intervention (telephone counselling) or control condition. In the intervention group, participants will receive up to six proactive phone calls during an intervention period of approximately six weeks. The provided treatment will combine the principles of motivational interviewing and those of the cognitive behavioural approach to treating substance use. Participants in the control condition will receive a self-help brochure to support smoking cessation. Data collection will take place at baseline as well as three (post assessment) and twelve months (follow-up assessment) after baseline assessment. Primary outcome measures will include the seven-day point prevalence abstinence at 3-month and 12-month assessments as well as prolonged abstinence (abstinence over the 12 month period). Secondary outcome measures will include a change in smoking-related cognitions and coping strategies among all participants. Among non-abstainers, treatment success indicators such as a reduction in number of cigarettes smoked per day and changes in the number and duration of quit attempts after intervention start will be assessed. It is expected that after both three and twelve months, smoking cessation rates will be higher in the telephone counselling condition compared to the control condition. Discussion The results will provide insights into the effectiveness of proactive telephone counselling by the national German Smokers Quitline. Trial registration The protocol for this study is registered with the German Clinical Trials Register: DRKS00025343, Date of registration: 2021/06/07, https://www.drks.de/drks_web/setLocale_EN.do
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Affiliation(s)
- Simone Delle
- IFT Institut für Therapieforschung, Munich, Germany
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, Munich, Germany.,Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden.,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | | | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Eva Hoch
- IFT Institut für Therapieforschung, Munich, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
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14
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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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15
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Hacker KA, Kang JY. Tobacco Cessation Quitlines: An Evolving Mainstay for an Enduring Cessation Support Infrastructure. Am J Prev Med 2021; 60:S185-S187. [PMID: 33663706 DOI: 10.1016/j.amepre.2020.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 11/01/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Karen A Hacker
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joann Yoon Kang
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
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16
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Glover-Kudon RM, Gates EF. The Role of Quitlines in Tobacco Cessation: An Introduction. Am J Prev Med 2021; 60:S99-S102. [PMID: 33663707 DOI: 10.1016/j.amepre.2020.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/14/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Rebecca M Glover-Kudon
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Emily F Gates
- Measurement, Evaluation, Statistics, & Assessment (MESA), Lynch School of Education and Human Development, Boston College, Chestnut Hill, Massachusetts
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