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Rogers ES, Rosen MI, Elbel B, Wang B, Kyanko K, Vargas E, Wysota CN, Sherman SE. Integrating Financial Coaching and Referrals into a Smoking Cessation Program for Low-income Smokers: a Randomized Waitlist Control Trial. J Gen Intern Med 2022; 37:2973-2981. [PMID: 35018561 PMCID: PMC9485413 DOI: 10.1007/s11606-021-07209-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/08/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Financial distress is a barrier to cessation among low-income smokers. OBJECTIVE To evaluate an intervention that integrated financial coaching and benefits referrals into a smoking cessation program for low-income smokers. DESIGN Randomized waitlist control trial conducted from 2017 to 2019. PARTICIPANTS Adult New York City residents were eligible if they reported past 30-day cigarette smoking, had income below 200% of the federal poverty level, spoke English or Spanish, and managed their own funds. Pregnant or breastfeeding people were excluded. Participants were recruited from two medical centers and from the community. INTERVENTION The intervention (n = 208) offered smoking cessation coaching, nicotine replacement therapy, money management coaching, and referral to financial benefits and empowerment services. The waitlist control (n=202) was usual care during a 6-month waiting period. MAIN MEASURES Treatment engagement, self-reported 7-day abstinence, and financial stress at 6 months. KEY RESULTS At 6 months, intervention participants reported higher abstinence (17% vs. 9%, P=0.03), lower stress about finances (β, -0.8 [SE, 0.4], P=0.02), and reduced frequency of being unable to afford activities (β, -0.8 [SE, 0.4], P=0.04). Outcomes were stronger among participants recruited from the medical centers (versus from the community). Among medical center participants, the intervention was associated with higher abstinence (20% vs. 8%, P=0.01), higher satisfaction with present financial situation (β, 1.0 [SE, 0.4], P=0.01), reduced frequency of being unable to afford activities (β, -1.0 [SE, 0.5], P=0.04), reduced frequency in getting by paycheck-to-paycheck (β, -1.0 [SE, 0.4], P=0.03), and lower stress about finances in general (β, -1.0 [SE, 0.4], P = 0.02). There were no group differences in outcomes among people recruited from the community (P>0.05). CONCLUSIONS Among low-income smokers recruited from medical centers, the intervention produced higher abstinence rates and reductions in some markers of financial distress than usual care. The intervention was not efficacious with people recruited from the community. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03187730.
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Affiliation(s)
- Erin S Rogers
- Department of Population Health, New York University Grossman School of Medicine, NY, New York, USA.
- VA NY Harbor Healthcare System, New York, NY, USA.
| | - Marc I Rosen
- Department of Psychiatry, Yale University, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Brian Elbel
- Department of Population Health, New York University Grossman School of Medicine, NY, New York, USA
- New York University, Wagner School of Public Service, New York, NY, USA
| | - Binhuan Wang
- Department of Population Health, New York University Grossman School of Medicine, NY, New York, USA
| | - Kelly Kyanko
- Department of Population Health, New York University Grossman School of Medicine, NY, New York, USA
| | - Elizabeth Vargas
- Department of Population Health, New York University Grossman School of Medicine, NY, New York, USA
| | - Christina N Wysota
- Department of Population Health, New York University Grossman School of Medicine, NY, New York, USA
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Scott E Sherman
- Department of Population Health, New York University Grossman School of Medicine, NY, New York, USA
- VA NY Harbor Healthcare System, New York, NY, USA
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Latent Heterogeneity in the Impact of Financial Coaching on Delay Discounting among Low-Income Smokers: A Secondary Analysis of a Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052736. [PMID: 35270426 PMCID: PMC8910110 DOI: 10.3390/ijerph19052736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 11/16/2022]
Abstract
Low-income adults are significantly more likely to smoke, and face more difficulty in quitting, than people with high income. High rates of delay discounting (DD) may be an important factor contributing to the high rates of tobacco use among low-income adults. Future-oriented financial coaching may offer a novel approach in the treatment of smoking cessation among low-income adults. This secondary analysis (N = 251) of data from a randomized controlled trial examined the integration of future-oriented financial coaching into smoking cessation treatment for low-income smokers. Linear regression and finite mixture models (FMM) estimated the overall and the latent heterogeneity of the impact of the intervention versus usual care control on DD rates 6 months after randomization. Though standard linear regression found no overall difference in DD between intervention and control (β = −0.23, p = 0.338), the FMM identified two latent subgroups with different responses to the intervention. Subgroup 1 (79% of the sample) showed no difference in DD between intervention and control (β = 0.25, p = 0.08). Subgroup 2 (21% of the sample) showed significantly lower DD (β = −2.06, p = 0.003) among intervention group participants versus control at 6 months. Participants were more likely to be a member of subgroup 2 if they had lower baseline DD rates, were living at or below 100% of federal poverty, or were married/living with a partner. This study identified a group of low-income adults seeking to quit smoking who responded to financial coaching with decreased DD rates. These results can be used to inform future targeting of the intervention to individuals who may benefit most, as well as inform future treatment adaptations to support the subgroup of low-income smokers, who did not benefit.
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Busch AM, Nederhoff DM, Dunsiger SI, Japuntich SJ, Chrastek M, Adkins-Hempel M, Rinehart LM, Lando H. Chronic care treatment for smoking cessation in patients with serious mental illness: a pilot randomized trial. BMC Psychiatry 2021; 21:104. [PMID: 33593332 PMCID: PMC7886429 DOI: 10.1186/s12888-021-03113-5] [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: 09/28/2020] [Accepted: 01/21/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Rates of smoking among those with serious mental illness (SMI) are two to three times higher than for the general population. Smoking is rarely addressed in mental health settings. Innovative outreach and treatment strategies are needed to address these disparities. The current study is a pilot study of the feasibility and acceptability of a chronic care model of tobacco cessation treatment implemented in outpatient psychiatry clinics. METHODS Participants were recruited from two outpatient psychiatric clinics and randomly assigned to intervention (counseling and nicotine replacement for 8 weeks, plus ongoing proactive outreach calls inviting reengagement in treatment) or control (brief education and referral to the state quit line). Assessments were conducted at 8 weeks (end of initial treatment block) and 6 months (end of window for retreatment). Feasibility was assessed by enrollment rate, treatment engagement, and completion of follow-up assessments. Acceptability was assessed both quantitatively and qualitatively. Preliminary efficacy was assessed by 7-day and 30-day abstinence rates, rate of quit attempts, and cigarettes per day. Psychological health was measured to assess for changes related to treatment group or attempts to quit smoking. RESULTS Nineteen participants were randomized to intervention and 19 to control. Recruitment proved feasible, and high rates of treatment engagement (mean of 4.5 sessions completed in initial treatment block, 89.5% uptake of nicotine replacement) and retention (94.7% of follow-up assessments completed) were observed. Treatment acceptability was high. As anticipated, there were no significant differences in abstinence between groups, but results generally favored the intervention group, including bio-verified 7-day abstinence rates of 21.1% in intervention vs. 17.6% in control and self-reported 30-day abstinence rates of 16.1% in intervention vs. 5.1% in control at 8 weeks. Significantly more intervention participants made at least one quit attempt (94.7% vs 52.6%; OR = 16.20, 95% CI: 1.79-147.01). Cigarettes per day decreased significantly more in the intervention group at 8 weeks (b = - 13.19, SE = 4.88, p = .02). CONCLUSIONS It was feasible to recruit and retain SMI patients in a smoking cessation trial in the context of outpatient psychiatry. The novel chronic care model treatment was acceptable to patients and showed promise for efficacy. If efficacious, a chronic care model could be effective at reducing smoking among SMI patients. TRIAL REGISTRATION ClinicalTrial.gov #: NCT03822416 (registered January 30th 2019).
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Affiliation(s)
- Andrew M. Busch
- grid.414021.20000 0000 9206 4546Department of Medicine, Hennepin Healthcare, 701 Park Avenue, S9-309, Minneapolis, MN 55415 USA ,grid.17635.360000000419368657Department of Medicine, University of Minnesota, 420 Delaware St. SE, Minneapolis, MN 55455 USA
| | - Dawn M. Nederhoff
- grid.17635.360000000419368657Division of Epidemiology and Community Health, University of Minnesota, 1300 South 2nd Street, Minneapolis, MN 55454 USA
| | - Shira I. Dunsiger
- grid.40263.330000 0004 1936 9094Department of Behavioral and Social Sciences, Center for Health Promotion and Health Equity, Brown University, School of Public Health, Box G-S121-8, Providence, RI 02912 USA
| | - Sandra J. Japuntich
- grid.414021.20000 0000 9206 4546Department of Medicine, Hennepin Healthcare, 701 Park Avenue, S9-309, Minneapolis, MN 55415 USA ,grid.17635.360000000419368657Department of Medicine, University of Minnesota, 420 Delaware St. SE, Minneapolis, MN 55455 USA
| | - Michelle Chrastek
- Hennepin Healthcare Research Institute, 701 Park Avenue, PP7.700, Minneapolis, MN 55415 USA
| | - Melissa Adkins-Hempel
- Hennepin Healthcare Research Institute, 701 Park Avenue, PP7.700, Minneapolis, MN 55415 USA
| | - Linda M. Rinehart
- grid.17635.360000000419368657Department of Psychiatry & Behavioral Sciences, University of Minnesota, 2450 Riverside Avenue, Minneapolis, MN 55454 USA
| | - Harry Lando
- grid.17635.360000000419368657Division of Epidemiology and Community Health, University of Minnesota, 1300 South 2nd Street, Minneapolis, MN 55454 USA
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Hammett PJ, Lando HA, Erickson DJ, Widome R, Taylor BC, Nelson D, Japuntich SJ, Fu SS. Proactive outreach tobacco treatment for socioeconomically disadvantaged smokers with serious mental illness. J Behav Med 2020; 43:493-502. [PMID: 31363948 PMCID: PMC7525931 DOI: 10.1007/s10865-019-00083-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
Smokers with serious mental illness (SMI) face individual, interpersonal, and healthcare provider barriers to cessation treatment utilization and smoking abstinence. Proactive outreach strategies are designed to address these barriers by promoting heightened contact with smokers and facilitating access to evidence-based treatments. The present study examined the effect of proactive outreach among smokers with SMI (n = 939) who were enrolled in the publicly subsidized Minnesota Health Care Programs (MHCP) and compared this effect to that observed among MHCP smokers without SMI (n = 1382). Relative to usual care, the intervention increased treatment utilization among those with SMI (52.1% vs 40.0%, p = 0.002) and without SMI (39.3% vs 25.4%, p < 0.001). The intervention also increased prolonged smoking abstinence among those with SMI (14.9% vs 9.4%, p = 0.010) and without SMI (17.7% vs 13.6%, p = 0.09). Findings suggest that implementation of proactive outreach within publicly subsidized healthcare systems may alleviate the burden of smoking in this vulnerable population. Trial Registration ClinicalTrials.gov identifier: NCT01123967.
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Affiliation(s)
- Patrick J Hammett
- VA HSR&D Center for Care Delivery and Outcomes Research (CCDOR), VA Medical Center (152), Minneapolis VA Health Care System, Minneapolis, MN, USA.
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Harry A Lando
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Darin J Erickson
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Rachel Widome
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Brent C Taylor
- VA HSR&D Center for Care Delivery and Outcomes Research (CCDOR), VA Medical Center (152), Minneapolis VA Health Care System, Minneapolis, MN, USA
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - David Nelson
- VA HSR&D Center for Care Delivery and Outcomes Research (CCDOR), VA Medical Center (152), Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Sandra J Japuntich
- Hennepin Healthcare Research Institute, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Steven S Fu
- VA HSR&D Center for Care Delivery and Outcomes Research (CCDOR), VA Medical Center (152), Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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Hammett PJ, Taylor BC, Lando HA, Widome R, Erickson DJ, Fu SS. Serious Mental Illness and Smoking Cessation Treatment Utilization: the Role of Healthcare Providers. J Behav Health Serv Res 2020; 48:63-76. [PMID: 32378032 DOI: 10.1007/s11414-020-09707-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Healthcare provider barriers to cessation resources may be undercutting quit rates for smokers with serious mental illness (SMI). The study aim was to examine how providers influence cessation treatment utilization among smokers with SMI. Data were taken from a trial conducted among smokers in Minnesota Health Care Programs. The sample was split into groups of participants with SMI (n = 939) and without SMI (n = 1382). Analyses assessed whether the association between SMI and treatment utilization was mediated by healthcare provider-delivered treatment advice and healthcare provider bias. Results revealed higher rates of treatment utilization among smokers with SMI than those without SMI (45.9% vs 31.7%, p < 0.001); treatment advice and provider bias did not mediate this association. Subsequent individual regression analyses revealed positive associations between treatment advice and treatment utilization (β 0.21-0.25, p < 0.05), independent of SMI status. Strategies to increase low-income smokers' contacts with providers may reduce treatment utilization barriers among these smokers.
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Affiliation(s)
- Patrick J Hammett
- VA HSR&D Center for Care Delivery and Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, MN, USA.
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Brent C Taylor
- VA HSR&D Center for Care Delivery and Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Harry A Lando
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Rachel Widome
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Darin J Erickson
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Steven S Fu
- VA HSR&D Center for Care Delivery and Outcomes Research (CCDOR), Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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Myers MG, Strong DR, Chen TC, Linke SE. Enhancing engagement in evidence-based tobacco cessation treatment for smokers with mental illness: A pilot randomized trial. J Subst Abuse Treat 2020; 111:29-36. [DOI: 10.1016/j.jsat.2019.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 12/19/2019] [Accepted: 12/27/2019] [Indexed: 12/24/2022]
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Thao V, Nyman JA, Nelson DB, Joseph AM, Clothier B, Hammett PJ, Fu SS. Cost-effectiveness of population-level proactive tobacco cessation outreach among socio-economically disadvantaged smokers: evaluation of a randomized control trial. Addiction 2019; 114:2206-2216. [PMID: 31483549 PMCID: PMC6899559 DOI: 10.1111/add.14752] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/31/2019] [Accepted: 07/09/2019] [Indexed: 11/27/2022]
Abstract
AIMS To estimate the cost-effectiveness at population-level of the OPT-IN proactive tobacco cessation outreach program for adult smokers enrolled in publicly funded health insurance plans for low-income persons (e.g. Medicaid). DESIGN Cost-effectiveness analysis using a state transition model based on data from the Offering Proactive Treatment Intervention (OPT-IN) randomized control trial. SETTING The trial was conducted in Minnesota, USA, and the economic analysis was conducted from the Medicaid program perspective. PARTICIPANTS Data were used from 2406 smokers who were randomized into the intervention or comparator groups. INTERVENTION AND COMPARATOR The intervention was comprised of proactive outreach (mailed invitation and telephone calls) and free cessation treatment (nicotine replacement therapy and intensive telephone counseling). The comparator was usual care, which comprised access to a primary care physician, insurance coverage of Food and Drug Administration (FDA)-approved smoking cessation medications and the state's telephone quitline. MEASUREMENTS Smoking status, quality of life and health-care use at varying times, including at baseline and 1 year. FINDINGS The OPT-IN program cost an average of $84 per participant greater than the comparator. One year after randomization, the population-level, 6-month prolonged smoking abstinence rate was 16.5% in the proactive outreach intervention group and 12.1% in the usual care group (P < 0.05). The model projected that the proactive outreach intervention added $78 in life-time cost and generated 0.005 additional quality-adjusted life-years (QALYs), with an expected incremental cost-effectiveness ratio of $4231 per QALY. Probabilistic sensitivity analysis found that the proactive outreach intervention would be cost-effective against a willingness-to-pay threshold of $50 000/QALY approximately 68% of the time. CONCLUSIONS Population-level proactive tobacco treatment with personal telephone outreach was effective in achieving higher population-level quit rates and was cost-effective at various willingness-to-pay thresholds, compared with usual care (i.e. reactive treatment). Taken together with prior research, population-level proactive tobacco cessation outreach programs are judged to be highly cost-effective over the long term.
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Affiliation(s)
| | - John A. Nyman
- University of Minnesota School of Public HealthMinneapolisMNUSA
| | - David B. Nelson
- VA Health Services Research and Development Center for Care Delivery and Outcomes Research (CCDOR)MinneapolisMNUSA
- Department of MedicineUniversity of Minnesota Medical SchoolMinneapolisMNUSA
| | - Anne M. Joseph
- Department of MedicineUniversity of Minnesota Medical SchoolMinneapolisMNUSA
| | - Barbara Clothier
- VA Health Services Research and Development Center for Care Delivery and Outcomes Research (CCDOR)MinneapolisMNUSA
| | - Patrick J. Hammett
- University of Minnesota School of Public HealthMinneapolisMNUSA
- VA Health Services Research and Development Center for Care Delivery and Outcomes Research (CCDOR)MinneapolisMNUSA
| | - Steven S. Fu
- VA Health Services Research and Development Center for Care Delivery and Outcomes Research (CCDOR)MinneapolisMNUSA
- Department of MedicineUniversity of Minnesota Medical SchoolMinneapolisMNUSA
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Hammett P, Fu SS, Nelson D, Clothier B, Saul JE, Widome R, Danan ER, Burgess DJ. A Proactive Smoking Cessation Intervention for Socioeconomically Disadvantaged Smokers: The Role of Smoking-Related Stigma. Nicotine Tob Res 2019; 20:286-294. [PMID: 28398492 DOI: 10.1093/ntr/ntx085] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 04/06/2017] [Indexed: 11/14/2022]
Abstract
Introduction Smoking denormalization has been paralleled by reduced smoking prevalence, but smoking rates among socioeconomically disadvantaged populations remain high. The social unacceptability of smoking has also led to increased perceptions of smoking-related stigma. By examining how smoking stigma influences cessation intervention effectiveness, we can better tailor interventions to socioeconomically disadvantaged smokers. Aims and Methods Data are from a randomized controlled trial evaluating the effectiveness of a proactive cessation intervention on abstinence. Current smokers enrolled in Minnesota Health Care Programs were randomized to proactive outreach (n = 1200) or usual care (n = 1206). The intervention included mailings, telephone outreach, counseling, and access to free cessation treatments. Using baseline measurements, groups with lower (n = 1227) and higher (n = 1093) perceived stigma were formed. Intervention, stigma, and their interaction term were added to a logistic regression modeling abstinence at 12 months. Results Lower perceived smoking-related stigma was associated with less support for quitting, lower rates of physician quitting advice, and less motivation for quitting. A logistic regression modeling abstinence found a significant intervention × stigma interaction. The proactive intervention was more effective among smokers with lower perceived smoking-related stigma (odds ratio 1.94, 95% confidence interval, 1.29 to 2.92) than those with higher perceived smoking-related stigma (odds ratio 1.04, 95% confidence interval, 0.70 to 1.55). Discussion Smokers with lower perceived smoking-related stigma had social environments that were conducive to smoking, received less physician advice to quit, and were less motivated to quit than higher stigma smokers. Despite these barriers, the intervention was more effective for lower stigma smokers, suggesting that proactive outreach is an efficient treatment for these hard-to-reach smokers. Implications Smoking denormalization has led to increased perceptions of smoking-related stigma among many smokers; however, little is known about how this stigma influences the cessation process. In the present study, smokers with lower levels of perceived smoking-related stigma lived in social environments that were more conducive to smoking and were less motivated to quit than higher stigma smokers. Despite these barriers, our proactive outreach cessation intervention was more effective for lower stigma smokers, suggesting that interventions which utilize proactive outreach to stimulate interest in quitting and offer facilitated access to free cessation treatments are an effective treatment approach for these hard-to-reach smokers. These strategies may be particularly effective for motivating smokers enrolled in government-subsidized health insurance programs to take advantage of cessation resources.
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Affiliation(s)
- Patrick Hammett
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN.,Department of Medicine, University of Minnesota Medical School, MN.,VA HSR&D Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, MN
| | - Steven S Fu
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN.,Department of Medicine, University of Minnesota Medical School, MN
| | - David Nelson
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN.,Department of Medicine, University of Minnesota Medical School, MN
| | - Barbara Clothier
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN
| | | | - Rachel Widome
- VA HSR&D Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, MN
| | - Elisheva R Danan
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN.,Department of Medicine, University of Minnesota Medical School, MN
| | - Diana J Burgess
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN.,Department of Medicine, University of Minnesota Medical School, MN
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A cross-sectional study of the relationship of proximal smoking environments and cessation history, plans, and self-efficacy among low-income smokers. J Smok Cessat 2019; 14:229-238. [PMID: 33777240 DOI: 10.1017/jsc.2019.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction Proximal environments could facilitate smoking cessation among low-income smokers by making cessation appealing to strive for and tenable. Aims We sought to examine how home smoking rules and proximal environmental factors such as other household members' and peers' smoking behaviors and attitudes related to low-income smokers' past quit attempts, readiness, and self-efficacy to quit. Methods This analysis used data from Offering Proactive Treatment Intervention (OPT-IN) (randomized control trial of proactive tobacco cessation outreach) baseline survey, which was completed by 2,406 participants in 2011/12. We tested the associations between predictors (home smoking rules and proximal environmental factors) and outcomes (past-year quit attempts, readiness to quit, and quitting self-efficacy). Results Smokers who lived in homes with more restrictive household smoking rules, and/or reported having 'important others' who would be supportive of their quitting, were more likely to report having made a quit attempt in the past year, had greater readiness to quit, and greater self-efficacy related to quitting. Conclusions Adjustments to proximal environments, including strengthening household smoking rules, might encourage cessation even if other household members are smokers.
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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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Hammett PJ, Lando HA, Taylor BC, Widome R, Erickson DJ, Joseph AM, Clothier B, Fu SS. The relationship between smoking cessation and binge drinking, depression, and anxiety symptoms among smokers with serious mental illness. Drug Alcohol Depend 2019; 194:128-135. [PMID: 30439609 PMCID: PMC6363348 DOI: 10.1016/j.drugalcdep.2018.08.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/14/2018] [Accepted: 08/22/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Concerns about the adverse effects of smoking cessation on alcohol use and mental health are a barrier to cessation for smokers with serious mental illness (SMI). The purpose of this study is to examine how incident smoking cessation affects binge drinking and symptoms of depression and anxiety among smokers with SMI. METHODS The present study is a secondary analysis of the OPTIN trial, which demonstrated the effectiveness of proactive outreach for smoking cessation among Minnesota Health Care Programs enrollees. Participants with ICD-9 codes indicating schizophrenia spectrum disorders, psychotic disorders, bipolar disorders, or severe/recurrent major depressive disorder were categorized as having SMI (n = 939); remaining smokers were categorized as non-SMI (n = 1382). Multivariable regressions modeled the association between incident smoking cessation and binge drinking, PHQ-2 depression scores, and PROMIS anxiety scores in the two groups. RESULTS Quitting smoking was not associated with binge drinking among those with SMI, but was associated with less binge drinking among those without SMI (p = 0.033). Quitting smoking was not associated with PHQ-2 depression scores among those with or without SMI. However, quitting smoking was associated with lower mean PROMIS anxiety scores for those with SMI (p = 0.031), but not those without SMI. CONCLUSION Quitting smoking was not associated with heightened binge drinking or symptoms of depression and anxiety among smokers with SMI. These findings suggest that quitting smoking is not detrimental for these patients, and provide evidential support for facilitating access to cessation resources for patients with serious mental illness who smoke.
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Affiliation(s)
- Patrick J Hammett
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN, USA; VA HSR and D Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, MN, USA.
| | - Harry A Lando
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN, USA
| | - Brent C Taylor
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN, USA; Department of Medicine, University of Minnesota Medical School, MN, USA; VA HSR and D Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, MN, USA
| | - Rachel Widome
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN, USA
| | - Darin J Erickson
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN, USA
| | - Anne M Joseph
- Department of Medicine, University of Minnesota Medical School, MN, USA
| | - Barbara Clothier
- VA HSR and D Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, MN, USA
| | - Steven S Fu
- Department of Medicine, University of Minnesota Medical School, MN, USA; VA HSR and D Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, MN, USA
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12
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Predicting Engagement in Smoking Cessation Treatment Following a Brief Telephone Evaluation and Referral Session. J Smok Cessat 2018. [DOI: 10.1017/jsc.2018.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction: Smoking cessation treatment combining medication and counselling yields the best outcomes; however, few smokers employ both modalities.Aims: The purpose of this study was to examine variables predicting treatment attendance.Methods: This was a chart review of US military Veterans (N = 340; 89% male, 59% non-Hispanic white) referred for smoking cessation, who completed a telephone call to encourage treatment utilization. Treatment engagement was defined as attending a smoking cessation session within 30 days following telephone contact. A logistic regression analysis examined predictors (demographics, smoking variables, and psychiatric diagnoses) of treatment engagement.Results/Findings: Greater age (Odds Ratio [OR] = 1.04, 95% confidence interval [CI] 1.01–1.06), more cigarettes (OR = 1.03, 95% CI 1.00–1.06), and higher perceived importance of quitting (OR = 1.11, 95% CI 1.00–1.23) predicted engaging in treatment within 30 days (all p values < 0.05).Conclusion: Veterans who attended treatment were older, smoked more cigarettes, and perceived quitting as more important than those who did not attend. These findings are consistent with prior studies examining factors associated with treatment utilization. Results highlight the need to identify strategies for engaging into treatment smokers who are younger, smoke fewer cigarettes, and view quitting as less important.
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13
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Kruse GR, Kelley JHK, Chase K, Rigotti NA. Feasibility of a proactive text messaging intervention for smokers in community health centers. JMIR Form Res 2017; 2:v2i1e11. [PMID: 30506038 PMCID: PMC6261471 DOI: 10.2196/formative.9608] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Few smokers receive evidence-based cessation services during primary care visits. Objective We aimed to assess the feasibility of a proactive text messaging program for primary care patients who smoke. Methods We used electronic health records to identify smokers who had a mobile phone number listed from two community health centers in Massachusetts. Between March 2014 and June 2015, patients were screened by their primary care physician and then sent a proactive text message inviting them to enroll by texting back. Patients who opted in were asked about their readiness to quit. The text message program included messages from the QuitNowTXT library and novel content for smokers who were not ready to quit. Results Among 949 eligible smokers, 88 (9.3%) enrolled after receiving a single proactive text message. Compared with those who did not enroll, enrollees were more often female (54/88, 61% vs 413/861, 48.0%, P=.02), but otherwise did not differ in age, race, insurance status, or comorbidities. In all, 28% (19/67) of enrollees reported they were not ready to quit in the next 30 days, 61% (41/67) were ready to quit, and 11% (7/67) already quit. The median time in the program was 9 days (interquartile range 2-32 days). Of current smokers, 25% (15/60) sent one or more keyword requests to the server. These did not differ by readiness to quit. Conclusions A proactively delivered text messaging program targeting primary care patients who smoke was feasible and engaged both smokers ready to quit and those not ready to quit. This method shows promise as part of a population health model for addressing tobacco use outside of the primary care office.
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Affiliation(s)
- Gina R Kruse
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital.,Tobacco Research and Treatment Center, Massachusetts General Hospital.,Harvard Medical School.,Partners Center for Connected Health, Massachusetts General Hospital
| | - Jennifer H K Kelley
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital.,Tobacco Research and Treatment Center, Massachusetts General Hospital.,Harvard Medical School.,Partners Center for Connected Health, Massachusetts General Hospital
| | - Karen Chase
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital.,Tobacco Research and Treatment Center, Massachusetts General Hospital.,Harvard Medical School.,Partners Center for Connected Health, Massachusetts General Hospital
| | - Nancy A Rigotti
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital.,Tobacco Research and Treatment Center, Massachusetts General Hospital.,Harvard Medical School.,Partners Center for Connected Health, Massachusetts General Hospital
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14
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Hammett PJ, Fu SS, Burgess DJ, Nelson D, Clothier B, Saul JE, Nyman JA, Widome R, Joseph AM. Treatment barriers among younger and older socioeconomically disadvantaged smokers. THE AMERICAN JOURNAL OF MANAGED CARE 2017; 23:e295-e302. [PMID: 29087167 PMCID: PMC6036916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Underutilization of smoking cessation treatments contributes to high rates of smoking in socioeconomically disadvantaged populations. Guided by a conceptual framework, the present study explored how healthcare provider factors, social environment characteristics, and cessation beliefs influence treatment utilization among low-income smokers and whether these associations vary by age. STUDY DESIGN Analyses were conducted on baseline data from 2406 participants enrolled in a randomized controlled trial that evaluated the effectiveness of a proactive outreach cessation intervention among a sample of younger (18-34 years) and older (35-64 years) smokers enrolled in public healthcare assistance programs. METHODS Multivariable logistic regression models predicted past year cessation treatment utilization (CTU) among younger and older smokers. Independent variables included measures of healthcare provider barriers, social environment characteristics, and cessation beliefs. RESULTS Younger smokers were less likely to have CTU than older smokers (27.2% vs 36.2%; P <.001). In both groups, number of cigarettes per day, more problems accessing healthcare, receiving medication-related cessation advice, and readiness to quit were positively associated with CTU (P <.05). Among younger smokers, living with another smoker was associated with lower odds of CTU while receipt of cessation advice was associated (P = .033) with higher odds of CTU. CONCLUSIONS In this sample of low-income smokers, interest in quitting was high but treatment utilization was low. Increasing utilization of cessation treatments via interventions that target issues specific to low-income smokers, including healthcare provider access and advice, the home environment, and motivation to quit, is an important step toward reducing smoking rates in this population.
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Affiliation(s)
- Patrick J Hammett
- VA Medical Center (152), 1 Veterans Dr, Minneapolis, MN 55417. E-mail:
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15
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Lown EA, Hijiya N, Zhang N, Srivastava DK, Leisenring WM, Nathan PC, Castellino SM, Devine KA, Dilley K, Krull KR, Oeffinger KC, Hudson MM, Armstrong GT, Robison LL, Ness KK. Patterns and predictors of clustered risky health behaviors among adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study. Cancer 2016; 122:2747-56. [PMID: 27258389 DOI: 10.1002/cncr.30106] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/28/2016] [Accepted: 04/15/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Health complications related to childhood cancer may be influenced by risky health behaviors (RHBs), particularly when RHBs co-occur. To the authors' knowledge, only limited information is available describing how RHBs cluster among survivors of childhood cancer and their siblings and the risk factors for co-occurring RHBs. METHODS Latent class analysis was used to identify RHB clusters using longitudinal survey data regarding smoking, alcohol use, and physical activity from adult survivors (4184 survivors) and siblings (1598 siblings) in the Childhood Cancer Survivor Study. Generalized logistic regression was used to evaluate associations between demographic characteristics, treatment exposures, psychological distress, health conditions, and cluster membership. RESULTS Three RHB clusters were identified: a low-risk cluster, an insufficiently active cluster, and a high-risk cluster (tobacco and risky alcohol use and insufficient activity). Compared with siblings, survivors were more likely to be in the insufficiently active cluster (adjusted odds ratio [ORadj ], 1.17; 95% confidence interval [95% CI], 1.06-1.27) and were less likely to be in the high-risk cluster (ORadj , 0.79; 95% CI, 0.69-0.88). Risk factors for membership in the high-risk cluster included psychological distress (ORadj , 2.76; 95% CI, 1.98-3.86), low educational attainment (ORadj , 7.49; 95% CI, 5.15-10.88), income <$20,000 (ORadj , 2.62; 95% CI, 1.93-3.57), being divorced/separated or widowed (ORadj , 1.36; 95% CI, 1.03-1.79), and limb amputation (ORadj , 1.52; 95% CI, 1.03-2.24). Risk factors for the insufficiently active cluster included chronic health conditions, psychological distress, low education or income, being obese or overweight, female sex, nonwhite race/ethnicity, single marital status, cranial radiation, and cisplatin exposure. CONCLUSIONS RHBs co-occur in survivors of childhood cancer and their siblings. Economic and educational disadvantages and psychological distress should be considered in screening and interventions to reduce RHBs. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2747-2756. © 2016 American Cancer Society.
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Affiliation(s)
- E Anne Lown
- Social and Behavioral Sciences, University of California, San Francisco, California
| | - Nobuko Hijiya
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nan Zhang
- Division of Health Sciences Research, Mayo Clinic, Scottsdale, Arizona
| | - Deo Kumar Srivastava
- Biostatistics Division, Epidemiology/Cancer Control Department, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Wendy M Leisenring
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Paul C Nathan
- Division of Haematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sharon M Castellino
- Department of Pediatric Hematology/Oncology, Emory School of Medicine, Atlanta, Georgia
| | - Katie A Devine
- Department of Medicine, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
| | - Kimberley Dilley
- General Pediatrics & Academic Medicine, Advocate Children's Hospital, Oak Lawn, Illinois
| | - Kevin R Krull
- Epidemiology/Cancer Control Department, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kevin C Oeffinger
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Melissa M Hudson
- Cancer Survivorship Division, Cancer Prevention & Control Program, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Gregory T Armstrong
- Epidemiology/Cancer Control Department, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Leslie L Robison
- Epidemiology/Cancer Control Department, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kirsten K Ness
- Epidemiology/Cancer Control Department, St. Jude Children's Research Hospital, Memphis, Tennessee
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16
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Stead LF, Koilpillai P, Fanshawe TR, Lancaster T. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database Syst Rev 2016; 3:CD008286. [PMID: 27009521 PMCID: PMC10042551 DOI: 10.1002/14651858.cd008286.pub3] [Citation(s) in RCA: 228] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Both behavioural support (including brief advice and counselling) and pharmacotherapies (including nicotine replacement therapy (NRT), varenicline and bupropion) are effective in helping people to stop smoking. Combining both treatment approaches is recommended where possible, but the size of the treatment effect with different combinations and in different settings and populations is unclear. OBJECTIVES To assess the effect of combining behavioural support and medication to aid smoking cessation, compared to a minimal intervention or usual care, and to identify whether there are different effects depending on characteristics of the treatment setting, intervention, population treated, or take-up of treatment. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register in July 2015 for records with any mention of pharmacotherapy, including any type of NRT, bupropion, nortriptyline or varenicline. SELECTION CRITERIA Randomized or quasi-randomized controlled trials evaluating combinations of pharmacotherapy and behavioural support for smoking cessation, compared to a control receiving usual care or brief advice or less intensive behavioural support. We excluded trials recruiting only pregnant women, trials recruiting only adolescents, and trials with less than six months follow-up. DATA COLLECTION AND ANALYSIS Search results were prescreened by one author and inclusion or exclusion of potentially relevant trials was agreed by two authors. Data was extracted by one author and checked by another.The main outcome measure was abstinence from smoking after at least six months of follow-up. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. We calculated the risk ratio (RR) and 95% confidence interval (CI) for each study. Where appropriate, we performed meta-analysis using a Mantel-Haenszel fixed-effect model. MAIN RESULTS Fifty-three studies with a total of more than 25,000 participants met the inclusion criteria. A large proportion of studies recruited people in healthcare settings or with specific health needs. Most studies provided NRT. Behavioural support was typically provided by specialists in cessation counselling, who offered between four and eight contact sessions. The planned maximum duration of contact was typically more than 30 minutes but less than 300 minutes. Overall, studies were at low or unclear risk of bias, and findings were not sensitive to the exclusion of any of the six studies rated at high risk of bias in one domain. One large study (the Lung Health Study) contributed heterogeneity due to a substantially larger treatment effect than seen in other studies (RR 3.88, 95% CI 3.35 to 4.50). Since this study used a particularly intensive intervention which included extended availability of nicotine gum, multiple group sessions and long term maintenance and recycling contacts, the results may not be comparable with the interventions used in other studies, and hence it was not pooled in other analyses. Based on the remaining 52 studies (19,488 participants) there was high quality evidence (using GRADE) for a benefit of combined pharmacotherapy and behavioural treatment compared to usual care, brief advice or less intensive behavioural support (RR 1.83, 95% CI 1.68 to 1.98) with moderate statistical heterogeneity (I² = 36%).The pooled estimate for 43 trials that recruited participants in healthcare settings (RR 1.97, 95% CI 1.79 to 2.18) was higher than for eight trials with community-based recruitment (RR 1.53, 95% CI 1.33 to 1.76). Compared to the first version of the review, previous weak evidence of differences in other subgroup analyses has disappeared. We did not detect differences between subgroups defined by motivation to quit, treatment provider, number or duration of support sessions, or take-up of treatment. AUTHORS' CONCLUSIONS Interventions that combine pharmacotherapy and behavioural support increase smoking cessation success compared to a minimal intervention or usual care. Updating this review with an additional 12 studies (5,000 participants) did not materially change the effect estimate. Although trials differed in the details of their populations and interventions, we did not detect any factors that modified treatment effects apart from the recruitment setting. We did not find evidence from indirect comparisons that offering more intensive behavioural support was associated with larger treatment effects.
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Affiliation(s)
- Lindsay F Stead
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
| | | | - Thomas R Fanshawe
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
| | - Tim Lancaster
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
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17
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Fu SS, van Ryn M, Nelson D, Burgess DJ, Thomas JL, Saul J, Clothier B, Nyman JA, Hammett P, Joseph AM. Proactive tobacco treatment offering free nicotine replacement therapy and telephone counselling for socioeconomically disadvantaged smokers: a randomised clinical trial. Thorax 2016; 71:446-53. [PMID: 26931362 PMCID: PMC4862067 DOI: 10.1136/thoraxjnl-2015-207904] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 01/05/2016] [Indexed: 11/15/2022]
Abstract
Background Evidenced-based tobacco cessation treatments are underused, especially by socioeconomically disadvantaged smokers. This contributes to widening socioeconomic disparities in tobacco-related morbidity and mortality. Methods The Offering Proactive Treatment Intervention trial tested the effects of a proactive outreach tobacco treatment intervention on population-level smoking abstinence and tobacco treatment use among a population-based sample of socioeconomically disadvantaged smokers. Current smokers (n=2406), regardless of interest in quitting, who were enrolled in the Minnesota Health Care Programs, the state's publicly funded healthcare programmes for low-income populations, were randomly assigned to proactive outreach or usual care. The intervention comprised proactive outreach (tailored mailings and telephone calls) and free cessation treatment (nicotine replacement therapy and intensive, telephone counselling). Usual care comprised access to a primary care physician, insurance coverage of Food and Drug Administration-approved smoking cessation medications, and the state's telephone quitline. The primary outcome was self-reported 6-month prolonged smoking abstinence at 1 year and was assessed by follow-up survey. Findings The proactive intervention group had a higher prolonged abstinence rate at 1 year than usual care (16.5% vs 12.1%, OR 1.47, 95% CI 1.12 to 1.93). The effect of the proactive intervention on prolonged abstinence persisted in selection models accounting for non-response. In analysis of secondary outcomes, use of evidence-based tobacco cessation treatments were significantly greater among proactive outreach participants compared with usual care, particularly combination counselling and medications (17.4% vs 3.6%, OR 5.69, 95% CI 3.85 to 8.40). Interpretation Population-based proactive tobacco treatment increases engagement in evidence-based treatment and is effective in long-term smoking cessation among socioeconomically disadvantaged smokers. Findings suggest that dissemination of population-based proactive treatment approaches is an effective strategy to reduce the prevalence of smoking and socioeconomic disparities in tobacco use. Trial registration number NCT01123967.
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Affiliation(s)
- Steven S Fu
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Michelle van Ryn
- Division of Health Care Policy & Research, Mayo Clinic, Rochester, Minnesota, USA
| | - David Nelson
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Diana J Burgess
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Janet L Thomas
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Jessie Saul
- North American Quitline Consortium, Phoenix, Arizona, USA
| | - Barbara Clothier
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA
| | - John A Nyman
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Patrick Hammett
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Anne M Joseph
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Widome R, Joseph AM, Hammett P, Van Ryn M, Nelson DB, Nyman JA, Fu SS. Associations between smoking behaviors and financial stress among low-income smokers. Prev Med Rep 2015; 2:911-5. [PMID: 26844167 PMCID: PMC4721304 DOI: 10.1016/j.pmedr.2015.10.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE Many American households struggle to bring in sufficient income to meet basic needs related to nutrition, housing, and healthcare. Nicotine addiction and consequent expenditures on cigarettes may impose extra financial strain on low-income households. We examine how cigarette use behaviors relate to self-reported financial stress/strain among low-income smokers. METHODS At baseline in 2011/12, OPT-IN recruited adult smokers age 18-64 from the administrative databases of the state-subsidized Minnesota Health Care Programs (N = 2406). We tested whether nicotine dependency, type of cigarettes used, and smoking intensity were associated with self-reported difficulty affording food, healthcare, housing, and living within one's income. All regression models were adjusted for race, education, income, age, and gender. RESULTS Difficulty living on one's income (77.4%), paying for healthcare (33.6%), paying for housing (38.4%), and paying for food (40.8%) were common conditions in this population. Time to first cigarette and cigarettes smoked per day predicted financial stress related to affording food, housing, and living within one's income (all p < 0.05). For instance, those whose time to first cigarette was greater than 60 minutes had about half the odds of reporting difficulty paying for housing compared to those who had their first cigarette within five minutes of waking (adjusted odds ratio = 0.55 [95% CI: 0.41, 0.73]). Type of cigarette used was not associated with any type of financial stress/strain. CONCLUSIONS Smoking and particularly heavy smoking may contribute in an important way to the struggles that low-income households with smokers face in paying for necessities.
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Affiliation(s)
- Rachel Widome
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN, USA
| | - Anne M Joseph
- Department of Medicine, University of Minnesota Medical School, MN, USA
| | - Patrick Hammett
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN, USA; Department of Medicine, University of Minnesota Medical School, MN, USA; VA HSR&D Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, MN, USA
| | - Michelle Van Ryn
- Mayo Clinic, Division of Health Care Policy & Research, Rochester, MN, USA
| | - David B Nelson
- VA HSR&D Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, MN, USA
| | - John A Nyman
- Division of Health Policy and Management, University of Minnesota School of Public Health, MN, USA
| | - Steven S Fu
- Department of Medicine, University of Minnesota Medical School, MN, USA; VA HSR&D Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, MN, USA
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