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Cobb CO, Budd S, Maldonado G, Imran R, Foulds J, Yingst J, Yen MS, Kang L, Sun S, Hall PB, Chowdhury N, Cohen JE. Predictors of attrition in a randomized controlled trial of an electronic nicotine delivery system among people interested in cigarette smoking reduction. Contemp Clin Trials 2024; 145:107662. [PMID: 39142511 DOI: 10.1016/j.cct.2024.107662] [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: 05/22/2024] [Revised: 08/04/2024] [Accepted: 08/10/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Mitigating attrition is a key component to reduce selection bias in longitudinal randomized controlled trials (RCTs). Few studies of electronic nicotine delivery systems (ENDS) allow for the examination of long-term retention. This analysis explores the relationship between attrition, baseline measures, and condition assigned for a RCT involving ENDS differing in nicotine delivery over a 24-week intervention period. METHODS Participants (N = 520) who smoked ≥10 cigarettes per day [CPD] for ≥1 year and reported interest in reducing but not quitting were randomized to 1 of 4 conditions: an ENDS containing 0, 8, or 36 mg/ml liquid nicotine (administered double-blind) or a cigarette-shaped plastic tube. Cox proportional hazards regression models were fit to examine attrition over time and predictors of attrition including baseline characteristics and condition. A stepwise approach was used to determine the final model; alpha was set at 0.05. RESULTS Attrition did not differ significantly by condition (223/520), and most (69%) were lost-to-follow-up. Only age, education level, and household income were significantly predictive of attrition. For every additional year of age, attrition risk fell by 3%. Holding a bachelor's degree or higher was associated with reduced attrition risk. Those with the lowest income (<$10 K) were more likely to be withdrawn compared to those earning $10 K-39 K, and those with the highest income ($100 K+) were more likely to be withdrawn compared with the latter bracket and those earning $70-99 K. CONCLUSION ENDS nicotine content did not drive differential attrition in this trial, and targeted retention efforts are needed for specific subgroups. Trial Registration #: NCT02342795.
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Affiliation(s)
- Caroline O Cobb
- Department of Psychology, Virginia Commonwealth University, 612 N Lombardy St, Richmond, VA 23284, USA; Center for the Study of Tobacco Products, Virginia Commonwealth University, 100 West Franklin Street, Suite 200, Richmond, VA 23220, USA.
| | - Serenity Budd
- Department of Biostatistics, Virginia Commonwealth University, One Capital Square 830 East Main Street, Richmond, VA 23219, USA
| | - Gabrielle Maldonado
- Department of Psychology, Virginia Commonwealth University, 612 N Lombardy St, Richmond, VA 23284, USA; Center for the Study of Tobacco Products, Virginia Commonwealth University, 100 West Franklin Street, Suite 200, Richmond, VA 23220, USA
| | - Rabia Imran
- Department of Psychology, Virginia Commonwealth University, 612 N Lombardy St, Richmond, VA 23284, USA; Center for the Study of Tobacco Products, Virginia Commonwealth University, 100 West Franklin Street, Suite 200, Richmond, VA 23220, USA
| | - Jonathan Foulds
- Center for Research on Tobacco and Health, Penn State University College of Medicine, 30 Long Lane, Hershey, PA 17036, USA; Penn State University College of Medicine, Department of Public Health Sciences, 700 HMC Crescent Road, Hershey, PA 17033, USA
| | - Jessica Yingst
- Center for Research on Tobacco and Health, Penn State University College of Medicine, 30 Long Lane, Hershey, PA 17036, USA; Penn State University College of Medicine, Department of Public Health Sciences, 700 HMC Crescent Road, Hershey, PA 17033, USA
| | - Miao-Shan Yen
- Center for the Study of Tobacco Products, Virginia Commonwealth University, 100 West Franklin Street, Suite 200, Richmond, VA 23220, USA; Department of Biostatistics, Virginia Commonwealth University, One Capital Square 830 East Main Street, Richmond, VA 23219, USA
| | - Le Kang
- Department of Biostatistics, Virginia Commonwealth University, One Capital Square 830 East Main Street, Richmond, VA 23219, USA
| | - Shumei Sun
- Department of Biostatistics, Virginia Commonwealth University, One Capital Square 830 East Main Street, Richmond, VA 23219, USA
| | - Phoebe Brosnan Hall
- Boston University, Department of Psychological and Brain Sciences, 64 Cummington Mall #149, Boston, MA 02215, USA
| | - Nadia Chowdhury
- NYU Langone Health, 550 First Avenue, New York, NY 10016, USA
| | - Joanna E Cohen
- Department of Health, Behavior and Society, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Fahey MC, Krukowski RA, Anderson RT, Cohn WF, Porter KJ, Reid T, Wiseman KP, You W, Wood CH, Rucker TW, Little MA. Reaching adults who smoke cigarettes in rural Appalachia: Rationale, design & analysis plan for a mixed-methods study disseminating pharmacy-delivered cessation treatment. Contemp Clin Trials 2023; 134:107335. [PMID: 37730197 PMCID: PMC10841546 DOI: 10.1016/j.cct.2023.107335] [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: 05/24/2023] [Revised: 08/25/2023] [Accepted: 09/15/2023] [Indexed: 09/22/2023]
Abstract
INTRODUCTION Unlike other U.S. geographical regions, cigarette smoking prevalence remains stagnant in rural Appalachia. One avenue for reaching rural residents with evidence-based smoking cessation treatments could be utilizing community pharmacists. This paper describes the design, rationale, and analysis plan for a mixed-method study that will determine combinations of cessation treatment components that can be integrated within community pharmacies in rural Appalachia. The aim is to quantify the individual and synergistic effects of five highly disseminable and sustainable cessation components in a factorial experiment. METHODS This sequential, mixed-method research design, based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, will use a randomized controlled trial with a 25 fully crossed factorial design (32 treatment combinations) to test, alone and in combination, the most effective evidence-based cessation components: (1) QuitAid (yes vs. no) (2) tobacco quit line (yes vs. no) (3) SmokefreeTXT (yes vs. no) (4) combination NRT lozenge + NRT patch (vs. NRT patch alone), and (5) eight weeks of NRT (vs. standard four weeks). RESULTS Logistic regression will model abstinence at six-months, including indicators for the five treatment factors and all two-way interactions between the treatment factors. Demographic and smoking history variables will be considered to assess potential effect modification. Poisson regression will model quit attempts and percent of adherence to treatment components as secondary outcomes. CONCLUSION This study will provide foundational evidence on how community pharmacies in medically underserved, rural regions can be leveraged to increase utilization of existing evidence-based tobacco cessation resources for treating tobacco dependence. CLINICAL TRIALS NCT05660525.
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Affiliation(s)
- M C Fahey
- Medical University of South Carolina, Charleston, SC, USA
| | - R A Krukowski
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA, USA
| | - R T Anderson
- University of Virginia, School of Medicine, Charlottesville, VA, USA
| | - W F Cohn
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA, USA
| | - K J Porter
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA, USA
| | - T Reid
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA, USA
| | - K P Wiseman
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA, USA
| | - W You
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA, USA
| | - C H Wood
- My Pharmacy, Greensboro, NC, USA
| | - T W Rucker
- University of Virginia, Health Systems, Nellysford, VA, USA
| | - M A Little
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA, USA.
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El-Toukhy S, Kamke K. Intervention targeting and retention, engagement and abstinence outcomes among Latino and White users of Smokefree.gov text messaging programmes: a cross-sectional study. BMJ PUBLIC HEALTH 2023; 1:e000222. [PMID: 38124887 PMCID: PMC10732326 DOI: 10.1136/bmjph-2023-000222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Background We examined retention, engagement, and abstinence among Latino users of SmokefreeTXT en Español (SFTXTesp), a Latino-targeted text messaging smoking cessation intervention, and Latino and White users of SmokefreeTXT (SFTXT), a non-targeted intervention. Methods Data came from 12281 users (1562 Latino SFTXTesp users and 2301 Latino and 8418 White SFTXT users). We conducted time-to-dropout analyses by race/ethnicity. Using logistic regression, we examined associations between intervention targeting, race/ethnicity, and responses to smoking status prompts, an engagement metric, and self-reported abstinence on quit day, intervention end, and one-month follow-up. Age, gender, census region, smoking frequency, cigarettes smoked per day, prequit time, and number of quit attempts were covariates. Results Latinos in SFTXTesp (aOR 0.63) and SFTXT (0.88) were less likely to drop out of the intervention than Whites. SFTXTesp Latino users had higher response rates to smoking prompts than SFTXT Latinos users (aORs 1.35, quit day; 1.84, intervention end; 1.82, one-month follow-up). However, SFTXTesp and SFTXT Latino users had lower response rates than Whites (aORs 0.68, 0.45, quit day; 0.60, 0.30, intervention end; 0.64, 0.33, one-month follow-up). Abstinence was equivalent among Latinos in SFTXTesp and SFTXT interventions, but Latinos using SFTXTesp and SFTXT were less likely to be abstinent than Whites (aORs 0.42, 0.41, quit day; 0.45, 0.37, intervention end; and 0.53, 0.35, one-month follow-up). Conclusion Linguistic intervention targeting improved retention and engagement among Latinos, but not abstinence. Latinos had higher retention but lower engagement and abstinence rates than Whites. Cultural targeting may engage Latinos in smoking cessation interventions and improve abstinence.
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Affiliation(s)
- Sherine El-Toukhy
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health
| | - Kristyn Kamke
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health
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Bloom EL, Japuntich SJ, Pierro A, Dallery J, Leahey TM, Rosen J. Pilot trial of QuitBet: A digital social game that pays you to stop smoking. Exp Clin Psychopharmacol 2022; 30:642-652. [PMID: 34110881 PMCID: PMC10259805 DOI: 10.1037/pha0000487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Contingency management is an effective treatment for cigarette smoking cessation but feasibility and acceptability concerns have been barriers to implementation. We conducted a pilot test of QuitBet, a commercial, digital (smartphone) social game for smoking cessation during which participants earned financial incentives for abstinence. QuitBet included a social feed for posting messages and entirely participant-funded incentives in the form of a deposit contract (the "bet"). QuitBet had a bet of $30 and lasted for 28 days. After a week to prepare for quitting, the quit day was Day 8. Between Day 9-28 (a 20-day period), participants earned back $1 of their $30 bet for each day of carbon monoxide (CO)-verified abstinence (≤ 6 ppm). Remaining bet money was pooled into a "grand prize" pot. Participants who were abstinent on at least 19 of the 20 days (1 "lapse" day allowed) were declared "winners" and split the grand prize pot equally. A game host posted a daily message containing evidence-based education about smoking cessation or a discussion topic. Recruitment goals were met. Among the players (N = 50 U.S. adults, 78% female), 17 (34%) were winners. Thirty-seven participants (74%) responded to a post-QuitBet survey, of whom 95% said they would be interested in playing another QuitBet and would recommend QuitBet to others. Overall, feedback was positive with some suggestions for improvement. In conclusion, a digital social game for smoking cessation with a deposit contract was feasible and acceptable. Next steps include conducting a randomized trial to establish efficacy and a sustainable business model. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Erika Litvin Bloom
- Behavioral and Policy Sciences, RAND Corporation, Boston, Massachusetts, United States
| | - Sandra J. Japuntich
- Department of Clinical Pharmacology and Toxicology, Hennepin Healthcare, Minneapolis, Minnesota, Hennepin
- Department of Medicine, University of Minnesota Medical School
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Birch JM, Jones RA, Mueller J, McDonald MD, Richards R, Kelly MP, Griffin SJ, Ahern AL. A systematic review of inequalities in the uptake of, adherence to, and effectiveness of behavioral weight management interventions in adults. Obes Rev 2022; 23:e13438. [PMID: 35243743 PMCID: PMC9285567 DOI: 10.1111/obr.13438] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 02/12/2022] [Indexed: 12/26/2022]
Abstract
The extent to which behavioral weight management interventions affect health inequalities is uncertain, as is whether trials of these interventions directly consider inequalities. We conducted a systematic review, synthesizing evidence on how different aspects of inequality impact uptake, adherence, and effectiveness in trials of behavioral weight management interventions. We included (cluster-) randomized controlled trials of primary care-applicable behavioral weight management interventions in adults with overweight or obesity published prior to March 2020. Data about trial uptake, intervention adherence, attrition, and weight change by PROGRESS-Plus criteria (place of residence, race/ethnicity, occupation, gender, religion, education, socioeconomic status, social capital, plus other discriminating factors) were extracted. Data were synthesized narratively and summarized in harvest plots. We identified 91 behavioral weight loss interventions and 12 behavioral weight loss maintenance interventions. Fifty-six of the 103 trials considered inequalities in relation to at least one of intervention or trial uptake (n = 15), intervention adherence (n = 15), trial attrition (n = 32), or weight outcome (n = 34). Most trials found no inequalities gradient. If a gradient was observed for trial uptake, intervention adherence, and trial attrition, those considered "more advantaged" did best. Alternative methods of data synthesis that enable data to be pooled and increase statistical power may enhance understanding of inequalities in behavioral weight management interventions.
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Affiliation(s)
- Jack M. Birch
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
| | | | - Julia Mueller
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
| | - Matthew D. McDonald
- Curtin School of Population HealthCurtin UniversityPerthWestern AustraliaAustralia
| | | | - Michael P. Kelly
- Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Simon J. Griffin
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
- Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Amy L. Ahern
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
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Hayes CB, Patterson J, Castello S, Burke E, O'Connell N, Darker CD, Bauld L, Vance J, Ciblis A, Dobbie F, Loudon K, Devane D, Dougall N. Peer-Delivery of a Gender-Specific Smoking Cessation Intervention for Women Living in Disadvantaged Communities in Ireland We Can Quit2 (WCQ2)-A Pilot Cluster Randomized Controlled Trial. Nicotine Tob Res 2021; 24:564-573. [PMID: 34939119 PMCID: PMC8887585 DOI: 10.1093/ntr/ntab242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 10/22/2021] [Accepted: 11/17/2021] [Indexed: 01/19/2023]
Abstract
Introduction We Can Quit” (WCQ) is community-based stop-smoking program delivered by trained community facilitators, based on the socio-ecological framework and developed using a Community-based Participatory Research approach, targeting women living in socioeconomically disadvantaged (SED) areas of Ireland. Aims and Methods The We Can Quit2 (WCQ2) pilot trial assessed the feasibility of WCQ. A pragmatic cluster randomized controlled trial with a process evaluation WCQ2, was conducted in four matched pairs of SED districts (8–10 000 women per district). Districts were independently randomized to WCQ (group support + nicotine replacement therapy), or to individual support delivered by health professionals. Participants were adult women smokers interested in quitting, who were living or working in trial districts. Recruitment of districts and 194 women in four waves (49 women per wave); retention at 12 weeks and 6 months; fidelity to intervention delivery and acceptability of trial-related processes were assessed. Validated smoking abstinence at 12-week and 6-month post-intervention was recorded, missing data assumed as continued smoking. Results Eight districts were recruited. 125/188 (66.5%) eligible women consented. The 49 women target was reached in wave4. Retention at 12 weeks was (Intervention [I]: 55.4%; Control [C]: 51.7%), at 6 months (I: 47.7%; C: 46.7%). Smoking abstinence at 12 weeks was (I: 23.1%, [95% CI: 14.5 to 34.7]; C: 13%, [95% CI: 6.9 to 24.1]). 83.8% of session activities were delivered. Trial-related processes were acceptable to facilitators. Low literacy was highlighted as a barrier for participants’ acceptability. Conclusions WCQ was feasible to deliver by trained facilitators and indicated a positive direction in abstinence rates. Low literacy will need to be addressed in a future trial design. Implications This pilot trial showed that a stop-smoking intervention tailored to a group of women smokers living in SED areas which was delivered by trained local women within their local communities was feasible. Furthermore, although not formally compared, more WCQ women were abstinent from smoking at the end of treatment. The results are relevant to enhance the design of a fully powered effectiveness trial, and provide important evidence on the barriers to deliver a tailored smoking cessation service to SED women smokers in Ireland.
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Affiliation(s)
- Catherine B Hayes
- Public Health and Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Jenny Patterson
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, Scotland
| | - Stefania Castello
- Public Health and Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Emma Burke
- Public Health and Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Nicola O'Connell
- Public Health and Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Catherine D Darker
- Public Health and Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Linda Bauld
- Usher Institute and SPECTRUM Consortium, College of Medicine and Veterinary Science, University of Edinburgh, Edinburgh, Scotland
| | | | | | - Fiona Dobbie
- Usher Institute, College of Medicine and Veterinary Science, University of Edinburgh, Edinburgh, Scotland
| | | | - Declan Devane
- HRB Trials Methodology Research Network, School of Nursing & Midwifery, NUI Galway, Galway, Ireland
| | - Nadine Dougall
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, Scotland
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Christofferson DE, Dennis PA, Hertzberg JS, Beckham JC, Knoeppel J, Hamlett-Berry K. Real-World Utilization and Outcomes of the Veterans Health Administration's Smoking Cessation Text Message Program. Nicotine Tob Res 2021; 23:931-938. [PMID: 32945887 DOI: 10.1093/ntr/ntaa183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 09/15/2020] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Smoking cessation mobile health (mHealth) programs are effective and have been recommended for integration into health care services but have not been evaluated in real-world health care settings. The Veterans Health Administration, a safety net health care provider, provides health care for 9 million US military veterans. Veterans Health Administration implemented the SmokefreeVET text message program in 2013. METHODS A retrospective evaluation of 6153 SmokefreeVET subscribers was conducted. The primary outcome was 30-day self-reported abstinence at 6 months. Secondary outcomes included percentage of opt outs, program completers, and 30-day self-reported abstinence at 3 months. RESULTS SmokefreeVET subscribers were on average 47.5 years old and 71.4% male. Smoking cessation medication use was reported by 11.5% of subscribers at the start of their quit attempt and subscribers enrolled in the program for an average of 29 days. Subscribers who were younger, female, and heavier smokers were more likely to opt out of the six-week program early. The abstinence rate for the primary outcome, self-reported 30-day abstinence at 6 months among all subscribers was 3.7%. CONCLUSIONS SmokefreeVET enrolled a younger and more female population of subscribers than other studies of veterans interested in tobacco treatment. The mHealth program was generally acceptable to veterans, yet strategies to increase retention may improve completion rates and outcomes. In this real-world setting, nearly half of the mHealth program subscribers combined use of the text program with smoking cessation medication. Further study of the optimal combination of mHealth with smoking cessation treatments is needed. IMPLICATIONS mHealth smoking cessation programs can be effectively implemented within real-world health care settings, even in those serving disadvantaged populations. Further research to improve mHealth program efficacy and integration into clinical settings will increase the population-level impact of these effective smoking cessation programs.
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Affiliation(s)
- Dana E Christofferson
- Veterans Health Administration, Office of Mental Health and Suicide Prevention, Washington, DC
| | - Paul A Dennis
- Durham VA Medical Center, Durham, NC.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | | | - Jean C Beckham
- Durham VA Medical Center, Durham, NC.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC.,VA Mid-Atlantic Mental Illness Research Education and Clinical Center, Durham, NC
| | - Jennifer Knoeppel
- Veterans Health Administration, Office of Mental Health and Suicide Prevention, Washington, DC
| | - Kim Hamlett-Berry
- Veterans Health Administration, Office of Mental Health and Suicide Prevention, Washington, DC
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Kim E, Williams RM, Eyestone E, Cordon M, Smith L, Davis K, Luta G, Anderson ED, McKee B, Batlle J, Ramsaier M, Howell J, Parikh V, Geronimo M, Stanton C, Niaura R, Abrams D, Taylor KL. Predictors of attrition in a smoking cessation trial conducted in the lung cancer screening setting. Contemp Clin Trials 2021; 106:106429. [PMID: 33964415 DOI: 10.1016/j.cct.2021.106429] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 01/01/2023]
Abstract
SIGNIFICANCE Although it is a requirement that tobacco treatment is offered to cigarette smokers undergoing low-dose computed tomographic lung cancer screening (LCS), not all smokers engage in treatment. To understand the barriers to tobacco treatment in this setting, we evaluated predictors of attrition in a smoking cessation trial among individuals undergoing LCS. METHODS Prior to LCS, 926 participants, 50-80 years old, completed the baseline (T0) phone assessment, including demographic, clinical, tobacco, and psychological characteristics. Following LCS and receipt of the results, participants completed the pre-randomization (T1) assessment. RESULTS At the T1 assessment, 735 (79%) participants were retained and 191 (21%) dropped out. In multivariable analyses, attrition was higher among those who: smoked >1 pack per day (OR = 1.44, CI 1.01, 2.06) or had undergone their first (vs. annual) LCS scan (OR = 1.70, CI 1.20, 2.42). Attrition was lower among those with: more education (associates (OR = 0.67, CI = 0.46, 0.98) or bachelor's degree (OR = 0.56, CI 0.35, 0.91) vs. high school/GED), some (vs. none/a little) worry about lung cancer (OR = 0.60, CI 0.39, 0.92), or a screening result that was benign (OR = 0.57, CI 0.39, 0.82) or probably benign (OR = 0.38, CI 0.16, 0.90) vs. negative. CONCLUSIONS This study illuminated several LCS-related factors that contributed to trial attrition. Increasing tobacco treatment in this setting will require targeted strategies for those who report little lung cancer worry, are undergoing their first LCS exam, and/or who have a negative LCS result. Addressing attrition and reducing barriers to tobacco treatment will increase the likelihood of cessation, thereby reducing the risk of developing lung cancer.
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Affiliation(s)
- Emily Kim
- Georgetown University Medical Center, D.C., USA
| | | | | | | | - Laney Smith
- Georgetown University Medical Center, D.C., USA
| | | | - George Luta
- Georgetown University Medical Center, D.C., USA
| | | | - Brady McKee
- Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Juan Batlle
- Baptist Health South Florida, Miami, FL, USA
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Voci S, Veldhuizen S, Tien S, Barker M, Minian N, Selby P, Zawertailo L. A comparison of quit outcomes for men and women in a smoking cessation program offering personalized nicotine replacement therapy and counselling in primary care clinics. Nicotine Tob Res 2021; 23:1673-1681. [PMID: 33912963 DOI: 10.1093/ntr/ntab082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/22/2021] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Women may have greater difficulty achieving long-term abstinence following a quit attempt compared to men. We sought to determine whether there were differences in treatment characteristics or outcome between female and male primary care patients enrolled in a smoking cessation program providing personalized nicotine replacement therapy (NRT) with counselling support. METHODS The sample included 27,601 Ontarians (53% female, 47% male) who enrolled in the Smoking Treatment for Ontario Patients program between 2016 and 2018. Dose, type, and duration of NRT supplied was personalized to need. Thirty-day point prevalence tobacco smoking abstinence was self-reported via online or telephone survey at 6 months post-enrollment. RESULTS Both female and male participants received a median of 8 weeks of NRT. Types of NRT received were similar, with 80% of both female and male participants receiving patch and short-acting NRT. Total cumulative dose was somewhat higher for men (1373 mg vs. 1265 mg, p<0.001); but when calculated as dose per day, per cigarette smoked at baseline, dose was slightly higher among women (1.6 mg vs. 1.5 mg, p<0.001). Quit rates at 6 months were lower for women versus men (24% vs. 27%; AOR = 0.84 [95% CI = 0.78-0.90], p<0.001). There were no significant interactions between gender and dose, type or duration of NRT supplied. CONCLUSIONS Women were slightly less likely to quit than men, despite receiving similar treatment. There was no evidence that women benefitted more or less from variations in dose, type or duration of NRT supply.
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Affiliation(s)
- Sabrina Voci
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen St. W., Toronto, ON, M6J 1H4, Canada
| | - Scott Veldhuizen
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen St. W., Toronto, ON, M6J 1H4, Canada
| | - Stephanie Tien
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen St. W., Toronto, ON, M6J 1H4, Canada
| | - Megan Barker
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen St. W., Toronto, ON, M6J 1H4, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON M5T 3M7, Canada
| | - Nadia Minian
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen St. W., Toronto, ON, M6J 1H4, Canada.,Department of Family and Community Medicine, University of Toronto, 500 University Ave., Toronto, ON M5G 1V7, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 60 White, Squirrel Way, Toronto, ON M6J 1H4, Canada
| | - Peter Selby
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen St. W., Toronto, ON, M6J 1H4, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON M5T 3M7, Canada.,Department of Family and Community Medicine, University of Toronto, 500 University Ave., Toronto, ON M5G 1V7, Canada.,Department of Psychiatry, University of Toronto, 250 College St., Toronto, ON M5T 1R8, Canada
| | - Laurie Zawertailo
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen St. W., Toronto, ON, M6J 1H4, Canada.,Department of Pharmacology and Toxicology, University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada
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Kruse GR, Park ER, Chang Y, Haberer JE, Abroms LC, Shahid NN, Howard S, Haas JS, Rigotti NA. Proactively Offered Text Messages and Mailed Nicotine Replacement Therapy for Smokers in Primary Care Practices: A Pilot Randomized Trial. Nicotine Tob Res 2020; 22:1509-1514. [PMID: 32198520 PMCID: PMC7443591 DOI: 10.1093/ntr/ntaa050] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/17/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Proactive, population health cessation programs can guide efforts to reach smokers outside of the clinic to encourage quit attempts and treatment use. AIMS AND METHODS This study aimed to measure trial feasibility and preliminary effects of a proactive intervention offering text messages (TM) and/or mailed nicotine replacement therapy (NRT) to smokers in primary care clinics. From 2017 to 2019 we performed a pilot randomized trial comparing brief telephone advice (control: BA), TM, 2 weeks of mailed NRT, or both interventions (TM + NRT). Patients were identified using electronic health records and contacted proactively by telephone to assess interest in the study. We compared quit attempts, treatment use, and cessation in the intervention arms with BA. RESULTS Of 986 patients contacted, 153 (16%) enrolled (mean age 53 years, 57% female, 76% white, 11% black, 8% Hispanic, 52% insured by Medicaid) and 144 (94%) completed the 12-week assessment. On average, patients in the TM arms received 159 messages (99.4% sent, 0.6% failed), sent 19 messages, and stayed in the program for 61 days. In all groups, a majority of patients reported quit attempts (BA 67% vs. TM 86% [p = .07], NRT 81% [p = .18], TM + NRT 79% [p = .21]) and NRT use (BA 51% vs. NRT 83% [p = .007], TM 65% [p = .25], TM + NRT 76% [p = .03]). Effect estimates for reported 7-day abstinence were BA 10% versus TM 26% (p = .09), NRT 28% (p = .06), and TM + NRT 23% (p = .14). CONCLUSIONS Proactively offering TM or mailed nicotine medications was feasible among primary care smokers and a promising approach to promote quit attempts and short-term abstinence. IMPLICATIONS Proactive intervention programs to promote quit attempts outside of office visits among smokers enrolled in primary care practices are needed. TM have potential to engage smokers not planning to quit or to support smokers to make a planned quit attempt. This pilot study demonstrates the feasibility of testing a proactive treatment model including TM and/or mailed NRT to promote quit attempts, treatment use, and cessation among nontreatment-seeking smokers in primary care. CLINICALTRIALS.GOV IDENTIFIER NCT03174158.
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Affiliation(s)
- Gina R Kruse
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Elyse R Park
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Yuchiao Chang
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Jessica E Haberer
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- Center for Global Health, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Naysha N Shahid
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Sydney Howard
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Jennifer S Haas
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Nancy A Rigotti
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
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11
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Buis L. Implementation: The Next Giant Hurdle to Clinical Transformation With Digital Health. J Med Internet Res 2019; 21:e16259. [PMID: 31746763 PMCID: PMC6893559 DOI: 10.2196/16259] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/22/2019] [Accepted: 11/11/2019] [Indexed: 01/09/2023] Open
Abstract
Clinical implementation of digital health is a major hurdle to overcome in the coming years. Considering the role of the Journal of Medical Internet Research in the past 20 years and looking toward the journal’s future, this viewpoint acknowledges the vision of medicine and the role that digital health plays in that vision. It also highlights barriers to implementation of digital health as an obstacle to achieving that vision. In particular, this paper focuses on how digital health research must start looking toward implementation as an area of inquiry and the role that the Journal of Medical Internet Research and its' sister journals from JMIR Publications can play in this process.
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Affiliation(s)
- Lorraine Buis
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
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