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Sanford BT, Toll BA, Eckard AR, Sterba KR, Cummings KM, Baker NL, Rojewski AM. Optimizing tobacco treatment delivery for people with HIV: trial protocol for a randomized controlled trial. Addict Sci Clin Pract 2022; 17:61. [PMID: 36335376 PMCID: PMC9636678 DOI: 10.1186/s13722-022-00341-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/09/2022] [Accepted: 10/03/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND With advances in antiretroviral therapy, people with HIV (PWH) are living longer and are less likely to die from AIDS-related complications. Yet, prior research has shown that smoking is often not addressed in the context of HIV care, and few individuals are offered cessation treatment. Optimizing tobacco treatment delivery for PWH may increase engagement with evidence-based treatments and successful quit attempts. METHODS The current study is a type 1 hybrid effectiveness-implementation trial to evaluate the impact of a proactive, opt-out tobacco treatment intervention on cessation outcomes and advance understanding of key barriers and facilitators of implementation processes. A total of 230 PWH who smoke will be recruited from an infectious diseases clinic at an academic medical center and will be randomized to receive (1) treatment as usual (TAU) or (2) Proactive Outreach with Medication Opt-out for Tobacco Treatment Engagement (PrOMOTE). Primary outcomes include: biochemically verified 7-day point prevalence abstinence (PPA) rates, continuous abstinence (Weeks 9-12), and the number of 24-hour quit attempts at the end of study treatment (Week 12). Secondary outcomes include: participant reach (proportion reached out of contact attempts), implementation fidelity (including number of prescriptions written), participant adherence to prescribed pharmacotherapy, acceptability (participant and provider satisfaction with intervention delivery and content), and perceived barriers. DISCUSSION This study will examine a novel approach to optimizing tobacco treatment delivery for PWH. Integrating effectiveness and implementation results will help define best practices for engaging PWH with evidence-based tobacco treatment interventions. The intervention is low-cost, has the potential to be highly scalable, and could be translatable to other ambulatory HIV clinic settings. TRIAL REGISTRATION ClinicalTrials.gov: NCT05019495 (August 24, 2021).
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Affiliation(s)
- Brandon T. Sanford
- grid.259828.c0000 0001 2189 3475Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, MSC 835, 29425 Charleston, SC USA
| | - Benjamin A. Toll
- grid.259828.c0000 0001 2189 3475Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, MSC 835, 29425 Charleston, SC USA ,grid.467988.c0000 0004 0390 5438Hollings Cancer Center, Charleston, SC USA
| | - Allison Ross Eckard
- grid.259828.c0000 0001 2189 3475Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, MSC 835, 29425 Charleston, SC USA
| | - Katherine R. Sterba
- grid.259828.c0000 0001 2189 3475Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, MSC 835, 29425 Charleston, SC USA
| | - K. Michael Cummings
- grid.259828.c0000 0001 2189 3475Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, MSC 835, 29425 Charleston, SC USA ,grid.467988.c0000 0004 0390 5438Hollings Cancer Center, Charleston, SC USA
| | - Nathaniel L. Baker
- grid.259828.c0000 0001 2189 3475Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, MSC 835, 29425 Charleston, SC USA
| | - Alana M. Rojewski
- grid.259828.c0000 0001 2189 3475Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, MSC 835, 29425 Charleston, SC USA ,grid.467988.c0000 0004 0390 5438Hollings Cancer Center, Charleston, SC USA
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Rojewski AM, Fucito LM, Baker NL, Palmer AM, Foster MG, Warren GW, Bernstein SL, Toll BA. Preoperative contingency management intervention for smoking abstinence in cancer patients: trial protocol for a multisite randomised controlled trial. BMJ Open 2021; 11:e051226. [PMID: 34187835 PMCID: PMC8245459 DOI: 10.1136/bmjopen-2021-051226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Continued smoking following a cancer diagnosis has substantial health risks including increased overall and cancer-specific mortality, risk of secondary malignancies, cancer treatment toxicity and risk of surgical complications. These risks can be mitigated by quitting smoking. The preoperative period represents a prime opportunity in which to administer robust smoking cessation treatment to both improve health and support and improve surgical outcomes. We will conduct a randomised clinical trial to evaluate the effectiveness of financial incentives delivered contingent on biochemically verified smoking abstinence (contingency management (CM)) in patients with cancer undergoing surgery. METHODS AND ANALYSIS The study will take place across two study sites, and participants (N=282) who smoke, are diagnosed with or suspected to have any type of operable cancer and have a surgical procedure scheduled in the next 10 days to 5 weeks will be randomised to receive standard care plus Monitoring Only or CM prior to surgery. All patients will receive breath carbon monoxide (CO) tests three times per week, nicotine replacement therapy and counselling. The CM group will also earn payments for self-reported smoking abstinence confirmed by CO breath test ≤4 ppm on an escalating schedule of reinforcement (with a reset if they smoked). Point prevalence abstinence (PPA) outcomes (self-report of 7-day abstinence confirmed by CO≤4 ppm and/or anabasine ≤2 ng/mL) will be assessed on the day of surgery and 6 months after surgery. The effect of CM on 7-day PPA at the time of surgery and 6-month follow-up will be modelled using generalised linear mixed effects models. ETHICS AND DISSEMINATION This study has been reviewed and approved by the Medical University of South Carolina Institutional Review Board. We will disseminate our scientific results through traditional research-oriented outlets such as presentations at scientific meetings and publications in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04605458.
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Affiliation(s)
- Alana M Rojewski
- Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Hollings Cancer Center, Charleston, South Carolina, USA
| | - Lisa M Fucito
- Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Nathaniel L Baker
- Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Amanda M Palmer
- Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Madeline G Foster
- Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Graham W Warren
- Hollings Cancer Center, Charleston, South Carolina, USA
- Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Steven L Bernstein
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Benjamin A Toll
- Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Hollings Cancer Center, Charleston, South Carolina, USA
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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Effects of Offering Nicotine Patches, Incentives, or Both on Quitline Demand. Am J Prev Med 2018; 55:S170-S177. [PMID: 30454671 DOI: 10.1016/j.amepre.2018.07.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 04/18/2018] [Accepted: 07/09/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Previous studies found that offering free nicotine patches significantly increases calls to quitlines, although most used pre-post designs and did not directly compare the effects of patches and other incentives. The current study with California Medicaid members used a 2 × 2 design to directly assess the effects of offering free patches and incentives on calls to a quitline. The hypotheses were that offering either would make members more likely to call, and that offering both would increase demand even further. METHODS Flyers were inserted into a mailing sent to 4,268,696 Medicaid households, with one of four offers: (1) free counseling; (2) counseling plus patches; (3) counseling plus a $20 gift card; and (4) counseling plus patches and gift card. Ninety percent received the first offer and 10% received one of the other three offers, in equal proportions. The mailers shipped late 2013 to early 2014. Data were collected 2013-2015 and analyzed 2018. RESULTS Response rates were 0.029% for counseling, 0.115% for counseling plus patches, 0.122% for counseling plus gift card, and 0.200% for counseling, patches, and gift card. Both patches and gift cards had statistically significant effects (both p<0.001). Promotional costs were 59%-75% lower with an incentive. Non-whites responded more strongly than whites to a gift card offer. CONCLUSIONS Offering either free patches or a $20 gift card quadrupled the likelihood of Medicaid smokers calling a quitline; offering both had a nearly additive effect. Incentive offers dramatically increased the cost-effectiveness of promotions. Piggybacking on existing Medicaid communications to promote cessation proved very successful. SUPPLEMENT INFORMATION This article is part of a supplement entitled Advancing Smoking Cessation in California's Medicaid Population, which is sponsored by the California Department of Public Health.
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Carpenter MJ, Jardin BF, Burris JL, Mathew AR, Schnoll RA, Rigotti NA, Cummings KM. Clinical strategies to enhance the efficacy of nicotine replacement therapy for smoking cessation: a review of the literature. Drugs 2014; 73:407-26. [PMID: 23572407 DOI: 10.1007/s40265-013-0038-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A number of smoking cessation pharmacotherapies have led to increases in quitting and thus to significant benefits to public health. Among existing medications, nicotine replacement therapy (NRT) has been available the longest, has the largest literature base in support, and is the only option for over-the-counter access. While the short-term efficacy of NRT is well documented in clinical trials, long-term abstinence rates associated with using NRT are modest, as most smokers will relapse. This literature review examines emerging clinical strategies to improve NRT efficacy. After an initial overview of NRT and its FDA-approved indications for use, we review randomized trials in which clinical delivery of NRT was manipulated and tested, in an attempt to enhance efficacy, through (1) duration of use (pre-quit and extended use), (2) amount of use (high-dose and combination NRT), (3) tailoring to specific smoker groups (genotype and phenotype), or (4) use of NRT for novel purposes (relapse prevention, temporary abstinence, cessation induction). Outcomes vary within and across topic area, and we highlight areas that offer stronger promise. Combination NRT likely represents the most promising strategy moving forward; other clinical strategies offer conflicting evidence but deserve further testing (pre-quit NRT or tailored treatment) or offer potential utility but are in need of further, direct tests. Some areas, though based on a limited set of studies, do not offer great promise (high-dose and extended treatment NRT). We conclude with a brief discussion of emergent NRT products (e.g., oral nicotine spray, among others), which may ultimately offer greater efficacy than current formulations. In order to further lower the prevalence of smoking, novel strategies designed to optimize NRT efficacy are needed.
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Affiliation(s)
- Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA.
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Burris JL, Wahlquist AE, Carpenter MJ. Characteristics of cigarette smokers who want to quit now versus quit later. Addict Behav 2013; 38:2257-60. [PMID: 23511065 DOI: 10.1016/j.addbeh.2013.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 02/18/2013] [Accepted: 02/19/2013] [Indexed: 11/17/2022]
Abstract
This study evaluated factors associated with adult smokers' immediate readiness to quit. Eligible smokers were proactively recruited online and invited to participate in either a telephone-based study for those who intend to quit in the next 30days (Quit Now) or a telephone-based study for those who intend to quit, but not in the next month (Quit Later). Thirty-five percent of smokers declined participation altogether. Of those who remained, 25% chose Quit Now participation. Baseline data were collected via mail questionnaire and telephone interview. Quit Now and Quit Later participants (N=1132) differed on demographic, smoking history, and psychological variables. Independent predictors of Quit Now group membership included younger age, stronger intention to quit in the next six months, greater self-efficacy to cope with temptation to smoke, and more support from significant others related to quit attempts-much of which is modifiable. Understanding factors that predict smokers' immediate readiness to quit (measured here as Quit Now group membership) could contribute to the development of smoking cessation treatments tailored for smokers who are seemingly not yet ready to quit.
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Affiliation(s)
- Jessica L Burris
- Department of Psychiatry and Behavioral Sciences & Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas St., MSC 955, Charleston, SC 29425, USA.
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Pierce JP, Cummins SE, White MM, Humphrey A, Messer K. Quitlines and Nicotine Replacement for Smoking Cessation: Do We Need to Change Policy? Annu Rev Public Health 2012; 33:341-56. [DOI: 10.1146/annurev-publhealth-031811-124624] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- John P. Pierce
- Moores UCSD Cancer Center, University of California, San Diego, La Jolla, California 92093; , , , ,
| | - Sharon E. Cummins
- Moores UCSD Cancer Center, University of California, San Diego, La Jolla, California 92093; , , , ,
| | - Martha M. White
- Moores UCSD Cancer Center, University of California, San Diego, La Jolla, California 92093; , , , ,
| | - Aimee Humphrey
- Moores UCSD Cancer Center, University of California, San Diego, La Jolla, California 92093; , , , ,
| | - Karen Messer
- Moores UCSD Cancer Center, University of California, San Diego, La Jolla, California 92093; , , , ,
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Cunningham JA, Leatherdale ST, Selby PL, Tyndale RF, Zawertailo L, Kushnir V. Randomized controlled trial of mailed Nicotine Replacement Therapy to Canadian smokers: study protocol. BMC Public Health 2011; 11:741. [PMID: 21955930 PMCID: PMC3198706 DOI: 10.1186/1471-2458-11-741] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 09/28/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Considerable public health efforts are ongoing Canada-wide to reduce the prevalence of smoking in the general population. From 1985 to 2005, smoking rates among adults decreased from 35% to 19%, however, since that time, the prevalence has plateaued at around 18-19%. To continue to reduce the number of smokers at the population level, one option has been to translate interventions that have demonstrated clinical efficacy into population level initiatives. Nicotine Replacement Therapy (NRT) has a considerable clinical research base demonstrating its efficacy and safety and thus public health initiatives in Canada and other countries are distributing NRT widely through the mail. However, one important question remains unanswered--do smoking cessation programs that involve mailed distribution of free NRT work? To answer this question, a randomized controlled trial is required. METHODS/DESIGN A single blinded, panel survey design with random assignment to an experimental and a control condition will be used in this study. A two-stage recruitment process will be employed, in the context of a general population survey with two follow-ups (8 weeks and 6 months). Random digit dialing of Canadian home telephone numbers will identify households with adult smokers (aged 18+ years) who are willing to take part in a smoking study that involves three interviews, with saliva collection for 3-HC/cotinine ratio measurement at baseline and saliva cotinine verification at 8-week and 6-month follow-ups (N = 3,000). Eligible subjects interested in free NRT will be determined at baseline (N = 1,000) and subsequently randomized into experimental and control conditions to receive versus not receive nicotine patches. The primary hypothesis is that subjects who receive nicotine patches will display significantly higher quit rates (as assessed by 30 day point prevalence of abstinence from tobacco) at 6-month follow-up as compared to subjects who do not receive nicotine patches at baseline. DISCUSSION The findings from the proposed trial are timely and highly relevant as mailed distribution of NRT require considerable resources and there are limited public health dollars available to combat this substantial health concern. In addition, findings from this randomized controlled trial will inform the development of models to engage smokers to quit, incorporating proactive recruitment and the offer of evidence based treatment. TRIAL REGISTRATION ClinicalTrials.gov: NCT01429129.
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Affiliation(s)
- John A Cunningham
- Centre for Addiction and Mental Health, 33 Russell St., Toronto, M5S 2S1, Canada
- Department of Psychology, University of Toronto, 100 St. George St., Toronto, M5S 3G3, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, M5T 3M7, Canada
| | - Scott T Leatherdale
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, M5T 3M7, Canada
- Department of Health Studies and Gerontology, University of Waterloo, 200 University Ave., Waterloo, N2L 3G1, Canada
- Department of Population Studies and Surveillance, Cancer Care Ontario, 620 University Ave., Toronto, M5G 2L7, Canada
| | - Peter L Selby
- Centre for Addiction and Mental Health, 33 Russell St., Toronto, M5S 2S1, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, M5T 3M7, Canada
- Department of Pharmaceutical Sciences, University of Toronto, 144 College St., Toronto, M5S 3M2, Canada
- Department of Family and Community Medicine, University of Toronto, 500 University Ave., Toronto, M5G 1V7, Canada
| | - Rachel F Tyndale
- Centre for Addiction and Mental Health, 33 Russell St., Toronto, M5S 2S1, Canada
- Department of Pharmacology and Toxicology, University of Toronto, 1 King's College Circle, Toronto, M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, 250 College St., Toronto, M5S 1A8, Canada
| | - Laurie Zawertailo
- Centre for Addiction and Mental Health, 33 Russell St., Toronto, M5S 2S1, Canada
- Department of Pharmacology and Toxicology, University of Toronto, 1 King's College Circle, Toronto, M5S 1A8, Canada
| | - Vladyslav Kushnir
- Centre for Addiction and Mental Health, 33 Russell St., Toronto, M5S 2S1, Canada
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Cunningham JA, Selby PL. Intentions of smokers to use free nicotine replacement therapy. CMAJ 2008; 179:145-6. [PMID: 18625985 DOI: 10.1503/cmaj.071241] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Public health initiatives to distribute nicotine replacement therapy free of charge as a means of promoting smoking cessation are ongoing. Are there enough smokers interested in using nicotine replacement therapy to have a substantial impact on the prevalence of smoking if this aid were distributed free to all interested smokers? We conducted a telephone survey of 825 randomly selected daily smokers aged 18 years or older who had smoked at least 10 cigarettes per day at some point in their lives. Overall, 58.9% of the respondents said they would be interested in nicotine replacement therapy if it were offered for free. Of those interested, almost all (93.8%) said that they would use the nicotine replacement therapy to help them quit for good. There were differences in the levels of interest: smokers who intended to quit were more interested in using the nicotine replacement therapy than those who planned to reduce or maintain their smoking.
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Affiliation(s)
- John A Cunningham
- Social, Prevention and Health Policy Research Department, The Centre for Addiction and Mental Health, Toronto, ON.
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Tinkelman D, Wilson SM, Willett J, Sweeney CT. Offering free NRT through a tobacco quitline: impact on utilisation and quit rates. Tob Control 2007; 16 Suppl 1:i42-6. [PMID: 18048631 DOI: 10.1136/tc.2007.019919] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess the impact on quitline utilisation and cessation outcomes of adding free nicotine patches to the existing programme offerings. METHODS Tobacco use status data from the Ohio tobacco quitline were collected from a subset of quitline callers 6 months after the initial intake call. To evaluate the impact of the nicotine replacement therapy (NRT) initiative, quit rates for two groups were compared: those who entered and exited the quitline programme before the availability of free NRT (n = 4657) and those who entered and exited the quitline programme after the availability of free NRT (n = 5715). RESULTS Call volume increased from 2351 intakes calls per month or 78 calls per day before the availability of free NRT to 3606 intake calls per month or 188 intakes per day following the availability of free NRT (p<0.0001). 7-day point prevalence abstinence at 6 months among all quitline callers increased from 10.3% (95% confidence interval (CI) 9.7 to 10.9) before the availability of NRT to 14.9% (95% CI 14.3 to 15.5) after the availability of NRT. CONCLUSION Offering free NRT through a state quitline is an effective means of increasing quitline utilisation and improving quit rates.
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Affiliation(s)
- David Tinkelman
- National Jewish Medical and Research Center, Denver, CO 80206, USA.
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Cummings KM, Fix B, Celestino P, Carlin-Menter S, O'Connor R, Hyland A. Reach, efficacy, and cost-effectiveness of free nicotine medication giveaway programs. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2006; 12:37-43. [PMID: 16340514 DOI: 10.1097/00124784-200601000-00009] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In an effort to increase access to evidence-based smoking cessation therapies, regional tobacco control programs in New York State implemented different interventions to make free nicotine patches and gum available to smokers wishing to quit. In one region, eligible smokers were sent a voucher redeemable at a local pharmacy for a 2-week supply of either nicotine patches or gum. In other regions, smokers received either a 1-week supply or a 2-week supply of nicotine patches sent to their home. In New York City, eligible smokers received a 6-week supply of nicotine patches and a follow-up phone call. All of the programs utilized the state's Smokers' Quitline to screen and register eligible smokers for the free medication. The reach of the different programs was evaluated by computing the proportion of eligible smokers within a given area enrolled in the program and tracking call volume to the Quitline before, during, and after the free giveaway promotions. Efficacy was evaluated by a telephone follow-up survey of program participants conducted 4 months after enrollment to measure use of the medications and smoking behavior. The quit rate of program participants was contrasted with the quit rate computed from an earlier follow-up survey of Quitline callers who were not provided nicotine replacement therapy (NRT). Free nicotine patches or gum was sent to 40,090 smokers representing about 2.9 percent of eligible heavy smokers (10+ cigarettes per day) in the state. In each time period and location where free NRT was offered, call volume to the Quitline increased dramatically. Quit rates varied in relationship to the supply of NRT sent to participants, but in all cases was higher than the quit rate observed among smokers not sent NRT (21%-35% vs 12%). The offer of free NRT appears to be a cost-effective method to induce large numbers of smokers to make a quit attempt.
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Affiliation(s)
- K Michael Cummings
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
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Hawk LW, Higbee C, Hyland A, Alford T, O'Connor R, Cummings KM. Concurrent Quit & Win and Nicotine Replacement Therapy Voucher Giveaway Programs. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2006; 12:52-9. [PMID: 16340516 DOI: 10.1097/00124784-200601000-00011] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study compares the participant characteristics, program costs, and outcomes of a Quit & Win contest and a nicotine replacement therapy (NRT) voucher giveaway promotion. Both programs were conducted simultaneously so that smokers could enroll in either one program alone (n = 849 and 690, respectively) or both programs (Combination group; n = 230). A follow-up telephone survey of a random sample of participants was conducted 4 to 7 months after enrollment to evaluate smoking status. At enrollment, participants in the three groups were comparable on most smoking and demographic variables, although Quit & Win participants were, on average, younger than those who signed up to get the NRT voucher. Compared with the characteristics of smokers in the region, those who enrolled in the intervention programs were heavier smokers and had more years of formal education. At follow-up, the self-reported quit rates were similar across the three intervention groups, ranging between 25 percent and 30 percent. The only evidence for a higher quit rate among those in the Combination group was among younger smokers. On a simple estimated cost per quit basis, the Quit & Win (130 dollars) and NRT (179 dollars) voucher interventions appear roughly comparable. In all groups, abstinence rates were higher among lighter smokers (<21 cigarettes per day), participants who did not live with another smoker, and those who were married. Both the Quit & Win and NRT voucher giveaway programs were effective in recruiting smokers to make a quit attempt, although combining both interventions did not generally increase abstinence rates.
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Affiliation(s)
- Larry W Hawk
- Department of Psychology, University at Buffalo, Buffalo, New York, USA
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Abstract
This review summarizes evidence pertaining to the role of nicotine medications in smoking cessation and focuses particularly on evaluating evidence of the impact that nicotine replacement therapies (NRT) have had on altering population trends in smoking behavior. Accumulated evidence from controlled clinical trials has demonstrated that available forms of NRT (e.g., gum, transdermal patch, nasal spray, inhaler, and lozenge) increase quit rates compared with placebos by 50%-100%. However, despite the positive results from these studies, fewer than one in five smokers making a quit attempt do so with the benefit of NRT. Because not enough smokers are using NRT, the availability of NRT has not had a measurable impact on influencing population trends in smoking behavior. Among the factors contributing to the low utilization of nicotine medications are the inadequacies of the current dosage strengths and formulations of existing medications, smokers' perceptions of the high cost of the drugs, and concerns that many smokers have about safety and efficacy of nicotine medications.
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Affiliation(s)
- K Michael Cummings
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
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