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Colston DC, Simard BJ, Xie Y, McLeod MC, Elliott MR, Thrasher JF, Fleischer NL. The Association between Quitline Characteristics and Smoking Cessation by Educational Attainment, Income, Race/Ethnicity, and Sex. Int J Environ Res Public Health 2021; 18:3297. [PMID: 33806747 PMCID: PMC8005103 DOI: 10.3390/ijerph18063297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/12/2021] [Accepted: 03/18/2021] [Indexed: 11/22/2022]
Abstract
Little research examines how tobacco quitlines affect disparities in smoking cessation in the United States. Our study utilized data from the Tobacco Use Supplement to the Current Population Survey (2010, 2011, 2012, 2015, 2018) (TUS-CPS) and state-level quitline data from the North American Quitline Consortium and National Quitline Data Warehouse. We ran multilevel logistic regression models assessing a state-run quitline's budget, reach, number of counseling sessions offered per caller, and hours of operation on 90-day smoking cessation. Multiplicative interactions between all exposures and sex, race/ethnicity, income, and education were tested to understand potential effect modification. We found no evidence that budget, reach, number of counseling sessions, or hours available for counseling were associated with cessation in the main effects analyses. However, when looking at effect modification by sex, we found that higher budgets were associated with greater cessation in males relative to females. Further, higher budgets and offering more sessions had a stronger association with cessation among individuals with lower education, while available counseling hours were more strongly associated with cessation among those with higher education. No quitline characteristics examined were associated with smoking cessation. We found evidence for effect modification by sex and education. Despite proven efficacy at the individual-level, current resource allocation to quitlines may not be sufficient to improve rates of cessation.
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Affiliation(s)
- David C. Colston
- Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; (B.J.S.); (N.L.F.)
| | - Bethany J. Simard
- Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; (B.J.S.); (N.L.F.)
| | - Yanmei Xie
- Biostatistics Core, Rogel Cancer Center, University of Michigan, Ann Arbor, MI 48109, USA; (Y.X.); (M.C.M.)
| | - Marshall Chandler McLeod
- Biostatistics Core, Rogel Cancer Center, University of Michigan, Ann Arbor, MI 48109, USA; (Y.X.); (M.C.M.)
| | - Michael R. Elliott
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA;
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI 48104, USA
| | - James F. Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA;
- Center for Population Health Research, Department of Tobacco Research, National Institute of Public Health, Cuernavaca 62100, Mexico
| | - Nancy L. Fleischer
- Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; (B.J.S.); (N.L.F.)
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Armin JS, Nair U, Giacobbi P, Povis G, Barraza Y, Gordon JS. Developing a Guided Imagery Telephone-Based Tobacco Cessation Program for a Randomized Controlled Trial. Tob Use Insights 2020; 13:1179173X20949267. [PMID: 32922107 PMCID: PMC7446272 DOI: 10.1177/1179173x20949267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 07/14/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND/AIMS Guided imagery is an evidence-based, multi-sensory, cognitive process that can be used to increase motivation and achieve a desired behavior. Quitlines are effective, standard care approaches for tobacco cessation; however, utilization of quitlines is low. Using guided imagery-based interventions for smoking cessation may appeal to smokers who do not utilize traditional quitline services. This paper reports the development of program materials for a randomized controlled feasibility trial of a guided imagery-based smoking cessation intervention. The objective of the formative work was to ensure that program materials are inclusive of groups that are less likely to use quitlines, including men and racial/ethnic minority tobacco users. METHODS A three-phase process was used to complete formative assessment: (1) integration of evidence-based cessation practices into program development; (2) iterative small group interviews (N = 46) to modify the program; and (3) pilot-testing the coaching protocol and study process among a small sample of smokers (N = 5). RESULTS The Community Advisory Board and project consultants offered input on program content and study recruitment based on their knowledge of minority communities with whom they conduct outreach. Small group interview participants included members of underserved quitline populations (52.37% non-white; 55.56% men). Only 28.26% of participants had prior experience with guided imagery, but others described the use of similar mindfulness and meditation practices. Participant feedback was incorporated into program materials and protocols. DISCUSSION Iteratively collected feedback and pilot testing influenced program content and delivery and informed study processes for a randomized controlled feasibility trial of a telephone-delivered, guided imagery-based intervention.
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Affiliation(s)
- Julie S Armin
- Department of Family & Community Medicine, The University of Arizona College of Medicine, Tucson, AZ, USA
| | - Uma Nair
- Department of Family & Community Medicine, The University of Arizona College of Medicine, Tucson, AZ, USA
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, USA
| | - Peter Giacobbi
- College of Physical Activity and Sport Sciences and School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Gayle Povis
- The University of Arizona Collaboratory for Metabolic Disease Prevention and Treatment, Tucson AZ, USA
| | - Yessenya Barraza
- The University of Arizona Collaboratory for Metabolic Disease Prevention and Treatment, Tucson AZ, USA
| | - Judith S Gordon
- College of Nursing, The University of Arizona, Tucson, AZ, USA
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Mann N, Nonnemaker J, Davis K, Chapman L, Thompson J, Juster HR. The Potential Impact of the New York State Smokers' Quitline on Population-Level Smoking Rates in New York. Int J Environ Res Public Health 2019; 16:ijerph16224477. [PMID: 31739413 PMCID: PMC6887956 DOI: 10.3390/ijerph16224477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/25/2019] [Accepted: 11/11/2019] [Indexed: 11/16/2022]
Abstract
Receiving smoking cessation services from telephone quitlines significantly increases quit success compared with no intervention or other quitting methods. To affect population-level smoking, quitlines must provide a sufficient proportion of smokers with effective interventions. Nationally, quitlines reach around 1% of adult smokers annually. From 2011 through 2016, the average annual reach of the New York State Smokers' Quitline (NYSSQL) was 2.9%. We used data on the reach and cessation outcomes of NYSSQL to estimate its current impact on population-level smoking prevalence and to estimate how much reach would have to increase to achieve population-level smoking prevalence reductions. We estimate NYSSQL is associated with a 0.02 to 0.04 percentage point reduction in smoking prevalence in New York annually. If NYSSQL achieved the recommended annual reach of 8% (CDC Best Practices) and 16% (NAQC), state-level prevalence would decrease by an estimated 0.07-0.12 and 0.13-0.24 percentage points per year, respectively. To achieve those recommended levels of reach, NYSSQL would need to provide services to approximately 3.5 to 6.9 times more smokers annually. Given their reach, quitlines are limited in their ability to affect population-level smoking. Increasing quitline reach may not be feasible and would likely be cost-prohibitive. It may be necessary to re-think the role of quitlines in tobacco control efforts. In New York, the quitline is being integrated into larger efforts to promote cessation through health systems change.
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Affiliation(s)
- Nathan Mann
- RTI International, Research Triangle Park, NC 27709, USA; (J.N.); (K.D.); (L.C.); (J.T.)
- Correspondence: ; Tel.: +(919)-485-5584; Fax: +(919)-541-6683
| | - James Nonnemaker
- RTI International, Research Triangle Park, NC 27709, USA; (J.N.); (K.D.); (L.C.); (J.T.)
| | - Kevin Davis
- RTI International, Research Triangle Park, NC 27709, USA; (J.N.); (K.D.); (L.C.); (J.T.)
| | - LeTonya Chapman
- RTI International, Research Triangle Park, NC 27709, USA; (J.N.); (K.D.); (L.C.); (J.T.)
| | - Jesse Thompson
- RTI International, Research Triangle Park, NC 27709, USA; (J.N.); (K.D.); (L.C.); (J.T.)
| | - Harlan R. Juster
- Bureau of Tobacco Control, New York State Department of Health, Albany, NY 12242, USA;
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Abstract
Background: High rates of smoking are documented among some American Indian and Alaska Native (AI/AN) communities, with potential variability by region and urban/rural settings. Quitlines are a cost-effective strategy for providing evidence-based cessation treatment, but little is known about the effectiveness of quitline services for the AI/AN population. Objectives: This study compared demographic characteristics, tobacco use, and cessation and program utilization behaviors between AI/AN (n = 297) and Non-Hispanic White (NHW; n = 13,497) quitline callers. The study also identified predictors of 30-day cessation at 7-month follow-up among AI/AN callers and determined if predictors were different between AI/AN and NHW callers. Methods: Data from callers to the Arizona Smokers' Helpline between January 2011 and June 2016 were analyzed. Results: At enrollment, AI/AN callers were less likely to use tobacco daily and were less dependent on nicotine compared to NHW callers. Both groups reported similar rates of 30-day cessation at 7-month follow-up (37.3% and 39.7% for AI/AN and NHW callers, respectively). For AI/AN callers, 30-day cessation was significantly associated with tobacco cessation medication use (OR = 2.24, 95% CI: 1.02-4.93), number of coaching sessions (OR = 1.14, 95% CI: 1.04-1.26), and other smokers in the home (OR = 0.41, 95% CI: 0.19-0.91). The effect of other smokers in the home was significantly different between AI/AN and NHW callers (p = .007). Conclusions: Different individual characteristics and predictors of cessation among AI/AN callers compared to NHW callers were documented. Findings may be used to inform the development of culturally-tailored strategies and protocols for AI/AN quitline callers.
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Affiliation(s)
- Nicole P. Yuan
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Jennifer L. Schultz
- Arizona Smokers’ Helpline, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Uma S. Nair
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
- Arizona Smokers’ Helpline, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Melanie L. Bell
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
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Matthews AK, Breen E, Veluz-Wilkins A, Ciecierski C, Simon M, Burrell D, Hitsman B. Adaptation of a Proactive Smoking Cessation Intervention to Increase Tobacco Quitline Use by LGBT Smokers. Prog Community Health Partnersh 2019; 13:71-84. [PMID: 31378737 PMCID: PMC6980318 DOI: 10.1353/cpr.2019.0040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The study purpose was to evaluate the content of a proactive population health management intervention aimed at promoting uptake of smoking cessation treatments offered by the Illinois Tobacco Quitline (ITQL) among lesbian, gay, bisexual, and transgender (LGBT)-identified smokers. METHODS This study represents a partnership between a community-based health center and university researchers. As part of the study, focus groups and in-depth interviews were conducted with LGBT smokers (N = 30). First, we conducted focus groups to obtain feedback on the readability, acceptability, and motivational salience of a targeted and nontargeteed proactive outreach letter. After revisions, a series of in-depth interviews were conducted to evaluate finalized materials. Focus groups and interviews were systematically analyzed. RESULTS Based on feedback, the revised intervention letter was rated more positively than the initial version, with 80% of participants indicating that they found the information in the letter to be useful. Further, more participants reported that the letter would motivate them to accept a call from a quitline counselor compared with the initial version (47.6% vs. 60.0%, respectively). In the final iteration, 60% of participants preferred the targeted letter, 30% preferred the non-targeted letter, and 10% had no preference. In the first iteration, outreach text messages were rated as unacceptable or completely unacceptable by 54% of participants. The revised text messages and protocols were seen as unacceptable by only 10% of participants. CONCLUSIONS The development and testing of population-based and cost-effective interventions is critical to the reduction of LGBT smoking disparities. The study protocol and intervention materials were well-received by participants. In a future study, we will evaluate the efficacy of the intervention in increasing use of the quitline among LGBT smokers.
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Brockman TA, Patten CA, Lukowski A. Skill Sets for Family Members and Friends to Help Motivate a Smoker to Seek Treatment: Research to Practice. Addict Res Theory 2018; 26:525-532. [PMID: 31787862 PMCID: PMC6884141 DOI: 10.1080/16066359.2018.1450872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 03/02/2018] [Accepted: 03/07/2018] [Indexed: 06/10/2023]
Abstract
Translation of effective behavioral interventions is a key challenge for the addictions treatment field. With the goal of disseminating an effective behavioral intervention to practice, this narrative study describes tobacco cessation coaches' skills sets and provides an illustrative case study of a 1-session phone intervention between a coach and a concerned family member who wants to help their smoker quit. Delivered through a quitline by quitline coaches, the intervention consisted of a 15-30 minute phone session and written materials. The goal of the intervention was for family members and friends (support persons) to encourage their smoker to use a quitline. Data were collected from transcripts of 193 audiotapes of the one session phone intervention from a previous trial (Patten et al., In Print). Using content analysis, major themes regarding barriers and challenges within the sessions and coaches' solutions assisted in selecting case study illustrating the dialogue between a coach and a support person, as well as demonstrating the coaches' skill sets used to deliver the session. In addition, the barriers and challenges among support persons (i.e., uncertainty about how to approach the smoke, the smoker is not ready to quit) and the coaches' responses and suggestions are illustrated. These types of data could be useful to clinicians, providers and others interested in implementing a behavioral intervention for nonsmokers who want to support a smoker to quit.
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Affiliation(s)
- Tabetha A. Brockman
- Center for Clinical and Translational Science; Office for Community Engagement in Research; Mayo Clinic, 200 First Street SW, Rochester, MN 55905; Phone: (507) 538-6625; Fax: (507) 266-2478
| | - Christi A Patten
- Department of Psychology and Psychiatry, Mayo Clinic, 200 First Street SW, Rochester, MN 55905; Phone: (507) 538-7370;
| | - Amy Lukowski
- National Jewish Health; 1400 Jackson Street, Denver, CO, 80206; Phone: 877-225-5654;
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Mann N, Nonnemaker J, Chapman L, Shaikh A, Thompson J, Juster H. Comparing the New York State Smokers' Quitline Reach, Services Offered, and Quit Outcomes to 44 Other State Quitlines, 2010 to 2015. Am J Health Promot 2017; 32:1264-1272. [PMID: 28805074 DOI: 10.1177/0890117117724898] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To summarize the reach, services offered, and cessation outcomes of the New York Quitline and compare with other state quitlines. DESIGN Descriptive study. SETTING Forty-five US states. PARTICIPANTS State-sponsored tobacco cessation quitlines in 45 US states that provided complete data to the Centers for Disease Control and Prevention's National Quitline Data Warehouse (NQDW) for 24 quarters over 6 years (2010-Q1 through 2015-Q4). INTERVENTION Telephone quitlines that offer tobacco use cessation services, including counseling, self-help materials, and nicotine replacement therapy (NRT), to smokers at no cost to them. MEASURES Percentage of adult tobacco users in the state who received counseling and/or free NRT from state quitlines (reach), services offered by state quitlines, and cessation outcomes among quitline clients 7 months after using quitline services. ANALYSIS Reach, services offered, and cessation outcomes for the New York Quitline were compared with similar measures for the other 44 state quitlines with complete NQDW data for all quarters from 2010 through 2015. RESULTS New York's average annual quitline reach from 2010 through 2015 was 3.0% per year compared to 1.1% per year for the other 44 states examined. CONCLUSION Although the New York Quitline was open fewer hours per week and offered fewer counseling sessions and a smaller amount of free NRT than most of the other 44 state quitlines, the New York Quitline had similar quit rates to most of those state quitlines.
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Affiliation(s)
- Nathan Mann
- 1 RTI International, Research Triangle Park, NC, USA
| | | | | | - Asma Shaikh
- 1 RTI International, Research Triangle Park, NC, USA
| | | | - Harlan Juster
- 2 The New York State Department of Health, Albany, NY, USA
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Bush T, Lovejoy J, Javitz H, Mahuna S, Torres AJ, Wassum K, Magnusson B, Benedict C, Spring B. IMPLEMENTATION, RECRUITMENT AND BASELINE CHARACTERISTICS: A RANDOMIZED TRIAL OF COMBINED TREATMENTS FOR SMOKING CESSATION AND WEIGHT CONTROL. Contemp Clin Trials Commun 2017; 7:95-102. [PMID: 29124236 PMCID: PMC5673122 DOI: 10.1016/j.conctc.2017.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Two-thirds of treatment-seeking smokers are obese or overweight. Most smokers are concerned about gaining weight after quitting. The average smoker experiences modest post-quit weight gain which discourages many smokers from quitting. Although evidence suggests that combined interventions to help smokers quit smoking and prevent weight gain can be helpful, studies have not been replicated in real world settings. Methods This paper describes recruitment and participant characteristics of the Best Quit Study, a 3-arm randomized controlled trial testing tobacco cessation treatment alone or combined with simultaneous or sequential weight management. Study participants were recruited via tobacco quitlines from August 5, 2013 to December 15, 2014. Results Statistical analysis on baseline data was conducted in 2015/2016. Among 5082 potentially eligible callers to a tobacco quitline, 2540 were randomized (50% of eligible). Compared with individuals eligible but not randomized, those randomized were significantly more likely to be female (65.7% vs 54.5%, p < 0.01), overweight or obese (76.3% vs 62.5%, p < 0.01), more confident in quitting (p < 0.01), more addicted (first cigarette within 5 min: 50.0% vs 44.4%, p < 0.01), and have a chronic disease (28.6% vs. 24.4%, p < 0.01). Randomized groups were not statistically significantly different on demographics, tobacco or weight variables. Two-thirds of participants were female and white with a mean age of 43. Conclusions Adding weight management interventions to tobacco cessation quitlines was feasible and acceptable to smokers. If successful for cessation and weight outcomes, a combined intervention may provide a treatment approach for addressing weight gain with smoking cessation through tobacco quitlines. Trial registration Clinicaltrials.gov NCT01867983.
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Affiliation(s)
- Terry Bush
- Alere Wellbeing, solely owned subsidiary of Optum, 999 Third Avenue Suite 1800, Seattle, Washington 98104-1139, USA
| | - Jennifer Lovejoy
- Arivale, Inc and University of Washington School of Public Health, Seattle, WA
| | | | | | - Alula Jimenez Torres
- Alere Wellbeing, solely owned subsidiary of Optum, 999 Third Avenue Suite 1800, Seattle, Washington 98104-1139, USA
| | | | | | - Cody Benedict
- Gates Foundation (previously at Alere Wellbeing), Seattle, WA
| | - Bonnie Spring
- Center for Behavior and Health, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Vickerman KA, Beebe LA, Schauer GL, Magnusson B, King BA. Electronic nicotine delivery system (ENDS) use during smoking cessation: a qualitative study of 40 Oklahoma quitline callers. BMJ Open 2017; 7:e013079. [PMID: 28365587 PMCID: PMC5775473 DOI: 10.1136/bmjopen-2016-013079] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Approximately 10% (40 000) of US quitline enrollees who smoke cigarettes report current use of electronic nicotine delivery systems (ENDS); however, little is known about callers' ENDS use. Our aim was to describe why and how quitline callers use ENDS, their beliefs about ENDS and the impact of ENDS use on callers' quit processes and use of FDA-approved cessation medications. DESIGN Qualitative interviews conducted 1-month postregistration. Interviews were recorded, transcribed, double-coded and analysed to identify themes. SETTING Oklahoma Tobacco Helpline. PARTICIPANTS 40 callers aged ≥18 who were seeking help to quit smoking were using ENDS at registration and completed ≥1 programme calls. RESULTS At 1-month postregistration interview, 80% of callers had smoked cigarettes in the last 7 days, almost two-thirds were using ENDS, and half were using cessation medications. Nearly all believed ENDS helped them quit or cut down on smoking; however, participants were split on whether they would recommend cessation medications, ENDS or both together for quitting. Confusion and misinformation about potential harms of ENDS and cessation medications were reported. Participants reported using ENDS in potentially adaptive ways (eg, using ENDS to cut down and nicotine replacement therapy to quit, and stepping down nicotine in ENDS to wean off ENDS after quitting) and maladaptive ways (eg, frequent automatic ENDS use, using ENDS in situations they did not previously smoke, cutting down on smoking using ENDS without a schedule or plan to quit), which could impact the likelihood of quitting smoking or continuing ENDS use. CONCLUSIONS These qualitative findings suggest quitline callers who use ENDS experience confusion and misinformation about ENDS and FDA-approved cessation medications. Callers also use ENDS in ways that may not facilitate quitting smoking. Opportunities exist for quitlines to educate ENDS users and help them create a coordinated plan most likely to result in completely quitting combustible tobacco.
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Affiliation(s)
- Katrina A Vickerman
- Center for Wellbeing Research, Optum (formerly Alere Wellbeing, Inc.), Seattle, Washington, USA
| | - Laura A Beebe
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Gillian L Schauer
- Battelle Public Health Center for Tobacco Research, Battelle Memorial Institute, Seattle, Washington, USA
- Office on Smoking and Health Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brooke Magnusson
- Center for Wellbeing Research, Optum (formerly Alere Wellbeing, Inc.), Seattle, Washington, USA
| | - Brian A King
- Office on Smoking and Health Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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McDaniel AM, Vickerman KA, Stump TE, Monahan PO, Fellows JL, Weaver MT, Carlini BH, Champion VL, Zbikowski SM. A randomised controlled trial to prevent smoking relapse among recently quit smokers enrolled in employer and health plan sponsored quitlines. BMJ Open 2015; 5:e007260. [PMID: 26124508 PMCID: PMC4486943 DOI: 10.1136/bmjopen-2014-007260] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To test adding an interactive voice response (IVR)-supported protocol to standard quitline treatment to prevent relapse among recently quit smokers. DESIGN Parallel randomised controlled trial with three arms: standard quitline, standard plus technology enhanced quitline with 10 risk assessments (TEQ-10), standard plus 20 TEQ assessments (TEQ-20). SETTING Quit For Life (QFL) programme. PARTICIPANTS 1785 QFL enrolees through 19 employers or health plans who were 24+ h quit. INTERVENTIONS QFL is a 5-call telephone-based cessation programme including medications and web-based support. TEQ interventions included 10 or 20 IVR-delivered relapse risk assessments over 8 weeks with automated transfer to counselling for those at risk. MAIN OUTCOME MEASURES Self-reported 7-day and 30-day abstinence assessed at 6-month and 12-month post-enrolment (response rates: 61% and 59%, respectively). Missing data were imputed. RESULTS 1785 were randomised (standard n=592, TEQ-10 n=602, TEQ-20 n=591). Multiple imputation-derived, intent-to-treat 30-day quit rates (95% CI) at 6 months were 59.4% (53.7% to 63.8%) for standard, 62.3% (57.7% to 66.9%) for TEQ-10, 59.4% (53.7% to 65.1%) for TEQ-20 and 30-day quit rates at 12 months were 61.2% (55.6% to 66.8%) for standard, 60.6% (56.0% to 65.2%) for TEQ-10, 54.9% (49.0% to 60.9%) for TEQ-20. There were no significant differences in quit rates. 73.3% of TEQ participants were identified as at-risk by IVR assessments; on average, participants completed 0.41 IVR-transferred counselling calls. Positive risk assessments identified participants less likely (OR=0.56, 95% CI 0.42 to 0.76) to be abstinent at 6 months. CONCLUSIONS Standard treatment was highly effective, with 61% remaining abstinent at 12 months using multiple imputation intent-to-treat (intent-to-treat missing=smoking quit rate: 38%). TEQ assessments identified quitters at risk for relapse. However, adding IVR-transferred counselling did not yield higher quit rates. Research is needed to determine if alternative designs can improve outcomes. TRIAL REGISTRATION NUMBER NCT00888992.
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Affiliation(s)
- Anna M McDaniel
- College of Nursing, University of Florida, Gainesville, Florida, USA
| | | | - Timothy E Stump
- Department of Biostatistics, Indiana University, School of Medicine, Indianapolis, Indiana, USA
| | - Patrick O Monahan
- Department of Biostatistics, Indiana University, School of Medicine, Indianapolis, Indiana, USA
| | | | - Michael T Weaver
- College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Beatriz H Carlini
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, Washington, USA
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Díaz-Toro EC, Fernández ME, Correa-Fernández V, Calo WA, Ortiz AP, Mejía LM, Mazas CA, Santos-Ortiz MDC, Wetter DW. Promoting tobacco cessation and smoke-free workplaces through community outreach partnerships in Puerto Rico. Prog Community Health Partnersh 2014; 8:157-68. [PMID: 25152097 PMCID: PMC4237274 DOI: 10.1353/cpr.2014.0032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Puerto Rico (PR) has a lower smoking prevalence than the United States (14.8% vs. 21.2%, respectively); nevertheless, the five leading causes of death are associated with smoking. There is a need to implement evidence-based tobacco control strategies in PR. OBJECTIVES The Outreach Pilot Program (OPP) was designed to engage communities, health professionals, and researchers in a network to advance health promotion activities and research to increase the use of the PR Quitline (PRQ) among smokers and promoting policies in support of smoke-free workplaces. METHODS Using community-based participatory research (CBPR) methods, the OPP mobilized a network of community and academic partners to implement smoking cessation activities including referrals to the PRQ, adoption of evidence-based smoking cessation programs, and promotion of smoke-free legislation. RESULTS Eighty organizations participated in the OPP. Collaborators implemented activities that supported the promotion of the PRQ and smoke-free workplaces policy and sponsored yearly trainings, including tobacco control conferences. From 2005 to 2008, physician referrals to the PRQ increased from 2.6% to 7.2%. The number of annual smokers receiving cessation services through the PRQ also increased from 703 to 1,086. The OPP shepherded a rigorous smoke-free law through participation in the development, promotion, and implementation of the smoke-free workplaces legislation as well as the creation of the PR Tobacco Control Strategic Plan, launched in 2006. CONCLUSIONS This project demonstrates the feasibility of developing a successful and sustainable community-based outreach program model that enlists the participation of academic researchers, community organizations, and health care providers as partners to promote tobacco control.
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Nonnemaker J, Hersey J, Homsi G, Busey A, Hyland A, Juster H, Farrelly M. Self-reported exposure to policy and environmental influences on smoking cessation and relapse: a 2-year longitudinal population-based study. Int J Environ Res Public Health 2011; 8:3591-608. [PMID: 22016705 PMCID: PMC3194106 DOI: 10.3390/ijerph8093591] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 08/25/2011] [Indexed: 11/16/2022]
Abstract
Although most smokers want to quit, the long-term success rate of quit attempts remains low; research is needed to understand the policy and environmental influences that can increase the success of cessation efforts. This paper uses regression methods to investigate self-reported exposure to policy and environmental influences on quit attempts, maintenance of a quit attempt for at least 6 months, and relapse in a longitudinal population-based sample, the New York Adult Cohort Survey, followed for 12 months (N = 3,261) and 24 months (N = 1,142). When policy or environmental influence variables were assessed independently of other policy or environmental influence variables, many were significant for at least some of the cessation outcomes. In the full models that included a full set of policy or environmental influence variables, many significant associations became nonsignificant. A number of policies may have an influence on multiple cessation outcomes. However, the effect varies by cessation outcome, and statistical significance is influenced by model specification.
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Affiliation(s)
- James Nonnemaker
- RTI International, 3040 Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709, USA; E-Mails: (J.H.); (G.H.); (A.B.); (M.F.)
| | - James Hersey
- RTI International, 3040 Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709, USA; E-Mails: (J.H.); (G.H.); (A.B.); (M.F.)
| | - Ghada Homsi
- RTI International, 3040 Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709, USA; E-Mails: (J.H.); (G.H.); (A.B.); (M.F.)
| | - Andrew Busey
- RTI International, 3040 Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709, USA; E-Mails: (J.H.); (G.H.); (A.B.); (M.F.)
| | - Andrew Hyland
- Roswell Park Cancer Institute, Department of Health Behavior, Elm and Carlton Streets, Buffalo, NY 14263, USA; E-Mail:
| | - Harlan Juster
- Corning Tower, Room 710, New York State Department of Health, Empire State Plaza, Albany, NY 12237, USA; E-Mail:
| | - Matthew Farrelly
- RTI International, 3040 Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709, USA; E-Mails: (J.H.); (G.H.); (A.B.); (M.F.)
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Abstract
OBJECTIVES This paper discusses the development of a minimal dataset (MDS) for tobacco cessation quitlines across North America. The goal was to create a standardised instrument and protocol that would allow for comparisons and pooling of data across quitlines for evaluation and research purposes. Principles of utilisation focused evaluation were followed to achieve consensus across diverse stakeholder groups in two countries. METHODS The North American Quitline Consortium (NAQC) assembled a working group with representatives from quitline service providers, funders, evaluators and researchers from Canada and the United States. An extensive, iterative consultation process over two years led to consensus on the evaluation domains, indicators and specific items. Descriptive information on quitline service models, data collection protocols and methodological issues were addressed. RESULTS The resulting minimal dataset (MDS) includes 15 items collected from eligible callers at intake and eight items collected from smokers participating in evaluation. Recommendations for selecting evaluation participants, length of follow-up and repeat callers were developed. Full MDS questions and technical documents are available on the NAQC website. CONCLUSION Adoption and implementation of the MDS occurred in the majority of North American quitlines by the end of 2006. Key success factors included a focus on utility and feasibility, a commitment to meeting multiple and varied needs, sensitivity to situational factors and investment in working interactively with stakeholders. The creation and implementation of a MDS across two countries is an important "first" in tobacco control which will help speed the creation of practice based evidence and facilitate practice based research.
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Affiliation(s)
- H Sharon Campbell
- Centre for Behavioural Research and Program Evaluation, University of Waterloo, Waterloo, Ontario, Canada.
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Keller PA, Koss KJ, Baker TB, Bailey LA, Fiore MC. Do state characteristics matter? State level factors related to tobacco cessation quitlines. Tob Control 2007; 16 Suppl 1:i75-80. [PMID: 18048637 PMCID: PMC2598526 DOI: 10.1136/tc.2006.019745] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Accepted: 04/18/2007] [Indexed: 11/04/2022]
Abstract
BACKGROUND Quitline services are an effective population-wide tobacco cessation strategy adopted widely in the United States as part of state comprehensive tobacco control efforts. Despite widespread evidence supporting quitlines' effectiveness, many states lack sufficient financial resources to adequately fund and promote this service. Efforts to augment state tobacco control efforts might be fostered by greater knowledge of state level factors associated with the funding and implementation of those efforts. METHODS We analysed data from the 2004 North American Quitline Consortium survey and from publicly available sources to identify state level factors related to quitline implementation and funding. Factors included in the analyses were state demographic characteristics, tobacco use variables, state tobacco control spending, and economic and political climate variables. Univariate and multivariate regression analyses were conducted. RESULTS The best fitting multivariate model that significantly predicted the presence or absence of a state quitline included only cigarette excise tax rate (p = 0.020). In terms of funding levels, states with high rates of cigarette consumption (p = 0.047) and with higher per capita expenditures for tobacco control programmes (p = 0 .0.004) were most likely to spend more on per capita operations budget for quitlines. CONCLUSION State level factors appear to play a part in whether states had established quitlines by mid-2004 and the amount of per capita quitline funding.
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Affiliation(s)
- Paula A Keller
- University of Wisconsin Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health 1930 Monroe Street, Suite 200, Madison, WI 53711, USA.
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Gordon JS, Andrews JA, Crews KM, Payne TJ, Severson HH. The 5A's vs 3A's plus proactive quitline referral in private practice dental offices: preliminary results. Tob Control 2007; 16:285-8. [PMID: 17652247 PMCID: PMC2598528 DOI: 10.1136/tc.2007.020271] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Accepted: 04/18/2007] [Indexed: 11/03/2022]
Abstract
AIMS The primary aim of our randomised control trial (RCT) was to evaluate the relative efficacy of two dental office based interventions compared to usual care. One intervention consisted of a combination of dental practitioner advice to quit and proactive telephone counselling (3A's), and the other arm consisted of a dental practitioner delivered intervention based on the 5A's of the Clinical Practice Guideline (5A's). METHOD 2177 tobacco using patients were enrolled from 68 dental practices in Mississippi. We collected 3-month outcome data from 76% (n = 1652) of participants. RESULTS Smokers in the two intervention conditions quit at a higher rate than those in usual care; chi2 (1, n = 1381) = 3.10, p<0.05. Although not significant, more patients in the 5A's condition quit than those in the 3A's. Of patients in the 3A's Condition, 50% reported being asked by their dentist or hygienists about fax referral to the quitline, and 35% were referred. Quitline counsellors contacted 143 (70%) referred participants. CONCLUSION These results suggest that there are both advantages and disadvantages to the use of quitlines as an adjunct to brief counselling provided by dental practitioners. Patients receiving quitline counselling quit at higher rates than those who did not; however, only a small percentage of patients received counselling from the quitline. Therefore, it appears that dental professionals may be most effective in helping their patients to quit by regularly providing the 5A's plus proactively referring only those patients who are highly motivated to a quitline for more intensive counselling.
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Affiliation(s)
- Judith S Gordon
- Oregon Research Institute, 1715 Franklin Blvd, Eugene, OR 97405, USA.
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