Do state characteristics matter? State level factors related to tobacco cessation quitlines

Fax referrals, academic detailing, and tobacco quitline use: a randomized trial

BACKGROUND

Fax referral programs quickly and economically can link smokers' visiting primary care clinics to state-based telephone quitlines. Yet, it is unclear how to optimize use of this strategy.

PURPOSE

To evaluate the potential of enhanced academic detailing in clinics (i.e., on-site training, technical assistance, and performance feedback) to boost utilization of a fax referral program called Fax to Quit.

DESIGN

Participants were randomized to one of two intervention conditions.

SETTING/PARTICIPANTS

Participants were drawn from 49 primary care clinics in southeastern Wisconsin. The sample size was based on a power analysis in which the control intervention condition was estimated to generate 0.5 referrals/clinic/month and the experimental condition 2.0 referrals/clinic/month.

INTERVENTIONS

One of two fax referral program interventions was administered: the control condition Fax to Quit-Only (F2Q-Only) or the experimental condition Fax to Quit plus Enhanced Academic Detailing (F2Q+EAD).

MAIN OUTCOME MEASURES

Clinic- and clinician-specific referral and quality referral rates (those resulting in quitline enrollment) were measured for 13 months post-intervention, starting in March 2009.

RESULTS

Mean number of post-intervention referrals/clinician to the Wisconsin Tobacco Quitline was 5.6 times greater for F2Q+EAD (8.5, SD=7.0) compared to F2Q-Only (1.6, SD=3.6, p<0.001). The F2Q+EAD (4.8, SD=4.1) condition produced a greater mean number of quality referrals/clinician than did the F2Q-Only (0.86, SD=1.8, p<0.001) condition. Data were analyzed in 2010.

CONCLUSIONS

Enhanced academic detailing, which included on-site training, technical assistance, and performance feedback, increased the number of referrals more than fivefold over a fax referral program implemented without such enhanced academic detailing.

TRIAL REGISTRATION

This study is registered at Clinicaltrials.gov NCT00989755.

State-level factors influencing tobacco cessation quitline spending in 2008

Tobacco cessation quitlines are an effective population-based smoking cessation treatment. However, quitline funding varies widely. Analyzing state-level factors may help explain these differences. We used data from the North American Quitline Consortium's 2008 survey of state quitlines and U.S. Census estimates to calculate per capita spending on quitline services. Publicly available data sources were used to identify demographic, tobacco use, tobacco control spending, and political and economic climate variables for the analysis. Linear regression analyses were used to identify potential predictors of per capita quitline services budgets in 2008. States with a greater percentage of their population with at least a high school degree, and states that spent more per capita on tobacco control programs overall, spent more per capita on quitline services (p > 0.05). In multivariate analysis, only per capita tobacco control expenditures was statistically significant (β=0.73, p =0.00, 95%CI 0.11-0.19). It appears that per capita tobacco control expenditures is the most consistent predictor of state per capita quitline expenditures. Additional research into whether and how state-level factors influence quitline funding levels is needed to allow advocates and policy-makers to understand better how to advocate for ongoing support of these population-based services.

Successful change in tobacco use in schizophrenia

The high rates of tobacco use among individuals with schizophrenia are well documented, but there has been less attention paid to identifying what are the special needs for this population. In fact, there have even been suggestions from early work that standard interventions and approaches might be adequate. In contrast, based on more than a decade of experience supporting change smoking behavior among people with schizophrenia, three key factors were identified as unique considerations that are associated with success. The first factor involves readiness to change; smokers with schizophrenia are rarely given opportunities to even try to quit unlike their counterparts in the general population and therefore have not benefited from the self-efficacy aspects of attempt experiences. The second factor is medication and symptom monitoring; there are special needs for nurses and medical staff to monitor symptoms (including schizophrenia symptoms and mood symptoms), medication dosage and side-effects, during the period when individuals with schizophrenia are changing (reducing) their tobacco use, particularly when nicotine replacement therapy is being implemented. Finally, the third factor is peer and caregiver support; the use of peer assistants in group-based programs and the teaching of nurses and other professional casegivers as well as family members about their role as supports can make an important difference in tipping the balance toward successful change and toward maintenance of change over time.

Tobacco cessation quitline spending in 2005 and 2006: what state-level factors matter?

Tobacco cessation telephone quitlines are an effective population-wide strategy for smoking cessation, but funding for this service varies widely. State-level factors may explain this difference. Data from the 2005 and 2006 North American Quitline Consortium surveys and from publicly available sources were analyzed to identify factors that predict higher levels of per capita quitline funding. The best-fitting multivariate model comprised higher per capita tobacco control funding (2005 p = 0.004, 2006 p=0.000), not securitizing Master Settlement Agreement payments (2005 p = 0.008, 2006 p=0.01), and liberal political ideology (2005 p = 0.002, 2006 p=0.002). Select state-level factors appear to have influenced per capita quitline services funding. These findings can help inform advocates and policymakers as they advocate for quitlines and tobacco control funding.

Bridging basic and clinical science with policy studies: The Partners with Transdisciplinary Tobacco Use Research Centers experience

INTRODUCTION

The Partners with Transdisciplinary Tobacco Use Research Centers (TTURCs) initiative was a transdisciplinary team-building program, funded by the Robert Wood Johnson Foundation, to expand the policy research capacity of the TTURCs. EXPANSION INTO POLICY RESEARCh: Policy research activities at the TTURCs fell into four broad domains: (a) health services research, (b) examination of the business case for cessation treatment and funding, (c) collaborative teams with key stakeholders, and (d) direct assessment of smoking-related policies. Examples of each domain are presented.

OUTCOMES

Goals of the initiative included efforts to foster collaborative, transdisciplinary research, to bring new investigators into the field, to develop programs of policy research, to answer next-step translational questions, and to enhance awareness of policy relevance. Success at meeting each of these goals is discussed.

RECOMMENDATIONS

We offer recommendations for incorporating programs of policy research into full-spectrum transdisciplinary research initiatives, including the roles of research teams, senior researchers, infrastructure, stakeholders, and communications activities.

CONCLUSIONS

The TTURC Partners initiative represented a first-generation effort to fill the gap between scientific discovery and research translation through expansion into policy studies. While all aspects of the effort were not equally successful, the effort demonstrated that it is possible to develop successful collaborations that extend more basic and applied research into studies that examine their policy and practice implications.