Quit Outcomes and Program Utilization by Mode of Entry Among Clients Enrolling in a Quitline

Feasibility and acceptability of testing a menstrual-cycle timed smoking cessation intervention for women of reproductive age (Project Phase): Protocol of a pilot randomized controlled trial

BACKGROUND

Compared to men, women have unique barriers to smoking cessation and are less likely to utilize quitline services. While current clinical recommendations have called for sex/gender-specific smoking cessation protocols, quitlines have not been expanded protocols to address the unique needs of women. Menstrual cycles (and/or ovarian hormones) influence quit outcomes in women. This paper presents the study design and protocol for a randomized control trial (Project Phase) designed to test the feasibility and acceptability of utilizing menstrual cycle timing to improve quit outcomes in women of reproductive age.

METHODS/DESIGN

Participants include treatment-seeking women (n = 116), between the ages of 18-40 with regular and naturally-occurring menstrual cycles. Eligible participants are randomized to either the mid-Follicular Phase (FP) or Standard Care (SC-control) group. Counseling includes six weekly telephone sessions with four weeks of nicotine replacement therapy. The timing and frequency of sessions is identical to both conditions, with the exception of the quit day (week 3 of counseling). In addition to providing education on menstrual cycle and quitting, quit day for FP participants is set within 6-8 days post onset of menses; the SC group quit day is set for Week 3 of counseling regardless of their menstrual cycle phase. Dried blood spots will be used to bioverify menstrual cycle phase and smoking status.

DISCUSSION

If feasible and acceptable, our behavioral counseling intervention that times the quit day to the mid-follicular phase of the menstrual may increase quit outcomes among women of reproductive age and has potential for dissemination across quitlines nationally.

Predictors of client retention in a state-based tobacco quitline

Introduction

Quitlines are standard care for smoking cessation; however, retaining clients in services is a problem. Little is known about factors that may predict dropout.

Aims

To examine predictors of retention while in-program and at follow-up for clients enrolling in a state quitline.

Methods

This was a retrospective analysis of quitline enrolled clients from 2011 to 2017 (N = 49,347). Client retention in-program was categorized as (a) low adherence to treatment (receiving zero coaching calls), moderate (1–2 calls), and high adherence (3+ calls). Dropout at follow-up included participants who were not reached for the 7-month follow-up.

Results

More than half the sample dropped out during treatment; 61% were not reached for follow-up. Women (odds ratio (OR) = 1.21; 95% confidence interval (CI) = [1.16, 127]) and those with high levels of nicotine dependence (OR = 1.03; 95% CI = [1.02, 1.04]) were more likely to have moderate adherence to treatment (1–2 coaching calls). Dropout at follow-up was more likely among clients who used nicotine replacement therapy (OR = 1.14; 95% CI = [1.09, 1.19]) and less likely among those who had high treatment adherence (OR = 0.41; 95% CI = [0.39, 0.42]).

Conclusion

Given the relapsing nature of tobacco use and the harms related to tobacco use, quitlines can improve their impact by offering tailored services to enhance client engagement and retention in-treatment and at follow-up.

Quitline program utilization and cessation outcomes: A comparison of provider-referred clients by healthcare settings

US Public Health Service guidelines recommend that healthcare providers assess patients for tobacco use and refer tobacco users to cessation services (e.g., quitlines). However, once referred, little is known on how program outcomes for referred tobacco users vary across healthcare settings. To examine differences in program enrollment, dropout at follow-up, utilization (number of coaching sessions and nicotine replacement therapy use), and quit outcomes among tobacco users referred across settings to a state quitline. In a retrospective analysis of clients referred to the quitline (January 2011-June 2016), referrals were categorized into six settings: general medical practice (reference group), acute care hospitals, behavioral health, federally qualified health centers (FQHCs), county health departments, and specialty clinics. Outcome variables included enrollment, dropout, program utilization, and 30-day tobacco abstinence at 7-month follow-up. Compared to medical practices, clients referred from behavioral health were less likely to enroll in services (OR = 0.81, 95%CI: 0.76, 0.87), less likely to report using NRT in-program (OR = 0.51, 95%CI: 0.42, 0.62), and along with clients referred from FQHCs (OR = 0.78, 95%CI: 0.64, 0.94) were less likely to be quit at follow-up (OR = 0.73, 95%CI: 0.59, 0.92). Clients referred from acute care hospitals were less likely to enroll in services (OR = 0.60, 95%CI: 0.56, 0.64) and were more likely to drop-out of cessation services (OR = 1.12; 95%CI: 1.00-1.26). Findings reflect the need for better tailoring of messages for tobacco assessment within specific healthcare settings while bolstering behavioral counseling that quitlines provide to increase enrollment, engagement, and retention in tobacco cessation services.

Quit outcomes among clients ineligible for cessation medication through the state quitline: a retrospective, observational study

BACKGROUND

Distribution of tobacco cessation medications through state quitlines increases service utilization and quit outcomes. However, some state quitlines have moved to models in which callers are instructed to obtain quit medications through their health insurance pharmaceutical benefit. We aimed to investigate the impact of this policy on medication access and quit outcomes in the state quitline setting for clients who must obtain covered medications through the state Medicaid program. We hypothesized that clients with Medicaid who were referred by their healthcare provider would be more likely to report using quit medication and have higher quit rates compared to clients with Medicaid who engaged the quitline on their own.

METHODS

An observational, retrospective study was conducted using state quitline clients with Medicaid health insurance who were ineligible for quitline provided cessation medications. Clients were stratified by referral type: self-referred, passively referred, and proactively referred. Unadjusted and adjusted logistic regression was used to estimate the effect of referral type on both quit status and cessation medication use.

RESULTS

Proactively referred clients were less likely to use quit medication (53.6%) compared to self (56.9%) and passively referred clients (61.1%). Proactively referred clients had lower quit rates (31.4%), as compared to passively referred (36.0%) and self-referred (35.1%). In adjusted models, proactively referred clients were significantly less likely to be quit than passively referred clients (OR = 0.75, 95% CI: 0.56, 0.99). There were no statistically significant differences in medication use or number of coaching sessions among proactive, passive, and self-referred clients in adjusted models.

CONCLUSIONS

In adjusted models, medication use did not significantly differ by mode of entry in this population of Medicaid beneficiaries. Psychosocial factors such as intention to quit in the next 30 days, social support for quitting, education level, race, and ethnicity impacted quit status and differed by mode of entry. Quitlines should use tailored strategies to increase engagement and reduce barriers among proactively referred clients.