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Baker AL, McCarter K, Turner A, Segan C, Castle D, Brophy L, Borland R, Kelly PJ, Bonevski B, Baird D, Filia S, Attia J, Szwec S, Palazzi K, White SL, Williams JM, Wrobel AL, Ireland A, Saxby K, Ghijben P, Petrie D, Sweeney R. 'Quitlink': Outcomes of a randomised controlled trial of peer researcher facilitated referral to a tailored quitline tobacco treatment for people receiving mental health services. Aust N Z J Psychiatry 2024; 58:260-276. [PMID: 37353970 PMCID: PMC10903138 DOI: 10.1177/00048674231181039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
OBJECTIVE The aim of this study was to test the effectiveness of a tailored quitline tobacco treatment ('Quitlink') among people receiving support for mental health conditions. METHODS We employed a prospective, cluster-randomised, open, blinded endpoint design to compare a control condition to our 'Quitlink' intervention. Both conditions received a brief intervention delivered by a peer researcher. Control participants received no further intervention. Quitlink participants were referred to a tailored 8-week quitline intervention delivered by dedicated Quitline counsellors plus combination nicotine replacement therapy. The primary outcome was self-reported 6 months continuous abstinence from end of treatment (8 months from baseline). Secondary outcomes included additional smoking outcomes, mental health symptoms, substance use and quality of life. A within-trial economic evaluation was conducted. RESULTS In total, 110 participants were recruited over 26 months and 91 had confirmed outcomes at 8 months post baseline. There was a difference in self-reported prolonged abstinence at 8-month follow-up between Quitlink (16%, n = 6) and control (2%, n = 1) conditions, which was not statistically significant (OR = 8.33 [0.52, 132.09] p = 0.131 available case). There was a significant difference in favour of the Quitlink condition on 7-day point prevalence at 2 months (OR = 8.06 [1.27, 51.00] p = 0.027 available case). Quitlink costs AU$9231 per additional quit achieved. CONCLUSION The Quitlink intervention did not result in significantly higher rates of prolonged abstinence at 8 months post baseline. However, engagement rates and satisfaction with the 'Quitlink' intervention were high. While underpowered, the Quitlink intervention shows promise. A powered trial to determine its effectiveness for improving long-term cessation is warranted.
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Affiliation(s)
- Amanda L Baker
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, NSW, Australia
| | - Kristen McCarter
- School of Psychological Sciences, College of Engineering, Science and Environment, University of Newcastle, Callaghan, NSW, Australia
| | - Alyna Turner
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, NSW, Australia
- IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Catherine Segan
- Cancer Council Victoria, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - David Castle
- Centre for Complex Interventions, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, ON, Canada
| | - Lisa Brophy
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Social Work and Social Policy, School of Allied Health, Human Services and Sport, La Trobe University Melbourne, VIC, Australia
| | - Ron Borland
- Cancer Council Victoria, Melbourne, VIC, Australia
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Peter J Kelly
- Illawarra Health and Medical Research Institute and the School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Billie Bonevski
- Flinders Health and Medical Research Institute (FHMRI), College of Medicine & Public Health, Flinders University, Bedford Park, SA, Australia
| | - Donita Baird
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, NSW, Australia
| | - Sacha Filia
- Cancer Council Victoria, Melbourne, VIC, Australia
| | - John Attia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, NSW, Australia
| | - Stuart Szwec
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Kerrin Palazzi
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | | | - Jill M Williams
- Division of Addiction Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Anna L Wrobel
- IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Andrew Ireland
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Karinna Saxby
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Peter Ghijben
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Dennis Petrie
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Rohan Sweeney
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
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Meaton I, Karouni F, Gillies J, Kapaya H. "Smoking during pregnancy - Perinatal outcomes, financial implications, and tobacco treatment services". Prev Med Rep 2023; 36:102451. [PMID: 37822980 PMCID: PMC10563039 DOI: 10.1016/j.pmedr.2023.102451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023] Open
Abstract
Objective Smoking in pregnancy is the leading modifiable risk factor for poor pregnancy outcomes. A sample population from United Lincolnshire Hospital NHS Trust (ULHT), with the highest prevalence of smoking at the time of delivery (SATOD) in England from April 2020 to March 2021 was studied. The project mapped the journey of women who smoked during pregnancy until birth and compared with a non-smoking cohort. In addition, it explored the options for possible changes to the current tobacco treatment service and importance of catering to the population demographics. Methods Data was analysed using Chi-squared or Mann Whitney and student T-test for categorical and continuous variables respectively. A p-value of < 0.05 was considered statistically significant. Results All women who smoked during pregnancy were referred to the stop smoking service. However, only 34.9 % accessed the service. Smoking mothers were younger (P = 0.001), had more complex obstetric history (P = 0.044), required increased fetal surveillance (P=<0.001), delivered at an earlier gestation (P = 0.033), and had babies with lower birth-weight (P=<0.001) compared to non-smokers. In addition, women who smoked demonstrated a downward trend in breast feeding their babies at birth and on discharge (P=<0.001 and P=<0.001 respectively). Conclusions Findings from the study informed a successful business case for improvements to the current tobacco treatment service and the development of in-house maternity model for pregnant smokers at ULHT.
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Affiliation(s)
- I. Meaton
- Foundation Year Doctor, Frimley Health NHS Foundation Trust, United Kingdom
| | - F. Karouni
- Research Support Officer, Queen's Medical Centre, Nottingham University Hospitals, Nottingham NG7 2UH, United Kingdom
| | - J. Gillies
- PGDiP Public Health, Tobacco Control Programme Manager, Office for Health Improvement and Disparities, Department of Health and Social Care, United Kingdom
| | - H. Kapaya
- SFHEA, Consultant Obstetrician Nottingham University Hospitals NHS Trust, United Kingdom
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Ohde JW, Warner DO, Egginton JS, Hagedorn HJ. Stakeholder perceptions of using "opt-out" for tobacco use treatment in a cancer care setting: a qualitative evaluation of patients, providers, and desk staff. Implement Sci Commun 2023; 4:117. [PMID: 37730738 PMCID: PMC10510286 DOI: 10.1186/s43058-023-00493-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 08/28/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Continued tobacco use in cancer patients increases the risk of cancer treatment failure and decreases survival. However, currently, most cancer patients do not receive evidence-based tobacco treatment. A recently proposed "opt-out" approach would automatically refer all cancer patients who use tobacco to tobacco treatment, but its acceptability to cancer patients and providers is unknown. We aimed to understand stakeholder beliefs, concerns, and receptivity to using the "opt-out" approach for tobacco treatment referrals in a cancer care setting. METHODS Semi-structured interviews were conducted with oncology patients, providers, and desk staff. The sample size was determined when theoretical saturation was reached. Given the differences among participant roles, separate interview guides were developed. Transcripts were analyzed using standard coding techniques for qualitative data using the Consolidated Framework for Implementation Research (CFIR) codebook. Emergent codes were added to the codebook to account for themes not represented by a CFIR domain. Coded transcripts were then entered into the qualitative analysis software NVivo to generate code reports for CFIR domains and emergent codes for each stakeholder group. Data were presented by stakeholder group and subcategorized by CFIR domains and emergent codes when appropriate. RESULTS A total of 21 providers, 19 patients, and 6 desk staff were interviewed. Overall acceptance of the "opt out" approach was high among all groups. Providers overwhelmingly approved of the approach as it requires little effort from them to operate and saves clinical time. Desk staff supported the opt-out system and believed there are clinical benefits to patients receiving information about tobacco treatment. Many patients expressed support for using an opt-out approach as many smokers need assistance but may not directly ask for it. Patients also thought that providers emphasizing the benefits of stopping tobacco use to cancer treatment and survival would be an important factor motivating them to attend treatment. CONCLUSIONS While providers appreciated that the system required little effort on their part, patients clearly indicated that promotion of tobacco cessation treatment by their provider would be vital to enhance willingness to engage with treatment. Future implementation efforts of opt-out systems will require implementation strategies that promote provider engagement with their patients around smoking cessation while continuing to limit burden on providers.
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Affiliation(s)
- Joshua W Ohde
- Center for Digital Health, Mayo Clinic, Rochester, MN, USA.
| | - David O Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jason S Egginton
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Hildi J Hagedorn
- Center for Care Delivery & Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
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Perez GK, Rabin JT, Tandon M, Strauss NM, Irwin K, Philpotts L, Ostroff J, Park ER. Do Tobacco Treatment Trials Address Disparities in Smoking Outcomes Among Black and Hispanic Cancer Patients? A Systematic Review of Smoking Cessation Interventions for Black and Hispanic Patients Diagnosed with Cancer. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01705-3. [PMID: 37468742 DOI: 10.1007/s40615-023-01705-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 05/30/2023] [Accepted: 06/27/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To characterize the representation of Black and Hispanic cancer patients in tobacco treatment trials, and to offer recommendations for future research. METHODS We conducted two systematic searches of the literature (2018, 2021) using 5 databases (MEDLINE via EBSCO, Pubmed, PsycInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica Database (EMBASE)) to examine the prevalence of tobacco trials that included Black or Hispanic cancer patients. Two coders independently screened all articles at title, abstract, and full-text to identify eligible trials. Information about the proportion of Black and Hispanic patients included, trial design features, and whether the authors analyzed outcomes for Black and Hispanic patients were documented. RESULTS Of 4682 identified studies, only 10 published trials included and reported on the rates of Black or Hispanic cancer patients enrolled in their tobacco trial. The proportion of enrolled Black cancer patients ranged from 2 to 55.6%. Only our studies documented enrollment rates for Hispanics, and rates were less than 6%. None of the studies offered strategies to promote or the accrual of Black or Hispanic patients. DISCUSSION There remains a large gap in the literature regarding the reach and efficacy of tobacco treatment for Black and Hispanic cancer patients. Black and Hispanic cancer patients remain largely under-represented in tobacco cessation trials, limiting the applicability of existing, evidence-based treatments. To optimize intervention generalizability, future studies should emphasize the targeted recruitment and engagement of these patients in tobacco trials.
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Affiliation(s)
- Giselle K Perez
- Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA.
- Health Promotion and Resilience Intervention Research Program, 100 Cambridge Street, 16th floor, Boston, MA, 02114, USA.
| | - Julia T Rabin
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
| | | | | | - Kelly Irwin
- Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
- Health Promotion and Resilience Intervention Research Program, 100 Cambridge Street, 16th floor, Boston, MA, 02114, USA
| | - Lisa Philpotts
- Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
| | - Jamie Ostroff
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elyse R Park
- Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
- Health Promotion and Resilience Intervention Research Program, 100 Cambridge Street, 16th floor, Boston, MA, 02114, USA
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Pluta K, Hohl SD, D'Angelo H, Ostroff JS, Shelley D, Asvat Y, Chen LS, Cummings KM, Dahl N, Day AT, Fleisher L, Goldstein AO, Hayes R, Hitsman B, Buckles DH, King AC, Lam CY, Lenhoff K, Levinson AH, Minion M, Presant C, Prochaska JJ, Shoenbill K, Simmons V, Taylor K, Tindle H, Tong E, White JS, Wiseman KP, Warren GW, Baker TB, Rolland B, Fiore MC, Salloum RG. Data envelopment analysis to evaluate the efficiency of tobacco treatment programs in the NCI Moonshot Cancer Center Cessation Initiative. Implement Sci Commun 2023; 4:50. [PMID: 37170381 PMCID: PMC10173908 DOI: 10.1186/s43058-023-00433-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/02/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND The Cancer Center Cessation Initiative (C3I) is a National Cancer Institute (NCI) Cancer Moonshot Program that supports NCI-designated cancer centers developing tobacco treatment programs for oncology patients who smoke. C3I-funded centers implement evidence-based programs that offer various smoking cessation treatment components (e.g., counseling, Quitline referrals, access to medications). While evaluation of implementation outcomes in C3I is guided by evaluation of reach and effectiveness (via RE-AIM), little is known about technical efficiency-i.e., how inputs (e.g., program costs, staff time) influence implementation outcomes (e.g., reach, effectiveness). This study demonstrates the application of data envelopment analysis (DEA) as an implementation science tool to evaluate technical efficiency of C3I programs and advance prioritization of implementation resources. METHODS DEA is a linear programming technique widely used in economics and engineering for assessing relative performance of production units. Using data from 16 C3I-funded centers reported in 2020, we applied input-oriented DEA to model technical efficiency (i.e., proportion of observed outcomes to benchmarked outcomes for given input levels). The primary models used the constant returns-to-scale specification and featured cost-per-participant, total full-time equivalent (FTE) effort, and tobacco treatment specialist effort as model inputs and reach and effectiveness (quit rates) as outcomes. RESULTS In the DEA model featuring cost-per-participant (input) and reach/effectiveness (outcomes), average constant returns-to-scale technical efficiency was 25.66 (SD = 24.56). When stratified by program characteristics, technical efficiency was higher among programs in cohort 1 (M = 29.15, SD = 28.65, n = 11) vs. cohort 2 (M = 17.99, SD = 10.16, n = 5), with point-of-care (M = 33.90, SD = 28.63, n = 9) vs. no point-of-care services (M = 15.59, SD = 14.31, n = 7), larger (M = 33.63, SD = 30.38, n = 8) vs. smaller center size (M = 17.70, SD = 15.00, n = 8), and higher (M = 29.65, SD = 30.99, n = 8) vs. lower smoking prevalence (M = 21.67, SD = 17.21, n = 8). CONCLUSION Most C3I programs assessed were technically inefficient relative to the most efficient center benchmark and may be improved by optimizing the use of inputs (e.g., cost-per-participant) relative to program outcomes (e.g., reach, effectiveness). This study demonstrates the appropriateness and feasibility of using DEA to evaluate the relative performance of evidence-based programs.
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Affiliation(s)
- Kathryn Pluta
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Rd, Gainesville, FL, 32610, USA
| | - Sarah D Hohl
- University of Wisconsin Carbone Cancer Center, 600 Highland Ave, Madison, WI, 53705, USA
- School of Medicine and Public Health, University of Wisconsin, 750 Highland Ave, Madison, WI, 53705, USA
| | - Heather D'Angelo
- National Cancer Institute, 9609 Medical Center Dr, Rockville, MD, 20850, USA
| | - Jamie S Ostroff
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Donna Shelley
- New York University School of Global Public Health, 708 Broadway, New York, NY, 10003, USA
| | - Yasmin Asvat
- Rush University Medical Center and Rush Cancer Center, 1725 W Harrison St, Suite 1010, Chicago, IL, 60612, USA
| | - Li-Shiun Chen
- Washington University Siteman Cancer Center, 4921 Parkview Pl, St. Louis, MO, 63110, USA
| | - K Michael Cummings
- Medical University of South Carolina, 171 Ashley Ave, Charleston, SC, 29425, USA
| | - Neely Dahl
- University of Virginia Comprehensive Cancer Center, 1240 Lee St, Charlottesville, VA, 22903, USA
| | - Andrew T Day
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Linda Fleisher
- Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Adam O Goldstein
- University of North Carolina Lineberger Cancer Center, 450 West Dr, Chapel Hill, NC, 27599, USA
| | - Rashelle Hayes
- Virginia Commonwealth University Department of Psychiatry, 501 N 2Nd St, Suite 400B, Richmond, VA, 23219, USA
| | - Brian Hitsman
- Northwestern University Feinberg School of Medicine and Lurie Comprehensive Cancer Center of Northwestern University, 420 E Superior St, Chicago, IL, 60611, USA
| | - Deborah Hudson Buckles
- Indiana University Simon Comprehensive Cancer Center, 535 Barnhill Dr, Indianapolis, IN, USA
| | - Andrea C King
- University of Chicago Medicine Comprehensive Cancer Center, 5758 S Maryland Dr, Chicago, IL, 60637, USA
| | - Cho Y Lam
- Huntsman Cancer Institute, University of Utah, 1950 Circle of Hope Dr, Salt Lake City, UT, 84112, USA
| | - Katie Lenhoff
- One Medical Center Drive, Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, NH, 03756, USA
| | - Arnold H Levinson
- University of Colorado Comprehensive Cancer Center, 1665 North Aurora Court, Aurora, 200480045, USA
| | - Mara Minion
- University of Wisconsin Carbone Cancer Center, 600 Highland Ave, Madison, WI, 53705, USA
| | - Cary Presant
- City of Hope Comprehensive Cancer Center and Beckman Research Institute, 1500 E Duarte Rd, Duarte, CA, 91010, USA
| | - Judith J Prochaska
- Stanford Cancer Institute, Stanford University, 265 Campus Dr, Ste G2103, Stanford, CA, 94305, USA
| | - Kimberly Shoenbill
- University of North Carolina Lineberger Cancer Center, 450 West Dr, Chapel Hill, NC, 27599, USA
| | - Vani Simmons
- H. Lee Moffitt Cancer Center, 3011 Holly Dr, Tampa, FL, 33612, USA
| | - Kathryn Taylor
- Georgetown University Lombardi Comprehensive Cancer Center, 3800 Reservoir Rd NW, Washington, DC, 20007, USA
| | - Hilary Tindle
- Vanderbilt University Medical Center Vanderbilt-Ingram Cancer Center, 2220 Pierce Ave, Nashville, TN, 37232, USA
| | - Elisa Tong
- University of California Davis Comprehensive Cancer Center, 2279 45Th St, Sacramento, CA, 95817, USA
| | - Justin S White
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St, Floor 7, San Francisco, CA, 94158, USA
| | - Kara P Wiseman
- University of Virginia Comprehensive Cancer Center, 1240 Lee St, Charlottesville, VA, 22903, USA
| | - Graham W Warren
- Medical University of South Carolina, 171 Ashley Ave, Charleston, SC, 29425, USA
| | - Timothy B Baker
- School of Medicine and Public Health, University of Wisconsin, 750 Highland Ave, Madison, WI, 53705, USA
| | - Betsy Rolland
- University of Wisconsin Carbone Cancer Center, 600 Highland Ave, Madison, WI, 53705, USA
- University of Wisconsin Institute for Clinical and Translational Research, 750 Highland Ave, Madison, WI, 53705, USA
| | - Michael C Fiore
- University of Wisconsin Carbone Cancer Center, 600 Highland Ave, Madison, WI, 53705, USA
- School of Medicine and Public Health, University of Wisconsin, 750 Highland Ave, Madison, WI, 53705, USA
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Rd, Gainesville, FL, 32610, USA.
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Schnoll RA, Leone FT, Quinn MH, Stevens N, Flitter A, Wileyto P, Kimberly J, Beidas RS, Hatzell J, Siegel SD, Crawford G, Hill N, Deatley T, Ziedonis D. A randomized clinical trial testing two implementation strategies to promote the treatment of tobacco dependence in community mental healthcare. Drug Alcohol Depend 2023; 247:109873. [PMID: 37084508 DOI: 10.1016/j.drugalcdep.2023.109873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/23/2023]
Abstract
INTRODUCTION People with serious mental illness (SMI) are more likely to smoke and less likely to receive tobacco treatment. Implementation strategies may address clinician and organizational barriers to treating tobacco in mental healthcare. METHODS A cluster-randomized trial (Clinic N=13, Client N=610, Staff N=222) tested two models to promote tobacco treatment in community mental healthcare: standard didactic training vs. Addressing Tobacco Through Organizational Change (ATTOC), an organizational model that provides clinician and leadership training and addresses system barriers to tobacco treatment. Primary outcomes were changes in tobacco treatment from clients, staff, and medical records. Secondary outcomes were changes in smoking, mental health, and quality of life (QOL), and staff skills and barriers to treat tobacco. RESULTS Clients at ATTOC sites reported a significant increase in receiving tobacco treatment from clinician at weeks 12 and 24 (ps<0.05) and tobacco treatments and policies from clinics at weeks 12, 24, 36, and 52 (ps<0.05), vs. standard sites. ATTOC staff reported a significant increase in skills to treat tobacco at week 36 (p=0.05), vs. standard sites. For both models, tobacco use medications, from clients (week 52) and medical records (week 36), increased (ps<0.05), while perceived barriers decreased at weeks 24 and 52 (ps<0.05); 4.3% of clients quit smoking which was not associated with model. QOL and mental health improved over 24 weeks for both models (ps<0.05). CONCLUSIONS Standard training and ATTOC improve use of evidence-based tobacco treatments in community mental healthcare without worsening mental health, but ATTOC may more effectively address this practice gap.
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Affiliation(s)
- Robert A Schnoll
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, United States.
| | - Frank T Leone
- Pulmonary, Allergy, & Critical Care Division, University of Pennsylvania, United States
| | - Mackenzie Hosie Quinn
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Nathaniel Stevens
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Alex Flitter
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Paul Wileyto
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - John Kimberly
- The Wharton School of Business, University of Pennsylvania, United States
| | - Rinad S Beidas
- Perelman School of Medicine, University of Pennsylvania, United States; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, United States
| | - Jane Hatzell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Scott D Siegel
- Institute for Research on Equity & Community Health (iREACH) and Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System,United States
| | - Grace Crawford
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Naja Hill
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Teresa Deatley
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
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Price SN, Neil JM, Flores M, Ponzani C, Muzikansky A, Ballini L, Ostroff JS, Park ER. Patient-Reported Receipt of Oncology Clinician-Delivered Brief Tobacco Treatment (5As) Six Months following Cancer Diagnosis. Oncology 2023; 101:328-342. [PMID: 36893738 PMCID: PMC10563136 DOI: 10.1159/000528963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/15/2022] [Accepted: 12/29/2022] [Indexed: 03/11/2023]
Abstract
INTRODUCTION Smoking after a cancer diagnosis represents a modifiable health risk. It is recommended that oncology clinicians address tobacco use among their patients using the 5As brief model: Asking about use, Advising users to quit, Assessing willingness to quit, Assisting in quit attempts (counseling and medication), and Arranging follow-up. However, cross-sectional studies have found limited adoption of 5As (especially Assist and Arrange) in oncology settings. Further investigation is needed to understand changes in, and factors associated with, 5As delivery over time. METHODS Patients recently diagnosed with cancer and reporting current smoking (N = 303) enrolled in a smoking cessation clinical trial and completed three longitudinal surveys; at pre-intervention baseline and 3- and 6-month follow-up post-enrollment. Patient-level correlates of 5As receipt at baseline, 3 months, and 6 months were identified using multilevel regression models. RESULTS At baseline, patient-reported rates of 5As receipt from oncology clinicians ranged from 85.17% (Ask) to 32.24% (Arrange). Delivery declined from baseline to 6-month follow-up for all 5As, with the largest declines observed for Ask, Advise, Assess, and Assist-Counseling. Diagnosis of a smoking-related cancer was associated with greater odds of 5As receipt at baseline but lower odds at 6-month follow-up. At each time point, female gender, religiosity, advanced disease, cancer-related stigma, and smoking abstinence were associated with lower odds of 5As receipt, while reporting a recent quit attempt prior to enrollment was associated with higher odds of 5As receipt. CONCLUSION Oncology clinicians' 5As delivery declined over time. Clinician delivery of the 5As varied based on patients' sociodemographics, clinical and smoking characteristics, and psychosocial factors.
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Affiliation(s)
- Sarah N. Price
- Department of Psychology, University of Arizona, Tucson, AZ, USA
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jordan M. Neil
- Departments of Psychiatry and Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, USA
| | - Melissa Flores
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Colin Ponzani
- Departments of Psychiatry and Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Alona Muzikansky
- Departments of Psychiatry and Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Lauren Ballini
- Department of Community Health, Tufts University, Medford, MA, USA
| | - Jamie S. Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elyse R. Park
- Departments of Psychiatry and Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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Otachi JK, Otis M, Flaherty C, Okoli CTC. Enhancing Provider Delivery of Tobacco Treatment Within the Inpatient Psychiatric Setting. Soc Work Public Health 2023; 38:72-83. [PMID: 35762032 DOI: 10.1080/19371918.2022.2093303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
People with mental illnesses (MI) smoke at higher rates than the general population. However, few mental health providers (MHPs) deliver tobacco treatment to patients with MI especially within inpatient psychiatric settings. According to evidence, fewer than half of MHPs in the US mental and behavioral health settings provide the recommended evidence-based tobacco treatment interventions to their clients with MI. This paper uses the theory of planned behavior to examine factors associated with provider intentions to deliver and their experiences in providing evidence-based tobacco treatment to clients with MI. Data were obtained from a cross-sectional survey of 219 providers in a state psychiatric hospital in Kentucky. Attitudes, subjective norms, and perceived behavioral control were associated with providers' intentions to deliver tobacco treatment when controlling for demographic and work-related variables. However, only profession, subjective norms, and attitudes were associated with reported provision of evidence-based tobacco treatment. Given the underuse of routine tobacco treatment for this vulnerable population, understanding factors influencing provider delivery of tobacco treatment is needed to guide strategies for reducing the disproportionate rates of tobacco use and related burden among people with MI.
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Affiliation(s)
- Janet K Otachi
- Senior Behavioral Health Social Worker, University of Kentucky Health Care (UKHC), Lexington, Kentucky, USA
| | - Melanie Otis
- College of Social Work, University of Kentucky, Lexington, Kentucky, USA
| | - Chris Flaherty
- College of Social Work, University of Kentucky, Lexington, Kentucky, USA
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Guo K, Zhou L, Shang X, Yang C, E F, Wang Y, Xu M, Wu Y, Li Y, Li M, Yang K, Li X. Varenicline and related interventions on smoking cessation: A systematic review and network meta-analysis. Drug Alcohol Depend 2022; 241:109672. [PMID: 36332593 DOI: 10.1016/j.drugalcdep.2022.109672] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/25/2022] [Accepted: 10/19/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Based on randomized controlled trials, a network meta-analysis was conducted to compare treatment effects across varenicline and related smoking interventions. METHODS English databases were screened for randomized controlled trials reporting the effect of varenicline as treatment for smoking. The risk of bias in included trials was assessed using the Cochrane Handbook tool. Stata 15.1 software was used to perform network meta-analysis, and the GRADE approach was used to assess the evidence credibility on the tobacco treatment effects of different interventions. RESULTS Thirty-four studies involving 26,130 smokers were included in the network meta-analysis. Varenicline and 11 other interventions were reported, yielding 66 pairs of comparisons. Network meta-analysis showed that varenicline monotherapy or its combination with other interventions were superior in achieving smoking cessation compared to bupropion, nicotine replacement therapy, counselling, and placebo. Furthermore, compared to the varenicline, evident abstinence superiority was found in varenicline + bupropion (odds ratio = 1.49, 95% confidence interval [1.02, 2.18]). Finally, the surface under the cumulative ranking curve value indicated that varenicline + bupropion has the highest probability to become the best intervention. CONCLUSIONS Varenicline monotherapy increased the odds of smoking cessation further than bupropion monotherapy, nicotine replacement therapy, counselling, and placebo, while varenicline combined with other interventions may even achieve a better abstinence effect. More credible evidence has been reported indicating that the combination of varenicline and bupropion is a superior treatment for smoking.
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Jackson MA, Buykx P, Brown AL, Baker AL, Dunlop AJ, Gould GS. Using mixed methods to establish tobacco treatment acceptability from the perspective of clients and clinicians of antenatal substance use services. Addict Sci Clin Pract 2022; 17:56. [PMID: 36195932 PMCID: PMC9531520 DOI: 10.1186/s13722-022-00337-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 09/12/2022] [Indexed: 11/29/2022] Open
Abstract
Background Up to 95% of pregnant women with alcohol and other drug (AOD) problems also smoke tobacco. Challenging psychosocial circumstances and a lack of targeted tobacco interventions contribute to low rates of prenatal abstinence and more effective treatment strategies are required. This study explores smoking in pregnant clients of AOD treatment services from a consumer and healthcare provider perspective to examine characteristics of behaviour change and the acceptability of evidence-based tobacco treatment strategies. Outcomes will support the design and implementation of a comprehensive tobacco intervention. Methods A mixed methods triangulated design was used. Thirteen women who smoked and attended antenatal AOD services in New South Wales, Australia, were interviewed and 28 clinicians from the same services were surveyed. Domains including experiences of tobacco smoking in pregnancy, motivators and barriers to cessation and evidence-based strategies to assist cessation during pregnancy were explored. Interviews were analysed using Iterative Categorization, with interpretation guided by Qualitative Description. Online surveys were analysed descriptively. A convergent-parallel mixed methods analysis was performed. Results Women and clinicians agreed that improving baby’s health outcomes was the primary motivation to stop smoking. Negative experiences with nicotine replacement therapy (NRT), financial constraints and maternal contraindications restricted its uptake and effectiveness during pregnancy. Both groups agreed that other AOD use, stopping multiple substances concurrently, difficulty coping with stress and the influence of partners who smoke had the biggest impacts on cessation efforts. Clinicians favoured harm-reduction rather than abstinence-based tobacco interventions and women appeared satisfied with reduction efforts. Both views may influence the attainment of prenatal abstinence-based goals. Although previous evidence suggested the contrary, clinicians were willing to encourage simultaneous cessation of tobacco and other substances. Non-judgmental treatment approaches that provide extra support, education and motivation were important for women. Women and clinicians supported use of NRT despite concerns. Financial incentives, counselling, partner support and offering tobacco treatment with antenatal AOD care were considered acceptable treatment options. Conclusions NRT, incentives, counselling and partner support could be utilized in a tobacco intervention for pregnant women with substance use concerns. Non-judgmental education, motivation, and provision of NRT including instruction for correct use are important considerations. Supplementary Information The online version contains supplementary material available at 10.1186/s13722-022-00337-y.
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Affiliation(s)
- Melissa A Jackson
- Hunter New England Local Health District Drug and Alcohol Clinical Services, Level 3, 670 Hunter Street, Newcastle, NSW, 2290, Australia.
| | - Penny Buykx
- School of Humanities, Creative Industries and Social Sciences, University of Newcastle, Callaghan, NSW, Australia
| | - Amanda L Brown
- Hunter New England Local Health District Drug and Alcohol Clinical Services, Level 3, 670 Hunter Street, Newcastle, NSW, 2290, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Adrian J Dunlop
- Hunter New England Local Health District Drug and Alcohol Clinical Services, Level 3, 670 Hunter Street, Newcastle, NSW, 2290, Australia
| | - Gillian S Gould
- Faculty of Health, Southern Cross University, Lismore, NSW, Australia
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Unger S, Golden SE, Melzer AC, Tanner N, Deepak J, Delorit M, Scott JY, Slatore CG. Study design for a proactive teachable moment tobacco treatment intervention among patients with pulmonary nodules. Contemp Clin Trials 2022; 121:106908. [PMID: 36087843 DOI: 10.1016/j.cct.2022.106908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/01/2022] [Accepted: 09/01/2022] [Indexed: 01/27/2023]
Abstract
INTRODUCTION We developed Teachable Moment to Opt-Out of Tobacco (TeaM OUT) as a tobacco treatment intervention based on a foundation of a theoretical model of teachable moments, "naturally occurring life transitions or health events thought to motivate individuals to spontaneously adopt risk-reducing health behaviors". The TeaM OUT intervention combines a teachable moment for patients with newly detected incidental pulmonary nodules with a proactive interactive voice response (IVR) system to increase connections to evidence-based tobacco treatment interventions. METHODS We will perform a convergent, nested observational mixed-methods study utilizing both randomized trial and observational methods to test the effectiveness and generalizability of the TeaM OUT intervention through three aims. AIM 1: Among patients recently diagnosed with a pulmonary nodule, we will utilize a pragmatic, stepped wedge randomized controlled design to evaluate the effectiveness of a proactive, teachable moment-based, tobacco treatment outreach intervention (TeaM OUT) on increasing engagement with tobacco treatment resources compared to Enhanced Usual Care. AIM 2: Using a longitudinal observational design, we will evaluate the association of receipt of the TeaM OUT intervention with seven-day point abstinence prevalence and quit motivation compared to Enhanced Usual Care. AIM 3: Qualitatively elicit perspectives from key stakeholders to inform acceptability and utility, implementation barriers and facilitators, and scalability of the TeaM OUT intervention. DISCUSSION We are hopeful that implementation of TeaM OUT will increase the number of patients who quit using cigarettes with subsequent improvements in their health.
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Affiliation(s)
- Stephanie Unger
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System; Portland, OR, USA
| | - Sara E Golden
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System; Portland, OR, USA.
| | - Anne C Melzer
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System; Minneapolis, MN, USA; Division of Pulmonary, Allergy, Critical Care and Sleep, Department of Medicine, University of Minnesota; Minneapolis, MN, USA
| | - Nichole Tanner
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veteran Affairs Hospital, Charleston, SC, USA; Division of Pulmonary, Critical Care, Allergy & Sleep, Department of Medicine, Medical University of South Carolina; Charleston, SC, USA
| | - Janaki Deepak
- Division of Pulmonary & Critical Care Medicine, University of Maryland Medical System; Baltimore, MD, USA; Baltimore VA Medical Center; Baltimore, MD, USA
| | - Molly Delorit
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System; Portland, OR, USA
| | - Jennifer Y Scott
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System; Portland, OR, USA
| | - Christopher G Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System; Portland, OR, USA; Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System; Portland, OR, USA; Division of Pulmonary & Critical Care Medicine, Department of Medicine, Oregon Health & Science University; Portland, OR, USA
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Ostroff JS, Shelley DR, Chichester LA, King JC, Li Y, Schofield E, Ciupek A, Criswell A, Acharya R, Banerjee SC, Elkin EB, Lynch K, Weiner BJ, Orlow I, Martin CM, Chan SV, Frederico V, Camille P, Holland S, Kenney J. Study protocol of a multiphase optimization strategy trial (MOST) for delivery of smoking cessation treatment in lung cancer screening settings. Trials 2022; 23:664. [PMID: 35978334 PMCID: PMC9383667 DOI: 10.1186/s13063-022-06568-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/01/2022] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is widespread agreement that the integration of cessation services in lung cancer screening (LCS) is essential for achieving the full benefits of LCS with low-dose computed tomography (LDCT). There is a formidable knowledge gap about how to best design feasible, effective, and scalable cessation services in LCS facilities. A collective of NCI-funded clinical trials addressing this gap is the Smoking Cessation at Lung Examination (SCALE) Collaboration. METHODS The Cessation and Screening to Save Lives (CASTL) trial seeks to advance knowledge about the reach, effectiveness, and implementation of tobacco treatment in lung cancer screening. We describe the rationale, design, evaluation plan, and interventions tested in this multiphase optimization strategy trial (MOST). A total of 1152 screening-eligible current smokers are being recruited from 18 LCS sites (n = 64/site) in both academic and community settings across the USA. Participants receive enhanced standard care (cessation advice and referral to the national Quitline) and are randomized to receive additional tobacco treatment components (motivational counseling, nicotine replacement patches/lozenges, message framing). The primary outcome is biochemically validated, abstinence at 6 months follow-up. Secondary outcomes are self-reported smoking abstinence, quit attempts, and smoking reduction at 3 and 6 months. Guided by the Implementation Outcomes Framework (IOF), our evaluation includes measurement of implementation processes (reach, fidelity, acceptability, appropriateness, sustainability, and cost). CONCLUSION We will identify effective treatment components for delivery by LCS sites. The findings will guide the assembly of an optimized smoking cessation package that achieves superior cessation outcomes. Future trials can examine the strategies for wider implementation of tobacco treatment in LDCT-LCS sites. TRIAL REGISTRATION ClinicalTrials.gov NCT03315910.
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Affiliation(s)
- Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA.
| | - Donna R Shelley
- School of Global Public Health, New York University, New York, USA
| | - Lou-Anne Chichester
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | | | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Elizabeth Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Andrew Ciupek
- GO2 Foundation for Lung Cancer, Washington, D.C., USA
| | | | | | - Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Elena B Elkin
- Department of Health Policy and Management, Columbia Mailman School of Public Health, New York, USA
| | - Kathleen Lynch
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Bryan J Weiner
- Department of Global Health, University of Washington, Seattle, USA
| | - Irene Orlow
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Chloé M Martin
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Sharon V Chan
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Victoria Frederico
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Phillip Camille
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Susan Holland
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
| | - Jessica Kenney
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA
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Haber Y, Fu SS, Rogers E, Richter K, Tenner C, Dognin J, Goldfeld K, Gold HT, Sherman SE. A novel opt-in vs opt-out approach to referral-based treatment of tobacco use in Veterans Affairs (VA) primary care clinics: A provider-level randomized controlled trial protocol. Contemp Clin Trials 2022; 116:106716. [PMID: 35276337 DOI: 10.1016/j.cct.2022.106716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/16/2021] [Revised: 02/17/2022] [Accepted: 02/23/2022] [Indexed: 11/18/2022]
Abstract
To determine whether an opt-out approach is effective for referral to treatment for tobacco use, we designed a clinical reminder for nurses in a primary care setting that provides a referral for patients who smoke cigarettes. We will use a two-arm, cluster-randomized design to assign nurses at the VA New York Harbor Healthcare System to test which mode of referral (opt-in vs opt-out) is more effective. All patients will be referred to evidence-based treatment for tobacco cessation including counseling from the New York State Quitline, and VetsQuit, a text messaging-based system for tobacco cessation counseling. We will measure patient engagement with the referral both in the short and long term to determine if referral modality had an impact on tobacco cessation treatment. We will also measure nurse engagement with the referral before, during, and after the implementation of the reminder to determine whether an opt-out approach is cost effective at the health system level. At the conclusion of this project, we expect to have developed and tested an opt-out system for increasing tobacco cessation treatment for Veterans in VA primary care and to have a thorough understanding of factors associated with implementation. Trial Registration:Clinicaltrials.govIdentifierNCT03477435.
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Affiliation(s)
- Yaa Haber
- VA New York Harbor Healthcare System, New York, NY, USA; Department of Medicine, VA New York Harbor Healthcare System, New York, NY, USA; NYU Grossman School of Medicine, Department of Population Health, New York, NY, USA.
| | - Steven S Fu
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Erin Rogers
- VA New York Harbor Healthcare System, New York, NY, USA; NYU Grossman School of Medicine, Department of Population Health, New York, NY, USA
| | - Kim Richter
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Craig Tenner
- VA New York Harbor Healthcare System, New York, NY, USA; NYU Grossman School of Medicine, Department of Medicine, New York, NY, USA
| | - Joanna Dognin
- VA New York Harbor Healthcare System, New York, NY, USA; NYU Grossman School of Medicine, Department of Medicine, New York, NY, USA; Department of Psychology, VA New York Harbor Healthcare System, New York, NY, USA
| | - Keith Goldfeld
- VA New York Harbor Healthcare System, New York, NY, USA; NYU Grossman School of Medicine, Department of Population Health, New York, NY, USA
| | - Heather T Gold
- VA New York Harbor Healthcare System, New York, NY, USA; NYU Grossman School of Medicine, Department of Population Health, New York, NY, USA
| | - Scott E Sherman
- VA New York Harbor Healthcare System, New York, NY, USA; NYU Grossman School of Medicine, Department of Population Health, New York, NY, USA; NYU Grossman School of Medicine, Department of Medicine, New York, NY, USA
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Bailey SR, Voss R, Angier H, Huguet N, Marino M, Valenzuela SH, Chung-Bridges K, DeVoe JE. Affordable Care Act Medicaid expansion and access to primary-care based smoking cessation assistance among cancer survivors: an observational cohort study. BMC Health Serv Res 2022; 22:488. [PMID: 35414079 PMCID: PMC9004133 DOI: 10.1186/s12913-022-07860-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/13/2021] [Accepted: 03/29/2022] [Indexed: 12/05/2022] Open
Abstract
Background Smoking among cancer survivors can increase the risk of cancer reoccurrence, reduce treatment effectiveness and decrease quality of life. Cancer survivors without health insurance have higher rates of smoking and decreased probability of quitting smoking than cancer survivors with health insurance. This study examines the associations of the Affordable Care Act (ACA) Medicaid insurance expansion with smoking cessation assistance and quitting smoking among cancer survivors seen in community health centers (CHCs). Methods Using electronic health record data from 337 primary care community health centers in 12 states that expanded Medicaid eligibility and 273 CHCs in 8 states that did not expand, we identified adult cancer survivors with a smoking status indicating current smoking within 6 months prior to ACA expansion in 2014 and ≥ 1 visit with smoking status assessed within 24-months post-expansion. Using an observational cohort propensity score weighted approach and logistic generalized estimating equation regression, we compared odds of quitting smoking, having a cessation medication ordered, and having ≥6 visits within the post-expansion period among cancer survivors in Medicaid expansion versus non-expansion states. Results Cancer survivors in expansion states had higher odds of having a smoking cessation medication order (adjusted odds ratio [aOR] = 2.54, 95%CI = 1.61-4.03) and higher odds of having ≥6 office visits than those in non-expansion states (aOR = 1.82, 95%CI = 1.22-2.73). Odds of quitting smoking did not differ significantly between patients in Medicaid expansion versus non-expansion states. Conclusions The increased odds of having a smoking cessation medication order among cancer survivors seen in Medicaid expansion states compared with those seen in non-expansion states provides evidence of the importance of health insurance coverage in accessing evidence-based tobacco treatment within CHCs. Continued research is needed to understand why, despite increased odds of having a cessation medication prescribed, odds of quitting smoking were not significantly higher among cancer survivors in Medicaid expansion states compared to non-expansion states.
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Affiliation(s)
- Steffani R Bailey
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA.
| | - Robert Voss
- OCHIN, Inc, 1881 SW Naito Parkway, Portland, OR, USA
| | - Heather Angier
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - Nathalie Huguet
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA.,Division of Biostatistics, School of Public Health, Oregon Health & Science University - Portland State University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - Steele H Valenzuela
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | | | - Jennifer E DeVoe
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
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15
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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] [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: 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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Neil JM, Marotta C, Gonzalez I, Chang Y, Levy DE, Wint A, Harris K, Hawari S, Noonan E, Styklunas G, Crute S, Howard SE, Sheppard J, Lennes IT, Jacobson F, Flores EJ, Haas JS, Park ER, Rigotti NA. Integrating tobacco treatment into lung cancer screening practices: Study protocol for the Screen ASSIST randomized clinical trial. Contemp Clin Trials 2021; 111:106586. [PMID: 34606988 PMCID: PMC8874354 DOI: 10.1016/j.cct.2021.106586] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Integrating tobacco treatment services into lung cancer screening (LCS) has the potential to leverage a 'teachable moment' to promote cessation among long-term smokers and reduce disparities in tobacco treatment access. This protocol paper describes the Screen ASSIST (Aiding Screening Support In Stopping Tobacco) trial, which will identify how to best deliver evidence-driven tobacco treatment in the context of LCS. METHODS Screen ASSIST is a randomized clinical trial with a 3-factor, fully crossed factorial design that enrolls current smokers (any cigarette use in the past 30 days) scheduled to attend LCS at multiple sites in the Mass General Brigham healthcare system. To maximize reach, recruitment is conducted at 3 time points: 1) at the time of LCS scheduling, 2) at the LCS visit, and 3) after the participant has received their LCS results. Participants are stratified by LCS study site and recruitment point and randomly assigned into 8 groups that test intervention components varying on telehealth counseling duration (4 weeks vs. 8 weeks), nicotine replacement therapy duration (2 weeks vs. 8 weeks), and systematic screening and referral for social determinants of health via a service named 'AuntBertha' (referral vs. no referral). The primary study outcome is self-reported past 7-day tobacco abstinence at 6-month follow-up. This trial will also assess systems integration and evaluate implementation of the intervention. DISCUSSION Screen ASSIST will identify the most effective combination of tobacco cessation treatments within the LCS context, in order to improve the cost-effectiveness of LCS and quality of life among long-term heavy smokers.
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Affiliation(s)
- Jordan M Neil
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America; TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, United States of America; Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
| | - Caylin Marotta
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Irina Gonzalez
- Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Yuchiao Chang
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Douglas E Levy
- Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Amy Wint
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Kimberly Harris
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Saif Hawari
- Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Elise Noonan
- Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Grace Styklunas
- Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Sydney Crute
- Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Sydney E Howard
- Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Joanne Sheppard
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Inga T Lennes
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Francine Jacobson
- Department of Radiology, Brigham and Women's Faulkner Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Efren J Flores
- Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Jennifer S Haas
- Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Elyse R Park
- Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Nancy A Rigotti
- Health Promotion and Resiliency and Intervention Research Program; Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
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17
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Salloum RG, D'Angelo H, Theis RP, Rolland B, Hohl S, Pauk D, LeLaurin JH, Asvat Y, Chen LS, Day AT, Goldstein AO, Hitsman B, Hudson D, King AC, Lam CY, Lenhoff K, Levinson AH, Prochaska J, Smieliauskas F, Taylor K, Thomas J, Tindle H, Tong E, White JS, Vogel WB, Warren GW, Fiore M. Mixed-methods economic evaluation of the implementation of tobacco treatment programs in National Cancer Institute-designated cancer centers. Implement Sci Commun 2021; 2:41. [PMID: 33836840 PMCID: PMC8033545 DOI: 10.1186/s43058-021-00144-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 04/01/2021] [Indexed: 11/25/2022] Open
Abstract
Background The Cancer Center Cessation Initiative (C3I) was launched in 2017 as a part of the NCI Cancer Moonshot program to assist NCI-designated cancer centers in developing tobacco treatment programs for oncology patients. Participating centers have implemented varied evidence-based programs that fit their institutional resources and needs, offering a wide range of services including in-person and telephone-based counseling, point of care, interactive voice response systems, referral to the quitline, text- and web-based services, and medications. Methods We used a mixed methods comparative case study design to evaluate system-level implementation costs across 15 C3I-funded cancer centers that reported for at least one 6-month period between July 2018 and June 2020. We analyzed operating costs by resource category (e.g., personnel, medications) concurrently with transcripts from semi-structured key-informant interviews conducted during site visits. Personnel salary costs were estimated using Bureau of Labor Statistics wage data adjusted for area and occupation, and non-wage benefits. Qualitative findings provided additional information on intangible resources and contextual factors related to implementation costs. Results Median total monthly operating costs across funded centers were $11,045 (range: $5129–$20,751). The largest median operating cost category was personnel ($10,307; range: $4122–$19,794), with the highest personnel costs attributable to the provision of in-person program services. Monthly (non-zero) cost ranges for other categories were medications ($17–$573), materials ($6–$435), training ($96–$516), technology ($171–$2759), and equipment ($10–$620). Median cost-per-participant was $466 (range: $70–$2093) and cost-per-quit was $2688 (range: $330–$9628), with sites offering different combinations of program components, ranging from individually-delivered in-person counseling only to one program that offered all components. Site interviews provided context for understanding variations in program components and their cost implications. Conclusions Among most centers that have progressed in tobacco treatment program implementation, cost-per-quit was modest relative to other prevention interventions. Although select centers have achieved similar average costs by offering program components of various levels of intensity, they have varied widely in program reach and effectiveness. Evaluating implementation costs of such programs alongside reach and effectiveness is necessary to provide decision makers in oncology settings with the important additional information needed to optimize resource allocation when establishing tobacco treatment programs.
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Affiliation(s)
- Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL, USA.
| | | | - Ryan P Theis
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL, USA
| | - Betsy Rolland
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA.,University of Wisconsin Institute for Clinical and Translational Research, Madison, WI, USA
| | - Sarah Hohl
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Danielle Pauk
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Jennifer H LeLaurin
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL, USA
| | - Yasmin Asvat
- Rush University Medical Center and Rush Cancer Center, Chicago, IL, USA
| | - Li-Shiun Chen
- Washington University Siteman Cancer Center, St Louis, MO, USA
| | - Andrew T Day
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Adam O Goldstein
- University of North Carolina Lineberger Cancer Center, Chapel Hill, NC, USA
| | - Brian Hitsman
- Northwestern University Feinberg School of Medicine and Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | - Deborah Hudson
- Indiana University Simon Cancer Center, Indianapolis, IN, USA
| | - Andrea C King
- University of Chicago Medicine Comprehensive Cancer Center, Chicago, IL, USA
| | - Cho Y Lam
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Katie Lenhoff
- Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, NH, USA
| | | | - Judith Prochaska
- Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | | | - Kathryn Taylor
- Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Janet Thomas
- University of Minnesota Masonic Cancer Center, Minneapolis, MN, USA
| | - Hilary Tindle
- Vanderbilt University Medical Center Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Elisa Tong
- University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Justin S White
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - W Bruce Vogel
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL, USA
| | - Graham W Warren
- Medical University of South Carolina Hollings Cancer Center, Charleston, SC, USA
| | - Michael Fiore
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA.,University of Wisconsin Institute for Clinical and Translational Research, Madison, WI, USA.,University of Wisconsin Center for Tobacco Research and Intervention, Madison, WI, USA
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18
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Quintiliani LM, Kathuria H, Truong V, Murillo J, Borrelli B, Xuan Z, Lasser KE. Patient navigation among recently hospitalized smokers to promote tobacco treatment: Results from a randomized exploratory pilot study. Addict Behav 2021; 113:106659. [PMID: 33010473 PMCID: PMC7946867 DOI: 10.1016/j.addbeh.2020.106659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/28/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Adding screening for health-related social needs to tobacco treatment interventions initiated during hospitalizations may improve intervention effectiveness among vulnerable populations. Our objective was to examine the effect the acceptability and feasibility of a intervention in which a patient navigator screens for and addresses social needs to increase receipt of smoking cessation medication among recently hospitalized smokers at a safety-net hospital. METHODS In a two-group randomized exploratory pilot study, we assigned hospitalized smokers to either the Enhanced Traditional Control (ETC) group (list of smoking cessation resources) or ETC + Patient Navigation (up to 10 h of navigation over a 3-month period, in which a navigator screens for and addresses health-related social needs). We assessed socio-demographics, smoking-related variables, and process data. RESULTS Of 171 individuals screened, 44 (26%) were enrolled. Participants (mean age = 54.9 years, 61.4% non-Hispanic black, 68.2% high school education or less) smoked a mean of 11.4 cigarettes/day. 20 participants received a prescription for a cessation medication, 42.9% in the ETC group and 47.8% in the ETC + Patient Navigation group. 11 participants (47.8%) in the ETC + Patient Navigation group received the minimum intervention dose (completion of the social needs screener and at least one counseling session). Barriers to navigation were participants' medical illness and difficulty connecting with participants. CONCLUSIONS Although nearly half of hospitalized smokers receiving support from a patient navigator received a prescription for a smoking cessation medication, the percentage did not differ by study arm. Refinement of the protocol to coordinate with hospital-wide tobacco treatment and social needs screening initiatives is needed.
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Affiliation(s)
- Lisa M Quintiliani
- Boston University, School of Medicine, Boston Medical Center, Section of General Internal Medicine, 801 Massachusetts Ave., Crosstown 2, Boston, MA 02118, United States.
| | - Hasmeena Kathuria
- Boston University, School of Medicine, The Pulmonary Center, Boston Medical Center, Section of Pulmonary, Allergy, Sleep & Critical Care Medicine, 72 East Concord St., Boston, MA 02118, United States
| | - Ve Truong
- Boston Medical Center, Section of General Internal Medicine, 801 Massachusetts Ave., Crosstown 2, Boston, MA 02118, United States
| | - Jennifer Murillo
- Boston Medical Center, Section of General Internal Medicine, 801 Massachusetts Ave., Crosstown 2, Boston, MA 02118, United States
| | - Belinda Borrelli
- Boston University, Henry M. Goldman School of Dental Medicine, Center for Behavioral Science Research, 560 Harrison Ave., Boston, MA 02118, United States
| | - Ziming Xuan
- Boston University, School of Public Health, 801 Massachusetts Ave., Crosstown CT453, Boston, MA 02118, United States
| | - Karen E Lasser
- Boston University, School of Medicine, Boston Medical Center, Section of General Internal Medicine, 801 Massachusetts Ave., Crosstown 2, Boston, MA 02118, United States
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19
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D'Angelo H, Ramsey AT, Rolland B, Chen LS, Bernstein SL, Fucito LM, Webb Hooper M, Adsit R, Pauk D, Rosenblum MS, Cinciripini PM, Joseph A, Ostroff JS, Warren GW, Fiore MC, Baker TB. Pragmatic Application of the RE-AIM Framework to Evaluate the Implementation of Tobacco Cessation Programs Within NCI-Designated Cancer Centers. Front Public Health 2020; 8:221. [PMID: 32596200 PMCID: PMC7304341 DOI: 10.3389/fpubh.2020.00221] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 10/05/2019] [Accepted: 05/13/2020] [Indexed: 11/13/2022] Open
Abstract
Tobacco cessation after cancer diagnosis leads to better patient outcomes. However, tobacco treatment services are frequently unavailable in cancer care settings, and multilevel implementation challenges can impede uptake of new programs. The National Cancer Institute (NCI) dedicated Cancer Moonshot funding through the Cancer Center Cessation Initiative (C3I) for NCI-Designated Cancer Centers to implement or enhance the implementation of tobacco treatment services. We examined a pragmatic application of the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance) to evaluate tobacco treatment programs implemented within Cancer Centers funded through C3I. Using three C3I-funded Centers as examples, we describe how each RE-AIM construct was operationalized to evaluate the implementation of a wide range of cessation services (e.g., tobacco use screening, counseling, Quitline referral, pharmacotherapy) in this heterogeneous group of cancer care settings. We discuss the practical challenges encountered in assessing RE-AIM constructs in real world situations, including using the electronic health record (EHR) to aid in assessment. Reach and effectiveness evaluation required that Centers define the setting(s) where cessation services were implemented (to determine the “denominator”), enumerate the patient population, report current patient tobacco use, patient engagement in tobacco treatment, and 6-month cessation outcomes. To reduce site heterogeneity, increase data accuracy, and reduce burden, reach was frequently captured via standardized EHR enhancements that improved the identification of current smokers and tobacco treatment referrals. Effectiveness was determined by cessation outcomes (30-day point prevalence abstinence at 6-months post-engagement) assessed through a variety of data collection approaches. Adoption was measured by the characteristics and proportion of targeted cancer care settings and clinicians engaged in cessation service delivery. Implementation was assessed by examining the delivery of tobacco screening assessments and intervention components across sites, and provider-level implementation consistency. Maintenance assessments identified whether tobacco treatment services continued in the setting after implementation and documented the sustainability plan and organizational commitment to continued delivery. In sum, this paper demonstrates a pragmatic approach to using RE-AIM as an evaluation framework that yields relevant outcomes on common implementation metrics across widely differing tobacco treatment approaches and settings.
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Affiliation(s)
- Heather D'Angelo
- Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Alex T Ramsey
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States.,Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, United States
| | - Betsy Rolland
- Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States.,Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Li-Shiun Chen
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States.,Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, United States
| | - Steven L Bernstein
- Yale Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Lisa M Fucito
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States.,Yale Cancer Center, Smilow Cancer Hospital at Yale-New Haven, New Haven, CT, United States
| | - Monica Webb Hooper
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, United States
| | - Robert Adsit
- Department of Medicine, Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Danielle Pauk
- Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Marika S Rosenblum
- Department of Medicine, Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States.,Department of Research, William S. Middleton Memorial Veterans Hospital, Madison, WI, United States
| | - Paul M Cinciripini
- Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Anne Joseph
- Department of Medicine, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Graham W Warren
- Department of Radiation Oncology, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States.,Department of Cell and Molecular, Pharmacology and Experimental Therapeutics, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Michael C Fiore
- Department of Medicine, Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Timothy B Baker
- Department of Medicine, Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
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20
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Abstract
Rates of certain tobacco products have decreased over the past decade, but nicotine use disorder is still prevalent among adolescents. New trends in tobacco use, such as in the use of electronic cigarettes, are creating alarm. This article reviews nicotine addiction and measurement in adolescents, along with potential health risks and comorbidities. Various psychosocial and pharmacologic interventions are reviewed along with novel interventions that show promise for reducing tobacco use in this vulnerable population.
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21
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Orr MF, Burduli E, Hirchak KA, Walsh Dotson JA, Young SL, Nelson L, Lennstrom E, Slaney T, Bush T, Gillaspy SR, Roll JM, Buchwald D, McPherson SM. Culturally-tailored text-messaging intervention for smoking cessation in rural American Indian communities: Rationale, design, and methods. Contemp Clin Trials Commun 2019; 15:100363. [PMID: 31049463 PMCID: PMC6484287 DOI: 10.1016/j.conctc.2019.100363] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 03/23/2019] [Accepted: 04/12/2019] [Indexed: 10/27/2022] Open
Abstract
Background American Indian (AI) and Alaska Native (AN) communities experience disproportionately high rates of tobacco use when compared to the overall U.S. population, especially among rural populations. Methods We implemented a single-blind, randomized clinical trial of a text messaging-based smoking cessation intervention through the tobacco quitlines of five states (Alaska, Minnesota, New Mexico, Oklahoma, and Wisconsin) with high percentages of AI residents. We partnered with state quitlines and Optum, a multi-state entity that manages quitlines. Participants who called the quitlines and identified as AI/AN were given the option to enroll in this trial. Upon consent, they were randomly assigned to either the standard quitline program (control) or a program culturally tailored for AI/ANs (intervention), which used a text messaging intervention to encourage smoking cessation. We adapted the text messages based on key informant and focus group input. Baseline data was analyzed for differences across age, sex, and the Fagerström Test for Nicotine Dependence. Results We recruited n = 487 AIs into the trial. Participants had an average age of 41.9 years (SD = 11.7) and 66% were female. The average Fagerström Test for Nicotine Dependence score was 5.38 (SD = 2.37). The intervention and control arms did not significantly differ across any of the baseline characteristics. Conclusion Implementation of this trial illustrated important lessons in adapting, implementing, and evaluating trials in collaboration with AI communities and local and national organizations. This work will inform future efforts to implement culturally-tailored interventions with AI/ANs and advance our knowledge about adapting and implementing smoking cessation interventions.
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Affiliation(s)
- Michael F Orr
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, 99210-1495, USA.,Program of Excellence in Addictions Research (PEAR), Washington State University, Spokane, WA, 99210-1495, USA.,College of Nursing, Washington State University, Spokane, WA, 99210-1495, USA
| | - Ekaterina Burduli
- Program of Excellence in Addictions Research (PEAR), Washington State University, Spokane, WA, 99210-1495, USA.,College of Nursing, Washington State University, Spokane, WA, 99210-1495, USA
| | - Katherine A Hirchak
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, 99210-1495, USA.,Initiative for Research and Education to Advance Community Health, Washington State University (IREACH), Spokane, WA, 99210-1495, USA.,Program of Excellence in Addictions Research (PEAR), Washington State University, Spokane, WA, 99210-1495, USA
| | - Jo Ann Walsh Dotson
- Program of Excellence in Addictions Research (PEAR), Washington State University, Spokane, WA, 99210-1495, USA.,College of Nursing, Washington State University, Spokane, WA, 99210-1495, USA
| | - Sara L Young
- Montana State University, Bozeman, MT, 59717-2220, USA
| | - Lonnie Nelson
- Initiative for Research and Education to Advance Community Health, Washington State University (IREACH), Spokane, WA, 99210-1495, USA.,College of Nursing, Washington State University, Spokane, WA, 99210-1495, USA
| | - Emma Lennstrom
- Initiative for Research and Education to Advance Community Health, Washington State University (IREACH), Spokane, WA, 99210-1495, USA
| | - Trevor Slaney
- Initiative for Research and Education to Advance Community Health, Washington State University (IREACH), Spokane, WA, 99210-1495, USA
| | - Terry Bush
- Optum 11000 Optum Circle, Eden Prairie, MN, 55344, USA
| | - Stephen R Gillaspy
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - John M Roll
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, 99210-1495, USA.,Program of Excellence in Addictions Research (PEAR), Washington State University, Spokane, WA, 99210-1495, USA.,College of Nursing, Washington State University, Spokane, WA, 99210-1495, USA
| | - Dedra Buchwald
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, 99210-1495, USA.,Initiative for Research and Education to Advance Community Health, Washington State University (IREACH), Spokane, WA, 99210-1495, USA
| | - Sterling M McPherson
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, 99210-1495, USA.,Program of Excellence in Addictions Research (PEAR), Washington State University, Spokane, WA, 99210-1495, USA
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22
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Okoli CT, Al-Mrayat YD, Shelton CI, Khara M. A retrospective analysis of the association between providing nicotine replacement therapy at admission and motivation to quit and nicotine withdrawal symptoms during an inpatient psychiatric hospitalization. Addict Behav 2018; 85:131-138. [PMID: 29908433 DOI: 10.1016/j.addbeh.2018.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 06/05/2018] [Accepted: 06/06/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Psychiatric patients have high tobacco use prevalence, dependence, and withdrawal severity. A tobacco-free psychiatric hospitalization necessitates the management of nicotine withdrawal (NW) for tobacco using patients. NW management often requires the provision of approved nicotine replacement therapy (NRT) to patients, which may also motivate tobacco users towards cessation. However, few studies have examined the associations between providing NRT, motivation to quit, and NW among psychiatric patients. OBJECTIVE(S) To examine the associations between providing NRT at admission and motivation to quit smoking and severity of NW symptoms. DESIGN A retrospective review of the medical records of 255 tobacco using patients on whom NW was assessed during their hospital stay. The time when NRT was provided (i.e., at admission vs. not provided vs. on the unit), motivation to quit smoking, and 8-item Minnesota Nicotine Withdrawal Scale were assessed. RESULTS The primary NW symptom was 'craving' (65.1%); reporting of 'anxiety' varied by psychiatric diagnosis. Providing NRT at admission was not associated with motivation to quit. Patients receiving NRT on the unit (i.e., delayed receipt) had significantly higher NW than those who received NRT at admission. In multivariate analyses, receiving NRT on the unit was significantly associated with greater NW severity (β = .19, p = .002). CONCLUSIONS Among psychiatric patients, providing NRT at admission is associated with greater severity of NW. The provision of NRT for NW management may be considered as standard practice during tobacco-free psychiatric stays. Future studies may consider the effect of other tobacco treatment medications (such as varenicline, bupropion) on managing NW.
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23
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Baldassarri SR, Bernstein SL, Chupp GL, Slade MD, Fucito LM, Toll BA. Electronic cigarettes for adults with tobacco dependence enrolled in a tobacco treatment program: A pilot study. Addict Behav 2018; 80:1-5. [PMID: 29304395 DOI: 10.1016/j.addbeh.2017.11.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 11/05/2017] [Accepted: 11/24/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Electronic cigarettes (ECs) have emerged as a potential harm-reducing alternative for tobacco smokers. However, the role ECs might play in treatment settings is unclear. We conducted an exploratory study of treatment-seeking smokers enrolling in a standard tobacco treatment program who were provided with either a nicotine or non-nicotine EC to use as needed to cease tobacco smoking. METHODS Treatment-seeking smokers received standard tobacco treatment for 8weeks and were given nicotine transdermal patch therapy, behavioral counseling, and either a nicotine or non-nicotine EC to use as needed. Smoking and EC use patterns were tracked longitudinally to week 24. RESULTS 40 subjects were enrolled into the study. At week 24, 6 subjects (15%) were abstinent, and the mean reduction in reported cigarettes smoked per day was 6.8±12. There were no significant differences in smoking outcomes between those who received a nicotine or non-nicotine EC (proportion abstinent at 24weeks: nicotine EC=4/20 (20%); non-nicotine EC=2/20 (10%); p=0.66). Among subjects assessed at follow-up, 62.5% were EC non-users. CONCLUSIONS The addition of a 2nd generation EC to outpatient tobacco treatment among tobacco smokers is feasible. Among those who quit smoking, half were still using the EC at 6-month follow-up. Appeal of the EC among smokers was variable, and those who had quit smoking tended to switch to lower strength nicotine solutions. Further research is needed to determine whether ECs can reduce harm and be an effective adjunct to existing tobacco treatment interventions.
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24
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Kalkhoran S, Kruse GR, Chang Y, Rigotti NA. Smoking-Cessation Efforts by US Adult Smokers with Medical Comorbidities. Am J Med 2018; 131:318.e1-318.e8. [PMID: 29024622 DOI: 10.1016/j.amjmed.2017.09.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/20/2017] [Accepted: 09/21/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Continued cigarette smoking by individuals with chronic medical diseases can adversely affect their symptoms, disease progression, and mortality. We assessed the association between medical comorbidities and smoking-cessation efforts among US adult smokers. METHODS We analyzed cross-sectional data from 12,494 past-year cigarette smokers aged ≥18 years from Wave 1 (2013-2014) of the nationally representative Population Assessment of Tobacco and Health study. We assessed the association between self-reported medical comorbidities and past-year quit attempts, use of evidence-based smoking-cessation treatment or electronic cigarettes, and successful smoking cessation using logistic regression, adjusting for sociodemographics, insurance status, geographic region, and having a past-year doctor visit. RESULTS In the study sample, 39% were aged 18 to 34 years, 45% were female, 70% were non-Hispanic white, and 48% reported ≥1 comorbidity. Smokers with any comorbidity, compared with those without comorbidities, had higher odds of trying to quit (adjusted odds ratio, 1.19; 95% confidence interval, 1.08-1.30), but no higher likelihood of quitting success. Having more medical comorbidities was associated with increased odds of trying to quit. Smokers with a comorbidity used evidence-based treatment more often than smokers without comorbidities (43% vs 26%); use of e-cigarettes to quit was similar between smokers with and without comorbidities (27% vs 28%). CONCLUSIONS Adult smokers with chronic medical diseases try to quit and use evidence-based tobacco-cessation treatment more often than smokers without comorbidities, but they are no more likely to quit, suggesting that their quit attempts are less likely to succeed. Smokers with medical comorbidities may require more intensive, prolonged, and repeated treatment to stop smoking.
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Affiliation(s)
- Sara Kalkhoran
- Division of General Internal Medicine, Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston; Harvard Medical School, Boston, Mass.
| | - Gina R Kruse
- Division of General Internal Medicine, Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston; Harvard Medical School, Boston, Mass
| | - Yuchiao Chang
- Division of General Internal Medicine, Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston; Harvard Medical School, Boston, Mass
| | - Nancy A Rigotti
- Division of General Internal Medicine, Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston; Harvard Medical School, Boston, Mass
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Baha M, Boussadi A, Le Faou AL. French smoking cessation services provide effective support even to the more dependent. Prev Med 2016; 90:34-8. [PMID: 27346755 DOI: 10.1016/j.ypmed.2016.06.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 06/14/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE France is one the few European countries offering a national quit line along with partially cost-covered nicotine replacement therapy (NRT) and cessation services. This study assesses outcomes and predictors of continued abstinence in French smoking cessation services. METHOD The French national smoking cessation registry (CDTnet) included 23,810 adult smokers followed-up between 2011 and 2013. We assessed 1-month continued abstinence among 10,161 who initiated a quit attempt before or during follow-up. Predictors of abstinence were determined using multivariable regression model. RESULTS Among quitters, 45.2% achieved CO-validated abstinence. Prescription of pharmacotherapy was associated with abstinence rates as high as 47% for combination NRT and 53% for varenicline. The effect of behavioural support associated with combination NRT versus behavioural support alone increased with attendance: OR 1.11 (95% CI 0.89-1.39) for 2-3 visits, OR 1.43 (95% CI 1.13-1.80) for 4-6 visits, OR 1.60 (95% CI 1.21-2.12) for ≥7 visits. Unemployed participants were as likely to be successful as participants in employment (OR 0.88; 95% CI 0.75-1.04). High cigarette dependence also did not significantly hinder abstinence. Young adults achieved the lowest abstinence rates. Predictors that significantly reduced odds of abstinence were: being aged 18 to 24 and a history of alcohol abuse. CONCLUSION With adapted treatment, even the more dependent or less affluent maintained abstinence. Our findings suggest that French cessation services have been successful in providing cessation support. Nevertheless, there is room for improvement in tailoring treatment for some subgroups of smokers.
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Affiliation(s)
- Monique Baha
- AP-HP, Hôpital Européen Georges Pompidou, 20 rue Leblanc, F-75015 Paris, France.
| | - Abdelali Boussadi
- AP-HP, Hôpital Européen Georges Pompidou, 20 rue Leblanc, F-75015 Paris, France; INSERM UMRs 1138, équipe 22, Paris, France
| | - Anne-Laurence Le Faou
- AP-HP, Hôpital Européen Georges Pompidou, 20 rue Leblanc, F-75015 Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, UMRS1123, Hôtel-Dieu 1, place du Parvis Notre-Dame, F-75004 Paris, France
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Park ER, Ostroff JS, Perez GK, Hyland KA, Rigotti NA, Borderud S, Regan S, Muzikansky A, Friedman ER, Levy DE, Holland S, Eusebio J, Peterson L, Rabin J, Miller-Sobel J, Gonzalez I, Malloy L, O'Brien M, de León-Sanchez S, Whitlock CW. Integrating tobacco treatment into cancer care: Study protocol for a randomized controlled comparative effectiveness trial. Contemp Clin Trials 2016; 50:54-65. [PMID: 27444428 DOI: 10.1016/j.cct.2016.07.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/14/2016] [Accepted: 07/17/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Despite the well-established risks of persistent smoking, 10-30% of cancer patients continue to smoke after diagnosis. Evidence-based tobacco treatment has yet to be integrated into routine oncology care. This paper describes the protocol, manualized treatment, evaluation plan, and overall study design of comparing the effectiveness and cost of two treatments across two major cancer centers. METHODS/DESIGN A two-arm, two-site randomized controlled comparative effectiveness trial is testing the hypothesis that an Intensive Treatment (IT) intervention is more effective than a Standard Treatment (ST) intervention in helping recently diagnosed cancer patients quit smoking. Both interventions include 4 weekly counseling sessions and FDA-approved smoking cessation medication advice. The IT includes an additional 4 biweekly and 3 monthly booster sessions as well as dispensal of the recommended FDA-approved smoking cessation medication at no cost. The trial is enrolling patients with suspected or newly diagnosed cancer who have smoked a cigarette in the past 30days. Participants are randomly assigned to receive the ST or IT condition. Tobacco cessation outcomes are assessed at 3 and 6months. The primary study outcome is 7-day point prevalence biochemically-validated tobacco abstinence. Secondary study outcomes include the incremental cost-effectiveness of the IT vs. ST. DISCUSSION This trial will answer key questions about delivering tobacco treatment interventions to newly diagnosed cancer patients. If found to be efficacious and cost-effective, this treatment will serve as a model to be integrated into oncology care settings nation-wide, as we strive to improve treatment outcomes and quality of life for cancer patients.
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Affiliation(s)
- Elyse R Park
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, United States; Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, United States; Cancer Outcomes Research Program, Massachusetts General Hospital, Boston, MA, United States; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States; Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, MA, United States; Department of Medicine, Harvard Medical School, Boston, MA, United States.
| | - Jamie S Ostroff
- Department of Psychiatry & Behavioral Sciences, Tobacco Treatment Program, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
| | - Giselle K Perez
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, United States; Cancer Outcomes Research Program, Massachusetts General Hospital, Boston, MA, United States; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.
| | - Kelly A Hyland
- H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL, United States.
| | - Nancy A Rigotti
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, United States; Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, United States; Department of Medicine, Harvard Medical School, Boston, MA, United States.
| | - Sarah Borderud
- Department of Psychiatry & Behavioral Sciences, Tobacco Treatment Program, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
| | - Susan Regan
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, United States.
| | - Alona Muzikansky
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, United States.
| | - Emily R Friedman
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, United States; Cancer Outcomes Research Program, Massachusetts General Hospital, Boston, MA, United States.
| | - Douglas E Levy
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, United States.
| | - Susan Holland
- Department of Psychiatry & Behavioral Sciences, Tobacco Treatment Program, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
| | - Justin Eusebio
- Cancer Outcomes Research Program, Massachusetts General Hospital, Boston, MA, United States.
| | - Lisa Peterson
- Department of Psychiatry & Behavioral Sciences, Tobacco Treatment Program, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
| | - Julia Rabin
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, United States; Cancer Outcomes Research Program, Massachusetts General Hospital, Boston, MA, United States.
| | - Jacob Miller-Sobel
- Department of Psychiatry & Behavioral Sciences, Tobacco Treatment Program, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
| | - Irina Gonzalez
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.
| | - Laura Malloy
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, MA, United States.
| | - Maureen O'Brien
- Department of Psychiatry & Behavioral Sciences, Tobacco Treatment Program, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
| | - Suhana de León-Sanchez
- Department of Psychiatry & Behavioral Sciences, Tobacco Treatment Program, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
| | - C Will Whitlock
- Department of Psychiatry & Behavioral Sciences, Tobacco Treatment Program, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
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Myers MG, Strong DR, Linke SE, Hofstetter CR, Al-Delaimy WK. Predicting use of assistance when quitting: a longitudinal study of the role of quitting beliefs. Drug Alcohol Depend 2015; 149:220-4. [PMID: 25707703 PMCID: PMC4464760 DOI: 10.1016/j.drugalcdep.2015.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 01/29/2015] [Accepted: 02/03/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND A growing literature addresses the need to reduce cigarette smoking prevalence by increasing the use of assistance when quitting. A key focus is to identify strategies for enhancing adoption of effective interventions in order to increase utilization of evidence-based treatments. PURPOSE To examine the effect of beliefs regarding ability to quit on utilization of assistance for smoking cessation. A mediation model was hypothesized whereby the relationship between smoking and use of assistance is influenced by beliefs in ability to quit. METHODS The present study includes 474 of 1000 respondents to baseline and follow-up California Smokers Cohort surveys conducted from 2011 to 2013. Included were baseline smokers who reported a 24-h quit attempt at follow-up. Baseline variables were used to predict use of assistance when quitting. RESULTS The hypothesized model was tested using a product of coefficients method, controlling for demographics. Greater heaviness of smoking and lower belief in ability to quit were significantly related to use of assistance. Quitting beliefs significantly mediated the relationship between nicotine dependence and use of assistance. CONCLUSIONS The present data support a mechanism whereby the effect of smoking rate on treatment utilization is mediated by beliefs in ability to quit. Greater belief in one's ability to quit may represent an obstacle to treatment utilization by reducing the likelihood of successful cessation. The present findings suggest the value of targeted messages from health care providers that normalize the need for assistance when attempting to change an addictive behavior and emphasize the difficulty of quitting without assistance.
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Affiliation(s)
- Mark G Myers
- Veterans Affairs San Diego Healthcare System, Psychology Service 116B, 3350 La Jolla Village Drive, San Diego, CA 92161, USA; University of California San Diego, Department of Psychiatry, 9500 Gilman Drive, La Jolla, CA 92093-0603, USA.
| | - David R Strong
- University of California San Diego, Department of Family and Preventive Medicine, 9500 Gilman Drive, La Jolla, CA 92093-0628, USA
| | - Sarah E Linke
- University of California San Diego, Department of Family and Preventive Medicine, 9500 Gilman Drive, La Jolla, CA 92093-0628, USA
| | - C Richard Hofstetter
- San Diego State University, Department of Political Science, 5500 Campanile Drive San Diego, CA 92182-4427, USA
| | - Wael K Al-Delaimy
- University of California San Diego, Department of Family and Preventive Medicine, 9500 Gilman Drive, La Jolla, CA 92093-0628, USA
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