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Bricker JB, McAfee T. Smartphone applications for intervening on addictive behaviors: efficacy is just one phase of the marathon. Addiction 2021; 116:3284-3285. [PMID: 34184335 PMCID: PMC8578285 DOI: 10.1111/add.15608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/07/2021] [Indexed: 01/08/2023]
Affiliation(s)
- Jonathan B. Bricker
- Division of Public Sciences, Fred Hutchinson Cancer
Research Center, Seattle, Washington, United States
- Department of Psychology, University of Washington,
Seattle, Washington, United States
| | - Tim McAfee
- Department of Health Services, University of Washington,
Seattle, Washington, United States
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2
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Affiliation(s)
- Tim McAfee
- Social and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Ruth E Malone
- Social and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Janine Cataldo
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, San Francisco, California, USA
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Zhang L, Rodes R, Mann N, Thompson J, McAfee T, Murphy-Hoefer R, Frank R, Davis K, Babb S. Differences in Quitline Registrants' Characteristics During National Radio Versus Television Antismoking Campaigns. Am J Prev Med 2021; 60:S107-S112. [PMID: 33663697 DOI: 10.1016/j.amepre.2020.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/12/2020] [Accepted: 08/17/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The Centers for Disease Control and Prevention's Tips From Former Smokers® campaign encourages smokers to get help with quitting smoking by promoting 1-800-QUIT-NOW. Campaign advertisements featuring an offer of help with obtaining free cessation medication aired nationally on radio for 2 weeks in 2016. Similar advertisements aired nationally on TV for 3 weeks in 2017. The comparison period of 2016 radio campaign and 2017 TV campaign was used to examine the characteristics of quitline registrants by a media referral source (TV or radio). METHODS Data on the number and demographics of quitline registrants in 2016 and 2017 were obtained from the Centers for Disease Control and Prevention's National Quitline Data Warehouse. The investigators conducted t-tests to assess the demographic differences between registrants who heard about the quitline through the radio advertisements and those who heard about it through the TV advertisements during the comparison period. This analysis was conducted in 2019. RESULTS The registrants who heard about the quitline from radio advertisements were more likely to be male, younger, and have more years of education. However, the registrants who heard about the quitline from TV advertisements were more likely to be Black, non-Hispanic, and have fewer years of education. CONCLUSIONS The findings suggest that the demographic profiles of quitline registrants vary significantly based on how registrants hear about the quitline (via radio or TV). These differences in the characteristics of registrants can help inform the tobacco control mass media purchasing strategies and may enable media efforts to target the specific subgroups of smokers in a better way.
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Affiliation(s)
- Lei Zhang
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Robert Rodes
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nathan Mann
- RTI International, Research Triangle Park, North Carolina
| | - Jesse Thompson
- RTI International, Research Triangle Park, North Carolina
| | - Tim McAfee
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington
| | - Rebecca Murphy-Hoefer
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Randi Frank
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kevin Davis
- RTI International, Research Triangle Park, North Carolina
| | - Stephen Babb
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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England L, Tong VT, Rockhill K, Hsia J, McAfee T, Patel D, Rupp K, Conrey EJ, Valdivieso C, Davis KC. Evaluation of a federally funded mass media campaign and smoking cessation in pregnant women: a population-based study in three states. BMJ Open 2017; 7:e016826. [PMID: 29259054 PMCID: PMC5778314 DOI: 10.1136/bmjopen-2017-016826] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES In 2012, theCenters for Disease Control and Prevention initiated a national anti-smoking campaign, Tips from Former Smokers (Tips). As a result of the campaign, quit attempts among smokers increased in the general population by 3.7 percentage points. In the current study, we assessed the effects of Tips on smoking cessation in pregnant women. METHODS We used 2009-2013 certificates of live births in three US states: Indiana, Kentucky and Ohio. Smoking cessation by the third trimester of pregnancy was examined among women who smoked in the 3 months prepregnancy. Campaign exposure was defined as overlap between the airing of Tips 2012 (March 19-June 10) and the prepregnancy and pregnancy periods. Women who delivered before Tips 2012 were not exposed. Adjusted logistic regression was used to determine whether exposure to Tips was independently associated with smoking cessation. RESULTS Cessation rates were stable during 2009-2011 but increased at the time Tips 2012 aired and remained elevated. Overall, 32.9% of unexposed and 34.7% of exposed smokers quit by the third trimester (p<0.001). Exposure to Tips 2012 was associated with increased cessation (adjusted OR: 1.07, 95% CI 1.05 to 1.10). CONCLUSIONS Exposure to a national anti-smoking campaign for a general audience was associated with smoking cessation in pregnant women.
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Affiliation(s)
- Lucinda England
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Van T Tong
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karilynn Rockhill
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jason Hsia
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tim McAfee
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Deesha Patel
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katelin Rupp
- Indiana State Department of Health, Tobacco Prevention and Cessation Commission, Indianapolis, Indiana, USA
| | - Elizabeth J Conrey
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Ohio Department of Mental Health, Columbus, Ohio, USA
| | | | - Kevin C Davis
- Center for Health Policy Science and Tobacco, RTI International, Research Triangle Park, North Carolina, USA
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Melstrom P, Koszowski B, Thanner MH, Hoh E, King B, Bunnell R, McAfee T. Measuring PM2.5, Ultrafine Particles, Nicotine Air and Wipe Samples Following the Use of Electronic Cigarettes. Nicotine Tob Res 2017; 19:1055-1061. [DOI: 10.1093/ntr/ntx058] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 03/06/2017] [Indexed: 11/12/2022]
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Azofeifa A, Mattson ME, Schauer G, McAfee T, Grant A, Lyerla R. National Estimates of Marijuana Use and Related Indicators - National Survey on Drug Use and Health, United States, 2002-2014. MMWR Surveill Summ 2016; 65:1-28. [PMID: 27584586 DOI: 10.15585/mmwr.ss6511a1] [Citation(s) in RCA: 270] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PROBLEM/CONDITION In the United States, marijuana is the most commonly used illicit drug. In 2013, 7.5% (19.8 million) of the U.S. population aged ≥12 years reported using marijuana during the preceding month. Because of certain state-level policies that have legalized marijuana for medical or recreational use, population-based data on marijuana use and other related indicators are needed to help monitor behavioral health changes in the United States. PERIOD COVERED 2002-2014. DESCRIPTION OF SYSTEM The National Survey on Drug Use and Health (NSDUH) is a national- and state-level survey of a representative sample of the civilian, noninstitutionalized U.S. population aged ≥12 years. NSDUH collects information about the use of illicit drugs, alcohol, and tobacco; initiation of substance use; frequency of substance use; substance dependence and abuse; perception of substance harm risk or no risk; and other related behavioral health indicators. This report describes national trends for selected marijuana use and related indicators, including prevalence of marijuana use; initiation; perception of harm risk, approval, and attitudes; perception of availability and mode of acquisition; dependence and abuse; and perception of legal penalty for marijuana possession. RESULTS In 2014, a total of 2.5 million persons aged ≥12 years had used marijuana for the first time during the preceding 12 months, an average of approximately 7,000 new users each day. During 2002-2014, the prevalence of marijuana use during the past month, past year, and daily or almost daily increased among persons aged ≥18 years, but not among those aged 12-17 years. Among persons aged ≥12 years, the prevalence of perceived great risk from smoking marijuana once or twice a week and once a month decreased and the prevalence of perceived no risk increased. The prevalence of past year marijuana dependence and abuse decreased, except among persons aged ≥26 years. Among persons aged ≥12 years, the percentage reporting that marijuana was fairly easy or very easy to obtain increased. The percentage of persons aged ≥12 reporting the mode of acquisition of marijuana was buying it and growing it increased versus getting it for free and sharing it. The percentage of persons aged ≥12 years reporting that the perceived maximum legal penalty for the possession of an ounce or less of marijuana in their state is a fine and no penalty increased versus probation, community service, possible prison sentence, and mandatory prison sentence. INTERPRETATION Since 2002, marijuana use in the United States has increased among persons aged ≥18 years, but not among those aged 12-17 years. A decrease in the perception of great risk from smoking marijuana combined with increases in the perception of availability (i.e., fairly easy or very easy to obtain marijuana) and fewer punitive legal penalties (e.g., no penalty) for the possession of marijuana for personal use might play a role in increased use among adults. PUBLIC HEALTH ACTION National- and state-level data can help federal, state, and local public health officials develop targeted prevention activities to reduce youth initiation of marijuana use, prevent marijuana dependence and abuse, and prevent adverse health effects. As state-level laws on medical and recreational marijuana use change, modifications might be needed to national- and state-level surveys and more timely and comprehensive surveillance systems might be necessary to provide these data. Marijuana use in younger age groups is a particular public health concern, and changing the perception of harm risk from smoking marijuana is needed.
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Affiliation(s)
- Alejandro Azofeifa
- Division of Evaluation, Analysis and Quality, Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration
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Bush T, Curry SJ, Hollis J, Grothaus L, Ludman E, McAfee T, Polen M, Oliver M. Preteen Attitudes about Smoking and Parental Factors Associated with Favorable Attitudes. Am J Health Promot 2016; 19:410-7. [PMID: 16022204 DOI: 10.4278/0890-1171-19.6.410] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To describe youth smoking-related attitudes and evaluate the effects of parental factors on child adoption of positive attitudes about smoking. Design. This study used baseline and 20-month data from a family-based smoking-prevention study (82.9% completed both surveys). Setting. Telephone recruitment from two health maintenance organizations. Subjects. Children aged 10 to 12 years and one parent of each child (n = 418 families) were randomly assigned to a frequent assessment cohort (12.5% of participants). Intervention. Families received a mailed smoking-prevention packet (parent handbook, videotape about youth smoking, comic book, pen, and stickers), outreach telephone counselor calls to the parent, a newsletter, and medical record prompts for providers to deliver smoking-prevention messages to parents and children. Measures. Demographics, tobacco status, attitudes about smoking (Teenage Attitudes and Practices Survey), family discussions about tobacco, family cohesiveness (family support and togetherness), parent involvement, parent monitoring, and parenting confidence. Results. One-third of the children endorsed beliefs that they could smoke without becoming addicted, and 8% to 10% endorsed beliefs on the benefits of smoking. Children's positive attitudes about smoking were associated with lower family cohesiveness (p = .01). Parental use of tobacco was the only significant predictor of children's positive attitudes about tobacco at 20 months (p = .03). Conclusions. Children as young as 10 years underestimate addictive properties of smoking, which may place them at risk for future smoking. Parental use of tobacco and family cohesiveness are important factors in the formulation of preteen attitudes about smoking.
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Affiliation(s)
- Terry Bush
- Center for Health Studies, Group Health Cooperative, 1730 Minor Ave, Suite 16, Seattle, WA 98101, USA.
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McAfee T, Davis KC, Shafer P, Patel D, Alexander R, Bunnell R. Increasing the dose of television advertising in a national antismoking media campaign: results from a randomised field trial. Tob Control 2015; 26:19-28. [PMID: 26678518 PMCID: PMC5108680 DOI: 10.1136/tobaccocontrol-2015-052517] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [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: 06/29/2015] [Accepted: 10/30/2015] [Indexed: 11/06/2022]
Abstract
Background While antismoking media campaigns have demonstrated effectiveness, less is known about the country-level effects of increased media dosing. The 2012 US Tips From Former Smokers (Tips) campaign generated approximately 1.6 million quit attempts overall; however, the specific dose–response from the campaign was only assessed by self-report. Objective Assess the impact of higher ad exposure during the 2013 Tips campaign on quit-related behaviours and intentions, campaign awareness, communication about campaign, and disease knowledge. Methods A 3-month national media buy was supplemented within 67 (of 190) randomly selected local media markets. Higher-dose markets received media buys 3 times that of standard-dose markets. We compared outcomes of interest using data collected via web-based surveys from nationally representative, address-based probability samples of 5733 cigarette smokers and 2843 non-smokers. Results In higher-dose markets, 87.2% of smokers and 83.9% of non-smokers recalled television campaign exposure versus 75.0% of smokers and 73.9% of non-smokers in standard-dose markets. Among smokers overall, the relative quit attempt rate was 11% higher in higher-dose markets (38.8% vs 34.9%; p<0.04). The higher-dose increase was larger in African-Americans (50.9% vs 31.8%; p<0.01). Smokers in higher-dose markets without a mental health condition, with a chronic health condition, or with only some college education made quit attempts at a higher rate than those in standard-dose markets. Non-smokers in higher-dose markets were more likely to talk with family or friends about smoking dangers (43.1% vs 35.7%; p<0.01) and had greater knowledge of smoking-related diseases. Conclusions The US 2013 Tips antismoking media campaign compared standard and higher doses by randomisation of local media markets. Results demonstrate the effectiveness of a higher dose for engaging non-smokers and further increasing quit attempts among smokers, especially African-Americans.
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Affiliation(s)
- Tim McAfee
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kevin C Davis
- Center for Health Policy Science and Tobacco Research RTI International, Research Triangle Park, North Carolina, USA
| | - Paul Shafer
- Center for Health Policy Science and Tobacco Research RTI International, Research Triangle Park, North Carolina, USA
| | - Deesha Patel
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Robert Alexander
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rebecca Bunnell
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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McAfee T, Davis KC, Cox SN, Beistle DM. Google Searches or Quit Attempts as a Success Measure for an Antismoking Campaign. Am J Prev Med 2015; 49:e131-2. [PMID: 26456878 PMCID: PMC5316515 DOI: 10.1016/j.amepre.2015.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 07/20/2015] [Accepted: 08/12/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Tim McAfee
- Office on Smoking and Health, CDC, Atlanta, Georgia
| | - Kevin C Davis
- RTI International, Research Triangle Park, North Carolina
| | - Shanna N Cox
- Office on Smoking and Health, CDC, Atlanta, Georgia
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10
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Rolle IV, Kennedy SM, Agaku I, Jones SE, Bunnell R, Caraballo R, Xu X, Schauer G, McAfee T. Cigarette, Cigar, and Marijuana Use Among High School Students — United States, 1997–2013. MMWR Morb Mortal Wkly Rep 2015; 64:1136-41. [DOI: 10.15585/mmwr.mm6440a2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Chiosi JJ, Andes L, Asma S, Palipudi K, McAfee T. Warning about the harms of tobacco use in 22 countries: findings from a cross-sectional household survey. Tob Control 2015; 25:393-401. [PMID: 25953532 DOI: 10.1136/tobaccocontrol-2014-052047] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 09/24/2014] [Accepted: 02/20/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND Knowledge about the harms of tobacco use deters initiation and is associated with cessation. Most studies on this knowledge in the general population have been in high-income countries, but the tobacco use burden is increasing in low-income and middle-income countries. We sought to estimate levels of knowledge about tobacco-related diseases in 22 countries and determine the factors associated with differences in knowledge. METHODS We used data from the Global Adult Tobacco Survey (GATS), a nationally representative survey of persons aged ≥15 years. GATSs were conducted from 2008 to 2013 in 22 low-income and middle-income countries. Information was gathered on tobacco-related knowledge and noticing of antismoking mass media messages and health warning labels on cigarette packages. We constructed a four-point knowledge scale and performed multivariate regression analyses. RESULTS Median country values for the proportion of adults who believed smoking causes a specific illness were 95.9% for lung cancer, 82.5% for heart attack and 74.0% for stroke. Knowledge scores ranged from 2.1 to 3.8. In multivariate regressions, adults scored significantly higher on the knowledge scale if they noticed antismoking media messages (22 countries) or health warning labels (17 countries). Significantly higher knowledge scores occurred in all 9 countries with pictorial health warning labels compared with only 8 out of 13 countries with text-only warning labels. CONCLUSIONS Antismoking media messages appear effective for warning the public about the harms from tobacco use in all 22 countries, while warning labels are effective in the majority of these countries. Our findings suggest opportunities to motivate smoking cessation globally.
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Affiliation(s)
- John J Chiosi
- Global Tobacco Control Branch, Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia, USA Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Linda Andes
- Global Tobacco Control Branch, Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Samira Asma
- Global Tobacco Control Branch, Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Krishna Palipudi
- Global Tobacco Control Branch, Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tim McAfee
- Global Tobacco Control Branch, Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Arrazola RA, Singh T, Corey CG, Husten CG, Neff LJ, Apelberg BJ, Bunnell RE, Choiniere CJ, King BA, Cox S, McAfee T, Caraballo RS. Tobacco use among middle and high school students - United States, 2011-2014. MMWR Morb Mortal Wkly Rep 2015; 64:381-5. [PMID: 25879896 PMCID: PMC5779546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Tobacco use and addiction most often begin during youth and young adulthood. Youth use of tobacco in any form is unsafe. To determine the prevalence and trends of current (past 30-day) use of nine tobacco products (cigarettes, cigars, smokeless tobacco, e-cigarettes, hookahs, tobacco pipes, snus, dissolvable tobacco, and bidis) among U.S. middle (grades 6-8) and high school (grades 9-12) students, CDC and the Food and Drug Administration (FDA) analyzed data from the 2011-2014 National Youth Tobacco Surveys (NYTS). In 2014, e-cigarettes were the most commonly used tobacco product among middle (3.9%) and high (13.4%) school students. Between 2011 and 2014, statistically significant increases were observed among these students for current use of both e-cigarettes and hookahs (p<0.05), while decreases were observed for current use of more traditional products, such as cigarettes and cigars, resulting in no change in overall tobacco use. Consequently, 4.6 million middle and high school students continue to be exposed to harmful tobacco product constituents, including nicotine. Nicotine exposure during adolescence, a critical window for brain development, might have lasting adverse consequences for brain development, causes addiction, and might lead to sustained tobacco use. For this reason, comprehensive and sustained strategies are needed to prevent and reduce the use of all tobacco products among youths in the United States.
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Affiliation(s)
- René A. Arrazola
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC,Corresponding contributor: René A. Arrazola, , 770-488-2414
| | - Tushar Singh
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC,Epidemic Intelligence Service, CDC
| | | | | | - Linda J. Neff
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | | | - Rebecca E. Bunnell
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | | | - Brian A. King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Shanna Cox
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Tim McAfee
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Ralph S. Caraballo
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
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Xu X, Alexander RL, Simpson SA, Goates S, Nonnemaker JM, Davis KC, McAfee T. A cost-effectiveness analysis of the first federally funded antismoking campaign. Am J Prev Med 2015; 48:318-25. [PMID: 25498550 PMCID: PMC4603744 DOI: 10.1016/j.amepre.2014.10.011] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 10/01/2014] [Accepted: 10/17/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND In 2012, CDC launched the first federally funded national mass media antismoking campaign. The Tips From Former Smokers (Tips) campaign resulted in a 12% relative increase in population-level quit attempts. PURPOSE Cost-effectiveness analysis was conducted in 2013 to evaluate Tips from a funding agency's perspective. METHODS Estimates of sustained cessations; premature deaths averted; undiscounted life years (LYs) saved; and quality-adjusted life years (QALYs) gained by Tips were estimated. RESULTS Tips saved about 179,099 QALYs and prevented 17,109 premature deaths in the U.S. With the campaign cost of roughly $48 million, Tips spent approximately $480 per quitter, $2,819 per premature death averted, $393 per LY saved, and $268 per QALY gained. CONCLUSIONS Tips was not only successful at reducing smoking-attributable morbidity and mortality but also was a highly cost-effective mass media intervention.
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Affiliation(s)
- Xin Xu
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion.
| | - Robert L Alexander
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion
| | - Sean A Simpson
- RTI International, Research Triangle Park, North Carolina
| | - Scott Goates
- Office of the Associate Director for Policy , Office of the Director, CDC, Atlanta, Georgia
| | | | - Kevin C Davis
- RTI International, Research Triangle Park, North Carolina
| | - Tim McAfee
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion
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Affiliation(s)
- Tim McAfee
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephen Babb
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Simon McNabb
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael C. Fiore
- Center for Tobacco Research and Intervention, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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15
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Garrett BE, Dube SR, Babb S, McAfee T. Addressing the Social Determinants of Health to Reduce Tobacco-Related Disparities. Nicotine Tob Res 2014; 17:892-7. [PMID: 25516538 DOI: 10.1093/ntr/ntu266] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 12/01/2014] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Comprehensive tobacco prevention and control efforts that include implementing smoke-free air laws, increasing tobacco prices, conducting hard-hitting mass media campaigns, and making evidence-based cessation treatments available are effective in reducing tobacco use in the general population. However, if these interventions are not implemented in an equitable manner, certain population groups may be left out causing or exacerbating disparities in tobacco use. Disparities in tobacco use have, in part, stemmed from inequities in the way tobacco control policies and programs have been adopted and implemented to reach and impact the most vulnerable segments of the population that have the highest rates of smokings (e.g., those with lower education and incomes). METHODS Education and income are the 2 main social determinants of health that negatively impact health. However, there are other social determinants of health that must be considered for tobacco control policies to be effective in reducing tobacco-related disparities. This article will provide an overview of how tobacco control policies and programs can address key social determinants of health in order to achieve equity and eliminate disparities in tobacco prevention and control. RESULTS Tobacco control policy interventions can be effective in addressing the social determinants of health in tobacco prevention and control to achieve equity and eliminate tobacco-related disparities when they are implemented consistently and equitably across all population groups. CONCLUSIONS Taking a social determinants of health approach in tobacco prevention and control will be necessary to achieve equity and eliminate tobacco-related disparities.
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Affiliation(s)
- Bridgette E Garrett
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA;
| | - Shanta R Dube
- Division of Epidemiology and Biostatistics, Georgia State University, Atlanta, GA
| | - Stephen Babb
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Tim McAfee
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA
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16
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Affiliation(s)
- Tim McAfee
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Deborah Burnette
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- ICF International, Atlanta, Georgia
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McAfee T, Davis K, Alexander R. Effect of the first federally funded US antismoking national media campaign. J Vasc Surg 2014. [DOI: 10.1016/j.jvs.2014.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
BACKGROUND Every year, smoking kills more than 5 million people globally, including 440,000 people in the USA, where the long-term decline in smoking prevalence has slowed. The US Centers for Disease Control and Prevention (CDC) delivered a national, 3-month antismoking campaign called Tips From Former Smokers (Tips) that started in March, 2012, in which hard-hitting, emotionally evocative television advertising was featured, depicting smoking-related suffering in real people. We aimed to assess the effects of the Tips campaign. METHODS We undertook baseline and follow-up surveys of nationally representative cohorts of adult smokers and non-smokers. The national effect of the Tips campaign was estimated by applying rates of change in the cohort before and after the campaign to US census data. FINDINGS 3051 smokers and 2220 non-smokers completed baseline and follow-up assessments. 2395 (78%) smokers and 1632 (74%) non-smokers recalled seeing at least one Tips advertisement on television during the 3-month campaign. Quit attempts among smokers rose from 31.1% (95% CI 30.3-31.9) at baseline to 34.8% (34.0-35.7) at follow-up, a 12% relative increase. The prevalence of abstinence at follow-up among smokers who made a quit attempt was 13.4% (95% CI 9.7-17.2). Nationally, an estimated 1.64 million additional smokers made a quit attempt, and 220,000 (95% CI 159,000-282,000) remained abstinent at follow-up. Recommendations by non-smokers to quit grew from 2.6% at baseline to 5.1% at follow-up, and the prevalence of people talking with friends and family about the dangers of smoking rose from 31.9% (95% CI 31.3-32.5) to 35.2% (34.6-35.9), resulting in an estimated 4.7 million additional non-smokers recommending cessation services and more than 6 million talking about the dangers of smoking. INTERPRETATION The high-exposure Tips media campaign was effective at increasing population-level quit attempts. The growth in smokers who quit and became sustained quitters could have added from a third to almost half a million quality-adjusted life-years to the US population. Expanded implementation of similar campaigns globally could accelerate progress on the WHO Framework Convention on Tobacco Control and reduce smoking prevalence globally. FUNDING CDC, US Department of Health and Human Services.
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Affiliation(s)
- Tim McAfee
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | - Robert L Alexander
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Terry F Pechacek
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rebecca Bunnell
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Bush T, Levine MD, Beebe LA, Cerutti B, Deprey M, McAfee T, Boeckman L, Zbikowski S. Addressing weight gain in smoking cessation treatment: a randomized controlled trial. Am J Health Promot 2013; 27:94-102. [PMID: 23113779 DOI: 10.4278/ajhp.110603-quan-238] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the effectiveness of a cognitive behavioral treatment (CBT) addressing cessation-related weight concerns delivered via a tobacco quitline that does not address weight concerns. DESIGN Randomized controlled trial, blinded 6-month follow-up. SETTING The Oklahoma Tobacco Helpline (OKHL). SUBJECTS All 7998 smokers who called the OKHL were screened; 4240 were eligible; 2000 were randomized to the standard quitline (STD) or the brief version of the CBT weight concerns program (WCP). INTERVENTION Telephone counseling to help people quit smoking and address concerns about cessation-related weight gain. MEASURES Demographics, weight, tobacco status, weight concerns, self-efficacy in quitting, and quitting without weight gain. ANALYSIS Descriptive statistics and logistic regression. RESULTS Of those randomized, 1002 participants completed the 6-month survey (response rates = 53.2% for STD, 47% for WCP). Compared with STD, WCP led to reduced weight concerns (p < .01) and less weight gain among quitters (1.8 vs. -3.4 pounds; p = .01). Although not significant, participants in the WCP were more likely to report 30-day abstinence (33.3% vs. 36.8%, p = .24; intent to treat = 17.7 vs. 17.3). CONCLUSION The WCP was successfully delivered via a quitline and resulted in improved attitudes about weight and decreased cessation-related weight gain without harming quit rates. Promotion of a quitline focused on addressing weight in conjunction with quitline treatment for smoking cessation may improve cessation and weight outcomes. Study limitations include use of self-report and survey response.
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Affiliation(s)
- Terry Bush
- Alere Wellbeing, Seattle, Washington, USA.
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Affiliation(s)
- Tim McAfee
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS-F79, Atlanta, GA 30341, USA.
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Jha P, Ramasundarahettige C, Landsman V, Rostron B, Thun M, Anderson RN, McAfee T, Peto R. 21st-century hazards of smoking and benefits of cessation in the United States. N Engl J Med 2013; 368:341-50. [PMID: 23343063 DOI: 10.1056/nejmsa1211128] [Citation(s) in RCA: 1109] [Impact Index Per Article: 100.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Extrapolation from studies in the 1980s suggests that smoking causes 25% of deaths among women and men 35 to 69 years of age in the United States. Nationally representative measurements of the current risks of smoking and the benefits of cessation at various ages are unavailable. METHODS We obtained smoking and smoking-cessation histories from 113,752 women and 88,496 men 25 years of age or older who were interviewed between 1997 and 2004 in the U.S. National Health Interview Survey and related these data to the causes of deaths that occurred by December 31, 2006 (8236 deaths in women and 7479 in men). Hazard ratios for death among current smokers, as compared with those who had never smoked, were adjusted for age, educational level, adiposity, and alcohol consumption. RESULTS For participants who were 25 to 79 years of age, the rate of death from any cause among current smokers was about three times that among those who had never smoked (hazard ratio for women, 3.0; 99% confidence interval [CI], 2.7 to 3.3; hazard ratio for men, 2.8; 99% CI, 2.4 to 3.1). Most of the excess mortality among smokers was due to neoplastic, vascular, respiratory, and other diseases that can be caused by smoking. The probability of surviving from 25 to 79 years of age was about twice as great in those who had never smoked as in current smokers (70% vs. 38% among women and 61% vs. 26% among men). Life expectancy was shortened by more than 10 years among the current smokers, as compared with those who had never smoked. Adults who had quit smoking at 25 to 34, 35 to 44, or 45 to 54 years of age gained about 10, 9, and 6 years of life, respectively, as compared with those who continued to smoke. CONCLUSIONS Smokers lose at least one decade of life expectancy, as compared with those who have never smoked. Cessation before the age of 40 years reduces the risk of death associated with continued smoking by about 90%.
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Affiliation(s)
- Prabhat Jha
- Center for Global Health Research, Toronto, ON M5C 1N8, Canada
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Palipudi KM, Gupta PC, Sinha DN, Andes LJ, Asma S, McAfee T. Social determinants of health and tobacco use in thirteen low and middle income countries: evidence from Global Adult Tobacco Survey. PLoS One 2012; 7:e33466. [PMID: 22438937 PMCID: PMC3306395 DOI: 10.1371/journal.pone.0033466] [Citation(s) in RCA: 154] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 02/09/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Tobacco use has been identified as the single biggest cause of inequality in morbidity. The objective of this study is to examine the role of social determinants on current tobacco use in thirteen low-and-middle income countries. METHODOLOGY/PRINCIPAL FINDINGS We used nationally representative data from the Global Adult Tobacco Survey (GATS) conducted during 2008-2010 in 13 low-and-middle income countries: Bangladesh, China, Egypt, India, Mexico, Philippines, Poland, Russian Federation, Thailand, Turkey, Ukraine, Uruguay, and Viet Nam. These surveys provided information on 209,027 respondent's aged 15 years and above and the country datasets were analyzed individually for estimating current tobacco use across various socio-demographic factors (gender, age, place of residence, education, wealth index, and knowledge on harmful effects of smoking). Multiple logistic regression analysis was used to predict the impact of these determinants on current tobacco use status. Current tobacco use was defined as current smoking or use of smokeless tobacco, either daily or occasionally. Former smokers were excluded from the analysis. Adjusted odds ratios for current tobacco use after controlling other cofactors, was significantly higher for males across all countries and for urban areas in eight of the 13 countries. For educational level, the trend was significant in Bangladesh, Egypt, India, Philippines and Thailand demonstrating decreasing prevalence of tobacco use with increasing levels of education. For wealth index, the trend of decreasing prevalence of tobacco use with increasing wealth was significant for Bangladesh, India, Philippines, Thailand, Turkey, Ukraine, Uruguay and Viet Nam. The trend of decreasing prevalence with increasing levels of knowledge on harmful effects of smoking was significant in China, India, Philippines, Poland, Russian Federation, Thailand, Ukraine and Viet Nam. CONCLUSIONS/SIGNIFICANCE These findings demonstrate a significant but varied role of social determinants on current tobacco use within and across countries.
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Affiliation(s)
- Krishna M Palipudi
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
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Bush T, Levine MD, Deprey M, Cerutti B, Zbikowski SM, McAfee T, Mahoney L, Beebe L. Prevalence of Weight Concerns and Obesity Among Smokers Calling a Quitline. J Smok Cessat 2012; 4:74-78. [PMID: 20548969 DOI: 10.1375/jsc.4.2.74] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND: Cessation-related weight gain and weight concerns are common among smokers and have a negative impact on quitting. Obese smokers tend to gain more than the average amount of weight and also have lower quit rates. This article describes the prevalence of obesity and weight concerns among smokers calling a state quitline in the United States. RESULTS: Among 3972 smokers using a state quitline, 33.3% were obese, 30.2% overweight, 33.3% normal weight and 3.2% underweight; a total of 60.6% were concerned about cessation-related weight gain. Compared with non-obese callers, obese callers were more likely to be female, Hispanic, non-White and heavier smokers. CONCLUSIONS: This is the first study to report data on body weight and weight concerns of smokers calling a national quitline. Given the lower quit rates among obese and weight-concerned smokers, and the burden of smoking and obesity, there is an opportunity to develop new treatment approaches for this at-risk population.
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Affiliation(s)
- Terry Bush
- Free & Clear, Inc., United States of America
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Bush T, Levine MD, Zbikowski S, Deprey M, Rabius V, McAfee T, Wiatrek DE. Weight Gain After Quitting: Attitudes, Beliefs and Counselling Strategies of Cessation Counsellors. J Smok Cessat 2012; 3:124-132. [PMID: 20574550 DOI: 10.1375/jsc.3.2.124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Postcessation weight gain is common and a frequent cause of relapse. Although interventions to address weight gain and weight gain concerns exist, the experience of telephone cessation coun- sellors in addressing weight concerns is unknown. We surveyed 134 cessation counsellors providing quitlines for 30 states regarding their experiences and attitudes about how to address weight gain concerns among smokers trying to quit. Counsellors estimated they discuss weight in 40% of their calls, primarily discussing concerns about gaining weight. Counsellors estimated that smokers gain about 4.1 kg after quitting and about 48% gain more than 2.3 kg. Most counsellors believed that exercise, education about weight gain and preparing smokers for weight gain would help people quit, which is consistent with current science. A total of 51% of counsellors believed that dieting while quitting would reduce weight gain and only 35% correctly identified that dieting reduces a smokers' ability to quit. Some counsellors believed they needed more training in weight management and may need to be reassured that they are currently following treatment guidelines when confronted with smokers who have concerns about postcessation weight gain.
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Affiliation(s)
- Terry Bush
- Free and Clear, Inc., United States of America
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Catz SL, Jack LM, McClure JB, Javitz HS, Deprey M, Zbikowski SM, McAfee T, Richards J, Swan GE. Adherence to varenicline in the COMPASS smoking cessation intervention trial. Nicotine Tob Res 2011; 13:361-8. [PMID: 21350041 PMCID: PMC3082504 DOI: 10.1093/ntr/ntr003] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 01/04/2011] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Patient adherence to smoking cessation medications can impact their effectiveness. It is important to understand the extent to which prescribed medications are actually taken by smokers, how this influences smoking cessation outcomes, and what factors may influence adherence. METHODS Smokers recruited from a large health plan were randomized to receive different modes of cessation counseling in combination with varenicline (Swan, G. E., McClure, J. B., Jack, L. M., Zbikowski, S. M., Javitz, H. S., Catz, S. L., et al. 2010.Behavioral counseling and varenicline treatment for smoking cessation. American Journal of Preventive Medicine, 38, 482-490). One thousand one hundred and sixty-one participants were mailed a 28-day varenicline supply when they set a quit date and were able to request up to two refills from the health plan pharmacy at no cost. Pharmacy fill records were obtained and telephone surveys completed at baseline, 21 days, 12 weeks, and 6 months post target quit date. RESULTS Good adherence to varenicline (≥80% of days taken) was associated with a twofold increase in 6-month quit rates compared with poor adherence (52% vs. 25%). Smokers were more likely than nonsmokers to stop varenicline early. Purposeful nonadherence was associated with smoking at 12 weeks and was predicted in multivariate analyses by age, gender, adherence self-efficacy, and initial medication side effect severity. CONCLUSIONS Innovative methods for increasing adherence to smoking cessation medications are needed, particularly early in the quit process. Simple metrics of adherence such as number of days cessation medication is taken can and should be routinely incorporated in effectiveness trials and reported to advance future attempts to understand and reduce nonadherence.
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Affiliation(s)
- Sheryl L Catz
- Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
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McClure JB, Swan GE, Catz SL, Jack L, Javitz H, McAfee T, Deprey M, Richards J, Zbikowski SM. Smoking outcome by psychiatric history after behavioral and varenicline treatment. J Subst Abuse Treat 2010; 38:394-402. [PMID: 20363092 PMCID: PMC2860053 DOI: 10.1016/j.jsat.2010.03.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [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: 11/09/2009] [Revised: 01/25/2010] [Accepted: 03/09/2010] [Indexed: 11/19/2022]
Abstract
Treatment outcomes were compared across smokers enrolled in the COMPASS cessation trial with (positive psychiatric history [PH+], n = 271) and without (PH-, n = 271) a diagnosis of PH based on medical record evidence of anxiety, depression, psychotic disorder, or bipolar disorder. Everyone received behavioral counseling plus varenicline and was followed for 6 months post quit date. PH+ smokers took varenicline for fewer days on average (59.4 vs. 68.5, p < or = .01) but did not differ in their use of behavioral treatment. PH+ smokers were more likely to report anxiety and depression, but side-effect intensity ratings did not differ after adjusting for multiple comparisons. Overall, all side effects were rated as moderate intensity or less. Groups had similar 30-day abstinence rates at 6 months (31.5% PH+ vs. 35.4% PH-, p = .35). In sum, having a psychiatric diagnosis in this trial did not predict worse treatment outcome or worse treatment side effects.
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Rothemich SF, Woolf SH, Johnson RE, Devers KJ, Flores SK, Villars P, Rabius V, McAfee T. Promoting primary care smoking-cessation support with quitlines: the QuitLink Randomized Controlled Trial. Am J Prev Med 2010; 38:367-74. [PMID: 20307804 DOI: 10.1016/j.amepre.2010.01.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Revised: 12/12/2009] [Accepted: 01/07/2010] [Indexed: 02/03/2023]
Abstract
BACKGROUND Counseling by clinicians promotes smoking cessation, but in most U.S. primary care practices, it is difficult to provide more than brief advice to quit in the course of routine work. Telephone quitlines can deliver effective intensive counseling, but few collaborate closely with clinicians. PURPOSE This study aimed to determine whether cessation support in practices is enhanced by a systems approach, in partnership with quitlines. DESIGN A cluster RCT was used. SETTING/PARTICIPANTS Participants included 1817 adult smokers from 16 primary care practices in the Virginia Ambulatory Care Outcomes Research Network. INTERVENTION An expanded tobacco-use "vital sign" intervention (identify smokers, advise cessation, and assess readiness to quit) that was combined with fax referral of preparation-stage smokers to a quitline providing feedback to practices was compared to a traditional tobacco-use vital sign alone. MAIN OUTCOME MEASURES The frequency of cessation support (in-office discussion of methods to quit or quitline referral) reported by patients in an exit survey (September 2005-July 2006, analyzed in 2008) was measured. RESULTS The adjusted percentage of smokers who reported receiving cessation support differed by 12.5% in intervention and control practices (40.7% vs 28.2%, respectively; p<0.001). Both in-office discussion of methods to quit and quitline referral increased significantly with the intervention. Post hoc analysis revealed that the increase in cessation was stable for both patient gender and visit type and was more pronounced with patients aged 35-54 years and with male and more experienced clinicians. CONCLUSIONS A systems approach to identifying smokers, advising and assessing readiness to quit, combined with a partnership with a quitline, increases delivery of cessation support for primary care patients beyond that accomplished by traditional tobacco-use vital sign screening alone. CLINICAL TRIAL REGISTRATION NCT00112268.
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Affiliation(s)
- Stephen F Rothemich
- Department of Family Medicine, Virginia Commonwealth University, Richmond, 23298-0251, USA.
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Sheffer MA, Redmond LA, Kobinsky KH, Keller PA, McAfee T, Fiore MC. Creating a perfect storm to increase consumer demand for Wisconsin's Tobacco Quitline. Am J Prev Med 2010; 38:S343-6. [PMID: 20176306 DOI: 10.1016/j.amepre.2009.11.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 10/28/2009] [Accepted: 11/25/2009] [Indexed: 11/16/2022]
Abstract
BACKGROUND Telephone quitlines are a clinically proven and cost-effective population-wide tobacco-dependence treatment, and this option is now available in all 50 states. Yet, only 1% of the smoking population accesses these services annually. This report describes a series of policy, programmatic, and communication initiatives recently implemented in Wisconsin that resulted in a dramatic increase in consumer demand for the Wisconsin Tobacco Quitline (WTQL). INTERVENTION In 2007, the Wisconsin legislature voted to increase the state cigarette excise tax rate by $1.00, from $0.77/pack to $1.77/pack effective January 1, 2008. In preparation for the tax increase, the Wisconsin Tobacco Prevention and Control Program, the University of Wisconsin Center for Tobacco Research and Intervention, which manages the WTQL, and the state's quitline service provider, Free & Clear, Inc., collaborated to enhance quitline knowledge, availability, and services with the goal of increasing consumer demand for services. The enhancements included for the first time, a free 2-week supply of over-the-counter nicotine replacement medication for tobacco users who agreed to receive multi-session quitline counseling. A successful statewide earned media campaign intensified the impact of these activities, which were timed to coincide with temporal smoking-cessation behavioral patterns (i.e., New Year's resolutions). RESULTS As a result, the WTQL fielded a record 27,000 calls during the first 3 months of 2008, reaching nearly 3% of adult Wisconsin smokers. CONCLUSIONS This experience demonstrates that consumer demand for quitline services can be markedly enhanced through policy and communication initiatives to increase the population reach of this evidence-based treatment.
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Affiliation(s)
- Megan A Sheffer
- University of Wisconsin Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, USA.
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Bush TM, McAfee T, Deprey M, Mahoney L, Fellows JL, McClure J, Cushing C. The impact of a free nicotine patch starter kit on quit rates in a state quit line. Nicotine Tob Res 2009; 10:1511-6. [PMID: 19023843 DOI: 10.1080/14622200802323167] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
All states offer telephone quit lines but they are under-used in part because of the costs associated with promotion. Offering nicotine replacement therapy (NRT) as well as behavioral counseling can increase treatment participation and abstinence rates, but is expensive. Offering less than a full NRT 8-week course can also generate calls to the quit line but less is known about its impact on program outcomes. In October 2004, Oregon--a state with over 3 million people, 500,000 smokers, and a state-funded quit line--introduced the Free Patch Initiative: a free 2-week introductory supply of NRT with phone counseling offered to all callers. We examined the impact of this intervention among insured callers. Most (97.2%) requested free patches, 86.2% used them, and 47.2% obtained additional patches on their own. Six-month outcome data were obtained from insured quit line participants before (n = 268) and after (n = 614) the Initiative launched. Compared with pre-Initiative controls, Free Patch participants were more satisfied with the quit line (84.8% vs. 89.8%; p = .04) and had higher 7-day quit rates using the assumption that eligible nonrespondents are smokers (9.3% vs. 17.0%, OR = 2.0; 95% CI 1.4-2.8) and using respondent only analysis (19% vs. 33.6%, OR = 2.15; 95% CI 1.52-3.04). Offering a free direct mail starter pack of NRT along with telephone counseling is an effective, cost-sharing method for promoting quit line use, enhancing participant satisfaction, and increasing the reach and effectiveness of quit lines among quit line callers with health insurance.
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McClure JB, Jack L, Deprey M, Catz S, McAfee T, Zbikowski S, Westbrook E, Swan G. Canary in a coal mine? Interest in bupropion SR use among smokers in the COMPASS trial. Nicotine Tob Res 2008; 10:1815-6. [DOI: 10.1080/14622200802488358] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Zbikowski SM, Hapgood J, Smucker Barnwell S, McAfee T. Phone and web-based tobacco cessation treatment: real-world utilization patterns and outcomes for 11,000 tobacco users. J Med Internet Res 2008; 10:e41. [PMID: 19017583 PMCID: PMC2630835 DOI: 10.2196/jmir.999] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Revised: 05/03/2008] [Accepted: 08/19/2008] [Indexed: 11/13/2022] Open
Abstract
Background Phone-based tobacco cessation programs have been proven effective and widely adopted. Web-based solutions exist; however, the evidence base is not yet well established. Many cessation treatments are commercially available, but few integrate the phone and Web for delivery and no published studies exist for integrated programs. Objective This paper describes a comprehensive integrated phone/Web tobacco cessation program and the characteristics, experience, and outcomes of smokers enrolled in this program from a real-world evaluation. Methods We tracked program utilization (calls completed, Web log-ins), quit status, satisfaction, and demographics of 11,143 participants who enrolled in the Free & Clear Quit For Life Program between May 2006 and October 2007. All participants received up to five proactive phone counseling sessions with Quit Coaches, unlimited access to an interactive website, up to 20 tailored emails, printed Quit Guides, and cessation medication information. The program was designed to encourage use of all program components rather than asking participants to choose which components they wanted to use while quitting. Results We found that participants tended to use phone services more than Web services. On average, participants completed 2-2.5 counseling calls and logged in to the online program 1-2 times. Women were more adherent to the overall program; women utilized Web and phone services significantly (P = .003) more than men. Older smokers (> 26 years) and moderate smokers (15-20 cigarettes/day) utilized services more (P < .001) than younger (< 26 years) and light or heavy smokers. Satisfaction with services was high (92% to 95%) and varied somewhat with Web utilization. Thirty-day quit rates at the 6-month follow-up were 41% using responder analysis and 21% using intent-to-treat analysis. Web utilization was significantly associated with increased call completion and tobacco abstinence rates at the 6-month follow-up evaluation. Conclusions This paper expands our understanding of a real-world treatment program combining two mediums, phone and Web. Greater adherence to the program, as defined by using both the phone and Web components, is associated with higher quit rates. This study has implications for reaching and treating tobacco users with an integrated phone/Web program and offers evidence regarding the effectiveness of integrated cessation programs.
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Affiliation(s)
- Susan M Zbikowski
- Free & Clear, Inc, 999 Third Avenue, Suite 2100, Seattle, WA 98104, USA.
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Abstract
AIM To examine heterogeneity in outcome at 12 months following 8 weeks of treatment for smoking cessation with bupropion sustained-release (SR) 150 or 300 mg/day combined with behavioural counselling. DESIGN, SETTING, PARTICIPANTS Smokers were recruited from a large healthcare system and then randomized to receive either bupropion SR 150 mg/day (n = 763) or 300 mg/day (n = 761) taken for 8 weeks in combination with either proactive telephone counselling or a tailored mail approach. MEASUREMENTS AND FINDINGS A comprehensive set of relevant individual pretreatment and treatment characteristics was included in the analysis. Smoking outcome at 12 months was defined as point-prevalence of any regular self-reported smoking within the 7 days prior to follow-up contact. Classification and regression tree analysis identified subgroups that varied with respect to likelihood of being nonsmokers at 12 months. Seven subgroups were identified among those receiving bupropion SR 150 mg/day (proportion of nonsmokers at 12 months ranged from 13.7% to 43.5%) and eight subgroups among those receiving bupropion SR 300 mg/day (proportion of nonsmokers at 12 months ranged from 9.6% to 51.7%). In the 150-mg/day group, those with the lowest rate reported no previous quit attempt of 1 month or more in duration while those with the highest rate all reported previous quit attempts of 1 month or longer. In the 300 mg/day group, those with the lowest rate had very high levels of dependence while those with the highest rate were more highly educated and smoked at a lower level. Across all subgroups, cost per 12-month quitter ranged from a low of USD302 to a high of USD2,502. CONCLUSIONS These results indicate the presence of a substantial amount of variation in outcome following treatment with both dosages of bupropion SR, with substantial cost consequences. Variation in outcome could be reduced by providing treatments tailored to subgroups of individuals who are at exceptionally high risk for smoking following a quit attempt.
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Affiliation(s)
- Gary E Swan
- Center for Health Sciences, SRI International, Menlo Park, California, USA.
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Fellows JL, Bush T, McAfee T, Dickerson J. Cost effectiveness of the Oregon quitline "free patch initiative". Tob Control 2007; 16 Suppl 1:i47-52. [PMID: 18048632 PMCID: PMC2598519 DOI: 10.1136/tc.2007.019943] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2007] [Accepted: 08/15/2007] [Indexed: 12/31/2022]
Abstract
OBJECTIVE We estimated the cost effectiveness of the Oregon tobacco quitline's "free patch initiative" compared to the pre-initiative programme. METHODS Using quitline utilisation and cost data from the state, intervention providers and patients, we estimated annual programme use and costs for media promotions and intervention services. We also estimated annual quitline registration calls and the number of quitters and life years saved for the pre-initiative and free patch initiative programmes. Service utilisation and 30-day abstinence at six months were obtained from 959 quitline callers. We compared the cost effectiveness of the free patch initiative (media and intervention costs) to the pre-initiative service offered to insured and uninsured callers. We conducted sensitivity analyses on key programme costs and outcomes by estimating a best case and worst case scenario for each intervention strategy. RESULTS Compared to the pre-intervention programme, the free patch initiative doubled registered calls, increased quitting fourfold and reduced total costs per quit by $2688. We estimated annual paid media costs were $215 per registered tobacco user for the pre-initiative programme and less than $4 per caller during the free patch initiative. Compared to the pre-initiative programme, incremental quitline promotion and intervention costs for the free patch initiative were $86 (range $22-$353) per life year saved. CONCLUSIONS Compared to the pre-initiative programme, the free patch initiative was a highly cost effective strategy for increasing quitting in the population.
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Affiliation(s)
- Jeffrey L Fellows
- Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR 97227, USA.
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Swan GE, Jack LM, Valdes AM, Ring HZ, Ton CC, Curry SJ, McAfee T. Joint effect of dopaminergic genes on likelihood of smoking following treatment with bupropion SR. Health Psychol 2007; 26:361-8. [PMID: 17500623 DOI: 10.1037/0278-6133.26.3.361] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the relationship between joint variation in 2 dopaminergic genes and the likelihood of nonsmoking following treatment with bupropion sustained release (SR). DESIGN Three hundred twenty-three participants in a bupropion SR smoking cessation effectiveness trial with 12-month follow-up were genotyped for variants of dopamine receptor gene DRD2 and dopamine transporter SLC6A3. MAIN OUTCOME MEASURES Self-reported 7-day point prevalence of nonsmoking. RESULTS Neither genotype alone was associated with 7-day point-prevalent nonsmoking at the 12-month follow-up. However, in the presence of the DRD2 A1 allele, SLC6A3 status was significantly associated with the likelihood of nonsmoking at the 12-month follow-up (individuals with DRD2 A1+ and SLC6A3 9- were more likely to be smoking). In the absence of the DRD2 A1 allele, the association between SLC6A3 status and nonsmoking was nonsignificant. CONCLUSION Although these results are suggestive, a more compelling test is needed of the hypothesis that dopaminergic gene interaction underlies, in part, the likelihood of smoking following treatment with bupropion SR. Most likely this will come from larger studies involving prospective randomization to treatment based on genotype.
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Affiliation(s)
- Gary E Swan
- Center for Health Sciences, SRI International, Menlo Park, CA 94025, USA.
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36
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Bentz CJ, Bayley KB, Bonin KE, Fleming L, Hollis JF, Hunt JS, LeBlanc B, McAfee T, Payne N, Siemienczuk J. Provider feedback to improve 5A's tobacco cessation in primary care: a cluster randomized clinical trial. Nicotine Tob Res 2007; 9:341-9. [PMID: 17365766 DOI: 10.1080/14622200701188828] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The electronic health record (EHR) may be an effective tool to help clinicians address tobacco use more consistently. To evaluate the impact of EHR-generated practice feedback on rates of referral to a state-level tobacco quitline, we conducted a cluster randomized clinical trial (feedback versus no feedback) within 19 primary care clinics in Oregon. Intervention clinics received provider-specific monthly feedback reports generated from EHR data. The reports rated provider performance in asking, advising, assessing, and assisting with tobacco cessation compared with a clinic average and an achievable benchmark of care. During 12 months of follow-up, EHR-documented rates of advising, assessing, and assisting were significantly improved in the intervention clinics compared with the control clinics (p<.001). A higher case-mix index and presence of a clinic champion were associated with higher rates of referral to a state-level quitline. EHR-generated provider feedback improved documentation of assistance with tobacco cessation. Connecting physician offices to a state-level quitline was feasible and well accepted.
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Affiliation(s)
- Charles J Bentz
- Providence/St. Vincent Hospital and Medical Center, Portland, OR 97225, USA.
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Thompson B, Coronado G, Chen L, Thompson LA, Halperin A, Jaffe R, McAfee T, Zbikowski SM. Prevalence and characteristics of smokers at 30 Pacific Northwest colleges and universities. Nicotine Tob Res 2007; 9:429-38. [PMID: 17365775 DOI: 10.1080/14622200701188844] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
College is an important transition period during which young adults explore tobacco use. Few large-scale studies have been conducted among college students regarding tobacco use. We initiated a study examining tobacco use in 30 colleges and universities in the Pacific Northwest. We conducted a baseline survey among students. Sample size varied by the school size; for the 14 largest schools, we drew a random sample of all students, oversampling freshmen (n approximately 750) so that we could recruit and follow a cohort to assess smoking onset during the college years. Of the remaining students, we sampled equivalent numbers of sophomores, juniors, and seniors (n = 200 each). For the 16 schools with fewer than 1,350 students, we surveyed all students. We found overall smoking rates of 17.2%. Males (18.6%) were more likely to smoke than females (16.6%; p = .03), and public college students were more likely to smoke (20.5%) than those who attended private independent schools (18.9%; p = .61), whose rates were higher than those of private religious schools (11.6%; p = .001). Overall, college students are light smokers who do not smoke every day of the month. Further, they tend not to be highly dependent on tobacco, do not consider themselves regular smokers, and plan to quit before they graduate (56.8%). School type should be considered when estimating smoking rates among 4-year college students. Data indicate that college smokers wish and plan to quit before graduation, suggesting that efforts to assist smokers in quitting during the college years may be fruitful.
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Affiliation(s)
- Beti Thompson
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
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An LC, Schillo BA, Kavanaugh A, Luxenberg MG, Joseph AM, McAfee T. Access to nicotine replacement therapy as part of a statewide tobacco telephone helpline. Am J Health Promot 2006; 20:267-71. [PMID: 16555800 DOI: 10.4278/0890-1171-20.4.267] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe change in Minnesota's QUITPLAN helpline operations following provision of nicotine replacement therapy (NRT) to multisession counseling enrollees. METHODS NRT access began September 2002. Call volume is reported from September 2001 to May 2003 (pre-NRT = 2734, post-NRT = 12,536). A survey administered at 2 weeks assesses self-reported connection to services (response rate 80%, n = 538/670, pre-NRT vs. 67%, n = 400/595, post-NRT, p < .001). RESULTS Provision of NRT was followed by an increase in call volume (439 +/- 229 calls/month January through May pre-NRT vs. 1292 +/- 308 calls/month January through May post-NRT, p = .001). Enrollment in multisession counseling increased (17.4% pre-NRT vs. 75.3% post-NRT, p < .001). Among survey respondents, connection to services was not changed (83.8% pre-NRT vs. 88.0% post-NRT, p = .072). At 2 weeks, more respondents who enrolled in multisession counseling reported having a follow-up call scheduled (43.9% pre-NRT vs. 64.1% post-NRT, p = .001). CONCLUSIONS This is an observational study. Providing NRT as part of a statewide helpline may increase recruitment and encourage callers to enroll in multisession counseling.
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Affiliation(s)
- Lawrence C An
- University of Minnesota, Department of Internal Medicine, Division of General Medicine, Mayo Building, Mail Code 741, 420 Delaware Street SE, Minneapolis, MN 55455, USA.
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You NC, Mu LN, McAfee T, Yang B, Cao W, Yu SZ, Jiang QW, Zhou XF, Ding BG, Wang RH, Cai L, Zhang ZF. 050-S: Environmental Tobacco Smoking and Smoking-Related Susceptibility Genes for the Risk of Esophageal Cancer. Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s13a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - L N Mu
- UCLA, Los Angeles, CA 90095
| | | | - B Yang
- UCLA, Los Angeles, CA 90095
| | - W Cao
- UCLA, Los Angeles, CA 90095
| | - S Z Yu
- UCLA, Los Angeles, CA 90095
| | | | | | | | | | - L Cai
- UCLA, Los Angeles, CA 90095
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Swan GE, Valdes AM, Ring HZ, Khroyan TV, Jack LM, Ton CC, Curry SJ, McAfee T. Dopamine receptor DRD2 genotype and smoking cessation outcome following treatment with bupropion SR. Pharmacogenomics J 2005; 5:21-9. [PMID: 15492764 DOI: 10.1038/sj.tpj.6500281] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The A1 allele of the dopamine D2 receptor gene (DRD2) is associated with a reduced number of dopamine binding sites in the brain and with the increased likelihood of substance abuse and addictive behavior. In a study of smokers enrolled in an open-label, randomized effectiveness trial, we investigated whether variants in the DRD2 receptor gene are associated with smoking cessation outcomes following treatment with a combination of bupropion SR and behavioral counseling. Adherence to treatment and point-prevalent smoking status were assessed at 3 and 12 months, respectively, following a target quit date. Compared to women who carry both A2 alleles, women with at least one A1 allele were more likely to report having stopped taking bupropion due to medication side effects (odds ratio (OR)=1.91, 95% confidence interval (CI)=1.01-3.60; P<0.04) and at 12 months were somewhat more likely to report smoking (OR=0.76, 95% CI=0.56-1.03; P<0.076). Significant associations or trends were not observed in men. In women, individual variability in responsiveness to bupropion-based treatment may be partially due to differences in genetic variants influencing dopamine receptor function.
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Affiliation(s)
- G E Swan
- Center for Health Sciences, SRI International, Menlo Park, CA 94025, USA.
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McAfee T, Ludman E, Grothaus L, Zbikowski SM, Bush T, Hollis J, Polen M, Curry SJ. Physician Tobacco Advice to Preteens in a Smoking-Prevention Randomized Trial: Steering Clear. J Pediatr Psychol 2005; 30:371-6. [PMID: 15863433 DOI: 10.1093/jpepsy/jsi031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine preadolescent and parental recall of tobacco prevention messages by health care providers. METHODS As part of a smoking prevention trial, providers were cued to reinforce the study and advise intervention participants (N=4,026) not to use tobacco. All parents were surveyed at baseline; children were surveyed at 20 months; and a subsample (504 households) was surveyed at 6 and 12 months to assess discussion of tobacco use prevention and other health behavior topics by providers as well as susceptibility and experimentation with tobacco among children. RESULTS During the 20-month follow-up, less than 25% of children recalled a provider discussing tobacco use prevention. Recall of exposure to tobacco prevention messages at school (68%), from parents (53%), and from mass media (71%) was higher. CONCLUSIONS Physician tobacco counseling is occurring at lower rates in pre-adolescents than it is in adults. A chart reminder to providers was insufficient to create a meaningful effect.
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Affiliation(s)
- Tim McAfee
- Free & Clear, 12401 East Marginal Way South, Tukwila, Washington 98168, USA.
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McAfee T, Montanari D, Tifft S, Zbikowski SM. Preventing premature death: tobacco treatment services for employees. Empl Benefits J 2004; 29:18-23. [PMID: 15069850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
This article presents a summary of current information concerning the health and financial costs of workplace smoking, with special emphasis on the costs to union workers and multiemployer health and welfare funds. It describes the potential savings from investing in tobacco cessation for workers and members, provides an overview of scientific evidence concerning the efficacy of different approaches to tobacco cessation, including behavioral services and medications, and discusses some of the benefit design and management issues involved in offering tobacco cessation services to employees and members.
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Affiliation(s)
- Tim McAfee
- Center for Health Promotion (CHP), Tukwila, Washington, USA
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Abstract
AIMS To examine heterogeneity in outcome following treatment for smoking cessation with combined bupropion SR and behavioral counseling in women and men. DESIGN, SETTING, PARTICIPANTS This study included 875 women and 649 men recruited from a large health-care system and randomized to one of four combinations of treatment [two dosage levels of bupropion SR (Zyban, 150 mg and 300 mg) were crossed with two counseling programs of lower and higher intensity to create a four-cell design]. MEASUREMENTS AND FINDINGS A comprehensive set of relevant individual characteristics prior to treatment and treatment characteristics was included in the analysis. Smoking outcome at 12 months was defined as point-prevalence of any regular smoking within the 7 days prior to follow-up contact. Classification and regression tree analysis identified six subgroups in women that ranged in proportion of non-smokers from 9.8% to 42.9% and six subgroups in men that ranged in proportion of non-smokers from 17.3% to 50.0%. CONCLUSIONS These results indicate the presence of a substantial amount of variation in treatment outcome among women and men receiving combined bupropion SR and counseling. Variation in outcome could be reduced by providing treatments tailored to subgroups of individuals who are at exceptionally high risk for smoking following cessation.
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Affiliation(s)
- Gary E Swan
- Center for Health Sciences, SRI International, Menlo Park, CA 94025, USA.
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Swan GE, Jack LM, Curry S, Chorost M, Javitz H, McAfee T, Dacey S. Bupropion SR and counseling for smoking cessation in actual practice: Predictors of outcome. Nicotine Tob Res 2003; 5:911-21. [PMID: 14668075 DOI: 10.1080/14622200310001646903] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
To date, only one study has been published on individual characteristics associated with outcome following standard treatment with bupropion SR for smoking cessation. To investigate treatment outcome beyond the 6-week end-of-treatment point, the present study examined characteristics associated with more clinically relevant smoking endpoints following treatment with bupropion SR in a large health care system. A total of 1,524 smokers (649 men and 875 women) of average age 45.1 years were randomized to receive one of four combinations of bupropion SR (150 or 300 mg) and behavioral counseling (tailored mailings or proactive telephone counseling) and assessed for point-prevalent smoking status at 3 and 12 months. Multiple logistic regression analyses of potential risk factors for 12-month point-prevalent smoking and for persistent smoking (point-prevalent smoking at both follow-ups) following treatment were conducted for men and women combined and separately. Risk factors for smoking at both endpoints in the combined sample included treatment with tailored mailings, female gender, younger age, higher levels of tobacco dependence, shorter previous quit attempts, previous use of nicotine replacement therapy, and report of current depressive symptoms or lifetime depression. Risk factors for smoking following treatment identified in women only included treatment with the lower dose of bupropion SR, younger age, and higher perceived stress, whereas those that were unique to men included the presence of lifetime depression. The results are discussed in terms of their implications for the need for more effective treatments in general, and the role of individual differences in the likelihood of returning to smoking following treatment for quitting.
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Affiliation(s)
- Gary E Swan
- Center for Health Sciences, SRI International, Menlo Park, CA 94025, USA.
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Abstract
BACKGROUND Each day more than 2000 youth under age 18 become daily smokers and the age of tobacco initiation has been going down. Health care settings can partner with families to encourage parent-child interactions that prevent youth tobacco use. This study evaluates a smoking prevention intervention package for parents and children (aged 10-12) provided through their managed care organization. METHODS A two-arm (usual care vs intervention) randomized trial was employed. The intervention included a mailed parental smoking prevention kit, outreach follow-up telephone calls to the parent by a health educator, child materials, medical record cues for physicians to deliver prevention messages, and parent newsletter. Outcome measures were susceptibility to smoking, experimentation with smoking, and smoking in the past 30 days as assessed by 20-month follow-up surveys of children. RESULTS A total of 4,026 families enrolled in the study. The response rate to the 20-month follow-up was 88%. There were no significant effects of the intervention on any of the primary outcomes. The intervention was associated with modest but statistically significant increases in parent-child discussions of smoking related topics. CONCLUSIONS A minimal-intensity family-based prevention program did not significantly reduce rates of susceptibility or tobacco use among youth aged 10-12 at baseline and 11 to 14 at follow-up. Development and evaluation of innovative approaches to tobacco use prevention must continue, despite our disappointing results. Parents and health care systems are too important to abandon as channels for prevention messages.
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Affiliation(s)
- Susan J Curry
- Center for Health Studies, Group Health Cooperative, Seattle, WA, USA.
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Swan GE, McAfee T, Curry SJ, Jack LM, Javitz H, Dacey S, Bergman K. Effectiveness of Bupropion Sustained Release for Smoking Cessation in a Health Care Setting. ACTA ACUST UNITED AC 2003; 163:2337-44. [PMID: 14581254 DOI: 10.1001/archinte.163.19.2337] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The efficacy of bupropion hydrochloride sustained release (SR) (Zyban) for smoking cessation has been evaluated in clinical trials that included frequent in-person behavioral counseling, but not in actual practice settings. OBJECTIVE To determine the differential effectiveness of 2 doses of bupropion SR in combination with behavioral interventions of minimal to moderate intensity in an actual practice setting. DESIGN Open-label randomized trial, with 1 year of follow-up. SETTING A large health system (Group Health Cooperative) based in Seattle. PARTICIPANTS Adult smokers (N = 1524) interested in quitting smoking. INTERVENTIONS Participants were randomly assigned to receive 1 of 4 combinations of bupropion SR (150 or 300 mg) and behavioral counseling (minimal or moderate intensity). MAIN OUTCOME MEASURES The primary outcome measure was self-reported point-prevalence 7-day nonsmoking status at 3 and 12 months following the target quit date. Secondary outcomes included adverse and abstinence effects reported since beginning treatment with bupropion SR. RESULTS At 3 months, a significantly higher rate of nonsmoking was observed among those receiving the larger bupropion SR dose (P=.005). At 12 months, moderate intensity counseling was associated significantly with a higher rate of nonsmoking (P=.001). At 3 months, the higher dose was associated with a significantly increased frequency of self-reported symptoms such as difficulty sleeping (P=.02), difficulty concentrating (P=.02), shakiness/tremor (P=.002), and gastrointestinal problems (P=.005)and a decreased frequency of reported desire to smoke (P=.001). CONCLUSIONS In this actual practice setting, the combination of bupropion SR and minimal or moderate counseling was associated with 1-year quit rates of 23.6% to 33.2%. This suggests that existing health care systems can substantially decrease tobacco use rates among their enrollees if they provide these modest interventions.
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Affiliation(s)
- Gary E Swan
- Center for Health Sciences, SRI International, 333 Ravenswood Ave, Menlo Park, CA 94025, USA.
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El-Bastawissi A, McAfee T, Zbikowski SM, Hollis J, Stark M, Wassum K, Clark N, Barwinski R, Broughton E. The uninsured and Medicaid Oregon tobacco user experience in a real world, phone based cessation programme. Tob Control 2003; 12:45-51. [PMID: 12612361 PMCID: PMC1759092 DOI: 10.1136/tc.12.1.45] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To describe the experience of uninsured and Medicaid Oregon tobacco users who registered in Free & Clear (F&C), a telephone based cessation programme including five scheduled outbound calls. DESIGN AND SETTING Using a retrospective cohort design, 1334 (423 uninsured, 806 Medicaid, and 105 commercially insured) Oregon tobacco users who registered in F&C between 18 November 1998 and 28 February 2000 were identified and followed for 12 months post-registration; 648 (48.6%) were successfully contacted at 12 months. Information was collected from the F&C database. Unconditional logistic regression, adjusted for race and education, was used. RESULTS The seven day quit rate at 12 months, assuming non-respondents were smokers, was 14.8% (95% confidence interval (CI) 13.0 to 16.9). This rate was significantly higher among commercially insured participants (v Medicaid but not uninsured) and among participants who completed > or = 5 calls (v < 5 calls). The quit rate for those contacted at 12 months was 30.6% (95% CI 27.0% to 34.3%) and varied, however not significantly, by insurance and number of calls. After adjustment, respondents who completed > or = 5 calls were 60% more likely to quit tobacco (odds ratio (OR) 1.6, 95% CI 0.9 to 3.1), and uninsured respondents who completed > or = 5 calls were 70% more likely to quit tobacco (OR 1.7, 95% CI 0.9 to 3.5), relative to those who completed < 5 calls, but the difference was not significant. CONCLUSIONS The quit rates are similar to those reported in efficacy trials. The observed variation in quitting tobacco for respondents by number of calls completed and by insurance merits further investigation concentrating on increasing compliance with the call schedule, particularly for the uninsured.
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Affiliation(s)
- Ay El-Bastawissi
- Department of Health, Community and Family Health, Olympia, Washington 98504, USA.
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Ringen K, Anderson N, McAfee T, Zbikowski SM, Fales D. Smoking cessation in a blue-collar population: results from an evidence-based pilot program. Am J Ind Med 2002; 42:367-77. [PMID: 12382249 DOI: 10.1002/ajim.10129] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Taft Hartley Funds provide group health care coverage for 10 million union workers as well as their dependents in industries such as construction and transportation. The adult smoking rate in these populations is estimated at approximately 40%, therefore, these funds include 9 million adult smokers. The absence of evidence demonstrating the effectiveness of smoking cessation programs has kept Taft Hartley Funds from investing in smoking cessation benefits. METHODS A prototype for Taft Hartley Funds consistent with the Federal Clinical Guidelines for Smoking Cessation was designed and implemented in a pilot demonstration in the Carpenters Health and Security Trust of Western Washington. Participants chose a 1-call or more intensive 5-call smoking cessation counseling plan provided by the Group Health Cooperative's Free and Clear program. Medications were limited to the nicotine patch, nicotine gum, and Bupropion. Assessment of outcomes was performed by Free and Clear through a telephone survey 12 months following the enrollment date. RESULTS Nine hundred thirty-five smokers participated in the program. This pilot evaluation covers 325 participants with at least 12 months since enrollment; 75% were male, the average age was 41.4 and 63% had smoked at least one pack per day for more than 20 years. Sixty-one percent selected 5-Call Counseling; 39% 1-Call. Seventy-five percent also used smoking cessation medications: gum, 4%; patch, 32%; Bupropion 21.5%; patch plus Bupropion, 15.7%. The point-prevalence-quit rates were: overall, 27.5%; 1-Call, 25.5%; and 5-Call, 28.9%. The cost of the program was $1025.28 per smoker who quit, or $11.78 per full-time equivalent employee covered by the Fund per year. The compounded savings in reduced lifetime tobacco-related medical costs for the participants who quit are estimated to be 15 times the cost of the program, yielding an annual return on investment of 27.6%. CONCLUSIONS These results strongly suggest that smoking cessation programs can be effective even in such hard-to-reach populations as itinerant building trades workers, provided that the program is designed to their needs and environment. Based on these findings, health plans need to consider whether they are at risk of violating their fiduciary duties if they fail to offer smoking cessation benefits.
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Affiliation(s)
- Knut Ringen
- Stoneturn Consultants, Seattle, Washington 98166, USA.
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Abstract
In 1999, Group Health Cooperative (GHC), a health system with 575,000 enrollees, launched a quality improvement initiative to systematically record patient tobacco-use status and provider intervention using an automated billing system. Performance feedback and senior-level incentives were added to foster compliance with the automated recording. Prior to this period, tobacco-use status was recorded primarily via a paper-based chart system, with billing-system recording averaging only 7.5% of primary care visits. In 2000, tobacco-use status was recorded using the billing system in an average of 82% of visits (p<0.001). Significant increases (p<0.0001) were also observed for the absolute number of visits in which automated entry of tobacco-use status was documented using the billing system, as well as for visits where intervention was documented. In 1998, tobacco use was documented in 22,086 visits, with intervention documentation in 13,235 of these visits. By 2000, tobacco-use documentation increased to 76,180, with intervention documentation in 45,527. This work demonstrates the feasibility of using automated performance feedback and senior-level incentives to increase provider compliance with a new system of tobacco status identification and intervention. Other potential uses of this system, and potential limitations, are discussed.
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Affiliation(s)
- Tim McAfee
- Center for Health Promotion, Group Health Cooperative, Tukwila, Washington 98168, USA.
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McAfee T. Bed sharing is not a "consumer product". Arch Pediatr Adolesc Med 2000; 154:530-1. [PMID: 10807310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
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