Effectiveness of proactive and reactive services at the Swedish National Tobacco Quitline in a randomized trial.
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ABSTRACT:
SUBMITTER: Nohlert E
PROVIDER: S-EPMC4059482 | biostudies-literature | 2014
REPOSITORIES: biostudies-literature
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Effectiveness of proactive and reactive services at the Swedish National Tobacco Quitline in a randomized trial.
Nohlert Eva E Ohrvik John J Helgason Asgeir R AR
Tobacco induced diseases 20140603 1
<h4>Background</h4>The Swedish National Tobacco Quitline (SNTQ), which has both a proactive and a reactive service, has successfully provided tobacco cessation support since 1998. As there is a demand for an increase in national cessation support, and because the quitline works under funding constraints, it is crucial to identify the most clinically effective and cost-effective service. A randomized controlled trial was performed to compare the effectiveness of the high-intensity proactive servi ...[more]
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Project description:Telephone-based tobacco quitlines are an evidence-based intervention, but little is known about how callers hear about quitlines and whether variations exist by demographics or state. This study assessed trends in "how-heard-abouts" (HHAs) in 38 states.Data came from the Centers for Disease Control and Prevention's (CDC's) National Quitline Data Warehouse, which stores nonidentifiable data collected from individual callers at quitline registration and reported quarterly by states. Callers were asked how they heard about the quitline; responses were grouped into the following categories: media, health professional, family or friends, and "other." We examined trends from 2010 through 2013 (N = 1,564,437) using multivariable models that controlled for seasonality and the impact of CDC's national tobacco education campaign, Tips From Former Smokers (Tips). Using data from 2013 only, we assessed HHAs variation by demographics (sex, age, race/ethnicity, education) and state in a 38-state sample (n = 378,935 callers).From 2010 through 2013, the proportion of HHAs through media increased; however, this increase was not significant when we controlled for calendar quarters in which Tips aired. The proportion of HHAs through health professionals increased, whereas those through family or friends decreased. In 2013, HHAs occurred as follows: media, 45.1%; health professionals, 27.5%, family or friends, 17.0%, and other, 10.4%. Media was the predominant HHA among quitline callers of all demographic groups, followed by health professionals (except among people aged 18-24 years). Large variations in source of HHAs were observed by state.Most quitline callers in the 38-state sample heard about quitlines through the media or health care professionals. Variations in source of HHAs exist across states; implementation of best-practice quitline promotional strategies is critical to maximize reach.
| S-EPMC4747436 | biostudies-other
Project description:Telephone tobacco quitlines are effective and are widely used, with more than 500,000 U.S. callers in 2010. This study investigated the clinical effectiveness and cost-effectiveness of 3 different quitline enhancements: combination nicotine replacement therapy (NRT), longer duration of NRT, and counseling to increase NRT adherence.In this study, 987 quitline callers were randomized to a combination of quitline treatments in a 2 × 2 × 2 factorial design: NRT duration (2 vs. 6 weeks), NRT type (nicotine patch only vs. patch plus nicotine gum), and standard 4-call counseling (SC) versus SC plus medication adherence counseling (MAC). The primary outcome was 7-day point-prevalence abstinence (PPA) at 6 months postquit in intention-to-treat (ITT) analyses.Combination NRT for 6 weeks yielded the highest 6-month PPA rate (51.6%) compared with 2 weeks of nicotine patch (38.4%), odds ratios [OR] = 1.71 (95% confidence interval [CI]:1.20-2.45). A similar result was found for 2 weeks of combination NRT (48.2%), OR = 1.49 (95% CI: 1.04-2.14) but not for 6 weeks of nicotine patch alone (46.2%), OR = 1.38 (95% CI: 0.96-1.97). The MAC intervention effect was nonsignificant. Cost analyses showed that the 2-week combination NRT group had the lowest cost per quit ($442 vs. $464 for 2-week patch only, $505 for 6-week patch only, and $675 for 6-week combination NRT).Combination NRT for 2 or 6 weeks increased 6-month abstinence rates by 10% and 13%, respectively, over rates produced by 2 weeks of nicotine patch when offered with quitline counseling. A 10% improvement would potentially yield an additional 50,000 quitters annually, assuming 500,000 callers to U.S. quitlines per year.
| S-EPMC3611992 | biostudies-literature
Project description:IntroductionQuitlines are effective in helping smokers quit, but pediatrician quitline referral rates are low, and few parents who smoke use the service. This study compared enrollment of parents who smoke in the quitline using electronic referral with that using manual referral.Study designThe study was designed as a pragmatic RCT.Setting/participantsParticipants were recruited from one large, urban pediatric primary care site in Philadelphia, Pennsylvania with a high percentage of low-income families. Participants included adult parents who smoked and were present at their child's healthcare visit.InterventionPediatricians screened for tobacco use; smokers were given brief advice to quit and, if interested in quitting, were referred to the quitline. The eReferral ("warm handoff") involved electronically sending parent information to the quitline (parent received a call within 24-48 hours). Control group procedures were identical to eReferral, except the quitline number was provided to the parent. Data were collected between March 2017 and February 2018 and analyzed in 2018.Main outcome measuresThe primary outcome was the proportion of parents enrolled in quitline treatment. Secondary outcomes included parent factors (e.g., demographics, nicotine dependence, and quitting motivation) associated with successful enrollment. Number of quitline contacts was also explored.ResultsDuring the study period, in the eReferral group, 10.3% (24 of 233) of parents who smoked and were interested in quitting enrolled in the quitline, whereas only 2.0% (5 of 251) of them in the control group enrolled in the quitline-a difference of 8.3% (95% CI=4.0, 12.6). Parents aged ≥50 years enrolled in the quitline more frequently. Although more parents in the eReferral group connected to the quitline, among parents who had at least one quitline contact, there was no significant difference in the mean number of quitline contacts between eReferral and control groups (mean, 2.04 vs 2.40 calls; difference, 0.36 [95% CI=0.35, 1.06]).ConclusionsSmoking parent eReferral from pediatric primary care may increase quitline enrollment and could be adopted by practices interested in increasing rates of parent treatment.Trial registrationThis study is registered at www.clinicaltrials.gov NCT02997735.
| S-EPMC6644070 | biostudies-literature
Project description:AimsTo estimate the cost-effectiveness at population-level of the OPT-IN proactive tobacco cessation outreach program for adult smokers enrolled in publicly funded health insurance plans for low-income persons (e.g. Medicaid).DesignCost-effectiveness analysis using a state transition model based on data from the Offering Proactive Treatment Intervention (OPT-IN) randomized control trial.SettingThe trial was conducted in Minnesota, USA, and the economic analysis was conducted from the Medicaid program perspective.ParticipantsData were used from 2406 smokers who were randomized into the intervention or comparator groups.Intervention and comparatorThe intervention was comprised of proactive outreach (mailed invitation and telephone calls) and free cessation treatment (nicotine replacement therapy and intensive telephone counseling). The comparator was usual care, which comprised access to a primary care physician, insurance coverage of Food and Drug Administration (FDA)-approved smoking cessation medications and the state's telephone quitline.MeasurementsSmoking status, quality of life and health-care use at varying times, including at baseline and 1 year.FindingsThe OPT-IN program cost an average of $84 per participant greater than the comparator. One year after randomization, the population-level, 6-month prolonged smoking abstinence rate was 16.5% in the proactive outreach intervention group and 12.1% in the usual care group (P < 0.05). The model projected that the proactive outreach intervention added $78 in life-time cost and generated 0.005 additional quality-adjusted life-years (QALYs), with an expected incremental cost-effectiveness ratio of $4231 per QALY. Probabilistic sensitivity analysis found that the proactive outreach intervention would be cost-effective against a willingness-to-pay threshold of $50 000/QALY approximately 68% of the time.ConclusionsPopulation-level proactive tobacco treatment with personal telephone outreach was effective in achieving higher population-level quit rates and was cost-effective at various willingness-to-pay thresholds, compared with usual care (i.e. reactive treatment). Taken together with prior research, population-level proactive tobacco cessation outreach programs are judged to be highly cost-effective over the long term.
| S-EPMC6899559 | biostudies-literature
Project description:OBJECTIVES:To coherently examine the responsiveness of the Swedish National Tobacco Quitline (SNTQ) to different types of anti-smoking policies over an extended period of calendar time. DESIGN:Quasi-experimental design with an intervention time-series analysis based on 19 years series of data collected between January 1999 and August 2017 (224 months). Statistical inference on calling rates and rate ratios was obtained using intervention time-series models (Poisson regression and transfer functions). PARTICIPANTS:A total of 179?851 phone calls to the SNTQ. INTERVENTIONS:Recent application of the 2014/40/ European Union (EU) Tobacco Products Directive in 2016. Historical interventions such as a campaign on passive smoking in January 2001; introduction of larger text warnings on cigarette packages since September 2002; banning smoking in restaurants since June 2005; and tobacco tax increase by 10% since January 2012. OUTCOME MEASURE:Calling rates to the SNTQ expressed per 100?000 smokers. SETTING:Sweden. RESULTS:The introduction of large pictorial warnings together with text warnings on cigarette packages (May 2016) was associated with a 35% increase in SNTQ calling rate (95% CI 1.16 to 1.57). The campaign on passive smoking (Jan 2001) was associated with a 61% higher calling rate (95% CI 1.06 to 2.45). Larger text warnings on cigarette packs (Sept 2002) conferred a 28% increment in the calling rate (95% CI 1.15 to 1.42); and prohibition to smoke in restaurants (Jun 2005) was associated with a 15% increase in the calling rate (95% CI 1.01 to 1.30). The 10% tobacco tax increase (Jan 2012) was associated with a 3% higher calling rate (95% CI 0.90 to 1.19). CONCLUSIONS:Within an overall decreasing trend of daily smoking in Sweden, we found that the recent introduction of pictorial warnings together with text warnings and referral text had a discernible positive impact on the calling rates to the smoking quitline. We were also able to detect a likely impact of earlier nationwide interventions.
| S-EPMC6924841 | biostudies-literature
Project description:BACKGROUND:Use of smokeless tobacco (moist snuff and chewing tobacco) is a significant public health problem but smokeless tobacco users have few resources to help them quit. Web programs and telephone-based programs (Quitlines) have been shown to be effective for smoking cessation. We evaluate the effectiveness of a Web program, a Quitline, and the combination of the two for smokeless users recruited via the Web. OBJECTIVES:To test whether offering both a Web and Quitline intervention for smokeless tobacco users results in significantly better long-term tobacco abstinence outcomes than offering either intervention alone; to test whether the offer of Web or Quitline results in better outcome than a self-help manual only Control condition; and to report the usage and satisfaction of the interventions when offered alone or combined. METHODS:Smokeless tobacco users (N= 1,683) wanting to quit were recruited online and randomly offered one of four treatment conditions in a 2×2 design: Web Only, Quitline Only, Web + Quitline, and Control (printed self-help guide). Point-prevalence all tobacco abstinence was assessed at 3- and 6-months post enrollment. RESULTS:69% of participants completed both the 3- and 6-month assessments. There was no significant additive or synergistic effect of combining the two interventions for Complete Case or the more rigorous Intent To Treat (ITT) analyses. Significant simple effects were detected, individually the interventions were more efficacious than the control in achieving repeated 7-day point prevalence all tobacco abstinence: Web (ITT, OR = 1.41, 95% CI = 1.03, 1.94, p = .033) and Quitline (ITT: OR = 1.54, 95% CI = 1.13, 2.11, p = .007). Participants were more likely to complete a Quitline call when offered only the Quitline intervention (OR = 0.71, 95% CI = .054, .093, p = .013), the number of website visits and duration did not differ when offered alone or in combination with Quitline. Rates of program helpfulness (p <.05) and satisfaction (p <.05) were higher for those offered both interventions versus offered only quitline. CONCLUSION:Combining Web and Quitline interventions did not result in additive or synergistic effects, as have been found for smoking. Both interventions were more effective than a self-help control condition in helping motivated smokeless tobacco users quit tobacco. Intervention usage and satisfaction were related to the amount intervention content offered. Usage of the Quitline intervention decreased when offered in combination, though rates of helpfulness and recommendations were higher when offered in combination. TRIAL REGISTRATION:Clinicaltrials.gov NCT00820495; http://clinicaltrials.gov/ct2/show/NCT00820495.
| S-EPMC4405799 | biostudies-literature
Project description:There is a high prevalence of smoking and high burden of tobacco-related diseases among low-income populations. Effective, evidenced-based smoking cessation treatments are available, but low-income smokers are less likely than higher-income smokers to use these treatments, especially the most comprehensive forms that include a combination of pharmacotherapy and intensive behavioral counseling.The primary objectives of this randomized controlled trial are to compare the effects of a proactive tobacco treatment intervention compared to usual care on population-level smoking abstinence rates and tobacco treatment utilization rates among a diverse population of low-income smokers, and to determine the cost-effectiveness of proactive tobacco treatment intervention. The proactive care intervention systematically offers low-income smokers free and easy access to evidence-based treatments and has two primary components: (1) proactive outreach to current smokers in the form of mailed invitation materials and telephone calls containing targeted health messages, and (2) facilitated access to free, comprehensive, evidence-based tobacco cessation treatments in the form of NRT and intensive, telephone-based behavioral counseling. The study aims to include a population-based sample (N?=?2500) of adult smokers enrolled in the Minnesota Health Care Programs (MHCP), a state-funded health insurance plan for low-income persons. Baseline data is obtained from MHCP administrative databases and a participant survey that is conducted prior to randomization. Outcome data is collected from a follow-up survey conducted 12 months after randomization and MHCP administrative data. The primary outcome is six-month prolonged smoking abstinence at one year and is assessed at the population level. All randomized individuals are asked to complete the follow-up survey, regardless of whether they participated in tobacco treatment. Data analysis of the primary aims will follow intent-to-treat methodology.There is a critical need to increase access to effective tobacco dependence treatments. This randomized trial evaluates the effects of proactive outreach coupled with free NRT and telephone counseling on the population impact of tobacco dependence treatment. If proven to be effective and cost-effective, national dissemination of proactive treatment approaches would reduce tobacco-related morbidity, mortality, and health care costs for low income Americans.ClinicalTrials.gov: NCT01123967.
| S-EPMC3995758 | biostudies-literature
Project description:Widening socioeconomic disparities in mortality in the United States are largely explained by slower declines in tobacco use among smokers of low socioeconomic status (SES) than among those of higher SES, which points to the need for targeted tobacco cessation interventions. Documentation of smoking status in electronic health records (EHRs) provides the tools for health systems to proactively offer tobacco treatment to socioeconomically disadvantaged smokers.To evaluate a proactive tobacco cessation strategy that addresses sociocontextual mediators of tobacco use for low-SES smokers.This prospective, randomized clinical trial included low-SES adult smokers who described their race and/or ethnicity as black, Hispanic, or white and received primary care at 1 of 13 practices in the greater Boston area (intervention group, n?=?399; control group, n?=?308).We analyzed EHRs to identify potentially eligible participants and then used interactive voice response (IVR) techniques to reach out to them. Consenting patients were randomized to either receive usual care from their own health care team or enter an intervention program that included (1) telephone-based motivational counseling, (2) free nicotine replacement therapy (NRT) for 6 weeks, (3) access to community-based referrals to address sociocontextual mediators of tobacco use, and (4) integration of all these components into their normal health care through the EHR system.Self-reported past-7-day tobacco abstinence 9 months after randomization ("quitting"), assessed by automated caller or blinded study staff.The intervention group had a higher quit rate than the usual care group (17.8% vs 8.1%; odds ratio, 2.5; 95% CI, 1.5-4.0; number needed to treat, 10). We examined whether use of intervention components was associated with quitting among individuals in the intervention group: individuals who participated in the telephone counseling were more likely to quit than those who did not (21.2% vs 10.4%; P?<?.001). There was no difference in quitting by use of NRT. Quitting did not differ by a request for a community referral, but individuals who used their referral were more likely to quit than those who did not (43.6% vs 15.3%; P?<?.001).Proactive, IVR-facilitated outreach enables engagement with low-SES smokers. Providing counseling, NRT, and access to community-based resources to address sociocontextual mediators among smokers reached in this setting is effective.clinicaltrials.gov Identifier: NCT01156610.
| S-EPMC4590783 | biostudies-literature
Project description:African Americans suffer disproportionately from tobacco-related illness and have more difficulty quitting smoking than other racial/ethnic groups. Previous research indicates that African American treatment-seekers are high utilizers of tobacco quitlines, yet cessation rates via quitlines are lower relative to whites. The goal of the present study is to test the effectiveness of adding a culturally specific, video-based, adjunct to standard quitline care. It is hypothesized that the integration of an evidence-based intervention (Pathways to Freedom: Leading the Way to a Smoke-Free Community©; PTF) into quitline services will increase cessation and treatment engagement compared to control conditions, and that effects will be moderated by sociocultural factors (e.g., culturally specific intervention expectancies, acculturation, and ethnic identity).This study is a 3-arm semi-pragmatic randomized controlled trial (RCT). Participants will be 1050 enrollees in the North Carolina State quitline (QuitlineNC) who self-identify as African American. Usual quitline care includes up to 4 proactive quit coaching calls, website access, and two-weeks of nicotine patch therapy. Eligible study participants will be randomized to receive (1) standard quitline services plus PTF (PTF); (2) quitline services plus a standard tobacco cessation DVD (attention control); or (3) quitline services alone (usual care). Assessments will be conducted at baseline, 3 and 6-months post-enrollment. The primary outcome will be biochemically verified 7 day ppa at 6-months. Generalized linear mixed models (GLMMs) and hierarchical logistic regression will be used to assess the effects of treatment group on cessation outcomes and to test potential moderators.This study will answer questions regarding the implementation and effectiveness of integrating a culturally specific video intervention into a real-world, population-level tobacco intervention. It will also aid our understanding of individual-difference variables that are associated with success. If an incremental benefit is found, this trial will have implications for increasing the responsiveness of tobacco quitlines for African Americans, reducing tobacco cessation disparities, and best practices for improving minority health. In addition, the PTF intervention has the potential for widespread disseminated through quitlines, which are available across the United States.Clinicaltrials.gov NCT03064971 . Registered on February 22, 2017.
| S-EPMC5763652 | biostudies-literature
Project description:Quitlines (QL) are an effective means for smoking cessation, but a paucity of data exist examining the dose-response relationship between use of QL services and quit rates, especially among low-income smokers. The purpose of this study was to study the relationship between tobacco abstinence and use of QL services among low-income smokers.Secondary analysis of a randomized trial of every- or some-day smokers aged 18 years or older visiting an urban emergency department. Inclusion criteria included self-pay or Medicaid insurance, as a proxy for low-income and low socioeconomic status. Intervention participants received a motivational interview, 6 weeks of nicotine patches and gum, a referral faxed to the state-sponsored QL, a booster call, and a quitline brochure. Control participants received the brochure. Smoking status was assessed by phone at 1 and 3 months, with confirmation via exhaled carbon monoxide testing at 3 months for those reporting abstinence. QL usage was obtained by utilization data from the QL database.Of 778 subjects, 197 (25.3%) reported any use of QL services at 3 months. Participants were trichotomized: no QL usage, 1 call only, and >1 call (583, 99, and 98 participants, respectively). Quit rates at 3 months in these no, low-, and high-use groups were, respectively, 7.2%, 9.1%, and 15.3% (P=0.03). Participants who used the QL had a median of 28 total minutes of telephone contact.Among low-income smokers, greater use of QL services is associated with higher abstinence. Whether this resulted from a direct effect of the QL, or greater motivation among smokers using QL services cannot be determined from these data.
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