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1.
Pharmacy (Basel) ; 10(3)2022 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-35736771

RESUMO

Pharmacists, as highly accessible members of the healthcare team, have considerable potential to address tobacco use among patients. However, while published data suggest that pharmacists are effective in helping patients quit, barriers exist to routine implementation of cessation services in community pharmacy settings. Within the context of a randomized trial (n = 64 pharmacies), surveys were administered over a period of 6 months to assess pharmacists' perceptions of factors associated with the implementation of "Ask-Advise-Refer", a brief intervention approach that facilitates patient referrals to the tobacco quitline. Study measures, grounded in Rogers' Diffusion of Innovations Theory, assessed pharmacists' perceptions of implementation facilitators and barriers, perceptions of intervention materials provided, and perceived efforts and personal success in implementing Ask-Advise-Refer at 6-months follow-up. Findings indicate that while the brief intervention approach was not difficult to understand or implement, integration into normal workflows presents greater challenges and is associated with overall confidence and implementation success. Lack of time was the most significant barrier to routine implementation. Most (90.6%) believed that community pharmacies should be active in promoting tobacco quitlines. Study results can inform future development of systems-based approaches that lead to broad-scale adoption of brief interventions, including but not limited to tobacco cessation, in pharmacy settings.

2.
JMIR Public Health Surveill ; 8(3): e32499, 2022 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-35262491

RESUMO

BACKGROUND: Tobacco use continues to be the leading preventable cause of death, disease, and disability in the United States. Since 2000, Washington state has offered free tobacco "quitline" services to help its residents stop using tobacco. In 2015, the state began offering free access to a tobacco cessation smartphone app to absorb excess quitline demand. Since most publicly funded tobacco cessation programs are designed to provide access to populations disproportionately impacted by tobacco use, it is important to consider who these public health interventions reach. OBJECTIVE: The aim of this study is to understand who used a free cessation app and the extent to which users represented populations disproportionately impacted by tobacco use. METHODS: This is an observational study of 1280 adult Washington state residents who registered for and activated the cessation app. Demographic data were collected as part of the sign-up process, examined using standard descriptive measures, and assessed against state-level surveillance data for representativeness. RESULTS: Participants were primarily non-Hispanic White (978/1218, 80.3%), identified as female (780/1236, 63.1%), were between ages 25-54 years (903/1186, 76.1%), had at least some college education (836/1222, 68.4%), and reported a household income under US $50,000 (742/1055, 70.3%). Fewer respondents were from rural counties (359/1220, 29.4%); identified as lesbian, gay, bisexual, pansexual, queer, questioning, or asexual (LGBQA; 153/1222, 12.5%); were uninsured (147/1206, 12.2%); or were currently pregnant, planning pregnancy, or breastfeeding (42/624, 6.7%). However, relative to available state data for tobacco users, there was high representation of women, 35- to 54-year-olds, college graduates, and LGBQA individuals, as well as individuals with low household income, poor mental health, Medicaid insurance, and those residing in rural counties. CONCLUSIONS: A diverse population of tobacco users will use a free cessation app, including some demographic groups disproportionately impacted by tobacco use. With high reach and high efficacy, it is possible to address health disparities associated with tobacco use and dependence treatment among certain underserved and at-risk groups.


Assuntos
Aplicativos Móveis , Abandono do Hábito de Fumar , Produtos do Tabaco , Abandono do Uso de Tabaco , Adulto , Demografia , Feminino , Humanos , Pessoa de Meia-Idade , Estados Unidos
3.
Transl Behav Med ; 10(1): 163-167, 2020 02 03.
Artigo em Inglês | MEDLINE | ID: mdl-30476236

RESUMO

Ask-Advise-Connect (AAC) was designed to link smokers in primary care settings with evidence-based tobacco treatment delivered via state quitlines. AAC involves training medical staff to Ask about smoking status, Advise smokers to quit, and offer to immediately Connect smokers with quitlines through an automated link within the electronic health record. We evaluated the efficacy of AAC in facilitating treatment engagement and smoking abstinence in a 34 month implementation trial conducted in a large, safety-net health care system. AAC was implemented from April 2013 through February 2016 in 13 community clinics that provided care to low-income, predominantly racial/ethnic minority smokers. Licensed vocational nurses were trained to implement AAC as part of standard care. Outcomes included (a) treatment engagement (i.e., proportion of identified smokers that enrolled in treatment) and (b) self-reported and biochemically confirmed abstinence at 6 months. Smoking status was recorded for 218,915 unique patients, and 40,888 reported current smoking. The proportion of all identified smokers who enrolled in treatment was 11.8%. Self-reported abstinence at 6 months was 16.6%, and biochemically confirmed abstinence was 4.5%. AAC was successfully implemented as part of standard care. Treatment engagement was high compared with rates of engagement for more traditional referral-based approaches reported in the literature. Although self-reported abstinence was in line with other quitline-delivered treatment studies, biochemically confirmed abstinence, which is not routinely captured in quitline studies, was dramatically lower. This discrepancy challenges the adequacy of self-report for large, population-based studies. A more detailed and comprehensive investigation is warranted.


Assuntos
Abandono do Hábito de Fumar , Aconselhamento , Atenção à Saúde , Etnicidade , Humanos , Grupos Minoritários , Fumar
4.
Prev Med Rep ; 13: 262-267, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30723660

RESUMO

The efficacy of tobacco treatment delivered by state quitlines in diverse populations is well-supported, yet little is known about associations between treatment dose and cessation outcomes following the implementation of Ask-Advise-Connect (AAC), an electronic health record-based systematic referral process that generates a high volume of proactive calls from the state quitline to smokers. The current study is a secondary analysis of a 34-month implementation trial evaluating ACC in 13 safety-net clinics in Houston, TX. Treatment was delivered by a quitline and comprised up to five proactive, telephone-delivered multi-component cognitive-behavioral treatment sessions. Associations between treatment dose and abstinence were examined. Abstinence was assessed by phone six months after treatment enrollment, and biochemically confirmed via mailed saliva cotinine. Among smokers who enrolled in treatment and agreed to follow-up (n = 3704), 29.2% completed no treatment sessions, 35.5% completed one session, 16.4% completed two sessions, and 19.0% completed ≥three sessions. Those who completed one (vs. no) sessions were no more likely to report abstinence (OR: 0.98). Those who completed two (vs. no) sessions were nearly twice as likely to report abstinence (OR: 1.83). Those who completed ≥three (vs. no) sessions were nearly four times as likely to report abstinence (OR: 3.70). Biochemically-confirmed cessation outcomes were similar. Most smokers received minimal or no treatment, and treatment dose had a large impact on abstinence. Results highlight the importance of improving engagement in evidence-based treatment protocols following enrollment. Given that motivation to quit fluctuates, systematically offering enrollment to all smokers at all visits is important.

5.
J Am Pharm Assoc (2003) ; 58(4): 387-394, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29779983

RESUMO

OBJECTIVES: To evaluate the long-term impact of 2 promising intervention approaches to engage pharmacy personnel (pharmacists, technicians) in referring patients who want to quit smoking to the tobacco quitline. DESIGN: Randomized trial. SETTING: Community pharmacies in Connecticut (n = 32) and Washington (n = 32). INTERVENTION: Two intervention approaches were evaluated: academic detailing (AD), which involved on-site training for pharmacy staff about the quitline, versus mailed quitline materials (MM). MAIN OUTCOME MEASURES: Changes in the overall percentage of quitline registrants who reported hearing about the quitline from any pharmacy during the 6-month baseline monitoring period versus the 12-month intervention period, and between-group comparisons of a) the number of quitline registrants who reported hearing about the quitline from one of the study pharmacies during the 12-month intervention period, and b) the number of quitline cards and brochures distributed to patients during the first 6 months of the intervention period. RESULTS: The percentage of quitline callers who reported having heard about the quitline from a pharmacy increased significantly, from 2.2% during the baseline monitoring period to 3.8% during the 12-month intervention (P < 0.0001). In addition, comparisons controlled for seasonal effects also revealed significant increases in referrals. Across all 64 pharmacies, 10,013 quitline cards and 4755 brochures were distributed. The number of quitline cards distributed and the number registrants who reported hearing about the quitline from a pharmacy did not differ by intervention approach (AD vs. MM), although AD pharmacies distributed more quitline brochures (P = 0.022). CONCLUSION: Brief cessation interventions are feasible in community pharmacies, and the 2 approaches evaluated for engaging pharmacy personnel were similarly effective and collectively led to meaningful increases in the number and proportion of all patients who called the quitline. Involvement of community pharmacy personnel in tobacco cessation presents a significant opportunity to promote quitline services by connecting patients with an effective publicly available resource.


Assuntos
Nicotiana/efeitos adversos , Farmácia , Abandono do Hábito de Fumar/métodos , Humanos , Farmacêuticos , Encaminhamento e Consulta
6.
J Med Internet Res ; 20(1): e32, 2018 01 26.
Artigo em Inglês | MEDLINE | ID: mdl-29374005

RESUMO

BACKGROUND: Chronic conditions in the United States are among the most costly and preventable of all health problems. Research suggests health coaching is an effective strategy for reducing health risks including decreases in weight, blood pressure, lipids, and blood glucose. Much less is known about how and when coaching works. OBJECTIVE: The aim of this study was to conduct an analysis of intrapersonal variations in participants' progression in health coaching, examining gender and age-related differences. METHODS: This was a cross-sectional, retrospective analysis of 35,333 health coaching participants between 2012 and 2016. Differences in number of goals and activities set and completed, and number of interactions were assessed using negative binomial models. Differences in goal type were assessed using logistic regression for gender and using the Welch test for age to account for unequal variances. RESULTS: Participants choosing online coaching were more likely to be younger and female (P<.001). Gender and age differences were found for the types of goals set by participants. Regarding program activity, women set and completed 12% more action steps than men (P<.001), averaging 21% more interactions than men (P<.001); no gender differences were found in number of goals completed (P=.12), although the percentage of males and females completing goals was significantly different at 60 and 120 days postenrollment (P<.001). Results indicated significant age-related differences in all aspects of program activity: number of interactions, goals set and completed, action steps set and completed (all P values <.01), as well as significant differences in percentage of individuals completing initial goals within 30 days, with older individuals completing more than younger individuals did (all P values <.001). CONCLUSIONS: This study found significant intrapersonal variation in how people participate in and progress through a coaching program. Age-related variations were found in all aspects of coaching activity, from modality preference and initial choice of goal type (eg, weight management, tobacco cessation) to goal completion, whereas gender-related differences were demonstrated for all program activities except number of goals set and completed. These findings indicate that to maximize behavior change, coaches need to personalize the coaching experience to the individual.


Assuntos
Tutoria/normas , Adulto , Estudos Transversais , Feminino , Objetivos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
7.
J Subst Abuse Treat ; 71: 58-62, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27776679

RESUMO

INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.


Assuntos
Linhas Diretas/estatística & dados numéricos , Entrevista Motivacional/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pobreza , Encaminhamento e Consulta/estatística & dados numéricos , Abandono do Hábito de Fumar/estatística & dados numéricos , Dispositivos para o Abandono do Uso de Tabaco/estatística & dados numéricos , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Folhetos , Abandono do Hábito de Fumar/métodos
8.
BMJ Open ; 5(6): e007260, 2015 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-26124508

RESUMO

OBJECTIVE: To test adding an interactive voice response (IVR)-supported protocol to standard quitline treatment to prevent relapse among recently quit smokers. DESIGN: Parallel randomised controlled trial with three arms: standard quitline, standard plus technology enhanced quitline with 10 risk assessments (TEQ-10), standard plus 20 TEQ assessments (TEQ-20). SETTING: Quit For Life (QFL) programme. PARTICIPANTS: 1785 QFL enrolees through 19 employers or health plans who were 24+ h quit. INTERVENTIONS: QFL is a 5-call telephone-based cessation programme including medications and web-based support. TEQ interventions included 10 or 20 IVR-delivered relapse risk assessments over 8 weeks with automated transfer to counselling for those at risk. MAIN OUTCOME MEASURES: Self-reported 7-day and 30-day abstinence assessed at 6-month and 12-month post-enrolment (response rates: 61% and 59%, respectively). Missing data were imputed. RESULTS: 1785 were randomised (standard n=592, TEQ-10 n=602, TEQ-20 n=591). Multiple imputation-derived, intent-to-treat 30-day quit rates (95% CI) at 6 months were 59.4% (53.7% to 63.8%) for standard, 62.3% (57.7% to 66.9%) for TEQ-10, 59.4% (53.7% to 65.1%) for TEQ-20 and 30-day quit rates at 12 months were 61.2% (55.6% to 66.8%) for standard, 60.6% (56.0% to 65.2%) for TEQ-10, 54.9% (49.0% to 60.9%) for TEQ-20. There were no significant differences in quit rates. 73.3% of TEQ participants were identified as at-risk by IVR assessments; on average, participants completed 0.41 IVR-transferred counselling calls. Positive risk assessments identified participants less likely (OR=0.56, 95% CI 0.42 to 0.76) to be abstinent at 6 months. CONCLUSIONS: Standard treatment was highly effective, with 61% remaining abstinent at 12 months using multiple imputation intent-to-treat (intent-to-treat missing=smoking quit rate: 38%). TEQ assessments identified quitters at risk for relapse. However, adding IVR-transferred counselling did not yield higher quit rates. Research is needed to determine if alternative designs can improve outcomes. TRIAL REGISTRATION NUMBER: NCT00888992.


Assuntos
Linhas Diretas , Seguro Saúde , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , Abandono do Hábito de Fumar/métodos , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar/terapia , Adulto , Aconselhamento , Feminino , Seguimentos , Planos de Assistência de Saúde para Empregados , Humanos , Masculino , Recidiva , Resultado do Tratamento
9.
J Med Internet Res ; 17(2): e36, 2015 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-25673013

RESUMO

BACKGROUND: Phone-based tobacco cessation program effectiveness has been established and randomized controlled trials have provided some support for Web-based services. Relatively little is known about who selects different treatment modalities and how they engage with treatments in a real-world setting. OBJECTIVE: This paper describes the characteristics, Web utilization patterns, and return rates of tobacco users who self-selected into a Web-based (Web-Only) versus integrated phone/Web (Phone/Web) cessation program. METHODS: We examined the demographics, baseline tobacco use, Web utilization patterns, and return rates of 141,429 adult tobacco users who self-selected into a Web-Only or integrated Phone/Web cessation program through 1 of 10 state quitlines from August 2012 through July 2013. For each state, registrants were only included from the timeframe in which both programs were offered to all enrollees. Utilization data were limited to site interactions occurring within 6 months after registration. RESULTS: Most participants selected the Phone/Web program (113,019/141,429, 79.91%). After enrollment in Web services, Web-Only were more likely to log in compared to Phone/Web (21,832/28,410, 76.85% vs 23,920/56,892, 42.04%; P<.001), but less likely to return after their initial log-in (8766/21,832, 40.15% vs 13,966/23,920, 58.39%; P<.001). In bivariate and multivariable analyses, those who chose Web-Only were younger, healthier, more highly educated, more likely to be uninsured or commercially insured, more likely to be white non-Hispanic and less likely to be black non-Hispanic, less likely to be highly nicotine-addicted, and more likely to have started their program enrollment online (all P<.001). Among both program populations, participants were more likely to return to Web services if they were women, older, more highly educated, or were sent nicotine replacement therapy (NRT) through their quitline (all P<.001). Phone/Web were also more likely to return if they had completed a coaching call, identified as white non-Hispanic or "other" race, or were commercially insured (all P<.001). Web-Only were less likely to return if they started their enrollment online versus via phone. The interactive Tobacco Tracker, Cost Savings Calculator, and Quitting Plan were the most widely used features overall. Web-Only were more likely than Phone/Web to use most key features (all P<.001), most notably the 5 Quitting Plan behaviors. Among quitlines that offered NRT to both Phone/Web and Web-Only, Web-Only were less likely to have received quitline NRT. CONCLUSIONS: This paper adds to our understanding of who selects different cessation treatment modalities and how they engage with the program in a real-world setting. Web-Only were younger, healthier smokers of higher socioeconomic status who interacted more intensely with services in a single session, but were less likely to re-engage or access NRT benefits. Further research should examine the efficacy of different engagement techniques and services with different subpopulations of tobacco users.


Assuntos
Telefone Celular/estatística & dados numéricos , Internet/estatística & dados numéricos , Aplicativos Móveis/estatística & dados numéricos , Abandono do Hábito de Fumar/métodos , Telemedicina/estatística & dados numéricos , Tabagismo/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Projetos de Pesquisa , Adulto Jovem
10.
Nicotine Tob Res ; 16(11): 1446-54, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24935757

RESUMO

OBJECTIVE: We conducted a pilot randomized trial of telephone-delivered acceptance and commitment therapy (ACT) versus cognitive behavioral therapy (CBT) for smoking cessation. METHOD: Participants were 121 uninsured South Carolina State Quitline callers who were adult smokers (at least 10 cigarettes/day) and who wanted to quit within the next 30 days. Participants were randomized to 5 sessions of either ACT or CBT telephone counseling and were offered 2 weeks of nicotine replacement therapy (NRT). RESULTS: ACT participants completed more calls than CBT participants (M = 3.25 in ACT vs. 2.23 in CBT; p = .001). Regarding satisfaction, 100% of ACT participants reported their treatment was useful for quitting smoking (vs. 87% for CBT; p = .03), and 97% of ACT participants would recommend their treatment to a friend (vs. 83% for CBT; p = .06). On the primary outcome of intent-to-treat 30-day point prevalence abstinence at 6 months postrandomization, the quit rates were 31% in ACT versus 22% in CBT (odds ratio [OR] = 1.5, 95% confidence interval [CI] = 0.7-3.4). Among participants depressed at baseline (n = 47), the quit rates were 33% in ACT versus 13% in CBT (OR = 1.2, 95% CI = 1.0-1.6). Consistent with ACT's theory, among participants scoring low on acceptance of cravings at baseline (n = 57), the quit rates were 37% in ACT versus 10% in CBT (OR = 5.3, 95% CI = 1.3-22.0). CONCLUSIONS: ACT is feasible to deliver by phone, is highly acceptable to quitline callers, and shows highly promising quit rates compared with standard CBT quitline counseling. As results were limited by the pilot design (e.g., small sample), a full-scale efficacy trial is now needed.


Assuntos
Terapia de Aceitação e Compromisso/métodos , Abandono do Hábito de Fumar/métodos , Abandono do Hábito de Fumar/psicologia , Fumar/psicologia , Fumar/terapia , Telefone , Adolescente , Adulto , Terapia Cognitivo-Comportamental/métodos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Fumar/epidemiologia , South Carolina/epidemiologia
11.
J Obes ; 2014: 414987, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24688791

RESUMO

Obesity is related to high health care costs and lost productivity in the workplace. Employers are increasingly sponsoring weight loss and wellness programs to ameliorate these costs. We evaluated weight loss outcomes, treatment utilization, and health behavior change in a low intensity phone- and web-based, employer-sponsored weight loss program. The intervention included three proactive counseling phone calls with a registered dietician and a behavioral health coach as well as a comprehensive website. At six months, one third of those who responded to the follow-up survey had lost a clinically significant amount of weight (≥5% of body weight). Clinically significant weight loss was predicted by the use of both the counseling calls and the website. When examining specific features of the web site, the weight tracking tool was the most predictive of weight loss. Health behavior changes such as eating more fruits and vegetables, increasing physical activity, and reducing stress were all predictive of clinically significant weight loss. Although limited by the low follow-up rate, this evaluation suggests that even low intensity weight loss programs can lead to clinical weight loss for a significant number of participants.


Assuntos
Comportamentos Relacionados com a Saúde , Estilo de Vida , Obesidade/terapia , Redução de Peso , Programas de Redução de Peso/métodos , Adulto , Índice de Massa Corporal , Peso Corporal , Aconselhamento , Dieta , Exercício Físico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estresse Psicológico , Resultado do Tratamento , Programas de Redução de Peso/normas , Programas de Redução de Peso/estatística & dados numéricos , Local de Trabalho
12.
Ann Behav Med ; 47(2): 208-17, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24048952

RESUMO

BACKGROUND: The use and effectiveness of tobacco quitlines by weight is still unknown. PURPOSE: This study aims to determine if baseline weight is associated with treatment engagement, cessation, or weight gain following quitline treatment. METHODS: Quitline participants (n = 595) were surveyed at baseline, 3 and 6 months. RESULTS: Baseline weight was not associated with treatment engagement. In unadjusted analyses, overweight smokers reported higher quit rates and were more likely to gain weight after quitting than obese or normal weight smokers. At 3 months, 40 % of overweight vs. 25 % of normal weight or obese smokers quit smoking (p = 0.01); 42 % of overweight, 32 % of normal weight, and 33 % of obese quitters gained weight (p = 0.05). After adjusting for covariates, weight was not significantly related to cessation (approaching significance at 6 months, p = 0.06) or weight gain. CONCLUSIONS: In the first quitline study of this kind, we found no consistent patterns of association between baseline weight and treatment engagement, cessation, or weight gain.


Assuntos
Peso Corporal/fisiologia , Obesidade/fisiopatologia , Abandono do Hábito de Fumar , Fumar/fisiopatologia , Apoio Social , Aumento de Peso/fisiologia , Adulto , Feminino , Humanos , Masculino , Fumar/terapia
13.
Am J Prev Med ; 45(6): 737-41, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24237916

RESUMO

BACKGROUND: Because smoking has a profound impact on socioeconomic disparities in illness and death, it is crucial that vulnerable populations of smokers be targeted with treatment. The U.S. Public Health Service recommends that all patients be asked about their smoking at every visit and that smokers be given brief advice to quit and referred to treatment. PURPOSE: Initiatives to facilitate these practices include the 5A's (ask, advise, assess, assist, arrange) and Ask-Advise-Refer (AAR). Unfortunately, primary care referrals are low, and most smokers referred fail to enroll. This study evaluated the efficacy of the Ask-Advise-Connect (AAC) approach to linking smokers with treatment in a large, safety net public healthcare system. DESIGN: The study design was a pair-matched group-randomized trial with two treatment arms. SETTING/PARTICIPANTS: Ten safety net clinics in Houston TX. INTERVENTION: Clinics were randomized to AAC (n=5; intervention) or AAR (n=5; control). Licensed vocational nurses (LVNs) were trained to assess and record the smoking status of all patients at all visits in the electronic health record. Smokers were given brief advice to quit. In AAC, the names and phone numbers of smokers who agreed to be connected were sent electronically to the Texas quitline daily, and patients were proactively called by the quitline within 48 hours. In AAR, smokers were offered a quitline referral card and encouraged to call on their own. Data were collected between June 2010 and March 2012 and analyzed in 2012. MAIN OUTCOME MEASURES: The primary outcome was impact, defined here as the proportion of identified smokers that enrolled in treatment. RESULTS: The impact (proportion of identified smokers who enrolled in treatment) of AAC (14.7%) was significantly greater than the impact of AAR (0.5%), t(4)=14.61, p=0.0001, OR=32.10 (95% CI=16.60, 62.06). CONCLUSIONS: The AAC approach to aiding smoking cessation has tremendous potential to reduce tobacco-related health disparities.


Assuntos
Disparidades nos Níveis de Saúde , Linhas Diretas , Abandono do Hábito de Fumar/métodos , Prevenção do Hábito de Fumar , Registros Eletrônicos de Saúde , Humanos , Encaminhamento e Consulta , Provedores de Redes de Segurança/métodos , Fumar/efeitos adversos , Fumar/economia , Fatores Socioeconômicos , Texas , Tabagismo/complicações , Tabagismo/economia , Tabagismo/reabilitação , Resultado do Tratamento
14.
Prev Chronic Dis ; 10: E105, 2013 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-23806800

RESUMO

INTRODUCTION: Having diabetes and smoking increases the risk of morbidity and mortality. However, cessation-related weight gain, a common side effect during quitting, can further complicate diabetes. Evidence-based telephone quitlines can support quitting but have not been studied adequately in populations with chronic diseases such as diabetes. The purpose of this study was to evaluate the use and effectiveness of a tobacco quitline among tobacco users with diabetes. Cessation-related weight concerns and weight gain were also assessed. METHODS: We administered a telephone-based follow-up survey to tobacco users with and without diabetes 7 months after their enrollment in a quitline. We collected and analyzed data on demographics, tobacco use, dieting, weight concern, quitting success (7- and 30-day point prevalence), and weight gain. We computed summary statistics for descriptive data, χ(2) and t tests for bivariate comparisons, and multivariable analyses to determine correlates of cessation. RESULTS: Tobacco users with diabetes used the quitline in a greater proportion than they were represented in the general population. Quit rates for those with and without diabetes did not differ significantly (24.3% vs 22.5%). No significant differences existed between groups for weight gain at follow-up, regardless of quit status. However, participants with diabetes reported more weight gain in previous quit attempts (34.2% vs 22.4% gained >20 lbs, P = .03). Weight concern was a significant correlate of continued smoking, regardless of diabetes status. CONCLUSIONS: Results suggest that quitlines are effective for participants with diabetes, but tailored interventions that address weight concerns during cessation are needed.


Assuntos
Linhas Diretas/estatística & dados numéricos , Abandono do Hábito de Fumar/métodos , Fumar/psicologia , Redução de Peso/fisiologia , Adolescente , Adulto , Idoso , Ansiedade/epidemiologia , Ansiedade/psicologia , Depressão/epidemiologia , Depressão/psicologia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Avaliação de Programas e Projetos de Saúde , Análise de Regressão , Fumar/epidemiologia , Fatores Socioeconômicos , Inquéritos e Questionários , Fatores de Tempo , Washington/epidemiologia , Adulto Jovem
15.
Nicotine Tob Res ; 15(10): 1787-91, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23658395

RESUMO

INTRODUCTION: Little is known about the prevalence of electronic cigarette (e-cigarette) use among tobacco users who seek help from state tobacco quitlines, the reasons for its use, and whether e-cigarettes impact a user's ability to successfully quit tobacco. This study investigates these questions and describes differences among state quitline callers who used e-cigarettes for 1 month or more, used e-cigarettes for less than 1 month, or never tried e-cigarettes. METHODS: Data on e-cigarette use were collected from 2,758 callers to 6 state tobacco quitlines 7 months after they received intervention from the quitline program. RESULTS: Nearly one third (30.9%) of respondents reported ever using or trying e-cigarettes; most used for a short period of time (61.7% for less than 1 month). The most frequently reported reasons for use were to help quit other tobacco (51.3%) or to replace other tobacco (15.2%). Both e-cigarette user groups were significantly less likely to be tobacco abstinent at the 7-month survey compared with participants who had never tried e-cigarettes (30-day point prevalence quit rates: 21.7% and 16.6% vs. 31.3%, p < .001). Demographic differences between the 3 groups are discussed. CONCLUSIONS: This study offers a preliminary look at e-cigarette use among state quitline callers and is perhaps the first to describe e-cigarette use in a large group of tobacco users seeking treatment. The notable rates of e-cigarette use and use of e-cigarettes as cessation aids, even though the U.S. Food and Drug Administration has not approved e-cigarettes for this purpose, should inform policy and treatment discussions on this topic.


Assuntos
Eletrônica , Dispositivos para o Abandono do Uso de Tabaco , Adolescente , Adulto , Feminino , Humanos , Masculino , Prevenção do Hábito de Fumar , Adulto Jovem
16.
JAMA Intern Med ; 173(6): 458-64, 2013 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-23440173

RESUMO

IMPORTANCE: Several national health care-based smoking cessation initiatives have been recommended to facilitate the delivery of evidence-based treatments, such as quitline (telephone-based tobacco cessation services) assistance. The most notable examples are the 5 As (Ask, Advise, Assess, Assist, Arrange) and Ask. Advise. Refer. (AAR) programs. Unfortunately, rates of primary care referrals to quitlines are low, and most referred smokers fail to call for assistance. OBJECTIVE: To evaluate a new approach--Ask-Advise-Connect (AAC)--designed to address barriers to linking smokers with treatment. DESIGN: A pair-matched, 2-treatment-arm, group-randomized design in 10 family practice clinics in a single metropolitan area. Five clinics were randomized to the AAC (intervention) and 5 to the AAR (control) conditions. In both conditions, clinic staff were trained to assess and record the smoking status of all patients at all visits in the electronic health record, and smokers were given brief advice to quit. In the AAC clinics, the names and telephone numbers of smokers who agreed to be connected were sent electronically to the quitline daily, and patients were called proactively by the quitline within 48 hours. In the AAR clinics, smokers were offered a quitline referral card and encouraged to call on their own. All data were collected from February 8 through December 27, 2011. SETTING: Ten clinics in Houston, Texas. PARTICIPANTS: Smoking status assessments were completed for 42,277 patients; 2052 unique smokers were identified at AAC clinics, and 1611 smokers were identified at AAR clinics. INTERVENTIONS: Linking smokers with quitline-delivered treatment. MAIN OUTCOME MEASURE: Impact was based on the RE-AIM (Reach, Efficacy, Adoption, Implementation, and Maintenance) conceptual framework and defined as the proportion of all identified smokers who enrolled in treatment. RESULTS: In the AAC clinics, 7.8% of all identified smokers enrolled in treatment vs 0.6% in the AAR clinics (t4 = 9.19 [P < .001]; odds ratio, 11.60 [95% CI, 5.53-24.32]), a 13-fold increase in the proportion of smokers enrolling in treatment. CONCLUSIONS AND RELEVANCE: The system changes implemented in the AAC approach could be adopted broadly by other health care systems and have tremendous potential to reduce tobacco-related morbidity and mortality.


Assuntos
Comunicação , Participação do Paciente , Desenvolvimento de Programas/métodos , Abandono do Hábito de Fumar/métodos , Fumar/terapia , Atenção à Saúde/organização & administração , Registros Eletrônicos de Saúde/estatística & dados numéricos , Medicina de Família e Comunidade/métodos , Medicina de Família e Comunidade/normas , Humanos , Avaliação de Programas e Projetos de Saúde/métodos , Encaminhamento e Consulta , Fumar/psicologia , Abandono do Hábito de Fumar/psicologia , Abandono do Hábito de Fumar/estatística & dados numéricos , Telemedicina/métodos , Estados Unidos
17.
Res Social Adm Pharm ; 9(1): 27-36, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-22554394

RESUMO

BACKGROUND: Despite the fact that individuals who smoke are at an increased risk for disease and therefore require frequent visits to pharmacies for medications, most community pharmacies do not integrate tobacco cessation activities into routine practice. OBJECTIVE: The objective of this report is to describe the methods and baseline findings for a 2-state randomized trial evaluating 2 intervention approaches for increasing pharmacy-based referrals to their state's tobacco quitline. METHODS: Participating community pharmacies in Connecticut (n=32) and Washington (n=32) were randomized to receive either (1) on-site education with an academic detailer, describing methods for implementing brief interventions with patients and providing referrals to the tobacco quitline or (2) quitline materials delivered by mail. Both interventions advocated for pharmacy personnel to ask about tobacco use, advise patients who smoke to quit, and refer patients to the tobacco quitline for additional assistance with quitting. Study outcome measures include the number of quitline registrants who are referred by pharmacies (before and during the intervention period), the number of quitline materials distributed to patients, and self-reported behavior of cessation counseling and quitline referrals, assessed using written surveys completed by pharmacy personnel (pharmacists, technicians). RESULTS: Pharmacists (n=124) and pharmacy technicians (n=127), representing 64 participating pharmacies with equal numbers of retail chain and independently owned pharmacies, participated in the study. Most pharmacists (67%) and half of pharmacy technicians (50%) indicated that they were not at all familiar with the tobacco quitline. During the baseline (preintervention) monitoring period, the quitline registered 120 patients (18 in Connecticut and 102 in Washington) who reported that they heard about the quitline from a pharmacy. CONCLUSION: Novel tobacco intervention approaches are needed to capitalize on the community pharmacy's frequent interface with tobacco users, and these approaches need to be evaluated to estimate their effectiveness. Widespread implementation of brief, yet feasible, pharmacy-based tobacco cessation efforts that generate referrals to a tobacco quitline could have a substantial impact on the prevalence of tobacco use.


Assuntos
Serviços Comunitários de Farmácia/organização & administração , Farmacêuticos/organização & administração , Encaminhamento e Consulta/estatística & dados numéricos , Abandono do Hábito de Fumar/métodos , Adulto , Idoso , Connecticut , Estudos de Viabilidade , Feminino , Linhas Diretas , Humanos , Capacitação em Serviço , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/métodos , Técnicos em Farmácia/organização & administração , Serviços Postais , Fumar/efeitos adversos , Prevenção do Hábito de Fumar , Washington
18.
Nicotine Tob Res ; 15(3): 718-28, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22992296

RESUMO

INTRODUCTION: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.


Assuntos
Linhas Diretas , Nicotina/uso terapêutico , Abandono do Hábito de Fumar/métodos , Fumar/terapia , Dispositivos para o Abandono do Uso de Tabaco/normas , Adulto , Goma de Mascar , Análise Custo-Benefício , Aconselhamento , Feminino , Linhas Diretas/normas , Humanos , Masculino , Pessoa de Meia-Idade , Nicotina/economia , Cooperação do Paciente , Fumar/economia , Abandono do Hábito de Fumar/economia , Telefone , Fatores de Tempo , Nicotiana , Resultado do Tratamento , Wisconsin
19.
Res Social Adm Pharm ; 9(4): 396-404, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-22841641

RESUMO

BACKGROUND: Community pharmacies have the potential to reduce the prevalence of tobacco use, yet most pharmacies do not integrate cessation activities into routine practice. OBJECTIVES: The objective of this study was to describe the recruitment strategy and participant yield for a 2-state, randomized trial evaluating 2 intervention approaches for increasing pharmacy-based referrals to tobacco quitlines. METHODS: Detailed study recruitment tracking forms were used to document all contact attempts between the study investigators and each potential study site. These data were analyzed to characterize the overall recruitment and consent process for community pharmacies and pharmacy personnel (pharmacists, technicians). RESULTS: Achieving the target sample size of 64 study sites required contacting a total of 150 pharmacies (84 independent and 66 chain). Excluding 22 ineligible pharmacies, participation rates were 49% (32 of 65) for independent pharmacies and 51% (32 of 63) for chain pharmacies (50% overall). Across the 64 participating pharmacies, a total of 124 pharmacists (of 171; 73%) and 127 pharmacy technicians (of 215; 59%) were enrolled in the study. Pharmacies that chose not to participate most often cited time constraints as the primary reason. Overall, combining both the recruitment and consent process, a median of 5 contacts were made with each participating pharmacy (range, 2-19; interquartile range [IQR], 4-7), and the median overall duration of time elapsed from initial contact to consent was 25 days (range, 3-122 days; IQR, 12-47 days). CONCLUSIONS: Results from this study suggest that community pharmacy personnel are receptive to participation in multisite, tobacco cessation clinical research trials. However, execution of a representative sampling and recruitment scheme for a multistate study in this practice setting is a time- and labor-intensive process.


Assuntos
Serviços Comunitários de Farmácia , Encaminhamento e Consulta , Abandono do Hábito de Fumar/métodos , Connecticut , Humanos , Farmacêuticos , Técnicos em Farmácia , Washington
20.
Prev Chronic Dis ; 9: E163, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23137862

RESUMO

INTRODUCTION: The death rate of people who have a chronic disease is lower among former smokers than current smokers. State tobacco cessation quitlines are available for free in every state. The objective of our study was to compare demographic characteristics, use of quitline services, and quit rates among a sample of quitline callers. METHODS: We used data from 15 states on tobacco users aged 18 or older who enrolled with a quitline between October 1, 2005, and May 31, 2008; 9 states also provided data from 7-month follow-up surveys. We used descriptive statistics and logistic regression to compare callers by disease status. RESULTS: Among 195,057 callers, 32.3% reported having 1 or more of the following chronic diseases: 17.7%, asthma; 5.9%, coronary artery disease; 11.1%, chronic obstructive pulmonary disease; and 9.3%, diabetes; 9.0% had 2 or more chronic diseases. Callers who had a chronic disease were older and better educated; more likely to be female, have Medicaid or other health insurance, and have used tobacco for 20 years or more; and less likely to quit smoking (22.3%) at 7 months than callers who had none of these chronic diseases (29.7%). CONCLUSION: About one-third of tobacco users who call state quitlines have a chronic disease, and those who have a chronic disease are less likely to quit using tobacco. Continued efforts are needed to ensure cessation treatments are reaching tobacco users who have a chronic disease and to develop and test ways to increase quit rates among them.


Assuntos
Doença Crônica/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Linhas Diretas/estatística & dados numéricos , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Doença Crônica/prevenção & controle , Aconselhamento/estatística & dados numéricos , Feminino , Seguimentos , Planejamento em Saúde , Humanos , Cobertura do Seguro/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Fumar/tendências , Prevenção do Hábito de Fumar , Marketing Social , Fatores Socioeconômicos
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