Effectiveness of a media campaign promoting health care provider tobacco dependence treatment.

The New York State Department of Health (NYSDOH) developed a provider-focused media campaign to encourage provision of evidence-based, clinical tobacco dependence treatment (TDT). The purpose of this study was to assess providers' awareness of the campaign and the relationship between campaign awareness and changes in campaign-related beliefs and clinical TDT intervention. We conducted a longitudinal, mailed survey of health care providers in New York State (n = 851; AAPOR3 RR: 24.6%). We estimated descriptive statistics and used multivariable regression analyses to assess whether changes in key outcomes (campaign-related beliefs and clinical TDT) from pre- to post-campaign vary by self-reported campaign awareness. Approximately 12% of providers were aware of the campaign. In multivariable analyses, changes from pre- to post-campaign in provider beliefs that the nicotine patch and gum are very effective at helping patients quit were greater for providers aware of the campaign compared with those not aware of the campaign (For patch: OR 2.17, CI 1.06-4.45, p = 0.03; for gum: OR 2.78, CI: 1.24-6.27, p = 0.01), but not for provider behavior. After seeing the NYSDOH campaign, providers' beliefs about the effectiveness of the patch and gum increased. Many state tobacco control programs and health care organizations are implementing tobacco-related policies and systems to facilitate the provision of clinical TDT; this study suggests that a digital and print provider-focused media campaign has the potential to complement health systems change interventions. Future studies should seek to identify ways to modify ad delivery to increase campaign awareness to maximize potential campaign impact.

Medicaid coverage for tobacco dependence treatment: Enrollee awareness and use.

Medicaid-insured adults smoke at twice the rate of privately insured adults. Insurance coverage for tobacco dependence treatments (TDTs) has been shown to increase quit attempts, but few published studies have measured enrollees' awareness of Medicaid coverage. We assessed awareness of Medicaid coverage for and use of TDTs among New York State (NYS) Medicaid-insured smokers and recent quitters. In July-August 2017, we conducted a probability-based online survey of Medicaid enrollees in NYS aged 18 to 65 in fee-for-service and managed care plans (n = 266; AAPOR 4RR = 22.5%). In 2017, we estimated descriptive statistics and used Adjusted Wald tests to assess differences in awareness and use of TDTs (p < 0.05). We used logistic regression to assess correlates of coverage awareness and use of TDTs. Most participants (94.3%) were aware of TDTs, but fewer were aware that Medicaid covers them (59.7%). Most participants believed TDTs are effective in helping smokers quit, although many also believed non-evidence-based methods are effective. Awareness of Medicaid coverage was associated with awareness of a Medicaid-related antitobacco television ad (p < 0.05), moderate nicotine dependence (p < 0.05), and believing that TDTs are effective (p < 0.01). Although awareness of Medicaid coverage for TDTs was found to be high, there remains room for improvement, even in a state that actively promotes these benefits. It is important for states to not only expand Medicaid coverage of TDTs but to also promote the benefits to improve the chances of quit success. Understanding Medicaid enrollees' awareness of and perceptions of covered TDTs can inform messaging to maximize utilization of evidence-based benefits.

Joint Effects of Parental Smoking Cessation and an Antismoking Parenting Program on Children's Susceptibility to Smoking: A Three-Year Prospective Study.

Cognitive susceptibility to smoking is indicated by positive social expectancies about smoking, being curious about smoking, wanting to try smoking, and intending to try smoking. Among children, cognitive susceptibility is a risk factor for initiating smoking; reducing susceptibility is, therefore, a viable primary prevention strategy. Our study tested prospectively the combined effect of two variables-parental modeling of smoking cessation and parental exposure to an antismoking parenting program-on cognitive susceptibility to smoking among children who had never puffed on a cigarette. The study sample comprised 859 daily smokers who called a state Quitline seeking assistance to quit smoking and these adults' 8- to 10-year-old children. The factors in the 2 × 2 design were parental modeling of cessation (successful cessation vs. continued smoking) and parental exposure to an antismoking parenting program (program vs. control). We hypothesized that children whose parents both quit smoking and received the antismoking parenting program would report lower susceptibility to smoking than children exposed to one or neither of these factors. Multivariable analysis of variance, conducted using child-reported susceptibility to smoking collected 12, 24, and 36 months post-baseline, confirmed this hypothesis. Post hoc tests for simple main effects showed that, at each time point, parent smoking cessation had a significant protective effect on children's susceptibility to smoking, but only among children whose parents received the parenting program. These tests also showed that the parenting program had a significant protective effect on children's susceptibility to smoking, but only among children whose parents had successfully quit smoking. Our study results suggest that Quitlines and other programs that assist adults in quitting smoking could extend the reach and benefits of such assistance by providing parents with resources that promote antismoking parenting practices.

A Media Campaign to Increase Health Care Provider Assistance for Patients Who Smoke Cigarettes.

Although most smokers visit a health care provider annually, only half report being provided evidence-based assistance with quitting, defined as brief counseling and an offer of medication. The New York State Department of Health designed a provider-targeted media campaign to increase provider-assisted quitting, which was implemented in 2016. Messaging focused on the addictive nature of tobacco products and evidence-based interventions. Online surveys of 400 New York State health care providers measured advertising awareness, associations between awareness and assistance with quit attempts, and perceptions that patients expect providers to assist with quitting. Forty-three percent of providers were aware of at least 1 advertisement, and providers who had seen an advertisement were more likely to provide evidence-based assistance (AOR = 2.55, P = .01), which includes recommending or prescribing cessation medications. Provider-targeted media is a promising approach to reach health care providers and encourage evidence-based smoking cessation treatment.

Dentist and hygienist smoking cessation counseling and awareness of Medicaid benefits.

OBJECTIVES: Integrating smoking cessation interventions into dental care is an efficient way to intervene with smokers. This study of dentists and dental hygienists who provide dental care to Medicaid-insured patients explores awareness of Medicaid smoking cessation benefits, awareness of Quitline resources, beliefs about perceived role in providing tobacco interventions, and behaviors around clinical intervention. METHODS: In 2015, we conducted a survey of dentists and hygienists who serve Medicaid patients in New York State. RESULTS: A total of 182 dentists and 92 hygienists completed the survey. Ninety percent reported that helping patients quit smoking is part of their role, while 51.0 percent reported feeling confident in their ability to counsel a patient about quitting. Most respondents (73.4 percent) asked patients about tobacco use, 83.7 percent advised smokers to quit, and 49.1 percent assisted with quit attempts. We found that 26.7 percent were aware that dentist smoking cessation counseling is covered by Medicaid, and 15.5 percent were aware that hygienist smoking cessation counseling is covered. A total of 38.9 percent were aware of any Medicaid coverage for smoking cessation. Awareness of the Medicaid smoking cessation benefit was associated with intervention behaviors of asking and assisting. CONCLUSIONS: Most dental care providers see smoking cessation as part of their role, but few are aware of the Medicaid benefits available to help patients. Expanding coverage of and promoting Medicaid benefits for smoking cessation have the potential to increase the reach and quality of smoking cessation interventions for Medicaid-insured smokers, a population disproportionately affected by tobacco use.

Providing Antismoking Socialization to Children After Quitting Smoking: Does It Help Parents Stay Quit?

PURPOSE: To test whether an antismoking parenting program provided to parents who had quit smoking for ≥24 hours increased parents' likelihood of remaining abstinent 2 and 3 years postbaseline. DESIGN: Two-group randomized controlled trial with 3-year follow-up. SETTING: Eleven states (Colorado, Indiana, Michigan, Minnesota, Montana, New York, Ohio, Pennsylvania, South Dakota, Utah, and Vermont). PARTICIPANTS: Five hundred seventy-seven adults (286 treatment and 291 control) who had smoked ≥10 cigarettes daily at baseline, had quit smoking for ≥24 hours after calling a Quitline, and were parents of an 8- to 10-year-old child; 358 (62%) completed the 2-year follow-up interview, and 304 (53%) completed the 3-year follow-up interview. INTERVENTION: Theory-driven, home-based, self-help parenting program. MEASURES: Sociodemographic, smoking history, and 30-day point prevalence. ANALYSIS: Multivariable regression analyses tested for group differences in 30-day abstinence. Attriters were coded as having relapsed. RESULTS: Between-group differences in abstinence rates were 5.6% and 5.9% at 2 and 3 years, respectively. Treatment group parents had greater odds of abstinence, an effect that was significant only at the latter time point (odds ratio [OR] = 1.49, P = .075 at 2 years; OR = 1.70, P = .026 at 3 years). CONCLUSIONS: This study obtained preliminary evidence that engaging parents who recently quit smoking as agents of antismoking socialization of children has the potential to reduce the long-term odds of relapse.

Reducing Children's Susceptibility to Alcohol Use: Effects of a Home-Based Parenting Program.

This 4-year efficacy trial tested whether a home-based, self-administered parenting program could have a long-term effect on children's cognitive susceptibility to alcohol use, and it tested hypothesized moderators and mediators of any such program effect. Using a two-group randomized controlled design, 1076 children (540 treatment; 536 control; mean age of 9.2 years at baseline) completed telephone interviews prior to randomization and follow-up interviews 12, 24, 36, and 48 months post-baseline. Mothers of children randomized to treatment received a 5-month-long parenting program during year 1, followed by two 1-month-long boosters in years 2 and 3. Exposure to the program was significantly inversely associated with susceptibility to alcohol use 48 months post-baseline (b = -0.03, p = .04), with no variation in program effects by parental alcohol use or mother's race/ethnicity or education, suggesting broad public health relevance of the parenting program. Path analyses of simple indirect effects through each hypothesized mediator showed that program exposure positively influenced parental communication to counter pro-drinking influences in the family and media domains and parental rule setting 36 months post-baseline; these variables, in turn, predicted reduced susceptibility to alcohol use 48 months post-baseline. Parallel (multiple) mediation analysis showed that the program had a significant indirect effect on susceptibility through parental rule setting. Together, the findings indicate that internalization of protective alcohol-related expectancies and intentions is possible among children whose mothers provide early exposure to alcohol-specific socialization. Additional research is needed to link alcohol-specific socialization during childhood with adolescent drinking outcomes.

A Parenting Program to Promote an Alcohol-Free Childhood: Influence on Parents' Readiness to Prevent Child Sipping.

OBJECTIVE: This study reports effects of a parenting program to increase parents' readiness to socialize their children against early alcohol use. METHOD: A two-group randomized controlled trial was conducted with a nonprobability sample of 816 mothers. Participants were recruited from school districts located primarily in North Carolina and completed telephone interviews at baseline and 6 and 18 months after delivery of a parenting program to the treatment group mothers. Mothers reported on psychological indicators of readiness to prevent child alcohol use (e.g., attitude toward child sipping) and on parenting behaviors with potential to prevent such use (e.g., setting rules about child sipping). Multivariate analysis of variance models tested program effects on composite sets of psychological and behavioral outcomes; step-down analysis identified the individual outcomes driving overall program effects. Moderation of program effects by mother's alcohol use, established beliefs about the consequences of child sipping, educational attainment, and race/ethnicity was tested. RESULTS: The program had significant overall effects on each composite set of psychological and behavioral outcomes. Effects on psychological outcomes were moderated by mother's alcohol use, beliefs about the consequences of child sipping, and educational attainment; effects on the behavioral outcomes were moderated by mother's race/ethnicity. CONCLUSIONS: The parenting program had favorable, sustained effects on targeted outcomes intended to increase parental readiness to socialize children against early alcohol use. Mothers expected to be least receptive to the program-those who, at baseline, believed that allowing children to sip alcohol can have beneficial consequences-were most changed by it.

Engaging Parents Who Quit Smoking in Antismoking Socialization of Children: A Novel Approach to Relapse Prevention.

INTRODUCTION: Data from a randomized controlled trial designed primarily to test the effect of an antismoking socialization parenting program on child initiation of smoking were used to test the subsidiary hypothesis that providing antismoking socialization to children would lower the odds of relapse within a sub-sample of parents who had recently quit smoking. METHODS: Over 13 months, 11 state Quitlines provided contact information for callers who were parents of 8- to 10-year-old children. Of 1604 parents enrolled in the trial, 689 (344 treatment; 345 control) had quit smoking cigarettes for at least 24 hours after calling a Quitline. Their data were used to test for group differences in 30-day abstinence measured using telephone interviews conducted 7 and 12 months post-baseline. Analyses of parents with complete follow-up data and intent-to-treat analyses incorporating parents lost to follow-up are presented. RESULTS: Among 465 parents with complete follow-up data, treatment group parents had twice the odds of being abstinent 12 months post-baseline (adjusted OR = 2.01; P = .001) relative to controls. Intent-to-treat analysis with all 689 parents, in which those lost to follow-up were coded as having relapsed, showed a smaller though significant treatment effect on 30-day abstinence at 12 months (adjusted OR = 1.58; P = .017). CONCLUSIONS: This study is the first to observe that engaging parents who have quit smoking in antismoking socialization of children can lower their odds of relapse. Additional research is needed to replicate this finding and to identify the psychological mechanisms underlying the observed effect. IMPLICATIONS: There is a clear the need for research to develop new relapse prevention strategies. This study is the first to observe that engaging parents who have quit smoking in antismoking socialization of children can lower their odds of relapse.

Early lessons learned from extramural school programs that offer HPV vaccine.

BACKGROUND: There has been little evaluation of school-located vaccination programs that offer human papillomavirus (HPV) vaccine in US schools without health centers (ie, extramural programs). This article summarizes lessons learned from such programs. METHODS: In July to August 2010, 5 programs were identified. Semistructured, in-depth telephone interviews were conducted with program representatives about practical aspects of planning and implementation, including configuration and effectiveness. RESULTS: Most programs offered HPV vaccine as part of a broader effort to increase uptake of adolescent vaccines. Respondents stressed the importance of building partnerships with local school systems throughout all aspects of the planning and implementation phases. All programs offered HPV vaccine at no cost to students. Most did not have a mechanism to bill private insurance, and some found Medicaid reimbursements to be a challenge. Programs achieved modest rates of initiation of the 3-dose HPV vaccine series (median 10%); however, among those who initiated the series, completion rates were high (median 78%). HPV vaccine uptake was lowest for a program that offered only HPV vaccine. CONCLUSIONS: Extramural programs may increase uptake of vaccines and decrease absenteeism due to noncompliance with vaccine requirements for school entry. Until extramural programs in the US receive better access to billing private insurers and Medicaid, sustainability of these programs relies on grant funding. Better integration of extramural school-located vaccine programs with existing local healthcare and other programs at schools is an area for growth.