Publications by authors named "Edward Lichtenstein"

30 Publications

  • Page 1 of 1

Effect of a Responsiveness-Based Support Intervention on Smokeless Tobacco Cessation: The UCare-ChewFree Randomized Clinical Trial.

Nicotine Tob Res 2020 03;22(3):381-389

College of Nursing, University of Arizona, Tucson, AZ.

Introduction: Partner behaviors and attitudes can motivate or undermine a tobacco user's cessation efforts. We developed a multimedia intervention, UCare (Understanding-CAring-REspect) for women who wanted their male partner to quit smokeless tobacco (ST), based on perceived partner responsiveness-the empirically based theory that support is best received when the supporter conveys respect, understanding, and caring.

Methods: One thousand one hundred three women were randomized to receive either immediate access to the UCare website and printed booklet (Intervention; N = 552), or a Delayed Treatment control (N = 551). We assessed supportive behaviors and attitudes at baseline and 6-week follow-up, and the ST-using partner's abstinence at 6 weeks and 7.5 months (surrogate report).

Results: For partners of women assigned to Intervention, 7.0% had quit all tobacco at 7.5 months, compared with 6.6% for control (χ2 (1, n = 1088) = .058, p = .810). For partners of women completing the intervention, 12.4% had quit all tobacco at 7.5 months, compared with 6.6% for Delayed Treatment (χ2 (1, n = 753) = 6.775, p = .009). A previously reported change in responsiveness-based behaviors and instrumental behaviors at 6 weeks mediated 7.5-month cessation, and change in responsiveness-based attitudes mediated the change in responsiveness-based behaviors, indirectly increasing cessation.

Conclusions: A responsiveness-based intervention with female partners of male ST users improved supportive attitudes and behaviors, leading to higher cessation rates among tobacco users not actively seeking to quit. The study demonstrates the potential for responsiveness as a basis for effective intervention with supporters. This approach may reach tobacco users who would not directly seek help.

Implications: This study demonstrates the value of a responsiveness-based intervention (showing respect, understanding, and caring) in training partners to provide support for a loved one to quit ST. In a randomized clinical trial, 1,103 women married to or living with a ST user were randomized to receive the UCare-ChewFree intervention (website + booklet) or a Delayed Treatment control. Women completing the intervention were more likely to improve their behaviors and attitudes, and change in behaviors and attitudes mediated cessation outcomes for their partners, who had not enrolled in the study and may not have been seeking to quit.

Trial Registration: ClinicalTrials.gov NCT01885221.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ntr/ntz074DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7297097PMC
March 2020

Linking smokers to a quitline: randomized controlled effectiveness trial of a support person intervention that targets non-smokers.

Health Educ Res 2017 08;32(4):318-331

Department of Family and Preventive Medicine, University of California, La Jolla, CA 92093, USA.

Evidence-based treatments (e.g. quitlines) are greatly underutilized by smokers limiting their public health impact. A three-session phone intervention for nonsmoking family members and friends (i.e. support persons) was successful for increasing smoker quitline enrollment. To enhance the intervention's potential translatability, in this study, we delivered treatment for the non-smoker within ongoing quitline services and compared the efficacy of the three-call intervention to a streamlined version (one call). A total of 704 adult non-smokers (85% female, 95% White) wanting to help a smoker quit and recruited statewide in Minnesota participated in this randomized controlled trial with parallel groups. Non-smokers received mailed written materials and were randomly assigned to a control condition (no additional treatment, n = 235), or to a one- (n = 233) or three-call (n = 236) intervention delivered by quitline coaches. The main outcome was smoker quitline enrollment through 7-month follow-up. Smoker quitline enrollment was similar for those linked to non-smokers in the one- and three-call interventions (14.6% [34/233] and 14.8% [35/236]), and higher than for smokers linked to control participants (6.4% [15/235]), P = 0.006. Just one quitline coaching call delivered to non-smokers increased treatment enrollment among smokers. The reach of quitlines could be enhanced by targeting the social support network of smokers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/her/cyx050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5914310PMC
August 2017

Randomized Controlled Trial of the Combined Effects of Web and Quitline Interventions for Smokeless Tobacco Cessation.

Internet Interv 2015 May;2(2):143-151

Oregon Research Institute, 1776 Millrace Drive, Eugene, OR 97403, USA.

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, = ) and Quitline (ITT: OR = 1.54, 95% CI = 1.13, 2.11, = ). Participants were more likely to complete a Quitline call when offered only the Quitline intervention (OR = 0.71, 95% CI = .054, .093, = .013), the number of website visits and duration did not differ when offered alone or in combination with Quitline. Rates of program helpfulness ( <.05) and satisfaction ( <.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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.invent.2015.02.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4405799PMC
May 2015

Randomized trial of nicotine lozenges and phone counseling for smokeless tobacco cessation.

Nicotine Tob Res 2015 Mar 28;17(3):309-15. Epub 2014 Aug 28.

Oregon Research Institute, Eugene, OR;

Introduction: Relatively few treatment programs have been developed specifically for smokeless tobacco (ST) users who want to quit. Their results suggest that self-help materials, telephone counseling, and nicotine lozenges are efficacious. This study provides the first direct examination of the separate and combined effects of telephone counseling and lozenges.

Methods: We recruited ST users online (N = 1067) and randomly assigned them to 1 of 3 conditions: (a) a lozenge group (n = 356), who were mailed 4-mg nicotine lozenges; (b) a coach calls group (n = 354), who were offered 3 coaching phone calls; or (c) a lozenge + coach calls group (N = 357), who received both lozenges and coaching calls. Additionally, all participants were mailed self-help materials. Self-reported tobacco abstinence was assessed at 3 and 6 months after randomization.

Results: Complete-case and intention-to-treat (ITT) analyses for all tobacco abstinence were performed at 3 months, 6 months, and both 3 and 6 months (repeated point prevalence). ITT analyses revealed a highly similar result: the lozenge + coach calls condition was significantly more successful in encouraging tobacco abstinence than either the lozenge group or the coach calls group, which did not differ.

Conclusions: Combining nicotine lozenges and phone counseling significantly increased tobacco abstinence rates compared with either intervention alone, whereas coach calls and lozenges were equivalent. The study confirms the high tobacco abstinence rates for self-help ST cessation interventions and offers guidance to providing tobacco treatment to ST users.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ntr/ntu145DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4837991PMC
March 2015

Randomized controlled trial of MyLastDip: a Web-based smokeless tobacco cessation program for chewers ages 14-25.

Nicotine Tob Res 2013 Sep 14;15(9):1502-10. Epub 2013 Feb 14.

Oregon Research Institute, Eugene, OR 97403, USA.

Introduction: Use of smokeless tobacco (ST) is a significant public health problem for young adults, many of whom want to quit. We describe the outcome of a Randomized Controlled Trial (RCT) examining the efficacy of two web-based ST cessation interventions targeting young chewers.

Methods: One thousand seven hundred and sixteen ST users wanting to quit were recruited online to the MyLastDip program and randomly assigned to one of two fully automated web-based ST cessation interventions: (a) an Enhanced Condition (N = 857) with tailored treatment recommendations and interactive features, or (b) a Basic Condition (N = 859) that provided an online ST cessation guide in static text.

Results: Assessment completion rates at 3 months, 6 months, and for both 3 and 6 months were 73%, 71%, and 65%, respectively. No significant differences were found between conditions. Using complete case analysis for repeated point prevalence (3- and 6-month assessments), all tobacco abstinence was 28.9% for participants in the Enhanced Condition and 25.6% in the Basic Condition. Using intent-to-treat analysis, abstinence rates were 35.2% versus 32.3%. Similar results were obtained for ST abstinence. Participants reported being satisfied with their programs and the Enhanced Condition participants were relatively more engaged. Differences in program engagement were not related to tobacco abstinence at 6 months.

Conclusions: Both web-based ST cessation programs encouraged robust levels of absolute tobacco and ST abstinence at follow-up. The absence of between-group differences was discussed in terms of composition of the control condition and implications for next steps in treatment development and testing.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ntr/ntt006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3741058PMC
September 2013

Support-person promotion of a smoking quitline: a randomized controlled trial.

Am J Prev Med 2011 Jul;41(1):17-23

Department of Psychology and Psychiatry, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.

Background: Quitlines and other evidence-based cessation treatments are greatly underutilized by smokers, limiting their public health impact. Social support is correlated with successful cessation. Thus, efforts targeting the social network of smokers could be a potential avenue to promote quitline utilization.

Purpose: This study examined the efficacy of an intervention for nonsmokers interested in helping a smoker (i.e., support people) to promote smoker utilization of the Minnesota QUITPLAN(®) Helpline. Data were collected from 2007 to 2010, and analyses were conducted from 2010 to 2011.

Design: Two-group randomized design evaluating the support-person intervention (n=267) compared with a control condition (written materials, n=267).

Setting/participants: Enrolled were 534 support people (91% female, 93% Caucasian) residing in Minnesota.

Intervention: Written materials plus three weekly telephone sessions lasting 10-30 minutes each. Based on Cohen's theory of social support, the intervention provided participants with information and skills needed to encourage their smoker to call the QUITPLAN Helpline.

Main Outcome Measures: Participants completed the Support Provided Measure (SPM) by mail at baseline and Week 4 (end-of-treatment). Helpline intake staff documented smoker calls to the Helpline through 6 months of follow-up.

Results: The proportion of calls to the Helpline was significantly (p=0.012) greater for smokers linked to support people in the intervention group (16.1%, 43/267) than in the control group (8.6%, 23/267). The treatment effect remained significant after adjusting for support person residing with the smoker (OR=2.04, 95% CI=1.19, 3.49, p=0.010). Among support people randomly assigned to the intervention group, greater number of sessions completed was associated with increased smokers' calls to the Helpline (p=0.004). After adjusting for the baseline score, the M±SD SPM score at Week 4 was significantly higher for support people in the intervention group (16.4±3.3) than for those in the control group (15.3±3.6), p=0.002.

Conclusions: A support-person intervention is effective in increasing smoker utilization of the QUITPLAN Helpline. There is potential for increasing the reach of quitlines by targeting the social network of smokers. TRIAL REGISTRATION #: NCT01311830.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amepre.2011.03.012DOI Listing
July 2011

Do faxed quitline referrals add value to dental office-based tobacco-use cessation interventions?

J Am Dent Assoc 2010 Aug;141(8):1000-7

Department of Family and Community Medicine, College of Medicine, University of Arizona, 1450 N. Cherry Ave., Tucson, AZ 85719, USA.

Background: The Ask, Advise, Refer (AAR) model of intervening with patients who use tobacco promotes a brief office-based intervention plus referral to a tobacco quitline. However, there is little evidence that this model is effective. The primary aim of this study was to evaluate the effects on patients' tobacco use of two levels of a dental office-based intervention compared with usual care.

Methods: The authors randomly assigned 68 private dental clinics to one of three conditions: 5 As (Ask, Advise, Assess, Assist, Arrange); 3 As (AAR model); or usual care, and they enrolled 2,160 participants.

Results: At the 12-month assessment, compared with those in usual care, participants in the two intervention conditions combined were more likely to report cessation of tobacco use, as measured by nine-month prolonged abstinence (3 percent versus 2 percent; F(1,66) = 3.97, P < .10) and 12-month point prevalence (12 percent versus 8 percent; F(1,66) = 7.32, P < .01). There were no significant differences between participants in the clinics using the 5 As and 3 As strategies.

Conclusions: The results of this study are inconclusive as to whether referrals to a quitline add value to brief dental office-based interventions. Patients receiving telephone counseling quit tobacco use at higher rates, but only a small percentage of those proactively referred actually received counseling.

Clinical Implications: The results confirm those of previous research: that training dental practitioners to provide brief tobacco-use cessation advice and assistance results in a change in their behavior, and that these practitioners are effective in helping their patients to quit using tobacco.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3780769PMC
http://dx.doi.org/10.14219/jada.archive.2010.0314DOI Listing
August 2010

Smoking cessation quitlines: an underrecognized intervention success story.

Am Psychol 2010 May-Jun;65(4):252-61

Oregon Research Institute, Eugene, Oregon 97405, USA.

Quitlines providing telephone counseling for smoking cessation derive from behavioral research and theory, have been shown to be effective, and have been adopted and then institutionalized at both the state and national levels. Although psychologists have made seminal contributions to quitline development and evaluation, this accomplishment has gone largely unnoticed by the practice and research communities in clinical, counseling, and health psychology. This article summarizes the development, content, structure, empirical status, and current reach of cessation quitlines. We note the rich research opportunities afforded by quitlines, describe some recent approaches to improving their effectiveness, and suggest that an understanding of how quitlines work could also improve their effectiveness. The implications for practitioners and the potential application of telephone counseling to other disorders are also considered.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1037/a0018598DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3169380PMC
October 2010

Use of non-assigned smoking cessation programs among participants of a Web-based randomized controlled trial.

J Med Internet Res 2009 Jun 25;11(2):e26. Epub 2009 Jun 25.

Oregon Research Institute, 1715 Franklin Blvd, Eugene, OR 97403, USA.

Background: Concurrent with their enrollment in Web-based Randomized Controlled Trials (RCTs), participants can easily choose to use treatment programs that are not assigned in the study. The prevalence of using non-assigned treatments is largely unknown although it is likely to be related to the extent to which non-assigned treatments are: (a) easy to find and use, (b) low in cost, (c) well publicized, and (d) available from trusted sources. The impact of using other programs--both beneficial and detrimental--warrants additional research investigation.

Objective: The aim of this report is to explore the extent to which participants enrolled in a Web-based intervention for smoking cessation used treatment methods that were not explicitly assigned ("non-assigned treatment"). In addition to describing the relation between using non-assigned treatments and smoking cessation outcomes, we also explore the broader issue of non-assigned program use by RCT participants in Web-based behavioral interventions, generally.

Methods: We describe the use of other programs (as measured by self-report at the 3-month follow-up assessment) by 1028 participants who were randomized to the Web-based SHIP (Smokers' Health Improvement Program) RCT which compared the Quit Smoking Network (QSN) treatment program and the Active Lives control condition. We examine the extent to which pharmacotherapy products were used by participants in the QSN condition (which explicitly recommended their use) and the Active Lives condition (which purposefully omitted mention of the use of pharmacotherapy). We also test for any between-condition impact of using non-assigned treatments and pharmacotherapy products on smoking cessation outcomes.

Results: A total of 24.1% (248/1028) participants reported using one or more smoking cessation treatment programs that were not explicitly recommended or assigned in their treatment protocol. Types of non-assigned treatments used in this manner included individual counseling (1.7%), group counseling (2.3%), hypnotherapy/acupuncture (4.5%), pamphlets/books (12.6%), and other Web-based smoking cessation programs (9.0%). Participants who used non-assigned treatments were more likely to be female and have at least a high school education. Use of non-assigned Web programs was related to greater levels of self-reported smoking cessation measured at the 3-month assessment (OR = 2.63, CI = 1.67 - 4.14, P < .001) as well as the combined 3- and 6-month assessments (OR = 2.09, CI = 1.11 - 3.91, P = .022). In terms of reported medication use, there were no differences between conditions in the number of pharmacotherapy products used. However, more participants in the QSN condition used at least one pharmacotherapy product: 50.0% (262/524) vs 43.8% (221/504); chi(2)(1, N = 1028) = 3.90, P = .048. The use of pharmacotherapy and non-assigned treatment types showed a small but marginally significant correlation: r(1028) = .061, P = .05.

Conclusions: A noteworthy proportion of individuals recruited via the Internet to participate in a Web-based intervention used treatment programs and tools not formally assigned as a part of their research protocol. We consider factors likely to influence using non-assigned treatments and suggest ways that future research can begin to study more fully this important phenomenon which is likely to be found in any type of research, but may be particularly pronounced in minimal contact, Web-based intervention trials.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/jmir.1172DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2762799PMC
June 2009

Women helping chewers: Effects of partner support on 12-month tobacco abstinence in a smokeless tobacco cessation trial.

Nicotine Tob Res 2009 Mar 5;11(3):332-5. Epub 2009 Mar 5.

Oregon Research Institute, 1715 Franklin Boulevard, Eugene, OR 97403, USA.

Introduction: Social support has been relatively unstudied in smokeless tobacco cessation research; partner support could encourage quitting, buffer the stress of quitting and withdrawal, and counteract tobacco cues.

Methods: Using 12-month follow-up data, we examined the impact of social support provided by female partners (n = 328) of male participants in a smokeless tobacco cessation program.

Results: The ratio of positive support to negative support that participants reported receiving from their partners was significantly related to point prevalence 12-month tobacco abstinence (odds ratio [OR] = 1.43, 95% CI = 1.11-1.84, p < .01)-a finding consistent with the 6-month follow-up-and it was related to repeated point prevalence tobacco abstinence at both 6 and 12 months (OR = 1.43, 95% CI = 1.09-1.88, p < .05).

Discussion: These 12-month follow-up results provide additional evidence that partner support can help encourage long-term tobacco abstinence among participants in smokeless tobacco cessation programs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ntr/ntn022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2666371PMC
March 2009

Support person intervention to promote smoker utilization of the QUITPLAN Helpline.

Am J Prev Med 2008 Dec;35(6 Suppl):S479-85

Mayo Clinic Cancer Center, Charlton 6-273, 200 First Street SW, Rochester, MN 55905, USA.

Background: Effective cessation services are greatly underutilized by smokers. Only about 1.5% of smokers in Minnesota utilize the state-funded QUITPLAN Helpline. Substantial evidence exists on the role of social support in smoking cessation. In preparation for a large randomized trial, this study developed and piloted an intervention for an adult nonsmoking support person to motivate and encourage a smoker to call the QUITPLAN Helpline.

Methods: The support person intervention was developed based on Cohen's theory of social support. It consisted of written materials and three consecutive, weekly, 20-30 minute telephone sessions. Smoker calls to the QUITPLAN Helpline were documented by intake staff.

Results: Participants were 30 support people (93% women, 97% Caucasian, mean age 49). High rates of treatment compliance were observed, with 28 (93%) completing all three telephone sessions. The intervention was ranked as somewhat or very helpful by 77% of the support people, and 97% would definitely or probably recommend the program. Five smokers linked to a support person called the QUITPLAN Helpline.

Conclusions: An intervention using natural support networks to promote smoker utilization of the QUITPLAN Helpline is both acceptable to a support person and feasible. A controlled randomized trial is under way to examine the efficacy of the intervention.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amepre.2008.09.003DOI Listing
December 2008

Comparing two web-based smoking cessation programs: randomized controlled trial.

J Med Internet Res 2008 Nov 18;10(5):e40. Epub 2008 Nov 18.

Oregon Research Institute, 1715 Franklin Boulevard, Eugene, OR 97403, USA.

Background: Smoking cessation remains a significant public health problem. Innovative interventions that use the Internet have begun to emerge that offer great promise in reaching large numbers of participants and encouraging widespread behavior change. To date, the relatively few controlled trials of Web-based smoking cessation programs have been limited by short follow-up intervals.

Objective: We describe the 6-month follow-up results of a randomized controlled trial in which participants recruited online were randomly assigned to either a Web-based smoking cessation program (Quit Smoking Network; QSN) or a Web-based exercise enhancement program (Active Lives) adapted somewhat to encourage smoking cessation.

Methods: The study was a two-arm randomized controlled trial that compared two Web-based smoking cessation programs: (1) the QSN intervention condition presented cognitive-behavioral strategies, and (2) the Active Lives control condition provided participants with guidance in developing a physical activity program to assist them with quitting. The QSN condition provided smoking cessation information and behavior change strategies while the Active Lives condition provided participants with physical activity recommendations and goal setting. The QSN condition was designed to be more engaging (eg, it included multimedia components) and to present much greater content than is typically found in smoking cessation programs.

Results: Contrary to our hypotheses, no between-condition differences in smoking abstinence were found at 3- and 6-month follow-up assessments. While participants in the QSN intervention condition spent more time than controls visiting the online program, the median number of 1.0 visit in each condition and the substantial attrition (60.8% at the 6-month follow-up) indicate that participants were not as engaged as we had expected.

Conclusions: Contrary to our hypothesis, our test of two Web-based smoking cessation conditions, an intervention and an attention placebo control, failed to show differences at 3- and 6-month assessments. We explored possible reasons for this finding, including limited engagement of participants and simplifying program content and architecture. Future research needs to address methods to improve participant engagement in online smoking cessation programs. Possible approaches in this regard can include new informed consent procedures that better explain the roles and responsibilities of being a research participant, new program designs that add more vitality (changing content from visit to visit), and new types of reminders pushed out to participants to encourage return visits. Simplifying program content through a combination of enhanced tailoring and information architecture also merits further research attention.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/jmir.993DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2630830PMC
November 2008

Quitlines.

December 2007

Cost-effectiveness of self-help smokeless tobacco cessation programs.

Nicotine Tob Res 2007 Sep;9(9):907-14

Oregon Research Institute, Eugene, OR 97403, USA.

This study assessed the cost-effectiveness of two low-intensity programs for quitting smokeless tobacco, based on results of a randomized trial with 1,069 volunteer participants. Cost data were collected for two levels of intervention: manual only (a self-help manual) and assisted self-help (the manual plus a videotape and two supportive phone calls from tobacco cessation counselors). Incremental cost-effectiveness ratios were calculated for assisted self-help vs. quitting on one's own, using the manual-only quit rate and data from another study as alternative proxies for no intervention. A threshold analysis was conducted to determine the spontaneous quit rate at which the manual-only intervention becomes more cost-effective than assisted self-help. The cost to provide and receive the assisted self-help intervention averaged US $56 per participant vs. $20 for the manual-only intervention (societal perspective, Year 2000 dollars). Estimates for incremental cost per quit for the assisted self-help intervention ranged from $922 to $1,758, depending on the proxy used for no intervention. The manual-only intervention was more cost-effective than assisted self-help if quitting among motivated chewers who do not receive treatment does not exceed 3.4%. Support from a wife or partner added little cost to a quit attempt for male chewers ($3-$4). Providing a manual, video, and brief phone counseling to smokeless tobacco users who want to quit is a reasonable use of health care resources. The self-help quitting guide also may be a cost-effective treatment, but it remains to be demonstrated whether it is more effective than quitting on one's own.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/14622200701488384DOI Listing
September 2007

Using radon risk to motivate smoking reduction II: randomized evaluation of brief telephone counseling and a targeted video.

Health Educ Res 2008 Apr 9;23(2):191-201. Epub 2007 Apr 9.

Oregon Research Institute, Eugene, OR, USA.

Radon and cigarette smoking have synergistic effects on lung cancer risk. Electric utility company bill stuffers offered free radon test kits to households with at least one smoker. Participating households (n = 1364) were randomized within a 2 x 2 design to evaluate the main effects of brief telephone counseling and a targeted video on smoking cessation and the establishment of new household smoking bans. Phone counseling was associated with cessation at 3-month follow-up but neither intervention led to 12-month or sustained cessation. While neither intervention had a significant effect on new bans, there were trends in the predicted direction and the combination of the two significantly increased new bans compared with no intervention. The presence of children in the household was associated with new bans. While few households had high levels of radon, such levels were associated with radon mitigation behaviors. Together with a previous study, these results suggest radon risk is a useful and inexpensive way to engage smoking households in risk reduction behaviors, especially the institution of household smoking bans.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/her/cym016DOI Listing
April 2008

Self-help cessation programs for smokeless tobacco users: long-term follow-up of a randomized trial.

Nicotine Tob Res 2007 Feb;9(2):281-9

Oregon Research Institute, Eugene, OR 97403-1983, USA.

This paper presents long-term outcomes of the largest clinical trial of smokeless tobacco (SLT) cessation reported to date. SLT users in five northwestern states were recruited to call a toll-free number, and 1,069 users were randomized to one of two self-help conditions: either a manual-only condition or an assisted self-help condition, which included the manual, a targeted video, and two support phone calls. Significant between-group differences were not found for either the 12- or 18-month point-prevalence measure of abstinence from either SLT only or all tobacco products using outcomes based on either the responder or intention-to-treat outcomes. However, using a repeated point-prevalence measure across all three assessment points, we found that significantly more assisted self-help participants reported abstinence, compared with manual-only participants. Compared with manual-only participants, those in the assisted self-help condition were significantly more likely to use recommended cessation techniques. Results demonstrate that low-cost, minimal interventions delivered by mail and phone can help a sizable proportion of individuals quit using SLT.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/14622200601080281DOI Listing
February 2007

Cost effectiveness of changing health professionals' behavior: training dental hygienists in brief interventions for smokeless tobacco cessation.

Prev Med 2006 Dec 22;43(6):482-7. Epub 2006 Aug 22.

Oregon Research Institute, Eugene, OR 94703, USA.

Objective: Disseminating effective interventions to health care professionals is a critical step in ensuring that patients receive needed advice and materials. This cost effectiveness analysis compared two methods of disseminating an effective protocol for smokeless tobacco cessation intervention.

Method: Interested dental hygienists (N = 1051) were recruited in 20 Western and Midwestern U.S. communities and randomized by community to receive workshop training, self-study with mailed materials, and delayed self-study training, in 1996-98. Hygienists were surveyed about their smokeless tobacco-related activities with patients at baseline and post-intervention. Data on intervention costs were collected, and incremental costs per unit of behavior change were calculated.

Results: Self-study was more cost effective than workshop training under a wide range of assumptions: change in group versus individual behavior, hygienists' time and travel costs included or excluded, and hygienist wage rates at the national median or substantially lower. However, workshops may be as cost effective in producing behavior change among hygienists earning wages substantially higher than the national median.

Conclusion: Self-study may be a more cost effective method than workshops to achieve behavior change among motivated health professionals.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ypmed.2006.07.006DOI Listing
December 2006

Personality traits, perceived risk, and risk-reduction behaviors: a further study of smoking and radon.

Health Psychol 2006 Jul;25(4):530-6

Department of Psychology, University of Surrey, Guildford, England.

Personality traits and risk perceptions were examined as predictors of changes in smoking behavior. Participants (N = 697) were part of a randomized controlled trial of interventions to reduce exposure to the combined hazard of radon and cigarette smoke. Participants with higher perceived risk at baseline for the combination of smoking and radon were more likely to have a more restrictive household smoking ban in place at 12-month follow-up (p < .05). Risk perceptions also predicted reductions in the total number of cigarettes smoked in the home for participants in the video intervention who had high or moderate levels of extraversion (p < .01). Greater perceived risk predicted whether highly or moderately conscientious women quit smoking (p < .05). The moderating effects of personality traits should be considered when evaluating risk-reduction interventions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1037/0278-6133.25.4.530DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2409280PMC
July 2006

Tobacco cessation in dental settings: research findings and future directions.

Drug Alcohol Rev 2006 Jan;25(1):27-37

Oregon Research Institute, Eugene, Oregon 97403, USA.

The hazards associated with cigarette smoking and smokeless tobacco use have been well documented. In addition to its association with many cancers and coronary conditions, tobacco plays a role in the aetiology of a number of oral morbidities. Dental care practitioners are a largely untapped resource for providing advice and brief counselling to tobacco-using patients, and there are good reasons to believe that they can be effective. Data from seven randomised trials indicate there is ample evidence for the efficacy of dental office-based interventions, but adoption of these tobacco cessation activities into practice has been slow. The limited research on dissemination of tobacco interventions is promising, but there is a need to develop and evaluate new methods for encouraging adoption, implementation and maintenance of tobacco interventions into routine dental care. Several studies currently under way may help to increase the effectiveness and dissemination of office-based tobacco cessation programmes into routine dental care. If dental practitioners provided cessation assistance routinely to their patients and achieved even modest success rates, the public health impact would be enormous. Researchers and clinicians must continue to work together towards universal adoption of effective tobacco cessation interventions at each clinical encounter.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09595230500459495DOI Listing
January 2006

Disseminating a smokeless tobacco cessation intervention model to dental hygienists: a randomized comparison of personalized instruction and self-study methods.

Health Psychol 2005 Sep;24(5):447-55

Oregon Research Institute, Eugene, OR 97403-1983, USA.

This study evaluated 2 methods of disseminating an empirically validated smokeless tobacco intervention delivered during routine dental care. Twenty cities within 12 states were stratified and then randomized to 1 of 3 groups: personalized instruction (PI), self-study (SS), or delayed training (DT) control. Dental hygienists in the SS condition were sent a manual and video. Those in the PI condition were recruited to attend a workshop. Thirty-seven percent of eligible hygienists agreed to participate. At 12 months postenrollment, hygienists in the SS and PI conditions significantly increased their "Assist" behaviors (discuss cessation techniques, help patient set a quit date, and provide cessation materials) and reported fewer perceived barriers to delivering the intervention as compared with hygienists in DT. An economic analysis suggests that SS is more cost-effective than PI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1037/0278-6133.24.5.447DOI Listing
September 2005

Teen reach: outcomes from a randomized, controlled trial of a tobacco reduction program for teens seen in primary medical care.

Pediatrics 2005 Apr;115(4):981-9

Center for Health Research, Kaiser Permanente, Portland, Oregon 97227, USA.

Objective: To test the long-term efficacy of brief counseling plus a computer-based tobacco intervention for teens being seen for routine medical care.

Methods: Both smoking and nonsmoking teens, 14 to 17 years of age, who were being seen for routine visits were eligible for this 2-arm controlled trial. Staff members approached teens in waiting rooms of 7 large pediatric and family practice departments within a group-practice health maintenance organization. Of 3747 teens invited at > or =1 visits, 2526 (67%) consented and were randomized to tobacco intervention or brief dietary advice. The tobacco intervention was individually tailored on the basis of smoking status and stage of change. It included a 30-second clinician advice message, a 10-minute interactive computer program, a 5-minute motivational interview, and up to two 10-minute telephone or in-person booster sessions. The control intervention was a 5-minute motivational intervention to promote increased consumption of fruits and vegetables. Follow-up smoking status was assessed after 1 and 2 years.

Results: Abstinence rates after 2 years were significantly higher for the tobacco intervention arm, relative to the control group, in the combined sample of baseline smokers and nonsmokers (odds ratio [OR]: 1.23; 95% confidence interval [CI]: 1.03-1.47). Treatment effects were particularly strong among baseline self-described smokers (OR: 2.42; 95% CI: 1.40-4.16) but were not significant for baseline nonsmokers (OR: 1.25; 95% CI: 0.97-1.61) or for those who had "experimented" in the past month at baseline (OR: 0.95; 95% CI: 0.45-1.98).

Conclusions: Brief, computer-assisted, tobacco intervention during routine medical care increased the smoking cessation rate among self-described smokers but was less effective in preventing smoking onset.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1542/peds.2004-0981DOI Listing
April 2005

The impact of a brief tobacco-use cessation intervention in public health dental clinics.

J Am Dent Assoc 2005 Feb;136(2):179-86; quiz 230-1

Oregon Research Institute, Eugene 97403-1983, USA.

Background: Public health dental clinic patients use tobacco at disproportionately high rates. The purpose of this study was to evaluate a tobacco-use cessation program delivered via public health dental practitioners.

Methods: Two public health dental clinics participated in this quasiexperimental design study. First, all patients in one clinic who used tobacco (n = 178) received usual care. Next, the authors trained all practitioners to conduct a tobacco-use assessment and provide a brief cessation intervention. Subsequently, all patients in both clinics who used tobacco (N = 190) received the intervention. All enrolled patients had an income at or below the federal poverty level. The authors conducted follow-up assessments at six weeks and three and six months after enrollment.

Results: Differences in self-reported quitting by condition between participants in the two groups were significant across all endpoints. Patients in the intervention group were more likely to quit than those receiving usual care (15.5 versus 4.3 percent) and after 12 months (18.8 versus 4.6 percent). Controlling for enrollment differences between patients in the two groups (age, race/ethnicity, time to first cigarette after waking), the authors found that differences between groups were significant for quitting at three months (P < .05; odds ratio [OR] = 4.85; 95 percent confidence interval [CI] = 1.20, 19.60), and six months (P < . 01; OR = 5.25; 95 percent CI = 1.35, 20.36).

Conclusions: The results of this study suggest the viability and effectiveness of delivering a tobacco intervention to low-income smokers via public dental practitioners. A randomized clinical trial is warranted.

Clinical Implications: The potential reach of public health dental clinics is great. Because of the high percentage of tobacco-using patients in these clinics, the public health impact of a program such as the one reported here would be significant.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.14219/jada.archive.2005.0139DOI Listing
February 2005

Adoption, reach, and implementation of a novel smoking control program: analysis of a public utility-research organization partnership.

Nicotine Tob Res 2004 Apr;6(2):269-74

Kaiser Permanente Colorado, Denver, CO, USA.

Interventions to reach and assist smokers and families of smokers have generally reached a plateau in terms of participation and success rates. This study reports on recruitment and implementation issues involved in a novel partnership with public utilities. The goal of the project is to use information on the synergistic risks of smoking and home radon exposure to motivate and assist smoking families to create smoke-free homes or to stop smoking. We report on recruitment, participation rates, and representativeness at both the utility and the individual or family level. This project recruited 55% of utilities approached and an estimated 11% of smoking families served by these utilities. Lessons learned for recruitment and implementation activities are discussed, and recommendations are made for the conduct and evaluation of future programs using innovative partnerships with public and population-based organizations to reach smokers and reduce exposure to environmental tobacco smoke.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/14622200410001676404DOI Listing
April 2004

Integrating prenatal-postnatal smoking interventions into usual care in a health maintenance organization.

Health Promot Pract 2003 Jul;4(3):236-48

Kaiser Permanente Center for Health Research, Portland, Oregon, USA.

Consistent with the increasing national emphasis on providing health promotion in clinical care settings, Stop Smoking for OuR Kids (STORK), a research-derived, prenatal-postnatal smoking cessation intervention, was implemented throughout prenatal clinics, inpatient postpartum services, and pediatric clinics of Kaiser Permanente Northwest. Process data collected during the project rollout and maintenance to monitor the clinical practices of clinicians and staff members, patient responses to the intervention, and penetration of the intervention into the health maintenance organization priority population of prenatal smokers high-lighted barriers to intervention delivery. These barriers fell into three categories related to the smoking intervention design, clinicians and staff members, and the organization. By monitoring the intervention implementation process, such problems were identified early. This allowed for implementing strategies to overcome many of these barriers and to assess their effectiveness. Keys to implementation success included simplifying the intervention activities, considering stakeholder needs, and providing tangible organizational resources and goals.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1524839903004003008DOI Listing
July 2003

The safety net: a cost-effective approach to improving breast and cervical cancer screening.

J Womens Health (Larchmt) 2003 Oct;12(8):789-98

Kaiser Permanente Center for Health Research Hawaii, Honolulu, Hawaii 96817, USA.

Purpose: The purposes of the study were (1). to assess the cost-effectiveness of three interventions to deliver breast and cervical cancer screening to women unscreened for >or=3 years and (2). to determine the relation of an invasive cervical cancer diagnosis to the interval since the last true screening test.

Methods: In a randomized trial, women were randomly assigned to (1). usual care, (2). letter plus follow-up letter, (3). letter plus follow-up phone call, (4). phone call plus follow-up phone call. Screening within 12 weeks was the outcome. A 5-year retrospective review of cervical cancer cases and screening histories was done.

Results: The 8% of women not screened for >or=5 years had 62% of the invasive cervical cancer cases. Mammography outreach led to screening in 10%, 24%, 51%, and 50% of controls, letter/letter, letter/phone, and phone/phone interventions groups, respectively. Cervical cancer screening outreach led to screening in 17%, 22%, 54%, and 50% of the respective groups. Letter reminders alone produced fewer tests at substantially higher costs than did personalized telephone notification.

Conclusions: For cervical cancer, only 1 person in 12 was not screened in the preceding 5 years, but these accounted for nearly two thirds of invasive cancers. Aggressive outreach to the rarely screened is an important part of screening programs. Letter reminder, followed by a telephone appointment call, was the most cost-effective approach to screening rarely screened women. Lack of accurate information on prior hysterectomy adds substantial unnecessary costs to a screening reminder program.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/154099903322447756DOI Listing
October 2003

Assessing perceptions of synergistic health risk: a comparison of two scales.

Risk Anal 2003 Oct;23(5):1021-9

Department of Psychology, University of Surrey, Guildford, UK.

Two approaches to measuring perceptions of synergistic risk were compared, one using the traditional Likert scale, the other using an anchored, relative scale. Perception of synergistic risk was defined as rating the combined hazard as more risky than each of its constituent single hazards. In a within-subjects design, a convenience sample from the community (N= 604) rated three hazard combinations and their constituents: Driving while Intoxicated (familiar, high synergy), Radon and Smoking (unfamiliar, high synergy), and Smoking and Driving (familiar, low synergy), on both scales. The relative scale was expected to be a more sensitive measure of synergy than the Likert scale. The effects of item order (single hazards rated first versus combined hazards rated first) were examined between subjects. Driving while Intoxicated was perceived by the large majority of participants as a synergistic risk on both scales, but neither of the other two combined hazards were rated synergistically on either scale. The relative scale demonstrated a slight advantage over the Likert scale, and presenting the single hazards first for the relative scale produced more synergistic ratings. It is recommended that anchored, relative scales be used to measure synergy and that single hazards be presented prior to the combined hazards when using relative scales.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/1539-6924.00378DOI Listing
October 2003

Why don't we see more translation of health promotion research to practice? Rethinking the efficacy-to-effectiveness transition.

Am J Public Health 2003 Aug;93(8):1261-7

Kaiser Permanente Colorado, USA.

The gap between research and practice is well documented. We address one of the underlying reasons for this gap: the assumption that effectiveness research naturally and logically follows from successful efficacy research. These 2 research traditions have evolved different methods and values; consequently, there are inherent differences between the characteristics of a successful efficacy intervention versus those of an effectiveness one. Moderating factors that limit robustness across settings, populations, and intervention staff need to be addressed in efficacy studies, as well as in effectiveness trials. Greater attention needs to be paid to documenting intervention reach, adoption, implementation, and maintenance. Recommendations are offered to help close the gap between efficacy and effectiveness research and to guide evaluation and possible adoption of new programs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447950PMC
http://dx.doi.org/10.2105/ajph.93.8.1261DOI Listing
August 2003

Tobacco use patterns and attitudes among teens being seen for routine primary care.

Am J Health Promot 2003 Mar-Apr;17(4):231-9

Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, Oregon 97227, USA.

Purpose: To describe the tobacco-related attitudes, behaviors, and needs of smoking and nonsmoking teens being seen for routine pediatric care and to identify predictors of tobacco use.

Design: Cross-sectional survey of adolescent primary care patients who completed self-administered questionnaires in medical office waiting rooms while waiting for routine care visits.

Setting: A group-practice HMO in the Pacific Northwest.

Subjects: A sample of 2526 teenagers, ages 14 to 17, who consented to receive health promotion interventions as a part of a randomized trial in seven pediatric and family practice offices.

Measures: A 38-item questionnaire assessed tobacco use history, attitudes, quit attempts, and stage of acquisition or cessation along with gender, age, race/ethnicity, body mass index, educational plans, frequency of exercise, attempts to lose weight, and depressed mood.

Results: Sixty-seven percent of teens approached (2526 of 3747) consented to complete a questionnaire and receive tobacco- or diet-related interventions as a part of their medical visit. About 23% of teen patients reported smoking at least one cigarette in the last month, although only 14% described themselves as current "smokers." Most current smokers (84%) smoked at least 20 days in the last month. Logistic regression predictors of smoking included older age, Native American ethnicity, lower educational aspirations, lower body mass index, smoking among half or more friends, smokers at home, and a positive depression screen. Among ever-regular smokers, most were in the action (28%), preparation (21%), or contemplation (22%) readiness to quit smoking stages, and 77% of current smokers had made one or more serious quit attempts in the last year.

Conclusions: Most teens in these medical facilities consented to receive tobacco and diet interventions, and most self-described current smokers were contemplating or preparing to quit. Medical visits provide attractive opportunities for tobacco intervention, but messages should be tailored based on the patient's tobacco status and stage of acquisition or cessation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4278/0890-1171-17.4.231DOI Listing
March 2009

From rapid smoking to the Internet: five decades of cessation research.

Nicotine Tob Res 2002 May;4(2):139-45

Oregon Research Institute, 1715 Franklin Boulevard, Eugene, OR 97403-1983, USA.

This review summarizes the author's smoking cessation research from the 1960s into the 21st century. Both contextual and personal factors that led the author to undertake cessation research and to move from intensive clinical interventions to brief, population-focused interventions, especially in healthcare settings, are described. Suggestions are offered as to how research can address the problem of inconsistent delivery of effective interventions in healthcare settings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/14622200210125769DOI Listing
May 2002

Women helping chewers: partner support and smokeless tobacco cessation.

Health Psychol 2002 May;21(3):273-8

Oregon Research Institute, Eugene 97403-1983, USA.

Data from 363 male smokeless tobacco users and their romantic partners were analyzed to discern the role of support in cessation. Women reported playing a part in enrollment (71%), and more than half examined program materials or discussed cessation activities with the chewers. Women's reports of delivered support correlated substantially with men's experience of received support. Men's received positive support predicted abstinence at 6-month follow-up (odds ratio = 1.29, confidence interval = 1.03-1.61) and more than 24 hr of abstinence for those still using tobacco at 6 months (odds ratio = 1.75, confidence interval = 1.30-2.36) and moderated the effect of baseline depression and addiction on abstinence. Women played a major role through all stages of cessation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1037//0278-6133.21.3.273DOI Listing
May 2002