Telephone Quitline Research Articles

Satisfaction with a Quitline-based Smoking Cessation Intervention among Cancer Survivors

Abstract Continued smoking after diagnosis jeopardizes cancer survivors' health and well-being. Quitline-based smoking cessation treatment is convenient, widely available and free, yet the appropriateness of this treatment approach for survivors is not known. We assessed satisfaction among participants in an enhanced quitline intervention as part of a randomized clinical trial assessing feasibility. Methods: We recruited cancer survivors through the NCI Community Clinical Oncology Program (CCOP) network within 6 months of treatment who smoked within the last 7 days and randomized them 2:1 to an enhanced quitline- based intervention (brief in-person motivational interviewing counseling session, quitline telephone counseling, 6 weeks of nicotine replacement patches) or usual care. We collected treatment satisfaction data and self-reported smoking status at 12 weeks and confirmed smoking status for reported non-smokers using a semi-quantitative urinary cotinine assessment. Results: We enrolled 146 survivors (75% female, 79% non-Hispanic white, mean age = 58 years). At entry, survivors reported smoking an average of 15 cigarettes per day; 77% reported smoking within 30 minutes of awakening. Assessments were completed by 63% of the quitline group and 75% of the usual care group at 12 weeks (P > 0.05). 83% of participants in the intervention arm (n = 98) completed at least one quitline call, and 18% completed ≥3 calls. Use of nicotine patches was 61% in the quitline group and 42% in usual care. Quitline participants were generally satisfied with both the in-person counseling (mean satisfaction score = 4.2 (SD = 1.0), on 1–5 scale) and the quitline telephone counseling (mean satisfaction score = 3.4 (SD = 1.3)). 87% would recommend the quitline program to others. Self-reported 7-day point prevalence cessation was 26% in the quitline group and 17% in the usual care arm (P = 0.33). Conclusions: An enhanced quitline smoking cessation intervention appears to be acceptable to cancer survivors and to result in a trend towards slightly higher cessation at 12 weeks. Increased efforts to retain survivors in treatment and encourage the use of nicotine replacement may be necessary to increase the impact of this intervention approach.

Long-term quit rates after a perioperative smoking cessation randomized controlled trial.

While surgery and perioperative smoking cessation interventions may motivate patients to quit smoking in the short term, it is unknown how often this translates into permanent cessation. In this study, we sought to determine the rates of long-term smoking cessation after a perioperative smoking cessation intervention and predictors of successful cessation at 1 year. We previously reported short-term results from a perioperative randomized controlled trial comparing usual care with an intervention involving (1) brief counseling by the preadmission nurse, (2) smoking cessation brochures, (3) referral to a telephone quitline, and (4) a free 6-week supply of transdermal nicotine replacement. We now report our 1-year follow-up outcomes. Between October 2010 and April 2012, 168 patients were randomized. At 1 year, 127 patients (76%) were available for follow-up telephone interview. Smoking cessation occurred in 8% of control patients compared with 25% of patients in the intervention group (relative risk, 3.0; 95% confidence interval [CI], 1.2-7.8; P = 0.018). The number needed-to-treat to achieve smoking cessation for 1 patient at 1 year postoperatively was 5.9 (95% CI, 3.4-25.9). Multivariable logistic regression modeling found that the intervention (P = 0.020) and lower nicotine dependency at baseline (P < 0.001) were predictive of success at smoking cessation at 1 year. Poisson regression showed that adjusted for nicotine dependency, those randomized to the intervention group were 2.7 times (95% CI, 1.1-6.7; P = 0.028) more likely to achieve long-term cessation than those in the control group. Adjusted for randomization group, a low level of nicotine dependency resulted in a relative risk of quitting of 5.1 (95% CI, 2.0-12.8; P = 0.001). This study demonstrates that an intervention designed for a busy preadmission clinic results in decreased smoking rates not only around the time of surgery but also continued benefit in smoking cessation at 1 year. Perioperative care providers have a unique opportunity to assist patients in smoking cessation and achieve long-lasting results.

Assessment of compliance with U.S. Public Health Service clinical practice guideline for tobacco by primary care physicians.

BackgroundThe US Public Health Service Clinical Practice Guideline Treating Tobacco Use and Dependence: 2008 Update established an expanded standard of care, calling on physicians to consistently identify their patients who use tobacco and treat them using counseling and medication.FindingsTo assess compliance, we examined the extent to which physicians self-report following four of the five components of the 5A model: Ask about tobacco use, Advise patients who use tobacco to quit, Assist the patient in making a quit attempt, and Arrange for follow-up care. We used data from a Web-based panel survey administered to a convenience sample of 1,253 primary care providers (family/general practitioners, internists, and obstetrician/gynecologists). We found that 97.1% of the providers reported that they consistently Asked and documented tobacco use, while 98.6% reported that they consistently Advised their patients to quit using tobacco. Among the family/general practitioners and internists, 98.3% recommended “any” (medication, counseling, counseling and medication, telephone quitline) smoking cessation strategies (Assist). Among all providers, 48.0% reported that they consistently scheduled a follow-up visit (Arrange).ConclusionsThis study revealed that most primary care physicians reported that they Ask their patients about tobacco use, Advise them to quit, and Assist them in making a quit attempt, but only half reported that they Arrange a follow-up visit. Tobacco use screening and intervention are among the most effective clinical preventive services; thus, efforts to educate, encourage, and support primary care physicians to provide evidence-based treatments to their patients should be continued.

The impact of a state-sponsored mass media campaign on use of telephone quitline and web-based cessation services.

IntroductionMost US smokers do not use evidence-based interventions as part of their quit attempts. Quitlines and Web-based treatments may contribute to reductions in population-level tobacco use if successfully promoted. Currently, few states implement sustained media campaigns to promote services and increase adult smoking cessation. This study examines the effects of Florida’s tobacco cessation media campaign and a nationally funded media campaign on telephone quitline and Web-based registrations for cessation services from November 2010 through September 2013.MethodsWe conducted multivariable analyses of weekly media-market–level target rating points (TRPs) and weekly registrations for cessation services through the Florida Quitline (1-877-U-CAN-NOW) or its Web-based cessation service, Web Coach (www.quitnow.net/florida).ResultsDuring 35 months, 141,221 tobacco users registered for cessation services through the Florida Quitline, and 53,513 registered through Web Coach. An increase in 100 weekly TRPs was associated with an increase of 7 weekly Florida Quitline registrants (β = 6.8, P < .001) and 2 Web Coach registrants (β = 1.7, P = .003) in an average media market. An increase in TRPs affected registrants from multiple demographic subgroups similarly. When state and national media campaigns aired simultaneously, approximately one-fifth of Florida’s Quitline registrants came from the nationally advertised portal (1-800-QUIT-NOW).ConclusionSustained, state-sponsored media can increase the number of registrants to telephone quitlines and Web-based cessation services. Federally funded media campaigns can further increase the reach of state-sponsored cessation services.

Randomised trial of two nicotine patch protocols distributed through a state quitline

BackgroundMost telephone quitlines provide free nicotine replacement therapy (NRT). An 8-week course is recommended, but few users complete it. Information is needed to help quitlines distribute NRT cost-effectively.DesignRandomised two-group trial.Setting/participantsColorado...

Cessation among state quitline participants with a mental health condition.

Telephone quitlines are an effective treatment option for tobacco cessation in the general population. Many participants who use quitline services have mental health conditions (MHC), yet few published studies have examined the use of quitline services in this population. This study examined the prevalence of MHC among state quitline participants and compared cessation outcomes among those with and without MHC. Demographic and tobacco use data were collected at enrollment and 7 months post-enrollment using standardized assessments for 10,720 eligible participants who enrolled in a state quitline between September, 2010 and August, 2012. The prevalence of self-reported MHC was 19.8% (2,086/10,720 callers). The intent to treat quit rate for participants with a MHC was 16.4% compared to 21.5% for those without a MHC (p < .001), and the responder quit rate was 36.9% for those with a MHC compared to 44.4% for those without (p < .001). The adjusted odds ratio describing the association of MHC status and tobacco cessation was identical for both the intent-to-treat and responder populations, and indicated that participants with MHC were 23% less likely to quit (p < .05). This study identified that participants with MHC accessed a state quitline, but were less likely to quit. The finding was independent of other factors influencing tobacco cessation, such as gender, race, and education. These findings indicate that although quitline services are an option for tobacco cessation among persons with MHC, further research is needed to determine why cessation rates are lower.

Abstract 5042: Using a statewide collaborative approach to improve tobacco cessation referral rates for cancer patients

Abstract Purpose: Though tobacco use by cancer patients is associated with poor therapeutic outcomes, most oncologists do not regularly provide tobacco cessation support for cancer patients. The purpose of this study was to determine if dedicated statewide services could substantially enhance delivery of evidence based cessation support to broad cancer patient populations across many oncology clinics. Methods: The Michigan Oncology Quality Consortium (MOQC) collaborated with the Michigan Department of Community Health and the Michigan Cancer Consortium to identify and address tobacco cessation support that could be improved for cancer patients. A statewide Tobacco Cessation Demonstration Project was developed to reduce patient barriers to access by increasing education, identifying all cancer patients who use tobacco, referring them to the Michigan Tobacco Quitline, and providing funding for free Quitline telephone counseling services and nicotine replacement therapy for cancer patients. Reported are results in 19 clinical practices. Results: Implementation of this project resulted in tobacco assessments in more than 98% of patients and increased tobacco cessation referral rates for participating practices from 15% in May 2013 to over 60% in July and September of 2013 (p &amp;lt; .001). Total statewide referrals to the Quitline increased by between 32% and 60% over the first 6 months, with an increasing proportion of patients (between 31% and 50%) being cancer patients referred by MOQC participating sites. FebMarAprMayJunJulAugSepOctTotal Michigan # Referrals140153153202233245238220210MOQC # Referralsn/an/an/a628812397104102MOQC Referrals % of Total Michigann/an/an/a31%38%50%41%47%49% Conclusions: Reducing patient barriers to access to tobacco cessation services and supplying clinic teams with scientific evidence, standard workflows, and lean tools improved the referral rate to a tobacco cessation program for oncology patients. Critical factors for success included strong physician leadership, adoption of an auto referral process, and front line staff accountability for identifying all patients who use tobacco and assessing their tobacco cessation status at subsequent clinic visits. Citation Format: Jane Severson, Hilary Baca, Douglas Blayney, Karen Brown, Grayce Galiyas, Mara Minasian, Joan Schmidt, Anna Schulze, Graham Warren. Using a statewide collaborative approach to improve tobacco cessation referral rates for cancer patients. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 5042. doi:10.1158/1538-7445.AM2014-5042

Five population-based interventions for smoking cessation: a MOST trial.

Little is known about the relative, additive, and interactive effects of different population-based treatments for smoking cessation. The goal of this study was to evaluate the main and interactive effects of five different smoking interventions. Using the multiphase optimization strategy (MOST), 1,034 smokers who entered a Web site for smokers (smokefree.gov) were randomly assigned to the "on" and "off" conditions of five smoking cessation interventions: the National Cancer Institute's (NCI) Web site (www.smokefree.gov vs a "lite" Web site), telephone quitline counseling (vs none), a smoking cessation brochure (vs a lite brochure), motivational e-mail messages (vs none), and mini-lozenge nicotine replacement therapy (NRT vs none). Analyses showed that the NCI Web site and NRT both increased abstinence; however, the former increased abstinence significantly only when it was not used with the e-mail messaging intervention (messaging decreased Web site use). The other interventions showed little evidence of effectiveness. There was evidence that mailed nicotine mini-lozenges and the NCI Web site (www.smokefree.gov) provide benefit as population-based smoking interventions.

Smoking cessation among people seeking mental health treatment.

This study examined smoking cessation characteristics of smokers who reported seeking mental health treatment. Data for adult current smokers (N=18,939) were combined from the 2000, 2005, and 2010 National Health Interview Survey. Multivariate regressions were used to assess associations between smoking cessation behaviors, cessation-related social norms, and mental health treatment. Smokers (N=1,897) who reported seeing mental health professionals for mental health problems had higher odds of having made attempts to quit in the past year (odds ratio [OR]=1.17), of having used nicotine replacement therapy (OR=1.28), and of using face-to-face counseling (OR=2.40), telephone quit lines (OR=1.81), and support groups (OR=1.63) to assist smoking cessation. They were more likely to have been advised by health professionals to quit smoking (OR=1.62) but less likely to live in a smoke-free home (OR=.78). Use of smoking cessation treatments and prevalence of smoke-free homes increased over the sampling period. Findings highlight the need for tailored efforts to reduce tobacco use among people with mental health problems.

Tobacco health warning messages on plain cigarette packs and in television campaigns: a qualitative study with Australian socioeconomically disadvantaged smokers.

Television advertisements, packaging regulations and health warning labels (HWLs) are designed to communicate anti-smoking messages to large number of smokers. However, only a few studies have examined how high smoking prevalence groups respond to these warnings. This study explored how socioeconomically disadvantaged smokers engage with health risk and cessation benefit messages. Six focus groups were conducted over September 2012-April 2013 with adult clients of welfare organizations in regional New South Wales, Australia who were current smokers (n = 51). Participants discussed HWLs, plain packaging and anti-smoking television advertisements. Discussions were audio-taped, transcribed verbatim and analysed using thematic analysis. Highly emotive warnings delivering messages of negative health effects were most likely to capture the attention of the study participants; however, these warning messages did not prompt quit attempts and participants were sceptical about the effectiveness of cessation programmes such as telephone quitlines. Active avoidance of health warning messages was common, and many expressed false and self-exempting beliefs towards the harms of tobacco. Careful consideration of message content and medium is required to communicate the anti-smoking message to disadvantaged smokers who consider themselves desensitized to warnings. Health communication strategies should continue to address false beliefs about smoking and educate on cessation services that are currently underutilized.

Quitters referring smokers: a quitline chain-referral pilot study.

BackgroundTelephone counseling Quitlines can support smoking cessation, but are under-utilized. We explored the use of smoker peer-referrals to increase use of a Quitline in Mississippi and Alabama.FindingsCollaborating with the Alabama and Mississippi Quitline, we piloted peer-referrals to Quitlines. Successful ‘quitters’ who had used the Quitline were contacted at routine follow-up and recruited to participate as a peer-referrer and refer their friends and family who smoked to the Quitline. Peer-referrers completed a training session, received a manual and a set of Quitline brochures a peer-referral forms. These peer-referral forms were then returned to the Quitline telephone counselors who proactively called the referred smokers. Of the initial potential pool of 96 who quit using the Quitline, 24 peer-referrers (75% Women, 29% African-American, and high school graduates/GED 67%) were recruited and initially agreed to participate as peer-referrers. Eleven of the 24 who initially agreed were trained, and of these 11, 4 (4%) actively referred 23 friends and family over 2 months. From these 23 new referrals, three intakes (100% Women, 66% African-American) were completed. Of the initial pool of 96, 4 (4%) actively participated in referring friends and family. Quitline staff and peer-referrers noted several barriers including: time-point in which potential peer-referrers were asked to participate, an ‘overwhelming’ referral form to use and limited ways to refer.ConclusionsThough ‘quitters’ were willing to agree to peer-refer, we received a minority of referrals. However, we identified several areas to improve this new method for increasing awareness and access to support systems like the Quitline for smokers who want to quit.

A cost-effectiveness analysis of online, radio and print tobacco control advertisements targeting 25-39 year-old males.

To assess the relative cost-effectiveness of various non-television advertising media in encouraging 25-39 year-old male smokers to respond to a cessation-related call to action. Information about how new electronic media compare in effectiveness is important to inform the implementation of future tobacco control media campaigns. Two testimonial advertisements featuring members of the target group were developed for radio, press and online media. Multiple waves of media activity were scheduled over a period of seven weeks, including an initial integrated period that included all three media and subsequent single media phases that were interspersed with a week of no media activity. The resulting Quit website hits, Quitline telephone calls, and registrations to online and telephone counselling services were compared to advertising costs to determine the relative cost-effectiveness of each media in isolation and the integrated approach. The online-only campaign phase was substantially more cost-effective than the other phases, including the integrated approach. This finding is contrary to the current assumption that the use of a consistent message across multiple media simultaneously is the most cost-effective way of reaching and affecting target audiences. Online advertising may be a highly cost-effective channel for low-budget tobacco control media campaigns.

Using the electronic health record to connect primary care patients to evidence-based telephonic tobacco quitline services: a closed-loop demonstration project.

Few smokers receive evidence-based tobacco treatment during healthcare visits. Electronic health records (EHRs) present an opportunity to efficiently identify and refer smokers to state tobacco quitlines. The purpose of this case study is to develop and evaluate a secure, closed-loop EHR referral system linking patients visiting healthcare clinics with a state tobacco quitline. A regional health system, EHR vendor, tobacco cessation telephone quitline vendor, and university research center collaborated to modify a health system's EHR to create an eReferral system. Modifications included the following: clinic workflow adjustments, EHR prompts, and return of treatment delivery information from the quitline to the patient's EHR. A markedly higher percentage of adult tobacco users were referred to the quitline using eReferral than using the previous paper fax referral (14 vs. 0.3%). The eReferral system increased the referral of tobacco users to quitline treatment. This case study suggests the feasibility and effectiveness of a secure, closed-loop EHR-based eReferral system.

Effect of Nicotine Replacement Therapy on Quitting by Young Adults in a Trial Comparing Cessation Services

Young adult smokers have the highest smoking prevalence among all US age groups but are least likely to use evidence-based cessation counseling or medication to quit. Use and effectiveness of nicotine patch were explored in a randomized trial evaluating smoking cessation interventions with this population. Smokers aged 18 to 30 (n = 3094) were recruited through online and off-line methods and from telephone quit lines and analyzed. Smokers were enrolled in a pretest-posttest trial, and randomized to 1 of 3 cessation services. Trial delivering counseling services by self-help booklet, telephone quit lines, or online expert system in the 48 continental United States. Smokers could request a free 2-week course of nicotine replacement therapy (NRT) patches from the project. Follow-up surveys at 12 and 26 weeks assessed smoking abstinence, use of NRT, counseling, and other cessation medications, and smoking-related variables. Overall, 69.0% of smokers reported using NRT (M = 3.2 weeks) at 12 weeks and 74.8% (M = 3.3 weeks) at 26 weeks. More smokers who were sent the free nicotine patches (n = 1695; 54.8%) reported using NRT than those who did not receive them (12 weeks: 84.3% vs 41.9%, P < .001; 26 weeks: 87.6% vs 51.1%, P < .001). The use of NRT was associated with greater smoking abstinence at 12 weeks (P < .001) and 26 weeks (P < .05), especially if used for more than 2 weeks (P < .001). Smokers assigned to a self-help booklet or cessation Web site and heavier smokers were most likely to use NRT (P < .05), whereas those reporting marijuana use and binge drinking used NRT less (P < .05). Many young adults were willing to try NRT, and it appeared to help them quit in the context of community-based cessation services. Strategies should be developed to make NRT available to this age group and support them in using it to prevent lifelong smoking.

Reassessing the Safety of Varenicline

Reassessing the Safety of Varenicline

Telephone Quitline Use and Effectiveness Among Young Adults

Introduction: Although smoking prevalence has declined dramatically among adults in the past 40 years, 19.3% of adults still smoke, including 20.1% of adults aged 18–24 years. Quitlines are effective, population-based interventions that increase successful cessation.Aims: This study aims to describe the characteristics of young adult smokers aged 18–24 years who used telephone cessation counselling for assistance with quitting, to assess self-reported quit rates, and to examine predictors of quitting, compared to older adults.Methods: We examined data from 4,542 young adult smokers aged 18–24 years and 46,094 smokers aged ≥25 years who enrolled in the American Cancer Society's quitline services during 2006–2008.Results: Young adult smokers aged 18–24 years who called quitlines differed slightly from older adults in demographics and tobacco-use behaviours. There were no age-related differences in self-reported seven-day quit rates or 30-day quit rates at the seven-month follow-up. Predictors of quitting were mostly similar for the young adults and the older adults, although the odds of quitting were lower among young adults for living with vs. not living with a smoker.Conclusions: Although young adult smokers under-utilise telephone cessation quitlines for assistance with quitting, those who do use these services have quit rates similar to older adults.

Telephone counselling for smoking cessation

Telephone services can provide information and support for smokers. Counselling may be provided proactively or offered reactively to callers to smoking cessation helplines. To evaluate the effect of proactive and reactive telephone support via helplines and in other settings to help smokers quit. We searched the Cochrane Tobacco Addiction Group Specialised Register for studies of telephone counselling, using search terms including 'hotlines' or 'quitline' or 'helpline'. Date of the most recent search: May 2013. randomized or quasi-randomised controlled trials in which proactive or reactive telephone counselling to assist smoking cessation was offered to smokers or recent quitters. One author identified and data extracted trials, and a second author checked them. The main outcome measure was the risk ratio for abstinence from smoking after at least six months follow-up. We selected the strictest measure of abstinence, using biochemically validated rates where available. We considered participants lost to follow-up to be continuing smokers. Where trials had more than one arm with a less intensive intervention we used only the most similar intervention without the telephone component as the control group in the primary analysis. We assessed statistical heterogeneity amongst subgroups of clinically comparable studies using the I² statistic. We considered trials recruiting callers to quitlines separately from studies recruiting in other settings. Where appropriate, we pooled studies using a fixed-effect model. We used a meta-regression to investigate the effect of differences in planned number of calls, selection for motivation, and the nature of the control condition (self help only, minimal intervention, pharmacotherapy) in the group of studies recruiting in non-quitline settings. Seventy-seven trials met the inclusion criteria. Some trials were judged to be at risk of bias in some domains but overall we did not judge the results to be at high risk of bias. Among smokers who contacted helplines, quit rates were higher for groups randomized to receive multiple sessions of proactive counselling (nine studies, > 24,000 participants, risk ratio (RR) for cessation at longest follow-up 1.37, 95% confidence interval (CI) 1.26 to 1.50). There was mixed evidence about whether increasing the number of calls altered quit rates but most trials used more than two calls. Three studies comparing different counselling approaches during a single quitline contact did not detect significant differences. Of three studies that tested the provision of access to a hotline two detected a significant benefit and one did not.Telephone counselling not initiated by calls to helplines also increased quitting (51 studies, > 30,000 participants, RR 1.27; 95% CI 1.20 to 1.36). In a meta-regression controlling for other factors the effect was estimated to be slightly larger if more calls were offered, and in trials that specifically recruited smokers motivated to try to quit. The relative extra benefit of counselling was smaller when it was provided in addition to pharmacotherapy (usually nicotine replacement therapy) than when the control group only received self-help material or a brief intervention.A further eight studies were too diverse to contribute to meta-analyses and are discussed separately. Two compared different intensities of counselling, both of which detected a dose response; one of these detected a benefit of multiple counselling sessions over a single call for people prescribed bupropion. The others tested a variety of interventions largely involving offering telephone counselling as part of a referral or systems change and none detected evidence of effect. Proactive telephone counselling aids smokers who seek help from quitlines. Telephone quitlines provide an important route of access to support for smokers, and call-back counselling enhances their usefulness. There is limited evidence about the optimal number of calls. Proactive telephone counselling also helps people who receive it in other settings. There is some evidence of a dose response; one or two brief calls are less likely to provide a measurable benefit. Three or more calls increase the chances of quitting compared to a minimal intervention such as providing standard self-help materials, or brief advice, or compared to pharmacotherapy alone.

The ONE Step Initiative: Quality Improvement in a Pediatric Clinic for Secondhand Smoke Reduction

Although comprehensive smoking counseling to limit secondhand smoke (SHS) is widely endorsed, it is often not done. Published evaluations of brief and practical systems that improve screening and counseling to reduce SHS are limited. Our objective was to determine if a quality improvement activity around smoking counseling leads to changes in (1) medical assistant and pediatric provider assessment of smoking history and (2) smoking or other behaviors affecting children's SHS exposure. In a large urban teaching clinic we assessed the ONE Step intervention, which included the following: (1) "Ask" (medical assistant asking whether caregivers smoke); (2) "Advise" (providers advising smoking outside and quitting if ready); (3) "Refer" (providers referring to the Colorado telephone QuitLine); and (4) electronic medical record prompts and required documentation regarding smoking. Medical assistant and provider assessments of smoking were evaluated with a chart review by using a pre-/posttest design. Caregiver behavior change was evaluated with a time-series survey that included assessment at baseline and follow-up via telephone at 6 and 12 months from study entry. ONE Step was associated with a statistically significant increase in Ask, Advise, and Refer documentation. Caregiver surveys showed that 97% found discussions of SHS with providers acceptable. Six- and 12-month follow-ups, respectively, showed that 14% and 13% of smokers reported quitting and that 63% and 70% of current smokers reported reduced SHS exposure. ONE Step was feasible to deliver in a busy outpatient setting, acceptable to families, and appears to have resulted in decreased exposure to SHS in our pediatric population.

Use and Effectiveness of Quitlines for Smokers With Diabetes: Cessation and Weight Outcomes, Washington State Tobacco Quit Line, 2008

IntroductionHaving 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.MethodsWe 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, χ2 and t tests for bivariate comparisons, and multivariable analyses to determine correlates of cessation.ResultsTobacco 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.ConclusionsResults suggest that quitlines are effective for participants with diabetes, but tailored interventions that address weight concerns during cessation are needed.

Nicotine Replacement Therapy Distribution to Light Daily Smokers Calling a Quitline

With an increasing prevalence of lighter smokers presenting for cessation assistance, outcome-based recommendations are needed to inform nicotine replacement therapy (NRT) distribution protocols by quitlines. A quasi-experimental design was utilized to compare quit rates based on samples selected from the time period before and after NRT (gum or lozenge) was offered to light daily smokers (1-9 cigarettes) contacting the New York State Smokers' Quitline. Outcome measures included self-reported 7- and 30-day abstinence rates, numbers of daily cigarettes among continuing smokers, and cost per quit analyses. Among responders to the follow-up survey, quit rates were higher for those given NRT compared with those not offered NRT at both 7 (33.0% vs. 27.2%; Relative Risk [RR] = 2.25 [95% CI: 1.15, 4.40; p < .05]) and 30 days (28.0% vs. 21.9%; RR = 2.63 [95% CI: 1.25, 5.54; p < .05]). Similar results were obtained based on intent-to-treat analyses for both 7 (13.4% vs. 11.3%; RR = 1.92 [95% CI: 1.08, 3.39; p < .05]) and 30 days (11.4% vs. 9.1%; RR = 2.29 [95% CI: 1.20, 4.40; p < .05]). Among continuing smokers, the mean number of cigarettes smoked per day increased from enrollment to follow-up in both groups, but less so in those receiving NRT. The additional cost associated with providing a 2-week free supply of nicotine replacement to smokers was $52 for gum and $74 for lozenge. This study demonstrates that light daily smokers (1-9 cigarettes) who contact a telephone quitline are interested in using NRT if offered and are able to achieve higher quit rates compared with those not offered NRT.