Use Of Evidence-based Cessation Treatments Research Articles

Exploring the perceived effectiveness and cultural acceptability of COVID-19 relevant social media intervention content among Alaska Native people who Smoke: The CAN Quit study

Social media platforms have potential for reach and effectiveness to motivate smoking cessation and use of evidence-based cessation treatment, even during the worldwide COVID-19 pandemic. This study builds on our prior community participatory approach to developing content postings for the CAN Quit Facebook intervention among Alaska Native (AN) people who smoke. With input from a community advisory committee, we selected new content on COVID-19 preventive practices (e.g., masking) and evaluated them using a validated, six-item perceived effectiveness scale and a single item assessing cultural relevance. We obtained feedback on six content postings (two videos and four text/pictures) from an online survey administered to 41 AN people (14 men, 27 women; age range 22–61 years) who smoke in Alaska statewide with 49 % residing in rural Alaska. Perceived effectiveness scale scores were high across postings, ranging from 3.9 to 4.4 out of a maximum score of 5.0. Cultural relevance item scores ranged from 3.9 to 4.3. We found no appreciable differences by sex, age, or rural/urban location for either score. This study adds new information on the adaptation, acceptability, and perceived effectiveness of content on COVID-19 preventive practices for future inclusion in a social media-based intervention for smoking cessation specifically tailored for AN people.

Lessons Learned From Beta-Testing a Facebook Group Prototype to Promote Treatment Use in the "Connecting Alaska Native People to Quit Smoking" (CAN Quit) Study.

Social media provides an effective tool to reach, engage, and connect smokers in cessation efforts. Our team developed a Facebook group, CAN Quit (Connecting Alaska Native People to Quit smoking), to promote use of evidence-based smoking cessation resources for Alaska Native people living in Alaska, which are underused despite their effectiveness. Often separated by geography and climate, Alaska Native people prefer group-based approaches for tobacco cessation that support their culture and values. Such preferences make Alaska Native people candidates for social media–based interventions that promote connection. This viewpoint discusses the steps involved and lessons learned in building and beta-testing our Facebook group prototype, which will then be evaluated in a pilot randomized controlled trial. We describe the process of training moderators to facilitate group engagement and foster community, and we describe how we developed and tested our intervention prototype and Facebook group. All parts of the prototype were designed to facilitate use of evidence-based cessation treatments. We include recommendations for best practices with the hope that lessons learned from the CAN Quit prototype could provide a model for others to create similar platforms that benefit Alaska Native and American Indian people in the context of smoking cessation.

Receipt of and Spending on Cessation Medication Among US Adults With Employer-Sponsored Health Insurance, 2010 and 2017.

Studies examining the use of smoking cessation treatment and related spending among enrollees with employer-sponsored health insurance are dated and limited in scope. We assessed changes in annual receipt of and spending on cessation medications approved by the US Food and Drug Administration (FDA) among tobacco users with employer-sponsored health insurance from 2010 to 2017. We analyzed data on 439 865 adult tobacco users in 2010 and 344 567 adult tobacco users in 2017 from the IBM MarketScan Commercial Database. We used a negative binomial regression to estimate changes in receipt of cessation medication (number of fills and refills and days of supply). We used a generalized linear model to estimate spending (total, employers', and out of pocket). In both models, covariates included year, age, sex, residence, and type of health insurance plan. From 2010 to 2017, the percentage of adult tobacco users with employer-sponsored health insurance who received any cessation medication increased by 2.4%, from 15.7% to 16.1% (P < .001). Annual average number of fills and refills per user increased by 15.1%, from 2.5 to 2.9 (P < .001) and days of supply increased by 26.4%, from 81.9 to 103.5 (P < .001). The total annual average spending per user increased by 53.6%, from $286.40 to $440.00 (P < .001). Annual average out-of-pocket spending per user decreased by 70.9%, from $70.80 to $20.60 (P < .001). Use of smoking cessation medications is low among smokers covered by employer-sponsored health insurance. Opportunities exist to further increase the use of cessation medications by promoting the use of evidence-based cessation treatments and reducing barriers to coverage, including out-of-pocket costs.

Association between income and education with quit attempts, use of cessation aids, and short-term success in tobacco smokers: A social gradient analysis from a population-based cross-sectional household survey in Germany (DEBRA study)

IntroductionSmoking is more prevalent in smokers from lower compared with higher socioeconomic (SES) groups, but studies are inconsistent regarding underlying mechanisms. We aimed to assess associations between SES indicators and three distinct aspects of the smoking cessation process: attempting to quit; use of evidence-based cessation treatments; and success. MethodsWe analysed data of 12,161 last-year smokers (i.e., current smokers and recent ex-smokers who quit ≤ 12 months) from 20 waves (June/July 2016 to August/September 2019) of the German Study on Tobacco Use (DEBRA) – a representative household survey. Associations between indicators of SES (income and education) and (1) last-year quit attempts; (2) use of evidence-based cessation treatment or electronic cigarettes during the last attempt; and (3) short-term self-reported abstinence were analysed using multivariable logistic regression, adjusted for potential confounders. ResultsOf all last-years smokers, 18.6% had attempted to quit, of whom 15.2% had successfully stopped. Higher income (OR 0.82, 95%CI = 0.77–0.88 per 1000€) but low vs. high education (OR 0.83, 95%CI = 0.73–0.95) were associated with lower odds of quit attempts. In smokers with quit attempts, higher income but not education was associated with higher odds of using cessation medication (OR 1.31, 95%CI = 1.08–1.59 per 1000 €). Neither income nor education were associated with using behavioural support or success. ConclusionsIn the German healthcare system without free access to evidence-based cessation therapy, low-income smokers are more likely to make a quit attempt but less likely to use cessation medication than high-income smokers. Equitable access to such medication is crucial to reduce SES-related health disparities.

Tobacco Use and Subsequent Cessation Among Hospitalized Patients in Mumbai, India: A Longitudinal Study.

Hospitalization is an important setting to address tobacco use. Little is known about post-discharge cessation and treatment use in low- and middle-income countries. Our objective was to assess tobacco use after hospital discharge among patients in Mumbai, India. Longitudinal observational study of inpatients (≥15 years) admitted at one hospital from November 2015 to October 2016. Patients reporting current tobacco use were surveyed by telephone after discharge. Of 2894 inpatients approached, 2776 participated and 15.7% (N = 437) reported current tobacco use, including 5.3% (N = 147) smokers, 9.1% (N = 252) smokeless tobacco (SLT) users, and 1.4% (N = 38) dual users. Excluding dual users, SLT users, compared to smokers, were less likely to report a plan to quit after discharge (42.6% vs. 54.2%, p = .04), a past-year quit attempt (38.1% vs. 52.7%, p = .004), to agree that tobacco has harmed them (57.9% vs. 70.3%, p = .02) or caused their hospitalization (43.4% vs. 61.4%, p < .001). After discharge, 77.6% of smokers and 78.6% of SLT users reported trying to quit (p = .81). Six-month continuous abstinence after discharge was reported by 27.2% of smokers and 24.6% of SLT users (p = .56). Nearly all relapses to tobacco use after discharge occurred within 30 days and did not differ by tobacco type (log-rank p = .08). Use of evidence-based cessation treatment was reported by 6.5% (N = 26). Three-quarters of tobacco users in a Mumbai hospital attempted to quit after discharge. One-quarter reported continuous tobacco abstinence for 6 months despite little use of cessation treatment. Increasing post-discharge cessation support could further increase cessation rates and improve patient outcomes. No prior study has measured the patterns of tobacco use and cessation among hospitalized tobacco users in India. Three-quarters of tobacco users admitted to a hospital in Mumbai attempted to quit after discharge, and one-quarter remained tobacco-free for 6 months, indicating that hospitalization may be an opportune time to offer a cessation intervention. Although smokers and SLT users differed in socioeconomic status, perceived risks and interest in quitting, they did not differ in their ability to stay abstinent after hospital discharge.

The differential impact of state tobacco control policies on cessation treatment utilization across established tobacco disparities groups

Tobacco control policies are effective in promoting quit attempts and increase the likelihood that smokers use evidence-based cessation treatments (e.g., nicotine replacement therapies (NRT), non-NRT medications, behavioral treatment, and/or quitlines). However, what is less clear is how these policies might differentially impact different groups of smokers, perhaps in some cases even widening disparities in the use of evidence-based tobacco dependence treatments. This paper examined how different state-level tobacco control policies impact the use of evidence-based cessation treatments by race/ethnicity, gender, socio-economic status (SES), age, and smoking history. Participants included 9110 adult smokers reporting a past-year quit attempt within the 2010–2011 Tobacco Use Supplement to the Current Population Survey. Lasso regression modeling was used to identify a subset of interactions between tobacco policies and individual smoker characteristics that predicted use of evidence-based cessation treatment. Significant interactions were fitted via participant-weighted generalized linear models to determine effect sizes and relations to each cessation treatment outcome. Results highlighted that various state level tobacco control policies differentially impacted the reported use of both prescription and non-prescription stop smoking medications by race/ethnicity, age, and SES. The relationship between state level tobacco control policies and the use of behavioral treatments and quitlines did not differ by smoker characteristics. In sum, tobacco control policies differentially impact the use of FDA approved stop smoking medications across different race/ethnicity, age, and SES groups. Understanding such effects can help to target interventions to ensure equal access to evidence-based tobacco dependence treatments.

Community-based navigators for tobacco cessation treatment: a proof-of-concept pilot study among low-income smokers.

BackgroundA majority of continuing smokers in the United States are socioeconomically disadvantaged (SED) adults, who are less likely than others to achieve and maintain abstinence despite comparable quit-attempt rates. A national research initiative seeks effective new strategies for increasing successful smoking cessation outcomes among SED populations. There is evidence that chronic and acute stressors may interfere with SED smokers who try to quit on their own. Patient navigators have been effectively used to improve adherence to chronic disease treatment. We designed and have pilot-tested an innovative, non-clinical community-based intervention – smoking cessation treatment navigators – to determine feasibility (acceptance, adherence, and uncontrolled results) for evaluation by randomized controlled trial (RCT).MethodsThe intervention was developed for smokers among parents and other household members of inner city pre-school for low-income children. Smoking cessation treatment navigators were trained and deployed to help participants choose and adhere to evidence-based cessation treatment (EBCT). Navigators provided empathy, resource-linking, problem-solving, and motivational reinforcement. Measures included rates of study follow-up completion, EBCT utilization, navigation participation, perceived intervention quality, 7-day point abstinence and longest abstinence at three months. Both complete-case and intent-to-treat analyses were performed.ResultsEighty-five percent of study participants (n = 40) completed final data collection. More than half (53 %) enrolled in a telephone quitline and nearly three-fourths (71 %) initiated nicotine replacement therapy. Participants completed a mean 3.4 navigation sessions (mean 30 min duration) and gave the intervention very high quality and satisfaction ratings. Self-reported abstinence was comparable to rates for evidence-based cessation strategies (21 % among study completers, 18 % using intent-to-treat analysis; median 21 days abstinent among relapsers).ConclusionsThe pilot results suggest that smoking cessation treatment navigators are feasible to study in community settings and are well-accepted for increasing use of EBCT among low-income smokers. Randomized controlled trial for efficacy is warranted.

Do Symptoms and Cognitive Problems Affect the Use and Efficacy of a Web-Based Decision Support System for Smokers With Serious Mental Illness?

Objective: People with severe mental illnesses are more likely to have nicotine dependence than the general population and do not use effective cessation treatment when they try to quit. Previous research has shown that a web-based motivational decision support system tailored for this population is associated with increased use of evidence-based cessation treatment. This study examines how user characteristics, including cognitive functioning and psychiatric symptoms, impact use and outcomes of this website. Methods: One hundred twenty-eight smokers with severe mental illnesses were assessed at baseline for demographics, smoking characteristics, symptoms, cognition, and reading ability. They used the decision support system within 2 weeks of the baseline interview. Two months after use of the decision support system, researchers assessed participants’ smoking behaviors, use of evidence-based cessation treatment, clinician contact, and other quitting behaviors. Analyses modeled the relationship of participant characteristics to (a) process outcomes, including time spent on the website, and (b) behavioral outcomes, including use of effective cessation treatment. Results: Thirty-two percent of smokers initiated one or more of the recommended treatments after using the decision support system and 51% demonstrated some kind of smoking cessation behavior. When controlling for cigarette use, symptoms, cognition, and other potential predictors, regression analysis showed that being older, having a diagnosis of a schizophrenia spectrum disorder, and cognitive impairment were associated with a greater amount of time spent in the motivation section. Older age and diagnosis of schizophrenia were associated with time spent in the decision support section. Controlling for multiple characteristics, participants’ self-reported readiness to quit smoking was the only characteristic that predicted use of cessation treatment and other cessation behaviors over the following 2 months. Conclusions: Smokers with serious mental illness compensated for symptoms, old age, lower cognition, and lower reading capability by taking more time using the motivational decision support system. Following use, one-third of smokers engaged in treatment regardless of individual characteristics. The flexible design of this intervention may allow participants to tailor their use of it to meet individual needs. Future research should address both process and outcomes of motivational smoking cessation interventions.

Increasing Consumer Demand among Medicaid Enrollees for Tobacco Dependence Treatment: The Wisconsin “Medicaid Covers It” Campaign

Smoking prevalence among Medicaid enrollees is higher than among the general population, but use of evidence-based cessation treatment is low. We evaluated whether a communications campaign improved cessation treatment utilization. Quasi-experimental. Wisconsin. Enrollees in the Wisconsin Family Medicaid program. The average monthly enrollment during the study period was approximately 170,000 individuals. Print materials for clinicians and consumers distributed to 13 health maintenance organizations (HMOs) serving Wisconsin Medicaid HMO enrollees. Wisconsin Medicaid pharmacy claims data for smoking cessation medications were analyzed before and after a targeted communications campaign. HMO enrollees were the intervention group. Fee-for-service enrollees were a quasi-experimental comparison group. Quit Line utilization data were also analyzed. Pharmacotherapy claims and number of registered Quit Line callers were compared precampaign and postcampaign. Precampaign, cessation pharmacotherapy claims declined for the intervention group and increased slightly for the comparison group (t = 2.29, p = .03). Postcampaign, claims increased in both groups. However, the rate of increase in the intervention group was significantly greater than in the comparison group (t = -2.2, p = .04). A statistically significant increase was also seen in the average monthly number of Medicaid enrollees that registered for Quit Line services postcampaign compared to precampaign (F [1,22] = 7.19, p = .01). This natural experiment demonstrated statistically significant improvements in both pharmacotherapy claims and Quit Line registrations among Medicaid enrollees. These findings may help inform other states' efforts to improve cessation treatment utilization.

Where There's an App, There's a Way?

The National Tobacco Cessation Collaborative identified six core strategies as part of its Consumer Demand Roundtable with the overarching goal of increasing the demand, reach, and use of evidence-based cessation treatments.1 Two of the six core strategies are especially relevant to the paper by Abroms and her colleagues2 in this issue of the American Journal of Preventive Medicine: (1) redesigning evidence-based products and services to better meet consumers' needs and wants and (2) marketing and promoting cessation products and services in ways that reach smokers.