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Saint Paul, MN, United States

Slater J.S.,5 East 7th Place | Slater J.S.,University of Minnesota | Nelson C.L.,5 East 7th Place | Parks M.J.,5 East 7th Place | Ebbert J.O.,Mayo Medical School
Addictive Behaviors | Year: 2016

The Affordable Care Act calls for using population-level incentive-based interventions, and cigarette smoking is one of the most significant health behaviors driving costs and adverse health in low-income populations. Telehealth offers an opportunity to facilitate delivery of evidence-based smoking cessation services as well as incentive-based interventions to low-income populations. However, research is needed on effective strategies for linking smokers to services, how to couple financial incentives with telehealth, and on how to scale this to population-level practice. The current paper evaluates primary implementation and follow-up results of two strategies for connecting low-income, predominantly female smokers to a telephone tobacco quitline (QL). The population-based program consisted of participant-initiated phone contact and two recruitment strategies: (1) direct mail (DM) and (2) opportunistic telephone referrals with connection (ORC). Both strategies offered financial incentives for being connected to the QL, and all QL connections were made by trained patient navigators through a central call center. QL connections occurred for 97% of DM callers (N. =. 870) and 33% of ORC callers (N. =. 4550). Self-reported continuous smoking abstinence (i.e., 30 smoke-free days at seven-month follow-up) was 20% for the DM group and 16% for ORC. These differences between intervention groups remained in ordered logistic regressions adjusting for smoking history and demographic characteristics. Each recruitment strategy had distinct advantages; both successfully connected low-income smokers to cessation services and encouraged quit attempts and continuous smoking abstinence. Future research and population-based programs can utilize financial incentives and both recruitment strategies, building on their relative strengths. © 2015 . Source

Bender A.P.,5 East 7th Place | Williams A.N.,5 East 7th Place | Soler J.,5 East 7th Place | Brown M.,5 East 7th Place
Cancer Causes and Control | Year: 2012

Background: The study of the geographical distribution of disease has expanded greatly with GIS technology and its application to increasingly available public health data. The emergence of this technology has increased the challenges for public health practitioners to provide meaningful interpretations for county-based state cancer maps. Methods: One of these challenges-spurious inferences about the significance of differences between county and overall state cancer rates-can be addressed through a nonparametric statistical method. The Wilcoxon's signed rank test (WSRT) has a practical application for determining the significance of county cancer rates compared to the statewide rate. This extension of the WSRT, developed by John Tukey, forms the basis for constructing a single confidence interval for all differences in county and state directly age-adjusted cancer rates. Empirical evaluation of this WSRT application was conducted using Minnesota cancer incidence data. Results: The WSRT procedure reduced the impact of statistical artifacts that are frequently encountered with standard normal significance testing of the difference between directly age-adjusted county and the overall state cancer rates. Conclusion: Although further assessment of its performance is required, the WSRT procedure appears to be a useful complement for mapping directly age-adjusted state cancer rates by county. © 2012 The Author(s). Source

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