&D Center for Chronic Disease Outcomes Research

Minneapolis, MN, United States

&D Center for Chronic Disease Outcomes Research

Minneapolis, MN, United States
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Fu S.S.,University of Minnesota | Nelson D.,University of Minnesota | Burgess D.J.,University of Minnesota | Thomas J.L.,University of Minnesota | And 5 more authors.
Thorax | Year: 2016

Background Evidenced-based tobacco cessation treatments are underused, especially by socioeconomically disadvantaged smokers. This contributes to widening socioeconomic disparities in tobacco-related morbidity and mortality. Methods The Offering Proactive Treatment Intervention trial tested the effects of a proactive outreach tobacco treatment intervention on population-level smoking abstinence and tobacco treatment use among a population-based sample of socioeconomically disadvantaged smokers. Current smokers (n=2406), regardless of interest in quitting, who were enrolled in the Minnesota Health Care Programs, the state's publicly funded healthcare programmes for low-income populations, were randomly assigned to proactive outreach or usual care. The intervention comprised proactive outreach (tailored mailings and telephone calls) and free cessation treatment (nicotine replacement therapy and intensive, telephone counselling). Usual care comprised access to a primary care physician, insurance coverage of Food and Drug Administration-approved smoking cessation medications, and the state's telephone quitline. The primary outcome was selfreported 6-month prolonged smoking abstinence at 1 year and was assessed by follow-up survey. Findings The proactive intervention group had a higher prolonged abstinence rate at 1 year than usual care (16.5% vs 12.1%, OR 1.47, 95% CI 1.12 to 1.93). The effect of the proactive intervention on prolonged abstinence persisted in selection models accounting for non-response. In analysis of secondary outcomes, use of evidence-based tobacco cessation treatments were significantly greater among proactive outreach participants compared with usual care, particularly combination counselling and medications (17.4% vs 3.6%, OR 5.69, 95% CI 3.85 to 8.40). Interpretation Population-based proactive tobacco treatment increases engagement in evidence-based treatment and is effective in long-term smoking cessation among socioeconomically disadvantaged smokers. Findings suggest that dissemination of population-based proactive treatment approaches is an effective strategy to reduce the prevalence of smoking and socioeconomic disparities in tobacco use. Trial registration number NCT01123967. © 2016 BMJ Publishing Group Ltd & British Thoracic Society.


Danan E.R.,&D Center for Chronic Disease Outcomes Research | Danan E.R.,University of Minnesota | Joseph A.M.,University of Minnesota | Sherman S.E.,VA New York Harbor Healthcare System | And 12 more authors.
Journal of General Internal Medicine | Year: 2016

Background: Current guidelines advise providers to assess smokers’ readiness to quit, then offer cessation therapies to smokers planning to quit and motivational interventions to smokers not planning to quit. Objectives: We examined the relationship between baseline stage of change (SOC), treatment utilization, and smoking cessation to determine whether the effect of a proactive smoking cessation intervention was dependent on smokers’ level of motivation to quit. Design: Secondary analysis of a multicenter randomized controlled trial. Participants: A total of 3006 current smokers, aged 18–80 years, at four Veterans Affairs (VA) medical centers. Interventions: Proactive care included proactive outreach (mailed invitation followed by telephone outreach), offer of smoking cessation services (telephone or face-to-face), and access to pharmacotherapy. Usual care participants had access to VA smoking cessation services and state telephone quitlines. Main Measures: Baseline SOC measured with Readiness to Quit Ladder, and 6-month prolonged abstinence self-reported at 1 year. Key Results: At baseline, 35.8 % of smokers were in preparation, 38.2 % in contemplation, and 26.0 % in precontemplation. The overall interaction between SOC and treatment arm was not statistically significant (p = 0.30). Among smokers in preparation, 21.1 % of proactive care participants achieved 6-month prolonged abstinence, compared to 13.1 % of usual care participants (OR, 1.8 [95 % CI, 1.2–2.6]). Similarly, proactive care increased abstinence among smokers in contemplation (11.0 % vs. 6.5 %; OR, 1.8 [95 % CI, 1.1–2.8]). Smokers in precontemplation quit smoking at similar rates (5.3 % vs. 5.6 %; OR, 0.9 [95 % CI, 0.5–1.9]). Within each stage, uptake of smoking cessation treatments increased with higher SOC and with proactive care as compared with usual care. Limitations: Mostly male participants limits generalizability. Randomization was not stratified by SOC. Conclusions: Proactive care increased treatment uptake compared to usual care across all SOC. Proactive care increased smoking cessation among smokers in preparation and contemplation but not in precontemplation. Proactively offering cessation therapies to smokers at all SOC will increase treatment utilization and population-level smoking cessation. © 2016, The Author(s).


PubMed | University of Minnesota, &D Center for Chronic Disease Outcomes Research, VA New York Harbor Healthcare System and National Center for PTSD
Type: Journal Article | Journal: Journal of general internal medicine | Year: 2016

Current guidelines advise providers to assess smokers readiness to quit, then offer cessation therapies to smokers planning to quit and motivational interventions to smokers not planning to quit.We examined the relationship between baseline stage of change (SOC), treatment utilization, and smoking cessation to determine whether the effect of a proactive smoking cessation intervention was dependent on smokers level of motivation to quit.Secondary analysis of a multicenter randomized controlled trial.A total of 3006 current smokers, aged 18-80 years, at four Veterans Affairs (VA) medical centers.Proactive care included proactive outreach (mailed invitation followed by telephone outreach), offer of smoking cessation services (telephone or face-to-face), and access to pharmacotherapy. Usual care participants had access to VA smoking cessation services and state telephone quitlines.Baseline SOC measured with Readiness to Quit Ladder, and 6-month prolonged abstinence self-reported at 1 year.At baseline, 35.8% of smokers were in preparation, 38.2% in contemplation, and 26.0% in precontemplation. The overall interaction between SOC and treatment arm was not statistically significant (p=0.30). Among smokers in preparation, 21.1% of proactive care participants achieved 6-month prolonged abstinence, compared to 13.1% of usual care participants (OR, 1.8 [95% CI, 1.2-2.6]). Similarly, proactive care increased abstinence among smokers in contemplation (11.0% vs. 6.5%; OR, 1.8 [95% CI, 1.1-2.8]). Smokers in precontemplation quit smoking at similar rates (5.3% vs. 5.6%; OR, 0.9 [95% CI, 0.5-1.9]). Within each stage, uptake of smoking cessation treatments increased with higher SOC and with proactive care as compared with usual care.Mostly male participants limits generalizability. Randomization was not stratified by SOC.Proactive care increased treatment uptake compared to usual care across all SOC. Proactive care increased smoking cessation among smokers in preparation and contemplation but not in precontemplation. Proactively offering cessation therapies to smokers at all SOC will increase treatment utilization and population-level smoking cessation.


PubMed | &D Center for Chronic Disease Outcomes Research
Type: | Journal: BMC public health | Year: 2014

There is a high prevalence of smoking and high burden of tobacco-related diseases among low-income populations. Effective, evidenced-based smoking cessation treatments are available, but low-income smokers are less likely than higher-income smokers to use these treatments, especially the most comprehensive forms that include a combination of pharmacotherapy and intensive behavioral counseling.The primary objectives of this randomized controlled trial are to compare the effects of a proactive tobacco treatment intervention compared to usual care on population-level smoking abstinence rates and tobacco treatment utilization rates among a diverse population of low-income smokers, and to determine the cost-effectiveness of proactive tobacco treatment intervention. The proactive care intervention systematically offers low-income smokers free and easy access to evidence-based treatments and has two primary components: (1) proactive outreach to current smokers in the form of mailed invitation materials and telephone calls containing targeted health messages, and (2) facilitated access to free, comprehensive, evidence-based tobacco cessation treatments in the form of NRT and intensive, telephone-based behavioral counseling. The study aims to include a population-based sample (N=2500) of adult smokers enrolled in the Minnesota Health Care Programs (MHCP), a state-funded health insurance plan for low-income persons. Baseline data is obtained from MHCP administrative databases and a participant survey that is conducted prior to randomization. Outcome data is collected from a follow-up survey conducted 12months after randomization and MHCP administrative data. The primary outcome is six-month prolonged smoking abstinence at one year and is assessed at the population level. All randomized individuals are asked to complete the follow-up survey, regardless of whether they participated in tobacco treatment. Data analysis of the primary aims will follow intent-to-treat methodology.There is a critical need to increase access to effective tobacco dependence treatments. This randomized trial evaluates the effects of proactive outreach coupled with free NRT and telephone counseling on the population impact of tobacco dependence treatment. If proven to be effective and cost-effective, national dissemination of proactive treatment approaches would reduce tobacco-related morbidity, mortality, and health care costs for low income Americans.ClinicalTrials.gov: NCT01123967.


PubMed | &D Center for Chronic Disease Outcomes Research
Type: | Journal: BMC public health | Year: 2012

Most smokers do not receive comprehensive, evidence-based treatment for tobacco use that includes intensive behavioral counseling along with pharmacotherapy. Further, the use of proven, tobacco treatments is lower among minorities than among Whites. The primary objectives of this study are to: (1) Assess the effect of a proactive care intervention (PRO) on population-level smoking abstinence rates (i.e., abstinence among all smokers including those who use and do not utilize treatment) and on utilization of tobacco treatment compared to reactive/usual care (UC) among a diverse population of smokers, (2) Compare the effect of PRO on population-level smoking abstinence rates and utilization of tobacco treatments between African American and White smokers, and (3) Determine the cost-effectiveness of the proactive care intervention.This prospective randomized controlled trial identifies a population-based sample of current smokers from the Department of Veterans Affairs (VA) electronic medical record health factor dataset. The proactive care intervention combines: (1) proactive outreach and (2) offer of choice of smoking cessation services (telephone or face-to-face). Proactive outreach includes mailed invitation materials followed by an outreach call that encourages smokers to seek treatment with choice of services. Proactive care participants who choose telephone care receive VA telephone counseling and access to pharmacotherapy. Proactive care participants who choose face-to-face care are referred to their VA facilitys smoking cessation clinic. Usual care participants have access to standard smoking cessation services from their VA facility (e.g., pharmacotherapy, smoking cessation clinic) and from their state telephone quitline. Baseline data is collected from VA administrative databases and participant surveys. Outcomes from both groups are collected 12 months post-randomization from participant surveys and from VA administrative databases. The primary outcome is self-reported smoking abstinence, which is assessed at the population-level (i.e., among those who utilize and those who do not utilize tobacco treatment). Primary analyses will follow intention-to-treat methodology.This randomized trial is testing proactive outreach strategies offering choice of smoking cessation services, an innovation that if proven effective and cost-effective, will transform the way tobacco treatment is delivered. National dissemination of proactive treatment strategies could dramatically reduce tobacco-related morbidity, mortality, and health care costs.ClinicalTrials.gov: NCT00608426.


PubMed | &D Center for Chronic Disease Outcomes Research
Type: Journal Article | Journal: Evaluation & the health professions | Year: 2012

Our objective was to determine how point-of-sale tobacco marketing may relate to sales to minors. The authors used data from a 2007 cross-sectional study of the retail tobacco marketing environments in the St. Paul, MN metropolitan area matched with a database of age-of-sale compliance checks (random, covert test purchases by a minor, coordinated by law enforcement) of tobacco retailers and U.S. Census data to test whether certain characteristics of advertising or neighborhoods were associated with compliance check failure. The authors found that tobacco stores were the most likely type of store to fail compliance checks (44% failure), supermarkets were least likely (3%). Aside from a marginally significant association with Hispanic population proportion, there was no other association between either store advertising characteristics or neighborhood demographics and stores compliance check failure. Though our findings were null, the relationship between advertising and real youth sales may be more nuanced as compliance checks do not perfectly simulate the way youth attempt to purchase cigarettes.

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