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      Tobacco cessation outcomes: The case for milestone-based services

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          Abstract

          INTRODUCTION

          This study focuses on a Midwest State’s tobacco quitline. The purpose was to understand possible relationships between services provided and cessation rates.

          METHODS

          The data examined in this study came from aggregated intake/treatment data and follow-up interview data. The overall response rate was 22.9%. Measures included quit rate, quit duration, length of services, number of services, stage of change, confidence to quit, and source of referral.

          RESULTS

          The dataset included 1452 cases; 77% enrolled in services only once, 17% enrolled twice and 6% enrolled three or more times. Use of medication was higher among those who quit [χ 2(1)=7.1, p=0.009, Cramer’s V=0.07] than among those who did not. Use of e-cigarettes was lower among those who quit at the time of follow-up [χ 2(1)=31.5, p<0.001, Cramer’s V=0.15]. Respondents who had quit at the time of the follow-up were significantly more likely to have reported a higher confidence to quit at intake [χ 2(1)=24.1, p<0.001, Cramer’s V=0.13]. Among those who improved their stage of change during treatment, 35% had quit at follow-up, compared with 18% among those who did not improve.

          CONCLUSIONS

          Study findings related to stage of change and associations between confidence and cessation may have meaningful implications. Cessation success may depend on what is accomplished during treatment and the intersection of clients’ motivation, satisfaction, confidence, and cessation status at the end of treatment.

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          Most cited references 9

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          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 to help smokers quit. We searched the Cochrane Tobacco Addiction Group trials register for studies using free text term 'telephone*' or the keywords 'telephone counselling' or 'Hotlines' or 'Telephone' . Date of the most recent search: January 2006. Randomized or quasi-randomized controlled trials in which proactive or reactive telephone counselling to assist smoking cessation was offered to smokers or recent quitters. Trials were identified and data extracted by one person (LS) and checked by a second (TL). The main outcome measure was the odds 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 sub groups of clinically comparable studies using the I(2) statistic. Where appropriate, we pooled studies using a fixed-effect model. A meta-regression was used to investigate the effect of differences in planned number of calls. Forty-eight trials met the inclusion criteria. Among smokers who contacted helplines, quit rates were higher for groups randomised to receive multiple sessions of call-back counselling (eight studies, >18,000 participants, odds ratio (OR) for long term cessation 1.41, 95% confidence interval (CI) 1.27 to 1.57). Two of these studies showed a significant benefit of more intensive compared to less intensive intervention. Telephone counselling not initiated by calls to helplines also increased quitting (29 studies, >17,000 participants, OR 1.33, 95% CI 1.21 to 1.47). A meta-regression detected a significant association between the maximum number of planned calls and the effect size. There was clearer evidence of benefit in the subgroup of trials recruiting smokers motivated to quit. Of two studies that provided access to a hotline one showed a significant benefit and one did not. Two studies comparing different counselling approaches during a single session did not detect significant differences. A further seven studies were too diverse to contribute to meta-analyses and are discussed separately. Proactive telephone counselling helps smokers interested in quitting. There is evidence of a dose response; one or two brief calls are less likely to provide a measurable benefit. Three or more calls increases the odds of quitting compared to a minimal intervention such as providing standard self-help materials, brief advice, or compared to pharmacotherapy alone. Telephone quitlines provide an important route of access to support for smokers, and call-back counselling enhances their usefulness.
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            The effectiveness and cost effectiveness of telephone counselling and the nicotine patch in a state tobacco quitline.

            State and national tobacco quitlines have expanded rapidly and offer a range of services. We examined the effectiveness and cost effectiveness of offering callers single session versus multisession counselling, with or without free nicotine patches. This 3x2 randomised trial included 4614 Oregon tobacco quitline callers and compared brief (one 15-minute call), moderate (one 30-minute call and a follow-up call) and intensive (five proactive calls) intervention protocols, with or without offers of free nicotine patches (nicotine replacement therapy, NRT). Blinded staff assessed tobacco use by phone at 12 months. Abstinence odds ratios were significant for moderate (OR = 1.22, CI = 1.01 to 1.48) and intensive (OR = 1.29, CI = 1.07 to 1.56) intervention, and for NRT (OR = 1.58, CI = 1.35 to 1.85). Intent to treat quit rates were as follows: brief no NRT (12%); brief NRT (17%); moderate no NRT (14%); moderate NRT (20%); intensive no NRT (14%); and intensive NRT (21%). Relative to brief no NRT, the added costs for each additional quit was $2467 for brief NRT, $1912 for moderate no NRT, $2109 for moderate NRT, $2641 for intensive no NRT, and $2112 for intensive NRT. Offering free NRT and multisession telephone support within a state tobacco quitline led to higher quit rates, and similar costs per incremental quit, than less intensive protocols.
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              Decision making in the transtheoretical model of behavior change.

              Decision making is an integral part of the transtheoretical model of behavior change. Stage of change represents a temporal dimension for behavior change and has been the key dimension for integrating principles and processes of change from across leading theories of psychotherapy and behavior change. The decision-making variables representing the pros and cons of changing have been found to have systematic relationships across the stages of change for 50 health-related behaviors. Implications of these patterns of relationships are discussed in the context of helping patients make more effective decisions to decrease health risk behaviors and increase health-enhancing behaviors.
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                Author and article information

                Journal
                Tob Prev Cessat
                Tob Prev Cessat
                TPC
                Tobacco Prevention & Cessation
                European Publishing on behalf of the European Network for Smoking and Tobacco Prevention (ENSP)
                2459-3087
                11 October 2018
                2018
                : 4
                Affiliations
                [1 ]Department of Health, Recreation, and Community Services, University of Northern Iowa, Cedar Falls, Iowa, United States
                [2 ]Center for Social and Behavioral Research, University of Northern Iowa, Cedar Falls, Iowa, United States
                Author notes
                CORRESPONDENCE TO Disa Cornish. Department of Health, Recreation, and Community Services, University of Northern Iowa, WRC 203, 506140241 Cedar Falls, United States. E-mail: disa.cornish@ 123456uni.edu
                33
                10.18332/tpc/97284
                7205149
                © 2018 Cornish D

                This is an Open Access article distributed under the terms of the Creative Commons Attribution NonCommercial 4.0 International License.

                Categories
                Research Paper

                helpline, quitline, services, cessation, correlation, tobacco

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