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North American Quitline Consortium
December 2015

For quick navigation, please click on the titles below of the topics featured in this month's issue of Connections
  Time-Sensitive News


NAQC News

Building State Capacity for Enhancing Cessation Coverage: New Resources!
Earlier this month, NAQC announced existing and new resources  for establishing partnerships with private and public insurers to enhance tobacco cessation coverage. The overall goal of such partnerships is to increase access to evidence-based cessation treatment by encouraging public and private insurers/employers to purchase quitline services (counseling and NRT) and provide comprehensive coverage to its members/employees. 
» learn more

NAQC Webinar Training  Series on eReferral! 
The most recent training webinar on eReferral was held on December 8, 2015 from noon to 1:30 p.m. ET and focused on successful implementation of eReferral between the PA quitline and University of Pittsburg Medical Center. This was the fourth in a series of five training webinars.

The series is made possible with funding from Pfizer Independent Grant for Learning & Change, in partnership with Smoking Cessation Leadership Center. This webinar training series is intended to provide practical training on building eReferral capacity.  The slides and recordings of the first four webinars are available
 here.

 Find more NAQC News in our Newsroom or go back to top.



Time-Sensitive News

Proposed Rule: “Instituting Smoke-Free Public Housing” – U.S. Department of Housing and Urban Development. Comments are due on Jan. 19, 2016.
NAQC plans to submit comments that are supportive of this proposed rule. If you submit comments, please share with us at NAQC@naquitline.org. The proposed rule would require each public housing agency (PHA) administering public housing to implement a smoke-free policy no later than 18 months from the effective date of the final rule. Each PHA must implement a policy prohibiting lit tobacco products in all living units, indoor common areas in public housing, and in PHA administrative office buildings (in brief, a smoke-free policy for all public housing indoor areas). The smoke-free policy must also extend to all outdoor areas up to 25 feet from the housing and administrative office buildings. HUD proposes implementation of smoke-free public housing to improve indoor air quality in the housing, benefit the health of public housing residents and PHA staff, reduce the risk of catastrophic fires, and lower overall maintenance costs.
» learn more

Deadline of January 15:  The FDA seeks nominations for the Tobacco Products Scientific Advisory Committee. 
The Food and Drug Administration (FDA) is requesting nominations for voting members to serve on the Tobacco Products Scientific Advisory Committee, Office of Science, Center for Tobacco Products. FDA seeks to include the views of women and men, members of all racial and ethnic groups, and individuals with and without disabilities on its advisory committees and, therefore encourages nominations of appropriately qualified candidates from these groups.
» learn more

Manager, Public-Private Partnerships (Tucson or Phoenix)!
The Manager, Public Private Partnerships position is responsible for designing and implementing a comprehensive public and private business plan for the delivery of smoking cessation services from the Arizona Smokers’ Helpline (ASHLine) to covered patrons of health insurance plans. The goal of this position is to establish an ongoing public-private partnership for cost-recoverable delivery of smoking cessation care to insurance patrons. This position is expected to uphold the mission and values established by MEZCOPH and ASHLine.
» learn more

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Tobacco Control

Broken Promises to Our Children: A State-by-State Look at the 1998 Tobacco Settlement 17 Years Later.
The Campaign for Tobacco-Free Kids, American Heart Association, American Cancer Society Cancer Action Network, American Lung Association, Robert Wood Johnson Foundation, Americans for Nonsmokers’ Rights and Truth Initiative released their annual report, “Broken Promises to Our Children: A State-by-State Look at the 1998 Tobacco Settlement 17 Years Later.” Despite the huge sums they get from the tobacco settlement and billions more they collect in tobacco taxes, the states continue to shortchange tobacco prevention and cessation programs that are proven to save lives and money.This gap is undermining efforts to save lives and health care dollars by reducing tobacco use, the number one cause of preventable death in the United States.
» learn more

State Tobacco Activities Tracking and Evaluation (STATE) System: Updated Fact Sheets.
CDC/OSH recently released updated State Tobacco Activities Tracking and Evaluation (STATE) System Fact Sheets with data current through September 30, 2015.  The collection includes eight legislative fact sheets (including a new fact sheet on e-cigarette state legislation), a fact sheet on Medicaid coverage of tobacco cessation treatments and five Systems-related fact sheets or Quick Start Guides.  These fact sheets are posted in PDF format so they can be downloaded and printed in full color. Data are presented in the fact sheets in maps and tables. A great way to prepare for meetings, presentations or conferences.
» learn more 

Nearly 50 Communities Receive Awards for Chronic Disease Prevention and Health Promotion.  
CDC Division of Community Health has funded 47 new communities to improve healthy eating, improve opportunities for physical activity, promote tobacco-free/smoke free environments, and/or improve access to chronic disease prevention, risk reduction, and disease management through clinical and community linkages. With this second round of funding, there are now 97 unique communities that have been supported since April 2015.
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LGBT Best and Promising Practices Throughout the Cancer Continuum.  
LGBT HealthLink and the National LGBT Cancer Network (November 2015). A report examining best practices to improve cancer care from prevention through end of life for LGBT people.
» learn more

Find more Tobacco Control in our Newsroom or go back to top.



Research
 
Boccio M, Sanna RS, Adams SR, Goler NC, Brown SD, Neugebauer RS, Ferrara A, Wiley DM, Bellamy DJ, Schmittdiel JA.
Telephone-Based Coaching: A Comparison of Tobacco Cessation Programs in an Integrated Health Care System.
Am J Health Promot. 2015 Nov 11. [Epub ahead of print]

Purpose . Many Americans continue to smoke, increasing their risk of disease and premature death. Both telephone-based counseling and in-persontobacco cessation classes may improve access for smokers seeking convenient support to quit. Little research has assessed whether such programs are effective in real-world clinical populations. Design . Retrospective cohort study comparing wellness coaching participants with two groups of controls. Setting . Kaiser Permanente Northern California, a large integrated health care delivery system. Subjects . Two hundred forty-one patients who participated in telephonic tobacco cessation coaching from January 1, 2011, to March 31, 2012, and two control groups: propensity-score-matched controls, and controls who participated in a tobacco cessation class during the same period. Wellness coaching participants received an average of two motivational interviewing-based coaching sessions that engaged the patient, evoked their reason to consider quitting, and helped them establish a quit plan. Measures . Self-reported quitting of tobacco and fills of tobacco cessation medications within 12 months of follow-up. Analysis . Logistic regressions adjusting for age, gender, race/ethnicity, and primary language. Results . After adjusting for confounders, tobaccoquit rates were higher among coaching participants vs. matched controls (31% vs. 23%, p < .001) and comparable to those of class attendees (31% vs. 29%, p = .28). Coaching participants and class attendees filled tobacco-cessation prescriptions at a higher rate (47% for both) than matched controls (6%, p < .001). Conclusion . Telephonic wellness coaching was as effective as in-person classes and was associated with higher rates of quitting compared to no treatment. The telephonic modality may increase convenience and scalability for health care systems looking to reduce tobacco use and improve health.
 
Davis KC, Alexander RL Jr., Shafer P, Mann N, Malarcher A, Zhang L.
The Dose–Response Relationship Between Tobacco Education Advertising and Calls to Quitlines in the United States, March–June, 2012.
Prev Chronic Dis 2015;12:150157. DOI: http://dx.doi.org/10.5888/pcd12.150157
 
We estimated changes in call volume in the United States in response to increases in advertising doses of the Tips From Former Smokers (Tips) campaign, the first federal national tobacco education campaign, which aired for 12 weeks from March 19 to June 10, 2012. We also measured the effectiveness of ad taglines that promoted calls directly with a quitline number (1-800-QUIT-NOW) and indirectly with a cessation help website (Smokefree.gov). Multivariate regressions estimated the weekly number of calls to 1–800-QUIT-NOW by area code as a function of weekly market-level gross rating points (GRPs) from CDC’s Tips campaign in 2012. The number of quitline calls attributable solely to Tips was predicted.
 
For quitline-tagged ads, an additional 100 television GRPs per week was associated with an increase of 89 calls per week in a typical area code in the United States (P < .001). The same unit increase in advertising GRPs for ads tagged with Smokefree.gov was associated with an increase of 29 calls per week in any given area code (P < .001). We estimated that the Tips campaign was responsible for more than 170,000 additional calls to 1–800-QUIT-NOW during the campaign and that it would have generated approximately 140,000 additional calls if all ads were tagged with 1–800-QUIT-NOW. For campaign planners, these results make it possible to estimate 1) the likely impact of tobacco prevention media buys and 2) the additional quitline capacity needed at the national level should future campaigns of similar scale use 1–800-QUIT-NOW taglines exclusively.
 
Katharine Bowker, Sarah Lewis, Tim Coleman, Sue Cooper
Changes in the Rate of Nicotine Metabolism Across Pregnancy: a Longitudinal Study.
Volume 110, Issue 11, pages 1827–1832, November 2015

Increased nicotine metabolism during pregnancy could explain why nicotine replacement therapy (NRT) appears to be less effective on smoking cessation in pregnancy than in non-pregnant smokers, but little is known about nicotine metabolism across pregnancy. This study was conducted to determine when changes in nicotine metabolism occur during pregnancy and to describe the magnitude of these changes. Longitudinal cohort study of pregnant smokers' nicotine metabolite ratio (NMR). 101 pregnant smokers recruited from hospital antenatal clinics in Nottingham, UK were asked to provide saliva samples at 8–14 weeks (n = 98), 18–22 weeks (n = 65), 32–36 weeks gestation (n = 47), 4 weeks postpartum (n = 44) and 12 weeks postpartum (n = 47).
 
Nicotine metabolite ratio (NMR) was measured using the ratio of cotinine to its primary metabolite trans-3'-hydroxycotinine. Multi-level modelling was used to detect any overall difference in NMR between time points. The 12 week postpartum NMR was compared with the NMRs collected antenatally and 4 weeks postpartum. NMR changed over time (p = 0.0006). Compared with NMR at 12 weeks postpartum, NMR was significantly higher at 18–22 weeks (26% higher, 95% CI 12% to 38%) and 32–36 weeks (23% higher, 95% CI 9% to 35%). There was no significant difference between the 8-14 weeks gestation or 4 weeks postpartum NMR and 12 weeks postpartum. Nicotine metabolism appears to be faster during pregnancy; this faster metabolism is apparent from 18 to 22 weeks of pregnancy and appears to fall by 4 weeks after childbirth.
 
Christine Ladd-Acosta, Chang Shu, Brian K. Lee, Nicole Gidaya, Alison Singer, Laura A. Schieve, Diana E. Schendel, Nicole Jones, Julie L. Daniels, Gayle C. Windham, Craig J. Newschaffer, Lisa A. Croen, Andrew P. Feinberg, M. Daniele Fallin
Presence of an Epigenetic Signature of Prenatal Cigarette Smoke Exposure in Childhood.
Environmental Research 144 (2016) 139–148

Prenatal exposure to tobacco smoke has lifelong health consequences. Epigenetic signatures such as differences in DNA methylation (DNAm) may be a biomarker of exposure and, further, might have functional significance for how in utero tobacco exposure may influence disease risk. Differences in infant DNAm associated with maternal smoking during pregnancy have been identified. Here we assessed whether these infant DNAm patterns are detectible in early childhood, whether they are specific to smoking, and whether childhood DNAm can classify prenatal smoke exposure status. Using the Infinium 450 K array, we measured methylation at 26 CpG loci that were previously associated with prenatal smoking in infant cord blood from 572 children, aged 3–5, with differing prenatal exposure to cigarette smoke in the Study to Explore Early Development (SEED). Striking concordance was found between the pattern of prenatal smoking associated DNAm among preschool aged children in SEED and those observed at birth in other studies. These DNAm changes appear to be tobacco-specific. Support vector machine classification models and 10-fold cross-validation were applied to show classification accuracy for childhood DNAm at these 26 sites as a biomarker of prenatal smoking exposure. Classification models showed prenatal exposure to smoking can be assigned with 81% accuracy using childhood DNAm patterns at these 26 loci. These findings support the potential for blood-derived DNAm measurements to serve as biomarkers for prenatal exposure.

Gemma Taylor, Alan Girling, Ann McNeill, and Paul Aveyard
Does Smoking Cessation Result in Improved Mental Health? A Comparison of Regression Modelling and Propensity Score Matching.
BMJ Open. 2015; 5(10): e008774. Published online 2015 Oct 21. doi:  10.1136/bmjopen-2015-008774
 
Smokers report that smoking is therapeutic; a recent meta-analysis suggests the contrary. However, the association in that review may be explained by group-membership bias and confounding. Propensity score matching (PSM) aims to produce causal estimates from observational data. We examined the association between cessation and change in mental health before and after PSM. A secondary analysis of prospective data from 5 placebo-controlled randomised trials for smoking reduction. All participants were adult smokers and had smoked for at least 3 years. Participants were excluded if they were pregnant, breast feeding, under psychiatric care, deemed to be unfit by a general practitioner or part of a cessation programme. In total, 937 participants provided smoking data at both 6-month and 12-month follow-ups. Of these, 68 were confirmed as abstinent at both 6 and 12 months and 589 as continuous smokers at both follow-ups.

Change in mental health (36-item Short Form Survey (SF-36), scored 0–100) from baseline (while all participants were smokers) to 12-month follow-up (after cessation) was compared between quitters and continuing smokers with and without adjustment, and after PSM. Before matching, quitters’ mental health scores improved compared with continuing smokers’, the mean difference and 95% CI was 5.5 (1.6 to 9.4). After adjustment, the difference was 4.5 (0.6 to 8.5), and after PSM, the difference was 3.4 (−2.2 to 8.9). Improvements in mental health after smoking cessation may be partly but not completely explained by group membership bias and confounding.
 
David Krauth and Dorie E. Apollonio
Overview of State Policies Requiring Smoking Cessation Therapy in Psychiatric Hospitals and Drug Abuse Treatment Centers.
Tob Induc Dis. 2015; 13: 33. Published online 2015 Oct 22. doi:  10.1186/s12971-015-0059-2
 
Research demonstrates that individuals in substance abuse treatment are more likely to die from tobacco addiction than from their primary addiction, yet historically substance abuse treatment has not included treatment for tobacco addiction. The purpose of our study was to (1) review the diffusion of state policies mandating the provision of tobacco cessation treatment as a condition of state licensure in substance abuse treatment facilities and psychiatric treatment centers and (2) describe the current landscape of policies relating to tobacco cessation in state-licensed substance abuse treatment facilities and psychiatric treatment centers. We conducted a nationwide assessment of all 50 states from May 2013 - October 2014 to determine the progress each has made with developing a statewide tobacco cessation policy. We reviewed state government websites, conducted phone interviews with state regulatory agencies, and emailed state employees. Overall, 13 of 50 states (26 %) require tobacco cessation provision in alcohol, drug rehabilitation, and or mental health treatment centers, 6 states (12 %) are currently working towards a state policy, and 31 states (62 %) do not require tobacco cessation nor are working towards a state policy, though many of them have smoke free policies in both substance abuse centers and mental health wards. Our updated review of statewide smoking cessation policies in alcoholic, drug abuse, and mental health populations reveals that while clinical findings that affect population health may be well-publicized in the research community, these findings are not necessarily translated into policy. Further research on policy diffusion is needed.
 
Slater JS1, Nelson CL2, Parks MJ3, Ebbert JO4.
Connecting Low-income Smokers to Tobacco Treatment Services.
Addict Behav. 2016 Jan;52:108-14. doi: 10.1016/j.addbeh.2015.10.013. Epub 2015 Oct 18.
 
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.
 
Merzel CR, Isasi CR, Strizich G, Castañeda SF, Gellman M, Maisonet Giachello AL, Lee DJ, Penedo FJ, Perreira KM, Kaplan RC.
Smoking Cessation Among U.S. Hispanic/Latino Adults: Findings from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).
Prev Med. 2015 Oct 26;81:412-419. doi: 10.1016/j.ypmed.2015.10.006. [Epub ahead of print]
 
This paper examines patterns of smoking cessation among Hispanics/Latinos with particular attention to gender, acculturation, and national background. Data are from the Hispanic Community Health Study/Study of Latinos, a population-based study of 16,415 non-institutionalized Hispanics/Latinos ages 18-74 from a stratified random sample of households in Chicago, Miami, the Bronx, and San Diego. Face-to-face interviews, in English or Spanish, were conducted from 2008 to 2011. Findings are based on 6398 participants who reported smoking at least 100 cigarettes in their lifetime. Associations with smoking cessation outcomes were assessed in bivariate and multivariable analyses. Findings indicate that approximately equal proportions of men and women were former smokers. There was little difference by gender in socioeconomic characteristics associated with smoking cessation. Both men and women who lived in households with smokers were less likely to be abstinent. Multivariable analysis indicated that the likelihood of quitting varied by national background primarily among men, however, Puerto Rican and Cuban smokers of both genders were the least likely to successfully quit smoking. Among women, but not men, younger and more socially acculturated individuals had lower odds of sustaining cessation. Over 90% of female and male former smokers reported quitting on their own without cessation aids or therapy. The results suggest that many Hispanics/Latinos are self-motivated to quit and are able to do so without clinical assistance. Heterogeneity in smoking behaviors among Hispanics/Latinos should be taken into account when developing and delivering smoking cessation interventions and public health campaigns.
 
Asfar T1, Arheart KL2, Dietz NA3, Caban-Martinez AJ4, Fleming LE5, Lee DJ3.
Changes in Cigarette Smoking Behavior Among US Young Workers From 2005 to 2010: The Role of Occupation.
Nicotine Tob Res. 2015 Oct 26. pii: ntv240. [Epub ahead of print]

Young adult workers (18-24 years) in the United States have been identified as a high-risk group for smoking. This study compares changes in smoking behavior by occupational class among this group between 2005 and 2010. Data were pooled from the Tobacco Supplement in the 2005 and 2010 National Health Interview Survey. All respondents 18-24 years who reported that they were employed during the two surveys were selected (n = 1880 in 2005; and n = 1531 in 2010). Weighted percentages and 95% confidence interval were reported. Logistic regression analyses were performed to compare smoking behavior between occupational groups (white-collar, blue-collar, and service) and between years (2005-2010), and to examine correlates of smoking, successful quit attempt, and heavy smoking.

Smoking prevalence and daily smoking declined in 2010 in white-collar. Smoking prevalence and intensity decreased while age of smoking initiation increased in blue-collar workers. Young workers were more likely to smoke in 2005 than 2010. Service and blue-collar workers were more likely to smoke than white-collar workers. Older young adults, whites, individuals with a high school/or less education, those without health insurance were more likely to smoke. White workers and individuals with a high school/or less education were more likely to be heavy smokers. White-collar workers have benefited the most from tobacco control efforts. Although improvements were seen in smoking behavior among blue-collar workers, smoking prevalence remained the highest in this group. Smoking behavior among service workers did not change. Young service workers and blue-collar are priority populations for workplace tobacco control efforts. The current study examines changes in smoking behavior among young adult workers (18-24 years) by occupational class (white-collar, blue-collar, and service workers) between 2005 and 2010. Data were pooled from the Tobacco Supplement in the 2005 and 2010 National Health Interview Survey. Smoking prevalence and daily smoking declined significantly in white-collar workers. No change in smoking behavior was observed among service workers. Positive changes in smoking behavior were observed among blue-collar workers, but smoking prevalence remained the highest in this group. Blue-collar and service workers are priority groups for future workplace tobacco control efforts.
 
Weaver SR, Majeed BA, Pechacek TF, Nyman AL, Gregory KR, Eriksen MP.
Use of Electronic Nicotine Delivery Systems and Other Tobacco Products among USA adults, 2014: Results From a National Survey.
Int J Public Health. 2015 Nov 12. [Epub ahead of print]

This study assessed the awareness and use of traditional and novel tobacco products and dual use of cigarettes with electronic nicotine delivery systems (ENDS) among USA adults. Data were obtained from the 2014 Tobacco Products and Risk Perceptions Survey of a probability sample of 5717 USA adults conducted June-November, 2014.

Use of ENDS varied by demography and by cigarette and other tobacco use. Adults aged 25-34, non-heterosexual adults, and those reporting poorer health reported higher rates of current ENDS use. Current cigarette smokers had much greater odds of ENDS ever use than never smokers, with one-half of all cigarette smokers having used ENDS and 20.7 % currently using them. However, 22.0 % of current ENDS users were former cigarette smokers, and 10.0 % were never cigarette smokers. Patterns of ENDS use are evolving rapidly and merit continued surveillance. Nearly 10 % of adult ENDS usage is among never smokers. The public health challenge is how to enhance the potential that ENDS can replace combusted tobacco products without expanding nicotine use among youth, long-term ex-smokers, and other vulnerable populations.

Paul T. Harrell, Vani N. Simmons, Barbara Piñeiro, John B. Correa, Nicole S. Menzie, Lauren R. Meltzer, Marina Unrod, Thomas H. Brandon.
E-cigarettes and Expectancies: Why do Some Users Keep Smoking?
Volume 110, Issue 11, pages 1833–1843, November 2015
 
Many smokers who have tried electronic cigarettes (‘e-cigarettes’) continue to smoke, perhaps influenced by their beliefs about the outcomes of using e-cigarettes (‘e-cigarette expectancies’). The primary aims of this study were to compare expectancies of dual users to former smokers, and to examine the association between expectancies and intentions to quit or reduce ‘vaping’ among former smokers. A large cross-sectional online survey of e-cigarette users conducted in the United States.

We surveyed current e-cigarette users (n = 1815), including both current cigarette smokers (‘dual users’, n = 381) and former smokers (n = 1434). We further subdivided former smokers into those with (n = 686) and without (n = 748) intentions to reduce or quit e-cigarette use. The primary outcomes were self-reported past-month smoking status and, among former smokers, current intentions to reduce or quit e-cigarette use, both adjusted for potential confounders. E-cigarette expectancy items were derived primarily from a previously validated measure of smoking expectancies.
 
Dual users reported less positive expectancies than former smokers about e-cigarettes, rating e-cigarettes as more physically irritating (β = 0.10, P < 0.001) and addictive (β = 0.06, P = 0.016), as well as less satisfying (β = –0.11, P < 0.001). Former smokers with intentions to quit e-cigarettes also rated e-cigarettes less positively than former smokers without intentions to quit e-cigarettes, rating them more likely to damage health (β = 0.16, P < 0.001) and cause addiction (β = 0.10, P < 0.001), but less likely to taste good (β = –0.08, P = 0.006). Positive e-cigarette expectancies among e-cigarette users are associated with a greater likelihood of having quit smoking, but lower likelihood of intention to quit e-cigarette use.
 
Timothy B. Baker, Linda M. Collins, Robin Mermelstein, Megan E. Piper, Tanya R. Schlam, Jessica W. Cook, Daniel M. Bolt, Stevens S. Smith, Douglas E. Jorenby, David Fraser, Wei-Yin Loh, Wendy E. Theobald & Michael C. Fiore
Enhancing the Effectiveness of Smoking Treatment Research: Conceptual Bases and Progress.
Addiction doi:10.1111/add.13154
 
A chronic care strategy could potentially enhance the reach and effectiveness of smoking treatment by providing effective interventions for all smokers, including those who are initially unwilling to quit. This paper describes the conceptual bases of a National Cancer Institute-funded research program designed to develop an optimized, comprehensive, chronic care smoking treatment. This research is grounded in three methodological approaches: (1) the Phase-Based Model, which guides the selection of intervention components to be experimentally evaluated for the different phases of smoking treatment (motivation, preparation, cessation, and maintenance); (2) the Multiphase Optimization Strategy (MOST), which guides the screening of intervention components via efficient experimental designs and, ultimately, the assembly of promising components into an optimized treatment package; and (3) pragmatic research methods, such as electronic health record recruitment, that facilitate the efficient translation of research findings into clinical practice. Using this foundation and working in primary care clinics, we conducted three factorial experiments (reported in three accompanying papers) to screen 15 motivation, preparation, cessation and maintenance phase intervention components for possible inclusion in a chronic care smoking treatment program. This research identified intervention components with relatively strong evidence of effectiveness at particular phases of smoking treatment and it demonstrated the efficiency of the MOST approach in terms both of the number of intervention components tested and of the richness of the information yielded. A new, synthesized research approach efficiently evaluates multiple intervention components to identify promising components for every phase of smoking treatment. Many intervention components interact with one another, supporting the use of factorial experiments in smoking treatment development.
 
Jessica W. Cook, Linda M. Collins, Michael C. Fiore, Stevens S. Smith, David Fraser, Daniel M. Bolt, Timothy B. Baker, Megan E. Piper, Tanya R. Schlam, Douglas Jorenby, Wei-Yin Loh & Robin Mermelstein
Comparative Effectiveness of Motivation Phase Intervention Components for Use with Smokers Unwilling to Quit: a Factorial Screening Experiment.
Addiction doi:10.1111/add.13161
 
To screen promising intervention components designed to reduce smoking and promote abstinence in smokers initially unwilling to quit. A balanced, four-factor, randomized factorial experiment. Eleven primary care clinics in southern Wisconsin, USA. A total of 517 adult smokers (63.4% women, 91.1% white) recruited during primary care visits who were willing to reduce their smoking but not quit. Four factors contrasted intervention components designed to reduce smoking and promote abstinence: (1) nicotine patch versus none; (2) nicotine gum versus none; (3) motivational interviewing (MI) versus none; and (4) behavioral reduction counseling (BR) versus none. Participants could request cessation treatment at any point during the study. The primary outcome was percentage change in cigarettes smoked per day at 26 weeks post-study enrollment; the secondary outcomes were percentage change at 12 weeks and point-prevalence abstinence at 12 and 26 weeks post-study enrollment. There were few main effects, but a significant four-way interaction at 26 weeks post-study enrollment (P= 0.01, β= 0.12) revealed relatively large smoking reductions by two component combinations: nicotine gum combined with BR and BR combined with MI. Further, BR improved 12-week abstinence rates (P= 0.04), and nicotine gum, when used without MI, increased 26–week abstinence after a subsequent aided quit attempt (P= 0.01). Motivation-phase nicotine gum and behavioral reduction counseling are promising intervention components for smokers who are initially unwilling to quit.
 
Megan E. Piper, Michael C. Fiore, Stevens S. Smith, David Fraser, Daniel M. Bolt, Linda M. Collins, Robin Mermelstein, Tanya R. Schlam, Jessica W. Cook, Douglas E. Jorenby, Wei-Yin Loh & Timothy B. Baker
Identifying Effective Intervention Components for Smoking Cessation: a Factorial Screening Experiment.
Addiction doi:10.1111/add.13162
 
To identify promising intervention components intended to help smokers to attain and maintain abstinence in their quit smoking attempts. A fully crossed, six-factor randomized fractional factorial experiment. Eleven primary care clinics in southern Wisconsin, USA. Participants A total of 637 adult smokers (55% women, 88% white) motivated to quit smoking who visited primary care clinics. Interventions Six intervention components designed to prepare smokers to quit, and achieve and maintain abstinence (i.e. for the preparation, cessation and maintenance phases of smoking treatment): (1) preparation nicotine patch versus none; (2) preparation nicotine gum versus none; (3) preparation counseling versus none; (4) intensive cessation in-person counseling versus minimal; (5) intensive cessation telephone counseling versus minimal; and (6) 16 versus 8 weeks of combination nicotine replacement therapy (nicotine patch + nicotine gum). Measurements Seven-day self-reported point-prevalence abstinence at 16 weeks. Findings Preparation counseling significantly improved week 16 abstinence rates (P = .04), while both forms of preparation nicotine replacement therapy interacted synergistically with intensive cessation in-person counseling (P < 0.05). Conversely, intensive cessation phone counseling and intensive cessation in-person counseling interacted antagonistically (P < 0.05)—these components produced higher abstinence rates by themselves than in combination. Conclusions Preparation counseling and the combination of intensive cessation in-person counseling with preparation nicotine gum or patch are promising intervention components for smoking and should be evaluated as an integrated treatment package.
 
Tanya R. Schlam, Michael C. Fiore, Stevens S. Smith, David Fraser, Daniel M. Bolt, Linda M. Collins, Robin Mermelstein, Megan E. Piper, Jessica W. Cook, Douglas E. Jorenby, Wei-Yin Loh & Timothy B. Baker
Comparative Effectiveness of Intervention Components for Producing Long-term Abstinence from Smoking: a Factorial Screening Experiment.
Addiction doi:10.1111/add.13153
 
To identify promising intervention components that help smokers attain and maintain abstinence during a quit attempt. A 2 × 2 × 2 × 2 × 2 randomized factorial experiment. Eleven primary care clinics in Wisconsin, USA. A total of 544 smokers (59% women, 86% white) recruited during primary care visits and motivated to quit. Five intervention components designed to help smokers attain and maintain abstinence: (1) extended medication (26 versus 8 weeks of nicotine patch + nicotine gum); (2) maintenance (phone) counseling versus none; (3) medication adherence counseling versus none; (4) automated (medication) adherence calls versus none; and (5) electronic medication monitoring with feedback and counseling versus electronic medication monitoring alone. The primary outcome was 7-day self-reported point-prevalence abstinence 1 year after the target quit day. Only extended medication produced a main effect. Twenty-six versus 8 weeks of medication improved point-prevalence abstinence rates (43 versus 34% at 6 months; 34 versus 27% at 1 year; P = 0.01 for both). There were four interaction effects at 1 year, showing that an intervention component’s effectiveness depended upon the components with which it was combined. Twenty-six weeks of nicotine patch + nicotine gum (versus 8 weeks) and maintenance counseling provided by phone are promising intervention components for the cessation and maintenance phases of smoking treatment.
 
M Casseus, J Garmon, M Hrywna, C D Delnevo
Cigarette Smokers’ Classification of Tobacco Products.
Tob Control doi:10.1136/tobaccocontrol-2015-052535
 
Cigarette consumption has declined in the USA. However, cigar consumption has increased. This may be due in part to some cigarette smokers switching to filtered cigars as a less expensive substitute for cigarettes. Additionally, some cigarette smokers may perceive and consume little filtered cigars as cigarettes. The purpose of this study was to determine how cigarette smokers classify tobacco products when presented with photographs of those products. An online survey was conducted with a sample of 344 self-identified cigarette smokers. Respondents were presented with pictures of various types of tobacco products, both with and without packaging, and then asked to categorise them as either a cigarette, little cigar, cigarillo, cigar or machine-injected roll-your-own cigarette (RYO). Respondents were also asked about their tobacco use and purchasing behaviour.
 
Overall, respondents had difficulty distinguishing between cigarettes, little cigars, cigarillos and RYO. When presented with images of the products without packaging, 93% of respondents identified RYO as a cigarette, while 42% identified a little cigar as a cigarette. Additionally, respondents stated that they would consider purchasing little cigars as substitutes for cigarettes because of the price advantage.
The results of this survey suggest that when presented with photographs of tobacco products, large proportions of current smokers were unable to differentiate between cigarettes, little cigars, cigarillos, RYO and cigars. Findings have implications for existing public health efforts targeting cigarette smokers, and underscore the need to review current definitions of tobacco products and federal excise taxes on such products.
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Announcements

January 22, 2016: It’s About A Billion Lives Symposium!
UC San Francisco Center for Tobacco Control Research and Education will host a Symposium Celebrating Tobacco Research and Education at UCSF. Learn more. 

February 29 - March 2, 2016: 9th NCTH Conference!
The Canadian Council for Tobacco Control is pleased host the 9th National Conference on Tobacco or Health, at the Westin Ottawa from February 29 to March 2, 2016. The call for abstracts is now open from November 27 until December 17, 2015 at 11 ET.

Together with researchers, policy makers, public and community health professionals, the Conference will provide a national forum to explore learning and innovation that is currently working or possible against the Tobacco epidemic in Canada. Learn more

April 18-20, 2016: 8th National Summit on Smokeless and Spit Tobacco!
Early Bird registration is now open and ends on January 22, 2016. Click here to register online.

The 8th NSST will take place at the Crowne Plaza Albuquerque in New Mexico
Crowne Plaza Albuquerque
1901 University Blvd NE, Albuquerque, NM 87102

Don’t miss your chance to save with Early Bird Registration and reserve a room at the Crowne Plaza Albuquerque.

Who Should Attend:

  • Local, state and federal tobacco prevention and control administrators
  • Tobacco program staff
  • Public health educators and policy professionals
  • Health care professionals and providers including physicians, nurses and clinic managers
  • Tobacco treatment specialists
  • Scientists
  • Dentists, dental hygienists and dental assistants
  • Higher education staff
  • Students
  • School and youth-serving agencies and youth advocates

Learn more here

April 25-26, 2016: Reduce Tobacco Use Conference! 
The Virginia Foundation for Health Youth and Prevention Connections will host the 12th Reduce Tobacco Use Conference to be held April 25-26, 2016 in Arlington, VA. Learn more here.

July 19-21, 2016: 2016 National Association of County and City Health Officials (NACCHO) Annual Conference – NACCHO!
The 2016 NACCHO Annual Conference, July 19–21 in Phoenix, will be the largest gathering of local health department leaders and other public health professionals in the United States.

The conference offers an opportunity for local health department staff, partners, funders, and individuals interested in local public health to share the latest research and ideas, network, and test their assumptions about the issues and topics that concern local public health. This year’s conference theme is “Cultivating a Culture of Health Equity.” Learn more here

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