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North American Quitline Consortium
May 2015

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


Reminder! Your Feedback is Due on the Proposed New Goals (i.e., called “ends” in our governance language) For NAQC by May 27!
Please find some background on NAQC’s current Ends, and information on the new Ends below. Please remember to provide feedback on the Ends by May 27th. It would be most helpful if you would please indicate:
  • You overall impression of the Ends
  • Your ideas for revising the proposed Ends
    • Changes in language
    • Additions
    • Deletions
Please send your feedback to
 » learn more

Reminder! Medicaid Survey Responses Due from States by May 27!
NAQC is gathering information about state quitline activities to provide and fund tobacco treatment for Medicaid members. The information from this survey will be used to create a report as well as a toolkit for states to use to further develop and strengthen partnerships with state Medicaid programs. More importantly, NAQC will use the information to explore ways we can advocate with Medicaid on behalf of state quitlines. This survey closes on May 27, 2015. If you have any questions, please contact Emma Goforth at

NAQC Conference 2015! UPDATE!
NAQC is planning a conference on August 17-18, 2015 in Atlanta, Georgia, USA. We hope you will "save the date!" 

To help you plan, here are a few “heads-up” items to watch for in May and June. Over the next few weeks, NAQC and the 2015 Conference Planning Workgroup will be sharing a preliminary agenda and asking for participants to serve on the abstract review workgroup. 
We will also be inviting NAQC members to submit abstract proposals for session presentations at the conference. The call for abstracts (including conference learning objectives and instructions for submission) will be posted May 22nd and proposals will be due to NAQC  by June 19th. We hope you will consider submitting an abstract to share the important work you are doing with the 2015 Conference attendees.

The registration fee for NAQC members is $325 (non-members, $475). The registration fee allows you to attend all workshops and sessions at the conference and includes lunches on both days and a ticket to the NAQC reception on August 17. Registration will open on May 27. 
Please note that the room block has been reserved at the Crowne Plaza Atlanta Perimeter at Ravinia located at 4355 Ashford Dunwoody Rd, Atlanta, GA 30346. To make a reservation, please call 770-395-7700 or visit their website and mention NAQC Conference. The room rate is $135 per night.
Contact us at if you have any questions. 
NAQC Launches 18-month eReferral Grant from Pfizer and the Smoking Cessation Leadership Center!
We are pleased to announce that NAQC has received an 18-month grant from Pfizer and the Smoking Cessation Leadership Center that will focus on delivering quitline services to more smokers, especially those in priority populations, by establishing national capacity to implement eReferral systems between state quitlines and healthcare organizations! Over the past 2.5 years, a NAQC workgroup comprised of quitline service providers, state managers and health care institutions has been meeting to discuss their progress in developing capacity to refer smokers from health care institutions to quitlines through the health care institution’s electronic medical records (EMR) system. We call this eReferral.
This new 18-month grant will extend this work on eReferral to 5 additional quitline service providers (University of Arizona (ASHLine), American Lung Association, Information and Quality Healthcare, Avera McKennan, and beBetter) . NAQC has created five state teams that are comprised of the state funder (AZ, IL, MS, SD and WV), the state quitline service provider, and a health care institution that serves predominately underserved populations. Each state team will be responsible for carrying out an eReferral pilot project. The project begins in May 2015 and will be completed in October 2016. NAQC will provide training, technical support, and resources to the state teams throughout the project. We will be providing information and updates on this project on our website in the coming weeks and months. In the meantime, check out the existing case studies and resources from the eReferral workgroup at: We hope that this project will increase referrals to quitlines and help integrate quitlines into health care institutions.
For any questions and more information, please contact Emma Goforth at 800-398-5489 Ext. 703 or
NAQC Membership Drive for 2016! Renew by June 30! 
Please renew your NAQC membership today to ensure no interruptions to your membership benefits, including a discounted registration rate to the upcoming in-person conference. NAQC is planning a conference on August 17-18, 2015 in Atlanta, Georgia, USA. The registration fee for NAQC members is $325 (non-members, $475). The registration fee allows you to attend all workshops and sessions at the conference and includes lunches on both days and a ticket to the NAQC reception on August 17.  If you have not yet received a renewal invoice or your membership has lapsed, please contact Natalia Gromov at 800-398-5489 ext. 701 or for assistance.

Please Review Your Quitline Map Profile for Accuracy!
The Quitline Map continues to be the most visited page on the NAQC website and we would like to ensure that your quitline details are always accurate.  In May, we made updates to the information in the smoke-free laws, tobacco tax and quitline metrics sections (US profiles only). Please review the information in these sections and let us know if you have any questions.  We also encourage you to review your state’s entire profile, as you are able to update the information for the following sections of the profile: services offered, eligibility criteria, specialized materials, and provider referral program.

For a refresher on how to make changes to your profiles and additional background information please visit the Quitline Map TA page. Please contact Natalia Gromov for assistance at 800-398-5489 ext. 701 or

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Time-Sensitive News

WEBINAR: A Team Approach- Integrating Tobacco Dependence Treatment Into Routine Clinical Practice!
The Smoking Cessation Leadership Center (SCLC), in collaboration with the Health Resources and Services Administration (HRSA), is pleased to invite you to an instructive webinar led by Chad Morris, Ph.D.  Associate Professor and Director of the Behavioral Health & Wellness Program, Department of Psychiatric at the University of Colorado, Anschutz Medical Campus. 

Wednesday, May 27, 2015, at 12:00 p.m. EDT – 1:30 p.m. EDT
After this webinar, you will be able to: 
  • Describe how tobacco treatment is essential to the “Triple Aim” of better health for the population, better quality healthcare for individuals, at less cost.
  • Explain how tobacco prevention and treatment is aligned with chronic care and patient-centered medical home models.
  • Apply effective tobacco cessation strategies to populations most at-risk for tobacco-related health disparities, including persons with behavior health conditions.
  • Employ office based tools and resources that will assist you in concurrently addressing tobacco and other addictions.
» learn more

WEBINAR: Medicaid Tobacco Cessation Coverage: A Panel on Leveraging Systems and Partnerships in Oklahoma!
May 29, 2015 from 2:00 to 3:30 PM ET. Register here.
Expanding tobacco cessation coverage in Medicaid and improving access to treatment can be challenging, but with the right strategies and partners, you can have success. Join us to hear about one state’s success in an engaging, discussion-based webinar with Oklahoma’s public health leaders. Speakers will discuss:
  • Oklahoma’s efforts to ensure compliance with ACA provisions and access to near-comprehensive and near barrier-free tobacco cessation coverage for Medicaid enrollees;
  • specific strategies and tactics employed by multiple systems within the state to improve the health and wellbeing of tobacco users on Medicaid; and
  • the critical role of partners, the environmental and infrastructure support leveraged to bolster success, challenges faced and lessons learned.
In the coming days, the American Lung Association will also release a case study exploring these topics. 
 » learn more
June 3: NY State Collaborative Conference Call: Save the Date!
Make sure to register for the upcoming call on June 3 from noon to 1 pm ET titled, "Healthcare Systems Change to Identify and Treat Patients Who Use Tobacco". Tobacco use still remains the single greatest cause of disease and premature death in the US today. With the development of comprehensive, evidenced-based treatment polices we can improve tobacco dependency interventions and continue our momentum towards a tobacco-free society.
 » learn more

New Mexico Tobacco Cessation RFP!
The New Mexico Department of Health released the Comprehensive Tobacco Cessation RFP. Please follow the link below to download the RFP. The announcement can be found in the Albuquerque Journal, Santa Fe New Mexican, and Las Cruces Sun News  on April 2nd.
» learn more

4 Benefits of The University of Arizona HealthCare Partnership Nicotine Dependence Treatment Certification - June 4 and 5!
The Nicotine Dependence Treatment Certification Program offered by the HealthCare Partnership at
The University of Arizona seeks to disseminate the recommendations of the US Public Health Service Clinical Practice Guideline: Treating Tobacco Use and Dependence along with current scientific-recommended methods and techniques.  The certification/continuing education program enables medical and allied health professionals to immediately apply evidence-based tobacco dependence treatment interventions.
The certificate/continuing education program is designed to build on 4 areas of practice:
1. Use a Validated Algorithm to treat tobacco use and dependence to reduce chronic diseases.
2. Build Self-Confidence to efficiently deliver evidence-based interventions specific to health risk behaviors with an emphasis on nicotine dependence.
3. Earn continuing education units/continuing medical education credits to support your credibility to deliver evidence-based interventions.
4. Activate system changes by teaching the program to those you work, play and volunteer with. 
» learn more

Review and Comment on the Meaningful Use Stage 3 Proposed Rule due May 29th!
The Proposed Rule for Meaningful Use, Stage 3, was released on March 30, 2015. Comments are due by Friday, May 29, at 5 p.m. eastern. The full 74 page proposed rule and link to submit comments may be found at NAQC plans to comment and will share our submission via an eBulletin. If you submit comments, please send a copy of your comments to NAQC!

Review and Comment on USPSTF Recommendations!
The U.S. Preventive Services Task Force posted a new Recommendation Statement to its website which is now available for review and public comment. It relates to behavioral and pharmacotherapy interventions for tobacco cessation in adults and pregnant women. To review the draft recommendation statement and draft evidence review and to submit comments, click the link below.
» learn more

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Tobacco Control

Two Important Announcements from the Food and Drug Administration, Center for Tobacco Products!
Earlier in May,  FDA/CTP announced that the agency has denied a Citizen Petition from R.J. Reynold Tobacco Company and American Snuff Company, LLC to change a smokeless tobacco warning statement. Also  FDA issued a draft guidance regarding the authority to issue a No-Tobacco Sales Order.
» learn more

Get Tools for No Menthol Sunday!
On World No Tobacco Day 2015 join the faith community in a national interfaith effort to say no to the sale of mentholated and candy-flavored tobacco products. For details visit the link below. 
» learn more

CDC Winnable Battles 2010-2015 Progress Report!
The Centers for Disease Control and Prevention (CDC) has published CDC Winnable Battles 2010-2015, Progress Report 2014. The new report uses recent data from CDC surveillance systems to track progress in seven public health areas, including tobacco. Note pages 4&5 for tobacco-related content. 
» learn more

NIOSH Report!
NIOSH Report Recommends All Workplaces Become Tobacco-FreeThe National Institute of Occupational Safety and Health. This new report is aimed at protecting workers from occupational hazards of tobacco, secondhand smoke and emissions from e-cigarettes. The report recommends that all workplaces become tobacco-free, including the use of e-cigarettes, and that employers make tobacco cessation programs available to workers.

» learn more

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

Scott D. Halpern, M.D., Ph.D., Benjamin French, Ph.D., Dylan S. Small, Ph.D., et. al.
Randomized Trial of Four Financial-Incentive Programs for Smoking Cessation
May 13, 2015DOI: 10.1056/NEJMoa1414293
We randomly assigned CVS Caremark employees and their relatives and friends to one of four incentive programs or to usual care for smoking cessation. Two of the incentive programs targeted individuals, and two targeted groups of six participants. One of the individual-oriented programs and one of the group-oriented programs entailed rewards of approximately $800 for smoking cessation; the others entailed refundable deposits of $150 plus $650 in reward payments for successful participants. Usual care included informational resources and free smoking-cessation aids. Overall, 2538 participants were enrolled. Of those assigned to reward-based programs, 90.0% accepted the assignment, as compared with 13.7% of those assigned to deposit-based programs (P<0.001). In intention-to-treat analyses, rates of sustained abstinence from smoking through 6 months were higher with each of the four incentive programs (range, 9.4 to 16.0%) than with usual care (6.0%) (P<0.05 for all comparisons); the superiority of reward-based programs was sustained through 12 months. Group-oriented and individual-oriented programs were associated with similar 6-month abstinence rates (13.7% and 12.1%, respectively; P=0.29). Reward-based programs were associated with higher abstinence rates than deposit-based programs (15.7% vs. 10.2%, P<0.001). However, in instrumental-variable analyses that accounted for differential acceptance, the rate of abstinence at 6 months was 13.2 percentage points (95% confidence interval, 3.1 to 22.8) higher in the deposit-based programs than in the reward-based programs among the estimated 13.7% of the participants who would accept participation in either type of program. Reward-based programs were much more commonly accepted than deposit-based programs, leading to higher rates of sustained abstinence from smoking. Group-oriented incentive programs were no more effective than individual-oriented programs.

Sara C. Hitchman, Leonie S. Brose, Jamie Brown, Debbie Robson, Ann McNeill
Associations Between E-Cigarette Type, Frequency of Use, and Quitting Smoking: Findings From a Longitudinal Online Panel Survey in Great Britain.
Nicotine & Tobacco Research, 2015, 1–8 doi:10.1093/ntr/ntv078
E-cigarettes can be categorized into two basic types, (1) cigalikes, that are disposable or use pre-filled cartridges and (2) tanks, that can be refilled with liquids. The aims of this study were to examine: (1) predictors of using the two e-cigarette types, and (2) the association between type used, frequency of use (daily vs. non-daily vs. no use), and quitting. Online longitudinal survey of smokers in Great Britain was first conducted in November 2012. Of 4064 respondents meeting inclusion criteria at baseline, this study included (N = 1643) current smokers followed-up 1 year later. Type and frequency of e-cigarette use were measured at follow-up.
At follow-up, 64% reported no e-cigarette use, 27% used cigalikes, and 9% used tanks. Among e-cigarette users at follow-up, respondents most likely to use tanks versus cigalikes included: 40–54 versus 18–24  year olds and those with low versus moderate/high education. Compared to no e-cigarette use at follow-up, non-daily cigalike users were less likely to have quit smoking since baseline (P = .0002), daily cigalike or non-daily tank users were no more or less likely to have quit (P = .3644 and P = .4216, respectively), and daily tank users were more likely to have quit (P = .0012).
Whether e-cigarette use is associated with quitting depends on type and frequency of use. Compared with respondents not using e-cigarettes, daily tank users were more likely, and non-daily cigalike users were less likely, to have quit. Tanks were more likely to be used by older respondents and respondents with lower education.
Klesges RC, Krukowski RA, Klosky JL, Liu W, Srivastava DK, Boyett JM, Lanctot JQ, Hudson MM, Folsom C, Lando H, Robison LL.
Efficacy of a Tobacco Quitline Among Adult Cancer Survivors.
Prev Med. 2015 Apr;73:22-7. doi: 10.1016/j.ypmed.2014.12.019. Epub 2015 Jan 5.
The purpose of the study (conducted 2010-2013) was to determine the efficacy of two common types of tobacco quitlines in adult cancer survivors who regularly smoked cigarettes. Adult onset cancer survivors in Memphis, Tennessee (n=427, 67% female, 60% Caucasian) were randomized either to a Proactive (i.e., counselor-initiated calls) or Reactive (i.e., participant-initiated calls) quitline. Both conditions also received nicotine replacement therapy. The primary outcome was biochemically-verified (i.e., salivary cotinine) smoking cessation.
While 12-month self-reported abstinence was consistent with other published studies of smoking cessation (22% and 26% point prevalence abstinence for Proactive and Reactive conditions, respectively), 48% of participants who were tested for cotinine failed biochemical verification, indicating a considerable falsification of self-reported cessation. Adjusted cessation rates were less than 5% in both intervention conditions.
Soha Talih, PhD, Zainab Balhas, ME, Rola Salman, BS, Nareg Karaoghlanian, BE, Alan Shihadeh, ScD.
“Direct Dripping”: A High Temperature, High Formaldehyde Emission Electronic Cigarette Use Method.
Nicotine Tob Res. 2015 Apr 11. pii: ntv080. [Epub ahead of print]
Electronic cigarettes electrically heat and vaporize a liquid solution to produce an inhalable nicotine-containing aerosol. Normally the electronic heater is fed the liquid via an automatic wick system. Some ECIG users however, elect to directly drip liquid onto an exposed heater coil, reportedly for greater vapor production and throat hit. Use of such “direct drip atomizers” (DDAs) may involve greater exposure to non-nicotine toxicant due to the potentially higher temperatures reached by the coil. In this study we examined nicotine and volatile aldehyde (VA) emissions from one type of DDA under various use scenarios, and measured heater temperature.
Due to higher temperatures attained, DDAs are inherently likely to produce high toxicant emissions. The diversity of ECIG use methods, including potential off-label methods, should be considered as ECIG regulatory efforts proceed.
Gillian Schauer, MPH, Ann Malacher, PhD, Stephen Babb, MPH.
Gradual Reduction of Cigarette Consumption as a Cessation Strategy: Prevalence, Correlates, and Relationship With Quitting.
Nicotine Tob Res (2015) 17 (5): 530-538 doi:10.1093/ntr/ntu172
Gradually reducing cigarette consumption is an approach used to quit smoking, but has not been widely studied at a population level. The purpose of this study was to assess the prevalence and demographic characteristics of US adult smokers with tried to reduce to quit, and the relationship between reducing and successful quitting.
Among adults who tried to quit smoking in the past year, 43.0% (n=5,444) tried reducing to quit. Compared to those who tried to quit without reducing consumption, those reducing to quit had a significantly higher prevalence of using counseling or medication (40.2% vs. 25.0%). Reducing to quit was negatively associated with successful past-year quitting (AOR=0.59,95%CI=0.48,0.72).
Victor J. Stevens, Leif I. Solberg, Steffani Bailey, Stephen E. Kurtz, Mary Ann McBurnie, Elisa L. Priest, Jon E. Puro, Rebecca Williams, Stephen P. Fortmann, and Brian L. Hazlehurst.
Assessing Trends in Tobacco Cessation in Diverse Patient Populations.
Nicotine Tob Res published 28 April 2015, 10.1093/ntr/ntv092
This study examined change in tobacco use over four years among the general population of patients in six diverse health care organizations using electronic medical record data. The study cohort (N = 34,393) included all patients age 18 years or older who were identified as smokers in 2007, and who then had at least one primary care visit in each of the following four years.
Among smokers who regularly used these care systems, one in seven had achieved long-term cessation after 4 years. This study shows the practicality of using electronic medical records for monitoring patient smoking status over time. Similar methods could be used to assess tobacco use in any health care organization to evaluate the impact of environmental and organizational programs.
Gillian Schauer, MPH, Ann Malacher, PhD, Stephen Babb, MPH.
Prevalence and Correlates of Switching to Another Tobacco Product to Quit Smoking Cigarettes.
Nicotine Tob Res (2015) 17 (5): 622-627 doi:10.1093/ntr/ntu181 

Using nationally representative data, we assessed the prevalence and correlates of cigarette smokers who tried switching to smokeless tobacco (SLT) or to other combusted tobacco (OCT) products to quit.  Data came from 12,400 current or former adult smokers who made a quit attempt in the past year and responded to the 2010–2011 Tobacco Use Supplement to the Current Population Survey. Demographics and smoking characteristics were computed among those switching to SLT, switching to OCT, or trying to quit without using either strategy. Bivariate and multinomial logistic regression models identified correlates of using each strategy.
Overall, 3.1% of smokers tried switching to SLT to quit, 2.2% tried switching to OCT, and 0.6% tried both strategies. Compared to those not using either switching strategy to try to quit, males were more likely than females to try switching to SLT or OCT; Blacks were less likely than Whites to try switching to SLT, but more likely to try switching to OCT; younger age groups were more likely to try switching to SLT or OCT; current someday smokers were more likely to have try switching to SLT (vs. everyday smokers), while recent former smokers were more likely to have tried switching to OCT. Both switching groups were more likely to have used cessation medication versus those not using switching strategies. Data suggest that switching to other tobacco products is a prevalent cessation approach; messages are needed to help clinicians encourage smokers who try to quit by switching to use evidence-based cessation approaches.
Al-Delaimy WK, Myers MG, Leas EC, Strong DR, Hofstetter CR.
E-Cigarette Use in the Past and Quitting Behavior in the Future: A Population-Based Study.
Am J Public Health. 2015 Apr 16:e1-e7. [Epub ahead of print]
We surveyed California smokers (n = 1000) at 2 time points 1 year apart. We conducted logistic regression analyses to determine whether history of e-cigarette use at baseline predicted quitting behavior at follow-up, adjusting for demographics and smoking behavior at baseline. We limited analyses to smokers who reported consistent e-cigarette behavior at baseline and follow-up.

Compared with smokers who never used e-cigarettes, smokers who ever used e-cigarettes were significantly less likely to decrease cigarette consumption (odds ratio [OR] = 0.51; 95% confidence interval [CI] = 0.30, 0.87), and significantly less likely to quit for 30 days or more at follow-up (OR = 0.41; 95% CI = 0.18, 0.93). Ever-users of e-cigarettes were more likely to report a quit attempt, although this was not statistically significant (OR = 1.15; 95% CI = 0.67, 1.97). Smokers who have used e-cigarettes may be at increased risk for not being able to quit smoking. These findings, which need to be confirmed by longer-term cohort studies, have important policy and regulation implications regarding the use of e-cigarettes among smokers.
Silfen SL, Cha J, Wang JJ, Land TG, Shih SC.
Patient Characteristics Associated With Smoking Cessation Interventions and Quit Attempt Rates Across 10 Community Health Centers With Electronic Health Records.
Am J Public Health. 2015 Apr 16:e1-e7. [Epub ahead of print]
Ten community health centers in New York City contributed 30 months of de-identified patient data from their EHRs. Of 302 940 patients, 40% had smoking status recorded and only 34% of documented current smokers received an intervention. Women and younger patients were less likely to have their smoking status documented or to receive an intervention. Patients with comorbidities that are exacerbated by smoking were more likely to have status documented (82.2%) and to receive an intervention (52.1%), especially medication (10.8%). Medication, either alone (odds ratio [OR] = 1.9; 95% confidence interval [CI] = 1.5, 2.3) or combined with counseling (OR = 1.8; 95% CI = 1.5, 2.3), was associated with higher quit attempts compared with no intervention.
Data from EHRs demonstrated under documentation of smoking status and missed opportunities for cessation interventions. Use of data from EHRs can facilitate quality improvement efforts to increase screening and intervention delivery, with the potential to improve smoking cessation rates. (Am J Public Health. Published online ahead of print April 16, 2015: e1-e7. doi:10.2105/AJPH.2014.302444).
Danaher BG, Severson HH, Zhu SH, Andrews JA, Cummins SE, Lichtenstein E, Tedeschi GJ, Hudkins C, Widdop C, Crowley R, Seeley JR.
Randomized Controlled Trial of the Combined Effects of Web and Quitline Interventions for Smokeless Tobacco Cessation.
Internet Interv. 2015 May 1;2(2):143-151.
Use of smokeless tobacco (moist snuff and chewing tobacco) is a significant public health problem but smokeless tobacco users have few resources to help them quit. Web programs and telephone-based programs (Quitlines) have been shown to be effective for smoking cessation. We evaluate the effectiveness of a Web program, a Quitline, and the combination of the two for smokeless users recruited via the Web. To test whether offering both a Web and Quitline intervention for smokeless tobacco users results in significantly better long-term tobacco abstinence outcomes than offering either intervention alone; to test whether the offer of Web or Quitline results in better outcome than a self-help manual only Control condition; and to report the usage and satisfaction of the interventions when offered alone or combined.

69% of participants completed both the 3- and 6-month assessments. There was no significant additive or synergistic effect of combining the two interventions for Complete Case or the more rigorous Intent To Treat (ITT) analyses. Significant simple effects were detected, individually the interventions were more efficacious than the control in achieving repeated 7-day point prevalence all tobacco abstinence: Web (ITT, OR = 1.41, 95% CI = 1.03, 1.94, p = .033) and Quitline (ITT: OR = 1.54, 95% CI = 1.13, 2.11, p = .007). Participants were more likely to complete a Quitline call when offered only the Quitline intervention (OR = 0.71, 95% CI = .054, .093, p = .013), the number of website visits and duration did not differ when offered alone or in combination with Quitline. Rates of program helpfulness (p <.05) and satisfaction (p <.05) were higher for those offered both interventions versus offered only quitline.

Combining Web and Quitline interventions did not result in additive or synergistic effects, as have been found for smoking. Both interventions were more effective than a self-help control condition in helping motivated smokeless tobacco users quit tobacco. Intervention usage and satisfaction were related to the amount intervention content offered. Usage of the Quitline intervention decreased when offered in combination, though rates of helpfulness and recommendations were higher when offered in combination.
Cummins SE, Wong S, Bonnevie E, Lee HR, Goto CJ, McCree-Carrington J, Kirby C, Zhu SH
A Multistate Asian-Language Tobacco Quitline: Addressing a Disparity in Access to Care. Am J Public Health. 
2015 Apr 23:e1-e6. [Epub ahead of print]
We conducted a dissemination and implementation study to translate an intervention protocol for Asian-language smokers from an efficacy trial into an effective and sustainable multistate service. Three state tobacco programs (in California, Colorado, and Hawaii) promoted a multistate cessation quitline to 3 Asian-language-speaking communities: Chinese, Korean, and Vietnamese. The California quitline provided counseling centrally to facilitate implementation. Three more states joined the program during the study period (January 2010-July 2012). We assessed the provision of counseling, quitting outcomes, and dissemination of the program.
A total of 2004 smokers called for the service, with 88.3% opting for counseling. Among those opting for counseling, the 6-month abstinence rate (18.8%) was similar to results of the earlier efficacy trial (16.4%). The intervention protocol, based on an efficacy trial, was successfully translated into a multistate service and further disseminated. This project paved the way for the establishment of a national quitline for Asian-language speakers, which serves as an important strategy to address disparities in access to care. (Am J Public Health. Published online ahead of print April 23, 2015: e1-e6. doi:10.2105/AJPH.2014.302418).
Marina Unrod, PhD, Vani N. Simmons, PhD, Steven K. Sutton, PhD, K. Michael Cummings, PhD, Paula Celestino, BS, Benjamin M. Craig, PhD, Ji-Hyun Lee, PhD, Lauren R. Meltzer, BA and Thomas H. Brandon, PhD
Relapse-Prevention Booklets as an Adjunct to a Tobacco Quitline: A Randomized Controlled Effectiveness Trial.
Nicotine Tob Res published 6 April 2015, 10.1093/ntr/ntv079

Relapse prevention (RP) remains a major challenge to smoking cessation. Previous research found that a set of self-help RP booklets significantly reduced smoking relapse. This study tested the effectiveness of RP booklets when added to the existing services of a telephone quitline. Quitline callers (N = 3458) were enrolled after their 2-week quitline follow-up call and randomized to one of three interventions: (1) Usual Care: standard intervention provided by the quitline, including brief counseling and nicotine replacement therapy; (2) Repeated Mailings (RM): eight Forever Free RP booklets sent to participants over 12 months; and (3) Massed Mailings: all eight Forever Free RP booklets sent upon enrollment. Follow-ups were conducted at 6-month intervals, through 24 months. The primary outcome measure was 7-day-point-prevalence-abstinence.
Overall abstinence rates were 61.0% at baseline, and 41.9%, 42.7%, 44.0%, and 45.9% at the 6-, 12-, 18- and 24-month follow-ups, respectively. Although RM produced higher abstinence rates, the differences did not reach significance for the full sample. Post-hoc analyses of at-risk subgroups revealed that among participants with high nicotine dependence (n = 1593), the addition of RM materials increased the abstinence rate at 12 months (42.2% vs. 35.2%; OR = 1.38; 95% CI = 1.03% to 1.85%; P = .031) and 24 months (45% vs. 38.8%; OR = 1.31; 95% CI = 1.01% to 1.73%; P = .046). Sending self-help RP materials to all quitline callers appears to provide little benefit to deterring relapse. However, selectively sending RP booklets to callers explicitly seeking assistance for RP and those identified as highly dependent on nicotine might still prove to be worthwhile.
Rubing Zhao-Shea, Steven R. DeGroot, Liwang Liu, Markus Vallaster, Xueyan Pang, Qin Su, Guangping Gao, Oliver J. Rando, Gilles E. Martin, Olivier George, Paul D. Gardner & Andrew R. Tapper.
Increased CRF Signaling in a Verntral Tegmental Area-interpeduncular Nucleus-medial Habenula Circuit Induces Anxiety During Nicotine Withdrawal.
Nature Communications 6,Article number:6770doi:10.1038/ncomms7770
Increased anxiety is a prominent withdrawal symptom in abstinent smokers, yet the neuroanatomical and molecular bases underlying it are unclear. Here we show that withdrawal-induced anxiety increases activity of neurons in the interpeduncular intermediate (IPI), a subregion of the interpeduncular nucleus (IPN). IPI activation during nicotine withdrawal was mediated by increased corticotropin releasing factor (CRF) receptor-1 expression and signalling, which modulated glutamatergic input from the medial habenula (MHb). Pharmacological blockade of IPN CRF1 receptors or optogenetic silencing of MHb input reduced IPI activation and alleviated withdrawal-induced anxiety; whereas IPN CRF infusion in mice increased anxiety. We identified a mesointerpeduncular circuit, consisting of ventral tegmental area (VTA) dopaminergic neurons projecting to the IPN, as a potential source of CRF. Knockdown of CRF synthesis in the VTA prevented IPI activation and anxiety during nicotine withdrawal. These data indicate that increased CRF receptor signalling within a VTA–IPN–MHb circuit triggers anxiety during nicotine withdrawal.
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July 7-9, 2015: NACCHO Conference!
The National Association of County and City Health Officials (NACCHO) is hosting their Annual Conference on July 7-9, 2015 in Kansas City, MO. Learn more here

September 10-11, 2015: The Geographic Health Equity Symposium! 
The Geographic Health Equity Symposium is the signature-training event that presents strategies to address tobacco and cancer health disparities through a geographic lens. 2015 marks the second year this event has taken place and has attracted academic and public health professionals, community wellness and substance abuse prevention coalitions, non-governmental organizations and youth from all around the country. The Geographic Health Equity Alliance is pleased to invite you to engage with their staff and featured trainers during this year’s Symposium, to be held in New Orleans, LA, on September 10 – 11, 2015, at the Tulane University School of Public Health and Tropical Medicine. Learn more at here

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