Factors in Nonadherence to Quitline Services: Smoker Characteristics Explain Little
ABSTRACT Background. Quitlines offer evidence-based, multisession coaching support for smoking cessation in the 50 U.S. states, Canada, and several other countries. Smokers who enroll in quitline services have, ipso facto, shown readiness to attempt to quit, but noncompletion of coaching services appears widespread and has not been widely investigated. The current study explored the magnitude and correlates of quitline service abandonment. Method. A state's quitline intake, coaching, and nicotine patch/gum utilization data were obtained for smokers who enrolled during the period July 2007 to June 2008 (n = 20,882). Analyses examined demographic, socioeconomic status, nicotine dependence-related, and nicotine replacement therapy-utilization factors associated with completion of only one coaching session (of five offered). Results. Almost half of enrollees (47.8%) completed only one session. All significant predictors together explained less than 4% of variance; not being sent nicotine replacement therapy was most strongly correlated with completion of only one session. A framework is proposed for directing research toward reducing quitline service nonadherence. Conclusions. Premature user abandonment of coaching calls is widespread within a quitline. Further research should determine the extent of the problem in national quitline systems, increase knowledge of mediators of nonadherence, and develop strategies for increasing coaching completion.
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ABSTRACT: BACKGROUND: Internet and telephone treatments for smoking cessation can reach large numbers of smokers. There is little research on their costs and the impact of adherence on costs and effects. OBJECTIVE: To conduct an economic evaluation of The iQUITT Study, a randomised trial comparing Basic Internet, Enhanced Internet and Enhanced Internet plus telephone counselling ('Phone') at 3, 6, 12 and 18 months. METHODS: We used a payer perspective to evaluate the average and incremental cost per quitter of the three interventions using intention-to-treat analysis of 30-day single-point prevalence and multiple-point prevalence (MPP) abstinence rates. We also examined results based on adherence. Costs included commercial charges for each intervention. Discounting was not included given the short time horizon. RESULTS: Basic Internet had the lowest cost per quitter at all time points. In the analysis of incremental costs per additional quitter, Enhanced Internet+Phone was the most cost-effective using both single and MPP abstinence metrics. As adherence increased, the cost per quitter dropped across all arms. Costs per quitter were lowest among participants who used the 'optimal' level of each intervention, with an average cost per quitter at 3 months of US$7 for Basic Internet, US$164 for Enhanced Internet and US$346 for Enhanced Internet+Phone. CONCLUSIONS: 'Optimal' adherence to internet and combined internet and telephone interventions yields the highest number of quitters at the lowest cost. Cost-effective means of ensuring adherence to such evidence-based programmes could maximise their population-level impact on smoking prevalence.Tobacco control 09/2012; 22(6). DOI:10.1136/tobaccocontrol-2012-050465 · 5.15 Impact Factor
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ABSTRACT: The use and effectiveness of tobacco quitlines by weight is still unknown. This study aims to determine if baseline weight is associated with treatment engagement, cessation, or weight gain following quitline treatment. Quitline participants (n = 595) were surveyed at baseline, 3 and 6 months. Baseline weight was not associated with treatment engagement. In unadjusted analyses, overweight smokers reported higher quit rates and were more likely to gain weight after quitting than obese or normal weight smokers. At 3 months, 40 % of overweight vs. 25 % of normal weight or obese smokers quit smoking (p = 0.01); 42 % of overweight, 32 % of normal weight, and 33 % of obese quitters gained weight (p = 0.05). After adjusting for covariates, weight was not significantly related to cessation (approaching significance at 6 months, p = 0.06) or weight gain. In the first quitline study of this kind, we found no consistent patterns of association between baseline weight and treatment engagement, cessation, or weight gain.Annals of Behavioral Medicine 09/2013; 47(2). DOI:10.1007/s12160-013-9537-z · 4.20 Impact Factor
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ABSTRACT: Objective To study whether demographic and smoking-related characteristics are associated with participation (reach) in a smoking cessation trial and subsequent use (uptake) of two specific smoking interventions (internet-based program and proactive telephone counseling). Methods We used data from a four-arm randomized smoking cessation trial (2011). Participants (n = 1,809) were recruited among 9,924 smokers who previously participated in two health surveys in Denmark (2007-2008 and 2010). Interventions were: 1) an internet-based smoking cessation program 2) proactive telephone counseling, 3) reactive telephone counseling, 4) self-help booklet. Results Reach (defined as the proportion accepting to participate in the trial of those invited) was highest among persons aged 40-59, women, heavy smokers and persons with long education. Among trial participants, uptake (defined as any use of the specific intervention at one-month follow-up) was 69% for the internet-based program, 74% and 9 % for proactive and reactive telephone counseling, and 84% for the self-help booklet. Young age was associated with uptake of the internet-based program and short education was associated with using proactive telephone counseling. Conclusions Internet-based interventions and proactive telephone counseling appeal to different age and educational groups. Further, offering similar intervention content by a proactive and a reactive approach can be associated with different intervention uptake.Preventive Medicine 05/2014; 62. DOI:10.1016/j.ypmed.2014.01.020 · 2.93 Impact Factor