Piñeiro Bárbara, Wetter David W, Vidrine Damon J, Hoover Diana S, Frank-Pearce Summer G, Nguyen Nga, Zbikowski Susan M, Williams Mary B, Vidrine Jennifer I
Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
Huntsman Cancer Institute and the Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.
Prev Med Rep. 2019 Jan 17;13:262-267. doi: 10.1016/j.pmedr.2019.01.009. eCollection 2019 Mar.
The efficacy of tobacco treatment delivered by state quitlines in diverse populations is well-supported, yet little is known about associations between treatment dose and cessation outcomes following the implementation of Ask-Advise-Connect (AAC), an electronic health record-based systematic referral process that generates a high volume of proactive calls from the state quitline to smokers. The current study is a secondary analysis of a 34-month implementation trial evaluating ACC in 13 safety-net clinics in Houston, TX. Treatment was delivered by a quitline and comprised up to five proactive, telephone-delivered multi-component cognitive-behavioral treatment sessions. Associations between treatment dose and abstinence were examined. Abstinence was assessed by phone six months after treatment enrollment, and biochemically confirmed via mailed saliva cotinine. Among smokers who enrolled in treatment and agreed to follow-up (n = 3704), 29.2% completed no treatment sessions, 35.5% completed one session, 16.4% completed two sessions, and 19.0% completed ≥three sessions. Those who completed one (vs. no) sessions were no more likely to report abstinence (OR: 0.98). Those who completed two (vs. no) sessions were nearly twice as likely to report abstinence (OR: 1.83). Those who completed ≥three (vs. no) sessions were nearly four times as likely to report abstinence (OR: 3.70). Biochemically-confirmed cessation outcomes were similar. Most smokers received minimal or no treatment, and treatment dose had a large impact on abstinence. Results highlight the importance of improving engagement in evidence-based treatment protocols following enrollment. Given that motivation to quit fluctuates, systematically offering enrollment to all smokers at all visits is important.
州戒烟热线为不同人群提供的烟草治疗效果得到了充分支持，但对于实施“询问-建议-联系”（AAC）这一基于电子健康记录的系统转诊流程后治疗剂量与戒烟结果之间的关联却知之甚少。该流程会促使州戒烟热线主动给大量吸烟者打电话。本研究是对一项为期34个月的实施试验的二次分析，该试验在德克萨斯州休斯顿的13家安全网诊所评估了AAC。治疗由戒烟热线提供，包括多达五次主动的、通过电话进行的多成分认知行为治疗课程。研究了治疗剂量与戒烟之间的关联。在治疗登记六个月后通过电话评估戒烟情况，并通过邮寄唾液可替宁进行生化确认。在登记接受治疗并同意随访的吸烟者中（n = 3704），29.2%未完成任何治疗课程，35.5%完成了一次课程，16.4%完成了两次课程，19.0%完成了≥三次课程。完成一次（与未完成相比）课程的人报告戒烟的可能性并无增加（比值比：0.98）。完成两次（与未完成相比）课程的人报告戒烟的可能性几乎是前者的两倍（比值比：1.83）。完成≥三次（与未完成相比）课程的人报告戒烟的可能性几乎是前者的四倍（比值比：3.70）。生化确认的戒烟结果相似。大多数吸烟者接受的治疗很少或没有接受治疗，治疗剂量对戒烟有很大影响。结果凸显了在登记后提高参与循证治疗方案程度的重要性。鉴于戒烟动机波动不定，在所有就诊时系统地向所有吸烟者提供登记机会很重要。
