Boosting Population Quits Through Evidence-Based Cessation Treatment and Policy

Abstract

Only large increases in adult cessation will rapidly reduce population smoking prevalence. Evidence-based smoking-cessation treatments and treatment policies exist but are underutilized. More needs to be done to coordinate the widespread, efficient dissemination and implementation of effective treatments and policies. This paper is the first in a series of three to demonstrate the impact of an integrated, comprehensive systems approach to cessation treatment and policy. This paper provides an analytic framework and selected literature review that guide the two subsequent computer simulation modeling papers to show how critical leverage points may have an impact on reductions in smoking prevalence. Evidence is reviewed from the U.S. Public Health Service 2008 clinical practice guideline and other sources regarding the impact of five cessation treatment policies on quit attempts, use of evidence-based treatment, and quit rates. Cessation treatment policies would: (1) expand cessation treatment coverage and provider reimbursement; (2) mandate adequate funding for the use and promotion of evidence-based state-sponsored telephone quitlines; (3) support healthcare systems changes to prompt, guide, and incentivize tobacco treatment; (4) support and promote evidence-based treatment via the Internet; and (5) improve individually tailored, stepped-care approaches and the long-term effectiveness of evidence-based treatments. This series of papers provides an analytic framework to inform heuristic simulation models in order to take a new look at ways to markedly increase population smoking cessation by implementing a defined set of treatments and treatment-related policies with the potential to improve motivation to quit, evidence-based treatment use, and long-term effectiveness.

Understanding the relationship between socioeconomic status, smoking cessation services provided by the health system and smoking cessation behavior in Brazil

“…Moreover, we found that smokers received advice to stop smoking more often than they received other types of help to stop smoking, such as prescriptions for medication to help give up smoking, irrespective of socioeconomic status. This combined data seems to demonstrate a shortfall in tobacco control actions, suggesting that effective "exposure" of smokers to cessation services is an essential issue to consider when defining health policies 2 ; quit rates are estimated to increase 200% with pharmacologic and behavioral treatment 18 , compared to informal or ineffective evidence-based-treatments. Furthermore, after considering the effect of multiple quit attempts among individuals seeking formal help that fail at their first attempt, population quit rates are likely to increase even more 19 .…”

“…Brazil has implemented a broad set of legislative, health care, educational and economic interventions to address tobacco use since 1986, making it a world leader in tobacco control and one of the most successful countries in reducing tobacco use (from 34.8% in 1989 to 18.2% in 2008) 3 . Interventions to reduce the burden and prevalence of tobacco use include national smoking cessation campaigns through the massmedia, prominent health warnings with graphic pictures on tobacco product packaging, and free telephone counseling for smoking cessation.…”

Smoking-related deaths averted due to three years of policy progress

“…2,22,23 The SimSmoke model has been validated for four states of the United States of America and more than 20 countries. [5][6][7][12][13][14][15][16][17][18][19][20]23,24 Table 1 summarizes policies and effect sizes based on expert panels and published literature reviews.…”

A Preliminary Randomized Controlled Trial of a Behavioral Exercise Intervention for Smoking Cessation

“…Receipt of multiple sessions of proactive telephone counseling for smokers who initiate contact with a quitline has demonstrated efficacy (Fiore et al, 2008;Stead, Perera, & Lancaster, 2007). Ultimately, quitlines may play a key role in improving systems integration (Abrams, Graham, Levy, Mabry, & Orleans, 2010). Future studies may explore the integration of exercise counseling, such as the cognitive-behavioral session content utilized in this study, within the context of telephone-delivered smoking cessation treatment.…”