Design and baseline characteristics from the KAN-QUIT disease management intervention for rural smokers in primary care

Cox, Lisa Sanderson; Cupertino, Ana Paula; Mussulman, Laura M.; Nazir, Niaman; Greiner, K. Allen; Mahnken, Jonathan D.; Ahluwalia, Jasjit S.; Ellerbeck, Edward F.

doi:10.1016/j.ypmed.2008.04.013

Cited by 23 publications

(10 citation statements)

References 55 publications

(50 reference statements)

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“…As part of a rural primary care research experience, trained medical students systematically screened patients, identified smokers, and recruited them for this study, regardless of their interest in quitting (12). Smokers were eligible if they had a primary care physician participating in this study, and they were ≥ 18 years of age, smoked ≥ 10 cigarettes/day, smoked for at least one year, smoked at least 25 out of the past 30 days, spoke English, and had a telephone.…”

Section: Methodsmentioning

confidence: 99%

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Effect of Varying Levels of Disease Management on Smoking Cessation

et al. 2009

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Background Cigarette smoking is a chronic, relapsing illness that is inadequately addressed in primary care practice. Objective To compare cessation rates among smokers receiving pharmacotherapy management alone or combined with either moderate- or high-intensity disease management that includes counseling and provider feedback. Design Randomized clinical trial from June 2004 to December 2007. Setting 50 rural primary care practices. Patients 750 patients smoking ≥ 10 cigarettes/day. Intervention Participants were randomized to one of three groups: pharmacotherapy management (n = 250); pharmacotherapy management supplemented with up to 2 counseling calls (moderate-intensity disease management (n = 249)); or pharmacotherapy management supplemented with up to 6 counseling calls (high-intensity disease management (n = 251)). Interventions were offered every six months for two years. All participants received offers of free pharmacotherapy; moderate-intensity and high-intensity disease management recipients had post-counseling progress reports faxed to their physicians. Participants and counselors were not blinded to treatment assignment. Measurements Self-reported point-prevalence smoking abstinence at 24 months (primary outcome) and overall (0 to 24 months) analyses of smoking abstinence, utilization of pharmacotherapy, and discussions about smoking with physicians (secondary outcomes). Research assistants, blinded to treatment assignment, conducted outcome assessments. Results Pharmacotherapy utilization was comparable across treatment groups, with 473 of 741 (63.8%), 302 of 739 (40.9%), 175 of 732 (23.9%), and 179 of 726 (24.7%) requesting pharmacotherapy during the 1st, 2nd, 3rd, and 4th 6-month cycles of treatment. Of participants that saw a physician during any given treatment cycle, 37.5 – 59.5% reported that they discussed smoking cessation with their physician, but this did not differ across the treatment groups. Abstinence rates increased throughout the 24-month study and overall (0 to 24 months) analyses demonstrated higher abstinence among recipients of high-intensity versus moderate-intensity disease management (OR, 1.43 [95% CI, 1.00 to 2.03]) and higher abstinence in the combined disease management groups compared to pharmacotherapy management alone (OR, 1.47 [95% CI, 1.08 to 2.00]). The primary outcome, self-reported abstinence at 24 months, was 68 of 244 (27.9%) and 56 of 238 (23.5%) in the high-intensity and moderate-intensity disease management groups, respectively (OR, 1.33 [95% CI, 0.88 to 2.02]) and 56 of 244 (23.0%) in the pharmacotherapy management group (OR, 1.12 [95% CI, 0.78 to 1.61] (combined disease management versus pharmacotherapy management alone)). Limitations The impact of pharmacotherapy management cannot be separated from the provision of free pharmacotherapy. Cessation was validated in only 58% of self-reported quitters. Conclusion Smokers are willing to make repeated pharmacotherapy-assisted quit attempts leading to progressively greater smoking abstinence. A...

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Section: Methodsmentioning

confidence: 99%

“…All interventions were conducted from a single central site by one of 9 counselors trained in smoking cessation and motivational interviewing (12). Participants were assigned to counselors without regard to practice site.…”

Section: Methodsmentioning

confidence: 99%

Effect of Varying Levels of Disease Management on Smoking Cessation

et al. 2009

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“…Lower SES is a risk factor for smoking, for persistent and is a barrier to access to smoking cessation treatment (Kiefe et al, 1998; Roddy et al, 2006; Schaap and Kunst, 2009; Weinberger et al, 2008). Additionally, clinical trials for smoking cessation generally exclude potential participants with current depression, as well as those with anxiety and substance use disorders, which are highly comorbid with both depression and smoking (Cox et al, 2008; Gierisch et al, 2012). Physical health problems are also commonly excluded, and therefore, clinical trials may be more apt to include “super healthy” smokers who are unlikely to be representative of the general population of smokers in the population.…”

Section: Introductionmentioning

confidence: 99%

Major depressive disorder and smoking relapse among adults in the United States: A 10-year, prospective investigation

Zvolensky

Bakhshaie

Sheffer

et al. 2015

Psychiatry Research

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This study investigated the relation between major depressive disorder (MDD) and smoking relapse in the U.S. over a 10-year period. Data were drawn from the Midlife Development in the United States (MIDUS) Survey Waves I & II. Logistic regression analyses were used to explore the associations between past-year MDD in 1994, past-year MDD in 2005 and persistent depression (1994 and 2005) and risk of smoking relapse in 2005 among former smokers, adjusting for demographics, anxiety disorders, and substance use problems and smoking characteristics. Among former smokers, MDD in 1994, compared to without MDD in 1994, was associated with significantly increased odds of smoking relapse by 2005. Current MDD in 2005 was associated with an even stronger risk of relapse in 2005 and persistent depression even more strongly predicted relapse by 2005. These associations remained significant and were not substantially attenuated by the covariates. In conclusion, MDD appears to confer long-term vulnerability to smoking relapse among adults in the general population. These results suggest interventions for smoking cessation should include screening and treatment for MDD if programs are to be optimally effective at achieving initial quit success as well as enduring abstinence.

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“…They are described by Miller and Rollnick [1,8] and have been incorporated into brief MI-based intervention protocols [3,9,10]. Motivation rulers have become popular clinically [11].…”

Section: Introductionmentioning

confidence: 99%

Motivation rulers for smoking cessation: a prospective observational examination of construct and predictive validity

Boudreaux

Sullivan

Abar

et al. 2012

Addict Sci Clin Pract

105

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BackgroundAlthough popular clinically, the psychometric properties of motivation rulers for tobacco cessation are unknown. This study examined the psychometric properties of rulers assessing importance, readiness, and confidence in tobacco cessation.MethodsThis observational study of current smokers was conducted at 10 US emergency departments (EDs). Subjects were assessed during their ED visit (baseline) and reassessed two weeks later. We examined intercorrelations between the rulers as well as their construct and predictive validity. Hierarchical multinomial logistic regressions were used to examine the rulers’ predictive ability after controlling for covariables.ResultsWe enrolled 375 subjects. The correlations between the three rulers ranged from 0.50 (between Important and Confidence) to 0.70 (between Readiness and Confidence); all were significant (p < 0.001). Individuals in the preparation stage displayed the highest motivation-ruler ratings (all rulers F 2, 363 ≥ 43; p < 0.001). After adjusting for covariables, each of the rulers significantly improved prediction of smoking behavior change. The strength of their predictive ability was on par with that of stage of change.ConclusionOur results provide preliminary support for the psychometric soundness of the importance, readiness, and confidence rulers.

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Design and baseline characteristics from the KAN-QUIT disease management intervention for rural smokers in primary care

Cited by 23 publications

References 55 publications

Effect of Varying Levels of Disease Management on Smoking Cessation

Effect of Varying Levels of Disease Management on Smoking Cessation

Major depressive disorder and smoking relapse among adults in the United States: A 10-year, prospective investigation

Motivation rulers for smoking cessation: a prospective observational examination of construct and predictive validity

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