Efficacy of a Tobacco Quitline in Active Duty Military and TRICARE Beneficiaries: A Randomized Trial

Abstract

A higher proportion of military personnel than civilians smoke cigarettes. Few randomized trials of tobacco use interventions have been conducted in the U.S. military. We evaluated the efficacy of a tobacco quitline (QL) in 1298 active duty military personnel, their dependents, reservists, and retirees who smoke cigarettes. Participants were randomized to either a proactive (counselor-initiated) or reactive (participant-initiated) QL intervention for 8 weeks. The proactive condition included up to an 8-week supply of free nicotine replacement therapy, and the reactive condition included a 2-week supply. The primary outcome was 12-month smoking abstinence. The enrolled population was predominantly affiliated with the Air Force and Army. At the end of treatment, proactive treatment was associated with a greater odds of both prolonged (44.22% vs. 24.96%; odds ratio [OR] = 2.4, P < 0.0001) and 7-day point prevalence (49.92% vs. 28.20%; OR = 2.5, P < 0.0001) smoking abstinence, a difference that was maintained for prolonged smoking abstinence at 12 months (22.03% vs. 13.41%; OR = 1.8, P < 0.0001). Our findings provide evidence that a proactive QL with nicotine replacement therapy is highly efficacious among Air Force and Army active duty and TRICARE beneficiaries and would provide an effective telephonic treatment option for this population of smokers.

Enhancing the efficacy of a smoking quit line in the military: Study rationale, design and methods of the Freedom quit line

“…Every eligible cigarette smoker who calls requesting assistance with smoking cessation receives a non-randomized, baseline standard smoking cessation program using our proactive QL (see Fig. 1) [8]. In addition, all participants receive 8 weeks of NRT in the form of a patch.…”

“…Once verbal consent is obtained, the participant completes the baseline questionnaires. At this point, the participant is enrolled in a non-randomized baseline standard smoking cessation program using our validated military proactive QL [8] and begins the nicotine patch, which is mailed to the participant. Part of the initial consent process is to explain that individuals who are still smoking at the 3-month follow-up will receive the opportunity to re-engage.…”

“…All participants receive a four-session standard smoking cessation intervention using our validated military proactive QL [8], designed to be delivered weekly over the course of four weeks telephonically. The goal of this intervention is to help the participant set a quit date and quit smoking by the end of the four treatment sessions (Table 1).…”

“…QLs are more effective if they are proactive (i.e., calls initiated by the counselor) rather than reactive (i.e., participant-initiated), offer free nicotine replacement therapy (NRT), and provide at least three treatment sessions [1,7]. In a randomized clinical trial, we observed that a military-tailored proactive intervention increased smoking abstinence rates more than a reactive QL at one year (OR = 1.8, P < 0.0001) among active duty (Army, Navy, Air Force, Marines and Coast Guard), retirees and dependents [8]. However, significant relapse back to smoking after end-of-treatment was observed with 49% achieving smoking cessation at 8 weeks relapsing back to smoking at one year [1].…”

“…Pro-actively reaching out to smokers has shown promise in re-engaging smokers after failed quit attempts. [10–13] In our military QL study [8], all participants who initially called the military QL were motivated to quit, but one year later half of these formerly motivated participants were smoking. Previous research has found that these smokers feel greater levels of disappointment and lower self-efficacy following a failed quit attempt which may prevent them from actively seeking treatment [13].…”