Clinical Interventions to Promote Quit Attempts:

Clinical Interventions to Promote Quit Attempts:

Treatment Development and Dissemination Matthew Carpenter, PhD Department of Psychiatry & Behavioral

Author Audrey Henry

10 downloads 717 Views 2MB Size
JOURNAL TRANSCRIPT
Clinical Interventions to Promote Quit Attempts:

Treatment Development and Dissemination Matthew Carpenter, PhD Department of Psychiatry & Behavioral Sciences Hollings Cancer Center Medical University of South Carolina March, 2012

Acknowledgements Funding NIDA

Collaborators

Research Team

Tony Alberg, PhD

Amy Boatright

R01DA021619

Marvella Ford, PhD

R01CA154992

Kevin Gray, MD

Liz Byrd

K23DA020482

John Hughes, MD

Kathleen Cartmell, MPH

Mike Saladin, PhD

Dakota Hadley

Prevent Cancer Foundation American Cancer Society IRG-97219-08 Hollings Cancer Center

Gerard Silvestri, MD

Michelle Byczkiewicz

Katherine Ryan Nicola Thornley Amy Wahlquist, MS

Disclosures (past 3 years): Grant review/consultant: NIH, UMinn, Wash U., FL Dept Health

Incidence of 24hr Quit Attempts 1 0.9 0.8

Not Yet Ready to Quit

0.7 0.6 0.5 0.4 0.3

Ready to Quit

0.2

0.1 0 1997

1998

1999

2000

2001

2002

2003

Source: www.cdc.gov/tobacco/research_data/mmwr.htm

2004

2005

2006

2007

2008

The Rest of the Pack: Cessation Induction Focus on unmotivated smokers, who are the majority: ~ 60% of smokers do not make a quit attempt in a given year ~ 75-80% of smokers uninterested in quitting in next 30 days Intended outcomes:    

induce motivation Induce confidence induce quit attempts induce abstinence

Cessation Induction Policy Interventions: 

  

Taxation Smokefree legislation Health warning labels  insurance premiums

Clinical Interventions:  

 

Stage of change- based interventions Motivational interviewing (MI) Physician delivered advice to quit Behavioral strategies to induce cessation

Novel Behavioral Interventions for Cessation Induction? I. Smoking Reduction II. Medication Sampling

III. Feedback of Genetic Risk IV. PREPs? V. Contingency Management

Archives of Internal Medicine 2011; 171:1901-1907

Aims and Design Principal Aim: Determine whether adding free NRT to brief advice to undertake a practice quit attempt will motivate more smokers to 1) make subsequent quit attempts and, 2) quit, than would brief advice without NRT Method: A large, randomized, controlled clinical trial testing: 1) PQA ONLY: Practice Quit Attempts (PQA) aided by brief advice and self-help materials 2) NRT Sampling: PQA aided by advice and self-help materials plus NRT A population-based sample of unmotivated, NRT-naïve smokers recruited through online channels. All treatments & assessments delivered via telephone / mailing.

Outcomes: Further quit attempts, cessation, use of pharmacotherapy, increases in (mediators) self-efficacy, social support, familiarization with NRT Main Hypothesis: NRT sampling will serve as cessation induction (increases in each of above outcomes)

Practice Quit Attempt - short period (hours, days) of sampling abstinence - remove stress of trying to quit for good - learn coping behaviors - what works, what doesn’t PQA + NRT - same as above - sample NRT - learn how it works, what it does, what it doesn’t do, etc - NRT  nicotine lozenge: OTC, prn dosing, minimal side effects Theory: PQA, particularly when combined with NRT, is a chance to 1) ↑ Self-Efficacy, 2) ↑ Familiarity w/ Cessation Aids, 3) ↑ Social Support, 4) ↓ Distress/Withdrawal

Increased Motivation & Efficacy to Quit “This isn’t so bad, I can do this” Increased Familiarity / Improved Attitudes towards Medication “I didn’t know these things worked” “I thought I was going to get addicted to these” Increased Social Support “Nice to get some encouragement for trying”

Non-Cessation Arm: RCT of NRT Sampling 849 Enrolled Participants 423 Practice Quit Attempt (PQA)

426 PQA + NRT

Week -6 Week -3

Week -6 Treatment Period

Week -3

Week 0

Week 0

Week 4

Week 4

Week 12

Follow-Up Period Assessment Only

Week 24

Week 12 Week 24

Potential Mediators: ↑ Self-Efficacy ↑ Familiarity w/ Cessation Aids ↑ Social Support

Final Assessment at Six Months

Demographics % Female % Caucasian Age (SD) % College graduate Smoking History FTND Age began smoking Cigs/Day (weekday) % >1 prior quit attempt % >1 prior quit attempt in past 6 mo. % Live with smoker Motivation to quit in next month (0-10) Confidence to quit (0-10)

PQA (n=423) 66% 88% 50.7 (11.4) 28%

PQA+NRT (n=426) 62% 88% 50.5 (11.8) 26%

4.9 (2.0) 18.2 (9.2) 20.1 (8.5) 83% 14% 47% 2.7 (2.9) 3.9 (2.9)

4.7 (2.1) 17.4 (4.8) 19.6 (11.3) 83% 15% 43% 2.4 (2.8) 4.0 (3.0)

Percent

100 90 80 70 60 50 40 30 20 10 0

PQA only PQA + NRT OR=1.5 (95% CI: 1.1 – 1.9)

OR=1.5 (95% CI: 1.1 – 2.0) OR=1.6 (95% CI: 1.2 – 2.2) OR=1.4 (95% CI: 1.0 – 2.0)

Any QA

Any 24hr QA

Any 72hr QA

at any point in study * Abstinence: 7 day point prevalence (self report)

Abstinent*

OR=1.2 (95% CI: 0.8 – 1.8)

Abstinent*

at 6 months

100 90 80 70 60 50 40 30 20 10 0

6-wk Treatment Period

Percent

6-mnth follow-up period

PQA/NRT PQA only PQA/NRT PQA only PQA/NRT PQA only PQA/NRT PQA only

Use of Any Med

Use of Any Medication Except Lozenge (sample)

Use of Behavioral Tx

“Since we last spoke”

Use of ANY Tx

NRT Sampling: Intent to quit (0-10) 10

PQA - 1 month

PQA - 6 months

PQA + NRT - 1 month

PQA + NRT - 6 months

8 6 Time x Group: n.s.

Time x Group: p

Smile Life

Show life that you have a thousand reasons to smile

Get in touch

© Copyright 2023 ELIB.TIPS - All rights reserved.