Does extended proactive telephone support increase smoking cessation among low-income women using nicotine patches?

doi:10.1016/j.ypmed.2004.06.005

Preventive Medicine

Volume 40, Issue 3, March 2005, Pages 306-313

https://doi.org/10.1016/j.ypmed.2004.06.005 Get rights and content

Abstract

Background. It is unclear whether proactive telephone support enhances smoking cessation beyond the provision of nicotine replacement therapy alone.

Methods. We randomly assigned 330 low-income women smokers to receive either free nicotine patches (control condition) or free nicotine patches with up to 16 weeks of proactive telephone support (experimental condition). All participants were assessed by telephone at baseline and at 2 weeks, 3 months, and 6 months post-baseline to determine smoking status.

Results. Results revealed a significant effect for the telephone support at 3 months, with 43% of experimental versus 26% of control condition women reporting 30-day point prevalent abstinence (P = 0.002). The difference was no longer significant at 6 months. A metaanalysis conducted with five randomized studies revealed a slight but non-significant long-term benefit of proactive telephone support when added to the provision of free nicotine patches for smoking cessation.

Conclusions. This is the second study to demonstrate a short-term effect for proactive telephone support added to free nicotine replacement therapy; however, neither the current study, nor the metaanalysis including the four other published trials, confirmed a longer-term benefit.

Introduction

The provision of proactive support and problem-solving assistance delivered by telephone appears to be an efficacious intervention for cigarette smoking. In a metaanalysis by Lichtenstein et al. [1], proactive telephone counseling increased 3- to 8-month smoking abstinence rates by 30% above control conditions. Similarly, in a series of metaanalyses by Stead and Lancaster [2] for the Cochran Review, the authors found a modest effect for proactive telephone counseling at 6 months when it was the main component of an intervention. When proactive telephone support was combined with face-to-face counseling or pharmacotherapy, its contributions to abstinence were less robust.

To date, four randomized controlled trials have examined the impact of proactive telephone support as an adjunct to nicotine replacement therapy (NRT) [3], [4], [5], [6]. The first three studies included a face-to-face physician intervention in both arms of the experimental design and found no 3- or 6-month effect for up to four proactive telephone counseling contacts. In contrast, Solomon et al. [6] had no face-to-face contact with participants, dispensed nicotine patches through the mail, and delivered a mean of seven support calls over 3 months. At a 3-month follow-up, they observed a significant effect for the proactive telephone support (P = 0.03); however, the difference between conditions was lost by the 6-month follow-up. Relapse rates between 3 and 6 months were nearly twice as great in the experimental versus comparison condition, leading the authors to speculate that a longer period of availability to telephone support might extend abstinence.

The current study was designed to replicate the latter trial, but includes the provision of proactive telephone support for up to 12 calls over 4 months. This telephone contact schedule is more intensive than that used by any telephone-based smoking cessation trial to date and was designed to provide support up to 6 weeks past the point when access to free nicotine patches would end. The primary objective was to determine if this longer telephone support option, when added to the provision of free nicotine patches, would significantly enhance abstinence at 6 months over the provision of nicotine patches alone.

Additionally, we conducted a metaanalysis, incorporating the 6-month outcome data from the current study, to determine the combined effect of existing trials examining the benefit of proactive telephone support added to free NRT. This metaanalysis helps to place the current study findings in a broader context and strengthens the interpretation of the results.

Section snippets

Participants

To be in the study, participants had to be women smokers between the ages of 18 and 50 currently receiving Medicaid or Vermont Health Assistance Plan (VHAP) health care coverage for low-income Vermonters. They had to smoke greater than four cigarettes per day, have a home telephone, report that they intend to quit smoking in the next 2 weeks, have no plans to move in the next 6 months, and have no contraindications for use of over-the-counter NRT.

Procedure

We recruited participants throughout Vermont by

Results

From October 2000 through January 2002, 662 women called our toll-free telephone number to inquire about the study. Of these, 330 were eligible and enrolled. Of the women not enrolled, 92% were excluded because they were not on Medicaid or VHAP, not aged 18–50, or were planning to move in the next 6 months. The remaining exclusions were due to no home telephone, contraindications for nicotine patch use, or because they smoked fewer than five cigarettes per day. Of those successfully recruited,

Discussion

Results from this study replicated our prior findings [6], demonstrating a significant effect for proactive telephone support as an adjunct to free NRT at 3 months post-baseline. Although the proportions of participants reporting quit attempts and the numbers of days of NRT use were comparable between conditions, the telephone support doubled the odds of being abstinent at 3 months, suggesting that the support and/or problem-solving assistance provided over the telephone strengthened efforts to

Acknowledgements

This research was funded by the Vermont Department of Health. We are very grateful to the interviewers and telephone support staff who contributed to this study.

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Is telephone counseling a useful addition to physician advice and nicotine replacement therapy in helping patients to stop smoking? A randomized controlled trial
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Outside of a treatment setting and within a community-recruited sample population composed of HUH women, the number of additional substances used is a primary correlate of ongoing tobacco use. Tailored cessation interventions that prioritize the issue of multiple substance use, and public health policies that allocate funding to address it, may increase tobacco cessation in this population.
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We found evidence that individual-level interventions can assist disadvantaged smokers with quitting, but there were no large moderating effects of tailoring for disadvantaged smokers. Improvements in tailored intervention development might be necessary to achieve equity-positive smoking cessation outcomes.
Cancer Research UK.
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Few published QL interventions have utilized financial incentives (Stead et al., 2013), and more interventions need to reach adults not motivated to quit (Asfar et al., 2011). Although proactive telephone-based cessation interventions (i.e., calls initiated by counselors [Lichtenstein et al., 1996]) have been effective in low-income populations (e.g., Solomon et al., 2005), less is known about reactive strategies (i.e., cessation counseling provided on demand). Proactive QL recruitment is designed to contact potential participants directly with QL operators in order to connect smokers directly to the QL at time of initial contact.
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Does extended proactive telephone support increase smoking cessation among low-income women using nicotine patches?

Abstract

Introduction

Section snippets

Participants

Procedure

Results

Discussion

Acknowledgements

Prev. Med

Telephone counseling for smoking cessation: rationales and meta-analytic review of evidence

Health Educ. Res

Telephone counselling for smoking cessation (Cochran review)

Increasing the efficacy of physician-delivered smoking interventions: a randomized clinical trial

J. Gen. Intern. Med

Telephone support as an adjunct to transdermal nicotine in smoking cessation

Am. J. Public Health

Is telephone counseling a useful addition to physician advice and nicotine replacement therapy in helping patients to stop smoking? A randomized controlled trial

CMAJ