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Proactive tobacco treatment offering free nicotine replacement therapy and telephone counselling for socioeconomically disadvantaged smokers: a randomised clinical trial.
Thorax. 2016 May; 71(5):446-53.T

Abstract

BACKGROUND

Evidenced-based tobacco cessation treatments are underused, especially by socioeconomically disadvantaged smokers. This contributes to widening socioeconomic disparities in tobacco-related morbidity and mortality.

METHODS

The Offering Proactive Treatment Intervention trial tested the effects of a proactive outreach tobacco treatment intervention on population-level smoking abstinence and tobacco treatment use among a population-based sample of socioeconomically disadvantaged smokers. Current smokers (n=2406), regardless of interest in quitting, who were enrolled in the Minnesota Health Care Programs, the state's publicly funded healthcare programmes for low-income populations, were randomly assigned to proactive outreach or usual care. The intervention comprised proactive outreach (tailored mailings and telephone calls) and free cessation treatment (nicotine replacement therapy and intensive, telephone counselling). Usual care comprised access to a primary care physician, insurance coverage of Food and Drug Administration-approved smoking cessation medications, and the state's telephone quitline. The primary outcome was self-reported 6-month prolonged smoking abstinence at 1 year and was assessed by follow-up survey.

FINDINGS

The proactive intervention group had a higher prolonged abstinence rate at 1 year than usual care (16.5% vs 12.1%, OR 1.47, 95% CI 1.12 to 1.93). The effect of the proactive intervention on prolonged abstinence persisted in selection models accounting for non-response. In analysis of secondary outcomes, use of evidence-based tobacco cessation treatments were significantly greater among proactive outreach participants compared with usual care, particularly combination counselling and medications (17.4% vs 3.6%, OR 5.69, 95% CI 3.85 to 8.40).

INTERPRETATION

Population-based proactive tobacco treatment increases engagement in evidence-based treatment and is effective in long-term smoking cessation among socioeconomically disadvantaged smokers. Findings suggest that dissemination of population-based proactive treatment approaches is an effective strategy to reduce the prevalence of smoking and socioeconomic disparities in tobacco use.

TRIAL REGISTRATION NUMBER

NCT01123967.

Authors+Show Affiliations

VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.Division of Health Care Policy & Research, Mayo Clinic, Rochester, Minnesota, USA.VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.North American Quitline Consortium, Phoenix, Arizona, USA.VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA.Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA.Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

26931362

Citation

Fu, Steven S., et al. "Proactive Tobacco Treatment Offering Free Nicotine Replacement Therapy and Telephone Counselling for Socioeconomically Disadvantaged Smokers: a Randomised Clinical Trial." Thorax, vol. 71, no. 5, 2016, pp. 446-53.
Fu SS, van Ryn M, Nelson D, et al. Proactive tobacco treatment offering free nicotine replacement therapy and telephone counselling for socioeconomically disadvantaged smokers: a randomised clinical trial. Thorax. 2016;71(5):446-53.
Fu, S. S., van Ryn, M., Nelson, D., Burgess, D. J., Thomas, J. L., Saul, J., Clothier, B., Nyman, J. A., Hammett, P., & Joseph, A. M. (2016). Proactive tobacco treatment offering free nicotine replacement therapy and telephone counselling for socioeconomically disadvantaged smokers: a randomised clinical trial. Thorax, 71(5), 446-53. https://doi.org/10.1136/thoraxjnl-2015-207904
Fu SS, et al. Proactive Tobacco Treatment Offering Free Nicotine Replacement Therapy and Telephone Counselling for Socioeconomically Disadvantaged Smokers: a Randomised Clinical Trial. Thorax. 2016;71(5):446-53. PubMed PMID: 26931362.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Proactive tobacco treatment offering free nicotine replacement therapy and telephone counselling for socioeconomically disadvantaged smokers: a randomised clinical trial. AU - Fu,Steven S, AU - van Ryn,Michelle, AU - Nelson,David, AU - Burgess,Diana J, AU - Thomas,Janet L, AU - Saul,Jessie, AU - Clothier,Barbara, AU - Nyman,John A, AU - Hammett,Patrick, AU - Joseph,Anne M, Y1 - 2016/03/01/ PY - 2015/10/11/received PY - 2016/01/05/accepted PY - 2016/3/3/entrez PY - 2016/3/5/pubmed PY - 2016/9/16/medline KW - Smoking cessation KW - Tobacco control SP - 446 EP - 53 JF - Thorax JO - Thorax VL - 71 IS - 5 N2 - BACKGROUND: Evidenced-based tobacco cessation treatments are underused, especially by socioeconomically disadvantaged smokers. This contributes to widening socioeconomic disparities in tobacco-related morbidity and mortality. METHODS: The Offering Proactive Treatment Intervention trial tested the effects of a proactive outreach tobacco treatment intervention on population-level smoking abstinence and tobacco treatment use among a population-based sample of socioeconomically disadvantaged smokers. Current smokers (n=2406), regardless of interest in quitting, who were enrolled in the Minnesota Health Care Programs, the state's publicly funded healthcare programmes for low-income populations, were randomly assigned to proactive outreach or usual care. The intervention comprised proactive outreach (tailored mailings and telephone calls) and free cessation treatment (nicotine replacement therapy and intensive, telephone counselling). Usual care comprised access to a primary care physician, insurance coverage of Food and Drug Administration-approved smoking cessation medications, and the state's telephone quitline. The primary outcome was self-reported 6-month prolonged smoking abstinence at 1 year and was assessed by follow-up survey. FINDINGS: The proactive intervention group had a higher prolonged abstinence rate at 1 year than usual care (16.5% vs 12.1%, OR 1.47, 95% CI 1.12 to 1.93). The effect of the proactive intervention on prolonged abstinence persisted in selection models accounting for non-response. In analysis of secondary outcomes, use of evidence-based tobacco cessation treatments were significantly greater among proactive outreach participants compared with usual care, particularly combination counselling and medications (17.4% vs 3.6%, OR 5.69, 95% CI 3.85 to 8.40). INTERPRETATION: Population-based proactive tobacco treatment increases engagement in evidence-based treatment and is effective in long-term smoking cessation among socioeconomically disadvantaged smokers. Findings suggest that dissemination of population-based proactive treatment approaches is an effective strategy to reduce the prevalence of smoking and socioeconomic disparities in tobacco use. TRIAL REGISTRATION NUMBER: NCT01123967. SN - 1468-3296 UR - https://www.unboundmedicine.com/medline/citation/26931362/Proactive_tobacco_treatment_offering_free_nicotine_replacement_therapy_and_telephone_counselling_for_socioeconomically_disadvantaged_smokers:_a_randomised_clinical_trial_ L2 - https://thorax.bmj.com/lookup/pmidlookup?view=long&pmid=26931362 DB - PRIME DP - Unbound Medicine ER -