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Does Motivation Matter? Analysis of a Randomized Trial of Proactive Outreach to VA Smokers.
J Gen Intern Med. 2016 08; 31(8):878-87.JG

Abstract

BACKGROUND

Current guidelines advise providers to assess smokers' readiness to quit, then offer cessation therapies to smokers planning to quit and motivational interventions to smokers not planning to quit.

OBJECTIVES

We examined the relationship between baseline stage of change (SOC), treatment utilization, and smoking cessation to determine whether the effect of a proactive smoking cessation intervention was dependent on smokers' level of motivation to quit.

DESIGN

Secondary analysis of a multicenter randomized controlled trial.

PARTICIPANTS

A total of 3006 current smokers, aged 18-80 years, at four Veterans Affairs (VA) medical centers.

INTERVENTIONS

Proactive care included proactive outreach (mailed invitation followed by telephone outreach), offer of smoking cessation services (telephone or face-to-face), and access to pharmacotherapy. Usual care participants had access to VA smoking cessation services and state telephone quitlines.

MAIN MEASURES

Baseline SOC measured with Readiness to Quit Ladder, and 6-month prolonged abstinence self-reported at 1 year.

KEY RESULTS

At baseline, 35.8 % of smokers were in preparation, 38.2 % in contemplation, and 26.0 % in precontemplation. The overall interaction between SOC and treatment arm was not statistically significant (p = 0.30). Among smokers in preparation, 21.1 % of proactive care participants achieved 6-month prolonged abstinence, compared to 13.1 % of usual care participants (OR, 1.8 [95 % CI, 1.2-2.6]). Similarly, proactive care increased abstinence among smokers in contemplation (11.0 % vs. 6.5 %; OR, 1.8 [95 % CI, 1.1-2.8]). Smokers in precontemplation quit smoking at similar rates (5.3 % vs. 5.6 %; OR, 0.9 [95 % CI, 0.5-1.9]). Within each stage, uptake of smoking cessation treatments increased with higher SOC and with proactive care as compared with usual care.

LIMITATIONS

Mostly male participants limits generalizability. Randomization was not stratified by SOC.

CONCLUSIONS

Proactive care increased treatment uptake compared to usual care across all SOC. Proactive care increased smoking cessation among smokers in preparation and contemplation but not in precontemplation. Proactively offering cessation therapies to smokers at all SOC will increase treatment utilization and population-level smoking cessation.

Authors+Show Affiliations

VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA. Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.VA New York Harbor Healthcare System, New York City, NY, USA. Department of Population Health, New York University School of Medicine, New York City, NY, USA.VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA. Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA. Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA.National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA. Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA. Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA. Steven.Fu@va.gov. Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA. Steven.Fu@va.gov.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

27071399

Citation

Danan, Elisheva R., et al. "Does Motivation Matter? Analysis of a Randomized Trial of Proactive Outreach to VA Smokers." Journal of General Internal Medicine, vol. 31, no. 8, 2016, pp. 878-87.
Danan ER, Joseph AM, Sherman SE, et al. Does Motivation Matter? Analysis of a Randomized Trial of Proactive Outreach to VA Smokers. J Gen Intern Med. 2016;31(8):878-87.
Danan, E. R., Joseph, A. M., Sherman, S. E., Burgess, D. J., Noorbaloochi, S., Clothier, B., Japuntich, S. J., Taylor, B. C., & Fu, S. S. (2016). Does Motivation Matter? Analysis of a Randomized Trial of Proactive Outreach to VA Smokers. Journal of General Internal Medicine, 31(8), 878-87. https://doi.org/10.1007/s11606-016-3687-1
Danan ER, et al. Does Motivation Matter? Analysis of a Randomized Trial of Proactive Outreach to VA Smokers. J Gen Intern Med. 2016;31(8):878-87. PubMed PMID: 27071399.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does Motivation Matter? Analysis of a Randomized Trial of Proactive Outreach to VA Smokers. AU - Danan,Elisheva R, AU - Joseph,Anne M, AU - Sherman,Scott E, AU - Burgess,Diana J, AU - Noorbaloochi,Siamak, AU - Clothier,Barbara, AU - Japuntich,Sandra J, AU - Taylor,Brent C, AU - Fu,Steven S, Y1 - 2016/04/12/ PY - 2015/11/02/received PY - 2016/03/17/accepted PY - 2016/02/10/revised PY - 2016/4/14/entrez PY - 2016/4/14/pubmed PY - 2018/1/9/medline KW - motivation KW - smoking cessation KW - veterans SP - 878 EP - 87 JF - Journal of general internal medicine JO - J Gen Intern Med VL - 31 IS - 8 N2 - BACKGROUND: Current guidelines advise providers to assess smokers' readiness to quit, then offer cessation therapies to smokers planning to quit and motivational interventions to smokers not planning to quit. OBJECTIVES: We examined the relationship between baseline stage of change (SOC), treatment utilization, and smoking cessation to determine whether the effect of a proactive smoking cessation intervention was dependent on smokers' level of motivation to quit. DESIGN: Secondary analysis of a multicenter randomized controlled trial. PARTICIPANTS: A total of 3006 current smokers, aged 18-80 years, at four Veterans Affairs (VA) medical centers. INTERVENTIONS: Proactive care included proactive outreach (mailed invitation followed by telephone outreach), offer of smoking cessation services (telephone or face-to-face), and access to pharmacotherapy. Usual care participants had access to VA smoking cessation services and state telephone quitlines. MAIN MEASURES: Baseline SOC measured with Readiness to Quit Ladder, and 6-month prolonged abstinence self-reported at 1 year. KEY RESULTS: At baseline, 35.8 % of smokers were in preparation, 38.2 % in contemplation, and 26.0 % in precontemplation. The overall interaction between SOC and treatment arm was not statistically significant (p = 0.30). Among smokers in preparation, 21.1 % of proactive care participants achieved 6-month prolonged abstinence, compared to 13.1 % of usual care participants (OR, 1.8 [95 % CI, 1.2-2.6]). Similarly, proactive care increased abstinence among smokers in contemplation (11.0 % vs. 6.5 %; OR, 1.8 [95 % CI, 1.1-2.8]). Smokers in precontemplation quit smoking at similar rates (5.3 % vs. 5.6 %; OR, 0.9 [95 % CI, 0.5-1.9]). Within each stage, uptake of smoking cessation treatments increased with higher SOC and with proactive care as compared with usual care. LIMITATIONS: Mostly male participants limits generalizability. Randomization was not stratified by SOC. CONCLUSIONS: Proactive care increased treatment uptake compared to usual care across all SOC. Proactive care increased smoking cessation among smokers in preparation and contemplation but not in precontemplation. Proactively offering cessation therapies to smokers at all SOC will increase treatment utilization and population-level smoking cessation. SN - 1525-1497 UR - https://www.unboundmedicine.com/medline/citation/27071399/Does_Motivation_Matter_Analysis_of_a_Randomized_Trial_of_Proactive_Outreach_to_VA_Smokers_ L2 - https://dx.doi.org/10.1007/s11606-016-3687-1 DB - PRIME DP - Unbound Medicine ER -