Evaluation of a Minimal Self-Help Smoking Cessation Intervention Following Cervical Cancer Screening

doi:10.1006/pmed.1999.0514

Preventive Medicine

Volume 29, Issue 2, August 1999, Pages 133-138

https://doi.org/10.1006/pmed.1999.0514 Get rights and content

Abstract

Objective. This study was undertaken to evaluate a smoking cessation intervention provided to women smokers as follow-up to cervical cancer screening.

Methods. Women who had had a Pap test in the prior month (N = 4,053) were called to complete a survey that assessed smoking status; 580 identified smokers were randomized to receive Usual care (n = 292) or a Self-help intervention (n = 288) that included a self-help booklet, a smoking and reproductive health infor mation card, and three telephone counseling calls. Women were followed up at 6 and 15 months postbase line.

Results. Cessation rates in the Usual care (UC) and Self-help (SH) groups did not differ at the 6-month (UC 10.5% vs SH 10.9%, P = 0.56) or 15-month follow-up (UC 15.5% vs SH 10.6%, P = 0.17). Among women with an abnormal Pap test result there were no differences by study group in cessation rates at 6-month (UC 9.8% vs SH 11.0%, P = 0.71) or 15-month follow-up (UC 14.6% vs SH 13.4%, P = 0.96).

Conclusion. Integrating interventions into the clini cal setting and involving providers at the point of care may have greater potential for capitalizing on this “teachable moment.”

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Cited by (50)

A Randomized Controlled Study of Integrated Smoking Cessation in a Lung Cancer Screening Program
2019, Journal of Thoracic Oncology
Citation Excerpt :
Finally, a pilot study recently reported on short-term (3-month) quit rates in 92 screening participants randomized to a telephone counseling intervention similar to ours versus usual care and noted similar self-reported quit rates (21.7% vs. 19.6%), although biochemically confirmed quit rates were higher (17.4% vs. 4.3%).36 Attempts at integrating smoking cessation with cervical cancer screening has had mixed success.16,37,38 The difficulty in showing increased smoking cessation rates in screening programs through the application of interventions otherwise considered effective requires further discussion.39
Smoking cessation activities incorporated into lung cancer screening programs have been broadly recommended, but studies to date have not shown increased quit rates associated with cessation programs in this setting. We aimed to determine the effectiveness of smoking cessation counseling in smokers presenting for lung cancer screening.
This study is a randomized control trial of an intensive telephone-based smoking cessation counseling intervention incorporating lung cancer screening results versus usual care (information pamphlet). All active smokers enrolled in the Alberta Lung Cancer Screening Study cohort were randomized on a 1:1 ratio with a primary endpoint of self-reported 30-day abstinence at 12 months.
A total of 345 active smokers participating in the screening study were randomized to active smoking cessation counseling (n = 171) or control arm (n = 174). Thirty-day smoking abstinence at 12 months post-randomization was noted in 22 of 174 (12.6%) and 24 of 171 (14.0%) of participants in the control and intervention arms, respectively, a 1.4% difference (95% confidence interval: -5.9 to 8.7, p = 0.7). No statistically significant differences in 7-day or point abstinence were noted, nor were differences at 6 months or 24 months.
A telephone-based smoking cessation counseling intervention incorporating lung cancer screening results did not result in increased 12-month cessation rates versus written information alone in unselected smokers undergoing lung cancer screening. Routine referral of all current smokers to counseling-based cessation programs may not improve long-term cessation in this patient cohort. Future studies should specifically focus on this subgroup of older long-term smokers to determine the optimal method of integrating smoking cessation with lung cancer screening (clinicaltrials.gov NCT02431962).
Smoking Cessation among Female and Male Veterans before and after a Randomized Trial of Proactive Outreach
2019, Women's Health Issues
Female veterans smoke cigarettes at high rates compared with both male veterans and nonveteran women. Proactive outreach to smokers may reduce gender disparities in cessation care. The objectives of this study were to compare baseline experiences with VA smoking cessation care for men and women and to assess for gender differences in response to a proactive outreach intervention.
We conducted a post hoc subgroup analysis of a pragmatic, multisite randomized, controlled trial comparing proactive outreach with usual care (UC). Baseline experiences included physician advice to quit, satisfaction with care, and past-year treatment use. At the 1-year follow-up, treatment use, quit attempts, and 6-month prolonged abstinence for women and men randomized to proactive outreach versus UC were compared using logistic regression.
Baseline and follow-up surveys were returned by 138 women and 2,516 men. At baseline, women were less likely than men to report being very or somewhat satisfied with the process of obtaining smoking cessation medications in the VA (47% of women vs. 62% of men), but no less likely to report having used cessation medications from the VA in the past year (39% of women vs. 34% of men). After the intervention, phone counseling and combined therapy increased among both women and men in proactive outreach as compared with UC. At the 1-year follow-up, men in proactive outreach were significantly more likely to report prolonged abstinence than those in UC (odds ratio, 1.65; 95% CI, 1.28–2.14); results for women were in the same direction but not statistically significant (odds ratio, 1.39; 95% CI, 0.48–3.99).
Satisfaction with cessation care in VA remains low. Proactive outreach to smokers was associated with an increased use of cessation therapies, and increased odds of achieving prolonged abstinence. A subgroup analysis by gender did not reveal significant differences in the treatment effect.
Acceptability of receiving lifestyle advice at cervical, breast and bowel cancer screening
2019, Preventive Medicine
Citation Excerpt :
Most participants indicated they would like to receive lifestyle advice at the screening appointment itself. Other research suggests the timing of interventions delivered in the context of cancer screening is important (McBride et al., 1999). It has also been reported that people attending screening would prefer advice to be given by an expert, such as a health professional (Fisher et al., 2007).
Cancer screening could be an opportunity to deliver cancer prevention advice, but it is not known how such information would be received. We explored willingness to receive lifestyle advice in the context of the English National Health Service cervical, breast, and bowel (FS; flexible sigmoidoscopy) screening programmes. A population-based survey was conducted in 2016 to collect nationally representative data on willingness to receive lifestyle advice across cervical (n = 768), breast (n = 420) and FS (n = 308) screening programmes. Additional items assessed the impact of lifestyle advice on screening attendance, preference for receiving advice in the event of an abnormal screening result, and timing of advice. Most respondents were willing to receive lifestyle advice around the time of cancer screening (cervical 78.9%, breast 79.4%, FS 81.8%), and if their results were abnormal (cervical 86.3%, breast 83.0%, FS 85.1%). A small proportion indicated it may discourage future attendance (cervical 4.9%, breast 7.0%, FS 8.8%). Most preferred information to be delivered at the screening appointment (cervical 69.8%, breast 72.6%, FS 70.7%). There were no associations between sociodemographic characteristics and willingness to receive lifestyle advice at breast screening. For those intending to attend cervical screening, non-White ethnicity and higher education were associated with increased willingness to receive lifestyle advice. Women were more likely to be willing to receive advice at FS screening than men. Providing lifestyle advice at cancer screening is likely to be acceptable to the general population. The optimal approach for delivery needs careful consideration to minimise potential negative effects on screening attendance.
The Equity Impact of Proactive Outreach to Smokers: Analysis of a Randomized Trial
2018, American Journal of Preventive Medicine
Population-based smoking-cessation services tend to preferentially benefit high-SES smokers, potentially exacerbating disparities. Interventions that include proactive outreach, telephone counseling, and free or low-cost cessation medications may be more likely to help low-SES smokers quit. This analysis evaluated the role of SES in smokers’ response to a population-based proactive smoking-cessation intervention.
This study, conducted in 2016 and 2017, was a secondary analysis of the Veterans Victory Over Tobacco Study, a multicenter pragmatic RCT of a proactive smoking-cessation intervention conducted from 2009 to 2011. Logistic regression modeling was used to test the effect of income or education level on 6-month prolonged abstinence at 1-year follow-up.
Of the 5,123 eligible, randomized participants, 2,565 (50%) reported their education level and 2,430 (47%) reported their income level. The interactions between education (p=0.07) or income (p=0.74) X treatment arm were not statistically significant at the 0.05 level. The largest effect sizes for the intervention were found among smokers in the lowest education category (≤11th grade), with a quit rate of 17.3% as compared with 5.7% in usual care (OR=3.5, 95% CI=1.4, 8.6) and in the lowest income range (<$10,000), with a quit rate of 18.7% as compared with 9.4% in usual care (OR=2.2, 95% CI=1.2, 4.0).
In a large, multicenter smoking-cessation trial, proactive outreach was associated with higher rates of prolonged abstinence among smokers at all SES levels. Proactive outreach interventions that integrate telephone-based care and facilitated cessation medication access have the potential to reduce socioeconomic disparities in quitting.
This study is registered at www.clinicaltrials.gov NCT00608426.
Preliminary evaluation of a telephone-based smoking cessation intervention in the lung cancer screening setting: A randomized clinical trial
2017, Lung Cancer
Citation Excerpt :
Building on our prior work [9,14–16], we evaluated a scalable telephone counseling (TC) cessation intervention to provide a personalized, intensive intervention in which the LCS result is leveraged to enhance motivation. TC has demonstrated effectiveness among older smokers [5,17–21], smokers who are not ready to quit [22–32], and non-treatment seeking smokers [29,33], making it an important intervention to test in this setting. In a randomized clinical trial, we hypothesized that TC would yield higher quit rates than usual care.
Incorporating effective smoking cessation interventions into lung cancer screening (LCS) programs will be essential to realizing the full benefit of screening. We conducted a pilot randomized trial to determine the feasibility and efficacy of a telephone-counseling (TC) smoking cessation intervention vs. usual care (UC) in the LCS setting. In collaboration with 3 geographically diverse LCS programs, we enrolled current smokers (61.5% participation rate) who were: registered to undergo LCS, 50–77 years old, and had a 20+ pack-year smoking history. Eligibility was not based on readiness to quit. Participants completed pre-LCS (T0) and post-LCS (T1) telephone assessments, were randomized to TC (N = 46) vs. UC (N = 46), and completed a final 3-month telephone assessment (T2). Both study arms received a list of evidence-based cessation resources. TC participants also received up to 6 brief counseling calls with a trained cessation counselor. Counseling calls incorporated motivational interviewing and utilized the screening result as a motivator for quitting. The outcome was biochemically verified 7-day point prevalence cessation at 3-months post-randomization. Participants (56.5% female) were 60.2 (SD = 5.4) years old and reported 47.1 (SD = 22.2) pack years; 30% were ready to stop smoking in the next 30 days. TC participants completed an average of 4.4 (SD = 2.3) sessions. Using intent-to-treat analyses, biochemically verified quit rates were 17.4% (TC) vs. 4.3% (UC), p < .05. This study provides preliminary evidence that telephone-based cessation counseling is feasible and efficacious in the LCS setting. As millions of current smokers are now eligible for lung cancer screening, this setting represents an important opportunity to exert a large public health impact on cessation among smokers who are at very high risk for multiple tobacco-related diseases. If this evidence-based, brief, and scalable intervention is replicated, TC could help to improve the overall cost-effectiveness of LCS.
NCT02267096, https://clinicaltrials.gov
Perspectives in Implementing a Primary Care-Based Intervention to Reduce Alcohol Misuse
2015, American Journal of Preventive Medicine
Citation Excerpt :
The model highlights the importance of clinical information systems (e.g., electronic health records and patient registries); decision support (e.g., evidence-based practice guidelines); delivery system design (e.g., specified roles for all practice personnel); and self-management support (e.g., behavioral counseling interventions) that may be supported by community resources. At the time this study was being designed and implemented, the research team had been involved in several primary care–based behavioral counseling studies.14–20 Although the behavioral targets and study protocols varied, all of the studies benefited from the Chronic Care Model as a guiding framework as well as from a foundational commitment to “get practice into research.”
In 2013, the U.S. Preventive Services Task Force (USPSTF) recommended screening followed by brief behavioral counseling to reduce alcohol misuse. Our study, Options Regarding Consumption of Alcohol (ORCA), was one of the studies included in an evidence review that comprised 23 RCTs. ORCA was designed to test whether a primary care–based intervention would reduce alcohol misuse among patients who screened positive for risky or hazardous drinking. Data collection occurred between 1995 and 1999; data analysis was conducted in 2000–2002. Study design and implementation built from a behavioral counseling research paradigm with four components: (1) population-based screening; (2) centralized delivery of intervention components; (3) involvement of primary care practitioners to motivate and reinforce behavior change; and (4) personalization of intervention components. In this paper, we assess the study features using the Pragmatic–Explanatory Continuum Indicator Summary Model domains. As a randomized trial, the study included some explanatory features (e.g., standardized follow-up surveys administered by study personnel); however, several aspects of the study were highly pragmatic. Practicable recruitment and training of providers, embedding population-based screening in pre-visit surveys, and keeping the delivery of the primary care intervention components consistent with the tempo and competing priorities of practice are three key features that contributed to the study’s success and relevance to the USPSTF.

View all citing articles on Scopus

^☆: This work was supported in part by National Cancer Institute Grants CA60141, CA72099, and CA76945 and National Heart Lung and Blood Institute Grant HL48121-05.

²: To whom reprint requests should be addressed at Duke Compre hensive Cancer Center, Cancer Prevention, Detection and Control Research Program, Hanes House—Box 2949, Trent Drive, Durham, NC 27710-2949.

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Regular ArticleEvaluation of a Minimal Self-Help Smoking Cessation Intervention Following Cervical Cancer Screening☆

Abstract

Am J Obstet Gynecol

Addict Be hav

Obstet Gynecol

Trends and effects of cigarette smoking among girls and women in the United States, 1965–1993

J Am Med Womens Assoc

Commentary: Smoking v women's health: the challenge ahead

J Am Med Womens Assoc

MMWR

Women's use of health care

Postpartum relapse to smoking: a prospective study

Health Educ Res

Biochemical epidemiology of cervical neopla sia: measuring cigarette smoke constituents in the cervix

Cancer Res

Nicotine and cotinine in the cervical mucus of smokers, passive smokers, and nonsmokers

Cancer Epidemiol Biomarkers Prev

Evaluation of intrinsic and extrinsic motivation interventions with a self-help smoking ces sation program

J Consult Clin Psychol

Regular Article
Evaluation of a Minimal Self-Help Smoking Cessation Intervention Following Cervical Cancer Screening☆