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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 18 of 18 Research Studies Displayed
Kowitt SD, Goldstein AO, Cykert S
A heart healthy intervention improved tobacco screening rates and cessation support in primary care practices.
This study investigated the outcomes of an evidence-based cardiovascular disease risk reduction tool called Heart Health Now to improve rates for tobacco cessation screening and counseling in small primary care practices in North Carolina. This tool was developed as part of AHRQ’s EvidenceNow initiative. This stepped wedge, stratified, cluster randomized trial looked at 28 practices that were staffed by 10 or fewer clinicians and had an electronic health record. Heart Health Now consisted of education tools, onsite practice facilitation for a year, and a practice-specific cardiovascular population management dashboard that included monthly, measure-specific run charts to help guide quality improvement. The practices included in their analyses consisted of 78,120 patients, and 17,687 smokers. From pre- to post-intervention, screening rates significantly increased from 82.7 to 96.2%. Cessation support rates also significantly increased from 44.3% to 50.1%. Some of the practices associated with improvement included being in an academic health center or faculty, having more clinicians, and having a lower percentage of White patients.
Citation: Kowitt SD, Goldstein AO, Cykert S . A heart healthy intervention improved tobacco screening rates and cessation support in primary care practices. J Prev 2022 Jun;43(3):375-86. doi: 10.1007/s10935-022-00672-5..
Keywords: Tobacco Use, Tobacco Use: Smoking Cessation, Screening, Primary Care, Evidence-Based Practice, Heart Disease and Health, Cardiovascular Conditions
Schnitzer K, Senft N, Tindle HA
Understanding engagement behaviors and rapport building in tobacco cessation telephone counseling: an analysis of audio-recorded counseling calls.
This study explored smokers’ and counselors’ engagement and rapport-building behaviors in telephone counseling for smoking cessation and patterns of these behaviors by smokers’ psychiatric symptoms. The study transcribed audio-recorded counseling calls among recently hospitalized participants enrolled in a smoking cessation randomized controlled trial (RCT). The study used baseline RCT data to explore frequencies of smokers’ behaviors among smokers who reported more symptoms of depression (PHQ8 ≥ 10) or anxiety (GAD7 ≥ 10) at study entry. A total of 37 participants were included, who were mostly female (23), White (26), with a median age of 58. At study entry many participants experienced moderate-to-severe symptoms of depression (18/37) and anxiety (22/37). Counselor-led behaviors included building off priority interaction, empathy, normalizing challenges, reframing and summarizing, validating achievements, and expressing shared experiences. Participant-led engagement behaviors occurred more often among patients with higher baseline depression and anxiety symptoms compared to those with lower symptom scores.
Citation: Schnitzer K, Senft N, Tindle HA . Understanding engagement behaviors and rapport building in tobacco cessation telephone counseling: an analysis of audio-recorded counseling calls. J Subst Abuse Treat 2022 Apr;135:108643. doi: 10.1016/j.jsat.2021.108643..
Keywords: Tobacco Use: Smoking Cessation, Tobacco Use, Patient and Family Engagement, Lifestyle Changes
McClure JB, Lapham G
Tobacco quitline engagement and outcomes among primary care patients reporting use of tobacco or dual tobacco and cannabis: an observational study.
Researchers examined dual users of tobacco and cannabis and how this use impacts individuals' interest in or ability to stop smoking. They found that, although dual use of tobacco and cannabis is common among smokers seen in primary care and those enrolling in quitline care, it may not undermine tobacco quitline engagement or smoking cessation. They concluded that tobacco quitline care was equally engaging and effective among tobacco users and dual users of tobacco and cannabis.
Citation: McClure JB, Lapham G . Tobacco quitline engagement and outcomes among primary care patients reporting use of tobacco or dual tobacco and cannabis: an observational study. Subst Abus 2021;42(4):417-22. doi: 10.1080/08897077.2020.1846665..
Keywords: Tobacco Use, Tobacco Use: Smoking Cessation, Primary Care
Lewis JA, Senft N, Chen H
Evidence-based smoking cessation treatment: a comparison by healthcare system.
The authors surveyed general medicine providers and specialists in a large academic health center (AHC) and its affiliated Veterans Health Administration (VHA) in the Mid-South in 2017 to determine the cross-sectional association of healthcare system in which the provider practiced (AHC versus VHA) with self-reported provision of evidence-based smoking cessation treatment at least once in the past 12 months. They found that VHA healthcare providers were significantly more likely to provide evidence-based smoking cessation treatment compared to AHC healthcare providers.
Citation: Lewis JA, Senft N, Chen H . Evidence-based smoking cessation treatment: a comparison by healthcare system. BMC Health Serv Res 2021 Jan 7;21(1):33. doi: 10.1186/s12913-020-06016-5..
Keywords: Health Systems, Tobacco Use: Smoking Cessation, Tobacco Use, Evidence-Based Practice, Veterans, Substance Abuse
Chu KH, Matheny SJ, Escobar-Viera CG
Smartphone health apps for tobacco cessation: a systematic review.
The objective of this systematic review was to identify and evaluate the types of studies that use smartphone apps for interventions in tobacco cessation. Findings showed that the majority of studies identified that use tobacco cessation apps as an intervention delivery modality were mostly at the pilot/feasibility stage. The growing field has resulted in studies that varied in methodologies, study design, and inclusion criteria. Recommendations included more consistency in intervention components and larger randomized controlled trials for tobacco cessation smartphone apps.
Citation: Chu KH, Matheny SJ, Escobar-Viera CG . Smartphone health apps for tobacco cessation: a systematic review. Addict Behav 2021 Jan;112:106616. doi: 10.1016/j.addbeh.2020.106616..
Keywords: Health Information Technology (HIT), Tobacco Use: Smoking Cessation, Tobacco Use, Evidence-Based Practice
Prochaska JJ, Brown-Johnson C, Baiocchi M
Treating tobacco dependence to aid re-employment among job-seekers: a randomized controlled trial.
This study evaluated whether a cessation intervention for job-seekers would result in significantly fewer cigarettes per day and a greater likelihood of tobacco abstinence and re-employment compared to a control group at 6-months follow-up. A cohort of unemployed job-seekers who smoked daily were recruited from five employment development departments in the San Francisco Bay Area from October 2015 to February 2018. The 360 participants were 70% men, 43% African American, 27% non-Hispanic Caucasian and 19% unhoused. They averaged 12 cigarettes per day, 67% smoked within 30 minutes of wakening, and 27% were in preparation stage to quit. Study participants were randomized to a brief motivationally-tailored, computer-assisted counseling intervention or referred to a toll-free quitline. Participants were more likely to make a quit attempt and reported a significantly greater reduction in cigarettes/day than control participants but bioconfirmed abstinence and re-employment did not differ by treatment group.
Citation: Prochaska JJ, Brown-Johnson C, Baiocchi M . Treating tobacco dependence to aid re-employment among job-seekers: a randomized controlled trial. Prev Med 2020 Dec;141:106259. doi: 10.1016/j.ypmed.2020.106259..
Keywords: Tobacco Use, Tobacco Use: Smoking Cessation
Oates GR, Harris WT, Gutierrez HH
Tobacco smoke exposure in pediatric cystic fibrosis: a qualitative study of clinician and caregiver perspectives on smoking cessation.
This qualitative study identified barriers and facilitators of smoking cessation in caregivers to children with cystic fibrosis (CF) and outlined potential interventional approaches. Researchers conducted semi-structured interviews with CF familial caregivers who were current or former smokers, and with members of the CF care team, asking about experiences, practices, and prerequisites for a successful program. Findings revealed intrapersonal, interpersonal, and structural barriers to eliminating tobacco smoke exposure in children with CF, outlined opportunities to address these barriers, and made recommendations for a comprehensive tobacco cessation strategy.
Citation: Oates GR, Harris WT, Gutierrez HH . Tobacco smoke exposure in pediatric cystic fibrosis: a qualitative study of clinician and caregiver perspectives on smoking cessation. Pediatr Pulmonol 2020 Sep;55(9):2330-40. doi: 10.1002/ppul.24879..
Keywords: Children/Adolescents, Tobacco Use, Tobacco Use: Smoking Cessation, Caregiving, Respiratory Conditions
Fan T, Smith HJ
AHRQ Author: Fan T
Primary care interventions for prevention and cessation of tobacco use in children and adolescents.
In this case study, three questions are posed concerning a 13-year-old girl presenting for a routine well-child visit who reports that she has never used tobacco products in any form.
Citation: Fan T, Smith HJ . Primary care interventions for prevention and cessation of tobacco use in children and adolescents. .
Keywords: U.S. Preventive Services Task Force (USPSTF), Case Study, Children/Adolescents, Tobacco Use: Smoking Cessation, Tobacco Use, Primary Care, Prevention, Substance Abuse
Friedman AS, Xu S
Associations of flavored e-cigarette uptake with subsequent smoking initiation and cessation.
Researchers evaluated whether new uptake of flavored e-cigarettes is more strongly associated with subsequent smoking initiation and cessation than uptake of unflavored e-cigarettes for youths, emerging adults, and prime-age adults. The cohort study conducted secondary data analyses of survey data from the Population Assessment of Tobacco and Health Study. The researchers found that vaping uptake was positively associated with smoking initiation in youth and in emerging adults, while vaping uptake was associated with cessation in adults. Additionally, vaping nontobacco flavors was no more associated with youth smoking initiation than vaping tobacco-flavors but was associated with increased adult smoking cessation. They recommended more research to establish the relationship between e-cigarette flavors and smoking and to guide related policy.
Citation: Friedman AS, Xu S . Associations of flavored e-cigarette uptake with subsequent smoking initiation and cessation. JAMA Netw Open 2020 Jun;3(6):e203826. doi: 10.1001/jamanetworkopen.2020.3826..
Keywords: Children/Adolescents, Young Adults, Tobacco Use: Smoking Cessation, Tobacco Use, Substance Abuse
Bailey SR, Marino M, Ezekiel-Herrera D
Tobacco cessation in Affordable Care Act Medicaid expansion states versus non-expansion states.
This study examined whether states that expanded Medicaid eligibility under the ACA had increased smoking quit rates, tobacco cessation medication orders, and greater health care utilization compared to patients in non-expansion states. The researchers used electronic health record (EHR) data from 219 community health centers (CHCs) in 10 states that expanded Medicaid as of January 2014. They identified patients aged 19-64 with tobacco use status in their records within six months prior to ACA Medicaid expansion and 1 or more visits. They found that patients in expansion states had increased adjusted odds of quitting, having a medication ordered and having follow-up visits compared to patients in non-expansion states.
Citation: Bailey SR, Marino M, Ezekiel-Herrera D . Tobacco cessation in Affordable Care Act Medicaid expansion states versus non-expansion states. Nicotine Tob Res 2020 Jun;22(6):1016-22. doi: 10.1093/ntr/ntz087..
Keywords: Tobacco Use: Smoking Cessation, Tobacco Use, Substance Abuse, Medication, Medicaid, Policy, Healthcare Utilization, Access to Care, Health Insurance
Selph S, Patnode C, Bailey SR
Primary care-relevant interventions for tobacco and nicotine use prevention and cessation in children and adolescents: updated evidence report and systematic review for the US Preventive Services Task Force.
Interventions to discourage the use of tobacco products (including electronic nicotine delivery systems or e-cigarettes) among children and adolescents may help decrease tobacco-related illness and injury. The objective of this study was to update the 2013 review on primary care-relevant interventions for tobacco use prevention and cessation in children and adolescents to inform the US Preventive Services Task Force.
Citation: Selph S, Patnode C, Bailey SR . Primary care-relevant interventions for tobacco and nicotine use prevention and cessation in children and adolescents: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 2020 Apr 28;323(16):1599-608. doi: 10.1001/jama.2020.3332..
Keywords: U.S. Preventive Services Task Force (USPSTF), Children/Adolescents, Tobacco Use, Tobacco Use: Smoking Cessation, Prevention, Primary Care, Evidence-Based Practice, Guidelines
Elkhadragy N, Corelli RL, Russ AL
Faculty perceptions of a tobacco cessation train-the-trainer workshop and experiences with implementation: a qualitative follow-up study.
Researchers conducted a long-term, qualitative follow-up study of faculty participants in the Rx for Change: Clinician-Assisted Tobacco Cessation workshop. All study participants reported implementing components of Rx for Change at their institution. The researchers’ analysis yielded eight major themes pertaining to faculty perceptions and experiences with implementation. They found that participation in the train-the-trainer workshop increased self-reported confidence for teaching tobacco cessation, and faculty valued access to useful, updated tools for teaching. Furthermore, the newly-acquired counseling skills were deemed helpful for treating patients' tobacco use and dependence in clinical practice.
AHRQ- funded; HS022119.
Citation: Elkhadragy N, Corelli RL, Russ AL . Faculty perceptions of a tobacco cessation train-the-trainer workshop and experiences with implementation: a qualitative follow-up study. Res Social Adm Pharm 2019 Dec;15(12):1436-45. doi: 10.1016/j.sapharm.2019.01.005..
Keywords: Tobacco Use: Smoking Cessation, Tobacco Use, Education: Continuing Medical Education
Maclean JC, Pesko MF, Hill SC
AHRQ Author: Hill SC
Public insurance expansions and smoking cessation medications.
The authors examined public insurance expansion on use of smoking cessation medications. The Affordable Care Act expanded coverage of these medications with financing with Medicaid. Data was analyzed from retail and online pharmacies from 2011 to 2017, and the expansion increased smoking cessation prescriptions by 24% in new medication use.
Citation: Maclean JC, Pesko MF, Hill SC . Public insurance expansions and smoking cessation medications. Econ Inq 2019 Oct;57(4):1798-820. doi: 10.1111/ecin.12794..
Keywords: Tobacco Use: Smoking Cessation, Tobacco Use, Health Insurance, Medication, Substance Abuse, Medicaid
Senft N, Sanderson M, Selove R
Attitudes toward precision treatment of smoking in the Southern Community Cohort Study.
Precision interventions using biological data may enhance smoking treatment, yet are understudied among smokers who are disproportionately burdened by smoking-related disease. In this study, the investigators surveyed smokers in the NCI-sponsored Southern Community Cohort Study, consisting primarily of African-American, low-income adults. The researchers concluded that among disproportionately burdened community smokers, most held favorable attitudes toward precision smoking treatment.
Citation: Senft N, Sanderson M, Selove R . Attitudes toward precision treatment of smoking in the Southern Community Cohort Study. Cancer Epidemiol Biomarkers Prev 2019 Aug;28(8):1345-52. doi: 10.1158/1055-9965.Epi-19-0179..
Keywords: Tobacco Use, Tobacco Use: Smoking Cessation, Substance Abuse, Social Determinants of Health, Cancer: Lung Cancer, Cancer
Chu KH, Colditz J, Malik M
Identifying key target audiences for public health campaigns: leveraging machine learning in the case of hookah tobacco smoking.
Current social media platforms provide researchers with opportunities to better identify and target specific audiences and even individuals. However, the investigators were not aware of systematic research attempting to identify audiences with mixed or ambivalent views toward hookah tobacco smoking (HTS). The objective of their study was to (1) confirm previous research showing positively skewed HTS sentiment on Twitter using a larger dataset by leveraging machine learning techniques and (2) systematically identify individuals who exhibit mixed opinions about HTS via the Twitter platform and therefore represent key audiences for intervention.
Citation: Chu KH, Colditz J, Malik M . Identifying key target audiences for public health campaigns: leveraging machine learning in the case of hookah tobacco smoking. J Med Internet Res 2019 Jul 8;21(7):e12443. doi: 10.2196/12443..
Keywords: Health Promotion, Public Health, Social Media, Tobacco Use, Tobacco Use: Smoking Cessation
Schnall R, Carcamo J, Porras T
Use of the phase-based model of smoking treatment to guide intervention development for persons living with HIV who self-identify as African American tobacco smokers.
To address the issue of developing effective tobacco cessation interventions for persons with HIV, this study conducted six focus group sessions with 45 African American smokers who are living with HIV in order to understand barriers to smoking cessation and strategies to help overcome these barriers. The participants articulated key components for incorporation into tobacco cessation intervention: personalized plans for quitting, reminders about the plan, and a support system. Participants also described barriers to use of pharmacotherapy, such as adverse side effects of nicotine gum and patch, and expressed concerns about negative health effects of some oral medications. The authors conclude that their findings provide information on the components of a tobacco cessation intervention for persons living with HIV.
Citation: Schnall R, Carcamo J, Porras T . Use of the phase-based model of smoking treatment to guide intervention development for persons living with HIV who self-identify as African American tobacco smokers. Int J Environ Res Public Health 2019 May 15;16(10). doi: 10.3390/ijerph16101703..
Keywords: Human Immunodeficiency Virus (HIV), Primary Care: Models of Care, Racial / Ethnic Minorities, Tobacco Use, Tobacco Use: Smoking Cessation
Cartmell KB, Dismuke CE, Dooley M
Effect of an evidence-based inpatient tobacco dependence treatment service on 1-year postdischarge health care costs.
In 2014, the Medical University of South Carolina (MUSC) implemented a Tobacco Dependence Treatment Service (TDTS) consistent with the Joint Commission (JC) standards recommending that hospitals screen patients for smoking, provide cessation support, and follow-up contact for relapse prevention within 1 month of discharge. This paper examined whether exposure to the TDTS influenced downstream health care charges 12 months after patients were discharged from the hospital.
Citation: Cartmell KB, Dismuke CE, Dooley M . Effect of an evidence-based inpatient tobacco dependence treatment service on 1-year postdischarge health care costs. Med Care 2018 Oct;56(10):883-89. doi: 10.1097/mlr.0000000000000979..
Keywords: Healthcare Costs, Inpatient Care, Screening, Substance Abuse, Tobacco Use: Smoking Cessation
Russo ET, Reid M, Taher R
Referral strategies to a tobacco quitline and racial and/or ethnic differences in participation.
This study evaluated the reach of two referral strategies to the Massachusetts tobacco-use quitline among African American and Hispanic smokers in Boston. The two strategies were a provider-referred strategy based in pediatric and dental clinics and a large-scale, targeted media campaign that promoted self-referral to the quitline. Demographic characteristics of the quitline participants during the study period were compared between the two strategies. Characteristics of self-referred smokers were also compared in the years before and after the media campaign, as were the characteristics of quitline participants with smokers in the 2010 Boston Behavioral Risk Factor Surveillance Survey. The results indicate that the media campaign was associated with higher quitline participation overall, but that the provider-referred strategy which was based in community health centers, yielded greater participation from African American and Hispanic smokers.
AHRQ-funded; HS024332; HS022986.
Citation: Russo ET, Reid M, Taher R . Referral strategies to a tobacco quitline and racial and/or ethnic differences in participation. Pediatrics 2018 Jan;141(Suppl 1):S30-s39. doi: 10.1542/peds.2017-1026G..
Keywords: Racial / Ethnic Minorities, Prevention, Tobacco Use, Tobacco Use: Smoking Cessation