Advertisement

Effectiveness of the Tobacco Tactics Program in the Trinity Health System

      Introduction

      This study determined the effectiveness of the Tobacco Tactics intervention.

      Design/setting/participants

      This was a pragmatic, quasi-experimental study conducted from 2010 to 2013 and analyzed from 2014 to 2015 in five Michigan community hospitals; three received the Tobacco Tactics intervention, and two received usual care. Smokers (N=1,528) were identified during hospitalization, and sent surveys and cotinine tests after 6 months. Changes in pre- to post-intervention quit rates in the intervention sites were compared with usual care control sites.

      Intervention

      The toolkit for nurses included: (1) 1 continuing education unit contact hour for training; (2) a PowerPoint presentation on behavioral and pharmaceutical interventions; (3) a pocket card entitled “Helping Smokers Quit: A Guide for Clinicians”; (4) behavioral and pharmaceutical protocols; and (5) a computerized template for documentation. The toolkit for patients included: (1) a brochure; (2) a cessation DVD; (3) the Tobacco Tactics manual; (4) a 1-800-QUIT-NOW card; (5) nurse behavioral counseling and pharmaceuticals; (6) physician reminders to offer brief advice to quit coupled with medication sign-off; and (7) follow-up phone calls by trained hospital volunteers.

      Main outcome measures

      The effectiveness of the intervention was measured by 6-month 30-day point prevalence; self-reported quit rates with NicAlert® urinary biochemical verification (48-hour detection period); and the use of electronic medical record data among non-responders.

      Results

      There were significant improvements in pre- to post-intervention self-reported quit rates (5.7% vs 16.5%, p<0.001) and cotinine-verified quit rates (4.3% vs 8.0%, p<0.05) in the intervention sites compared with no change in the control sites. Propensity-adjusted multivariable analyses showed a significant improvement in self-reported 6-month quit rates from the pre- to post-intervention time periods in the intervention sites compared to the control sites (p=0.044) and a non–statistically significant improvement in the cotinine-verified 6-month quit rate.

      Conclusions

      The Tobacco Tactics intervention, which meets the Joint Commission standards for inpatient smoking, has the potential to significantly decrease smoking among inpatient smokers.

      Trial Registration

      This study is registered at www.clinicaltrial.gov NCT01309217.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Rigotti N.A.
        • Clair C.
        • Munafo M.R.
        • Stead L.F.
        Interventions for smoking cessation in hospitalised patients.
        Cochrane Database Syst Rev. 2012; 5: CD001837https://doi.org/10.1002/14651858.cd001837.pub3
        • Rice V.H.
        • Hartmann-Boyce J.
        • Stead L.F.
        Nursing interventions for smoking cessation.
        Cochrane Database Syst Rev. 2013;
        • Simon J.A.
        • Carmody T.P.
        • Hudes E.S.
        • Snyder E.
        • Murray J.
        Intensive smoking cessation counseling versus minimal counseling among hospitalized smokers treated with transdermal nicotine replacement: a randomized trial.
        Am J Med. 2003; 114: 555-562https://doi.org/10.1016/S0002-9343(03)00081-0
        • Taylor C.B.
        • Curry S.J.
        Implementation of evidence-based tobacco use cessation guidelines in managed care organizations.
        Ann Behav Med. 2004; 27: 13-21https://doi.org/10.1207/s15324796abm2701_3
        • Kaufman A.
        • Augustson E.
        • Davis K.I.A.
        • Finney Rutten L.J.
        Awareness and use of tobacco quitlines: evidence from the Health Information National Trends Survey.
        J Health Commun. 2010; 15: 264-278https://doi.org/10.1080/10810730.2010.526172
        • Vick L.
        • Duffy S.A.
        • Ewing L.A.
        • Rugen K.
        • Zak C.
        Implementation of an inpatient smoking cessation programme in a Veterans Affairs facility.
        J Clin Nurs. 2013; 22: 866-880
        • Duffy S.A.
        • Ronis D.L.
        • Valenstein M.
        • et al.
        A tailored smoking, alcohol, and depression intervention for head and neck cancer patients.
        Cancer Epidemiol Biomarkers Prev. 2006; 15: 2203-2208https://doi.org/10.1158/1055-9965.EPI-05-0880
        • Duffy S.A.
        • Ronis D.L.
        • Richardson C.
        • et al.
        Protocol of a randomized controlled trial of the Tobacco Tactics website for operating engineers.
        BMC Public Health. 2012; 12: 335https://doi.org/10.1186/1471-2458-12-335
        • Duffy S.A.
        • Ronis D.L.
        • Karvonen-Gutierrez C.A.
        • et al.
        Effectiveness of the Tobacco Tactics Program in the Department of Veterans Affairs.
        Ann Behav Med. 2014; 48: 265-274https://doi.org/10.1007/s12160-014-9605-z
        • Duffy S.A.
        • Karvonen-Gutierrez C.A.
        • Ewing L.A.
        • Smith P.M.
        Veterans Integrated Services Network (VISN) 11 Tobacco Tactics Team. Implementation of the Tobacco Tactics Program in the Department of Veterans Affairs.
        J Gen Intern Med. 2010; 25: 3-10https://doi.org/10.1007/s11606-009-1075-9
      1. Tobacco Use and Dependence Guideline Panel. Treating tobacco use and dependence: 2008 update. http://www.ncbi.nlm.nih.gov/books/NBK63952/. Published 2008. Accessed March 7, 2016.

        • Duffy S.A.
        • Ronis D.L.
        • Titler M.G.
        • et al.
        Dissemination of the nurse-administered Tobacco Tactics intervention versus usual care in six Trinity community hospitals: study protocol for a comparative effectiveness trial.
        Trials. 2012; 13: 125https://doi.org/10.1186/1745-6215-13-125
        • Dillman D.A.
        • Smyth J.D.
        • Christian L.M.
        Internet, Mail and Mixed-Mode Surveys: The Tailored Design Method. 3rd ed. Wiley & Sons, Hoboken, NJ2009
        • Ewing L.A.
        • Karvonen-Gutierrez C.A.
        • Noonan D.
        • Duffy S.A.
        Development of the Tobacco Tactics logo: from thumb prints to press.
        Tob Induc Dis. 2012; 10: 6https://doi.org/10.1186/1617-9625-10-6
        • Duffy S.A.
        • Ewing L.A.
        • Louzon S.A.
        • Ronis D.L.
        • Jordan N.
        • Harrod M.
        Evaluation and costs of volunteer telephone cessation follow-up counseling for Veteran smokers discharged from inpatient units: a quasi-experimental, mixed methods study.
        Tob Induc Dis. 2015; 13: 4https://doi.org/10.1186/s12971-015-0028-9
      2. Louisville Metro Department of Public Health and Wellness. Remember the 3 R’s. https://louisvilleky.gov/sites/default/files/health_and_wellness/educationalmaterials/wk11-_three_rs_handout.pdf. Accessed January 13, 2016.

      3. Green CJ. Quit Smoking Aids—The 4D’s—Delay, Deep Breath, Drink Water and Do Something Else. http://ezinearticles.com/?Quit-Smoking-Aids---The-4Ds---Delay,-Deep-Breath,-Drink-Water-and-Do-Something-Else&id=3864747. Published 2010. Accessed January 13, 2016.

        • Riley W.T.
        • Stevens V.J.
        • Zhu S.H.
        • Morgan G.
        • Grossman D.
        Overview of the Consortium of Hospitals Advancing Research on Tobacco (CHART).
        Trials. 2012; 13: 122https://doi.org/10.1186/1745-6215-13-122
      4. The International Classification of Diseases, Tenth Revision. Diseases and Injuries Tabular Index.
        • Dawson D.A.
        • Grant B.F.
        • Stinson F.S.
        • Zhou Y.
        Effectiveness of the derived Alcohol Use Disorders Identification Test (AUDIT-C) in screening for alcohol use disorders and risk drinking in the US general population.
        Alcohol Clin Exp Res. 2005; 29: 844-854https://doi.org/10.1097/01.ALC.0000164374.32229.A2
      5. Ware J.E. SF-36 Health Survey: Manual and Interpretation Guide. The Health Institute, New England Medical Center, Boston, MA1993
        • Herdman M.
        • Gudex C.
        • Lloyd A.
        • et al.
        Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L).
        Qual Life Res. 2011; 20: 1727-1736https://doi.org/10.1007/s11136-011-9903-x
        • Austin P.C.
        An introduction to propensity score methods for reducing the effects of confounding in observational studies.
        Multivariate Behav Res. 2011; 46: 399-424https://doi.org/10.1080/00273171.2011.568786
        • D’Agostino Jr, R.B.
        Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group.
        Stat Med. 1998; 17: 2265-2281https://doi.org/10.1002/(SICI)1097-0258(19981015)17:19<2265::AID-SIM918>3.0.CO;2-B
        • Morel J.G.
        • Bokossa M.C.
        • Neerchal N.K.
        Small sample correction for the variance of GEE estimators. Biometric J. 2003; 45: 395-409https://doi.org/10.1002/bimj.200390021
        • Rigotti N.
        • Regan S.
        • Levy D.
        • et al.
        Sustained care intervention and postdischarge smoking cessation among hospitalized adults: a randomized clinical trial.
        JAMA. 2014; 312: 719-728https://doi.org/10.1001/jama.2014.9237
        • Mohiuddin S.M.
        • Mooss A.N.
        • Hunter C.B.
        • Grollmes T.L.
        • Cloutier D.A.
        • Hilleman D.E.
        Intensive smoking cessation intervention reduces mortality in high-risk smokers with cardiovascular disease.
        Chest. 2007; 131: 446-452https://doi.org/10.1378/chest.06-1587
        • Chouinard M.C.
        • Robichaud-Ekstrand S.
        The effectiveness of a nursing inpatient smoking cessation program in individuals with cardiovascular disease.
        Nurs Res. 2005; 54: 243-254https://doi.org/10.1097/00006199-200507000-00006
        • Gadomski A.M.
        • Gavett J.
        • Krupa N.
        • Tallman N.
        • Jenkins P.
        Effectiveness of an inpatient smoking cessation program.
        J Hosp Med. 2011; 6: E1-E8https://doi.org/10.1002/jhm.641
        • Reid R.D.
        • Mullen K.A.
        • Slovinec D’Angelo M.E.
        • et al.
        Smoking cessation for hospitalized smokers: an evaluation of the “Ottawa Model.”.
        Nicotine Tob Res. 2010; 12: 11-18https://doi.org/10.1093/ntr/ntp165
        • Lando H.
        • Hennrikus D.
        • McCarty M.
        • Vessey J.
        Predictors of quitting in hospitalized smokers.
        Nicotine Tob Res. 2003; 5: 215-222https://doi.org/10.1080/0955300031000083436
      6. Joint Commission on Accreditation of Healthcare Organizations. Tobacco Treatment Measures (TTM). www.jointcommission.org/assets/1/6/Tobacco%20Treatment%20Measures%20List1.PDF. Published 2011. Accessed February 2, 2012.

        • Reid J.L.
        • Hammond D.
        • Boudreau C.
        • Fong G.T.
        • Siahpush M.
        Socioeconomic disparities in quit intentions, quit attempts, and smoking abstinence among smokers in four western countries: findings from the International Tobacco Control Four Country Survey.
        Nicotine Tob Res. 2010; 12: S20-S33https://doi.org/10.1093/ntr/ntq051
        • Tzelepis F.
        • Paul C.L.
        • Walsh R.A.
        • McElduff P.
        • Knight J.
        Proactive telephone counseling for smoking cessation: meta-analyses by recruitment channel and methodological quality.
        J Natl Cancer Inst. 2011; 103: 922-941https://doi.org/10.1093/jnci/djr169
        • Haapanen-Niemi N.
        • Miilunpalo S.
        • Vuori I.
        • Pasanen M.
        • Oja P.
        The impact of smoking, alcohol consumption, and physical activity on use of hospital services.
        Am J Public Health. 1999; 89: 691-698https://doi.org/10.2105/AJPH.89.5.691
        • Twardella D.
        • Loew M.
        • Rothenbacher D.
        • Stegmaier C.
        • Ziegler H.
        • Brenner H.
        The diagnosis of a smoking-related disease is a prominent trigger for smoking cessation in a retrospective cohort study.
        J Clin Epidemiol. 2006; 59: 82-89https://doi.org/10.1016/j.jclinepi.2005.05.003
        • Boudreaux E.D.
        • Baumann B.M.
        • Camargo Jr, C.A.
        • O’Hea E.
        • Ziedonis D.M.
        Changes in smoking associated with an acute health event: theoretical and practical implications.
        Ann Behav Med. 2007; 33: 189-199https://doi.org/10.1007/BF02879900
        • Solty H.
        • Crockford D.
        • White W.D.
        • Currie S.
        Cigarette smoking, nicotine dependence, and motivation for smoking cessation in psychiatric inpatients.
        Can J Psychiatry. 2009; 54: 36-45
        • Katz D.A.
        • Holman J.E.
        • Johnson S.R.
        • et al.
        Implementing best evidence in smoking cessation treatment for hospitalized veterans: results from the VA-BEST Trial.
        Jt Comm J Qual Patient Saf. 2014; 40: 493-503
        • Gadomski A.M.
        • Stayton M.
        • Krupa N.
        • Jenkins P.
        Implementing a smoke-free medical campus: impact on inpatient and employee outcomes.
        J Hosp Med. 2010; 5: 51-54https://doi.org/10.1002/jhm.473
        • Nelson D.B.
        • Partin M.R.
        • Fu S.S.
        • Joseph A.M.
        • An L.C.
        Why assigning ongoing tobacco use is not necessarily a conservative approach to handling missing tobacco cessation outcomes.
        Nicotine Tob Res. 2009; 11: 77-83https://doi.org/10.1093/ntr/ntn013