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Optimizing Cost-Efficiency in Telephone Counseling for Smoking Cessation

Optimizing Cost-Efficiency in Telephone Counseling for Smoking Cessation. A Randomized Clinical Trial. Vance Rabius, PhD Alfred McAlister, PhD K. Joanne Pike, MA, LPC Dawn Wiatrek, PhD Presented at Bridging the Health Care Divide: Research and Programs to Eliminate Cancer Disparities

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Optimizing Cost-Efficiency in Telephone Counseling for Smoking Cessation

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  1. Optimizing Cost-Efficiency in Telephone Counseling for Smoking Cessation A Randomized Clinical Trial Vance Rabius, PhD Alfred McAlister, PhD K. Joanne Pike, MA, LPC Dawn Wiatrek, PhD Presented at Bridging the Health Care Divide: Research and Programs to Eliminate Cancer Disparities New Orleans, Louisiana – April 19, 2007

  2. Quitline and Disparities • Is Quitline relevant in our efforts to alleviate disparities in health care for African-Americans? • Do African-Americans use Quitline? • Quitline use is a function of promotion. • Do African-Americans benefit from Quitline?

  3. Quitline Utilization • African-Americans tend to use Quitline services in proportions • greater than their representation in the smoking community • Texas - 2001-2006 - 20,913 Quitline callers • 19% of Quitline callers and • 9% of Texas smokers and • 12% of Texas population are African-American • Louisiana - 2005-2006 - 5,227 Quitline callers • 36% of Quitline callers and • 26% of Louisiana smokers and • 33% of Louisiana population are African-American • Washington DC - 2006-2007 - 447 Quitline callers • 89% of Quitline callers and • 63% of Washington DC smokers and • 57% of Washington DC population are African-American

  4. Quitline Benefits • African-Americans tend to benefit from Quitline services at rates comparable to European-Americans Quit Rates as a Function of Treatment and Race/Ethnicity African-American European-American N = 3523, 15% African-American - Clinical Trial I - Presented at the 23rd Annual Meeting of the Society for Behavioral Medicine, Washington, DC ( April 2002)

  5. Clinical Trial Study Phases Enrollment phase Participant screening and randomization Baseline assessment • Demographic Information • Stage of Change • Treatment Moderators • Depression Indicator Treatment phase Intervention delivery Evaluation phase Assessment of smoking status Data analysis

  6. CLINICAL TRIAL DATES FEBRUARY 2002 – AUGUST 2004 6233 Cases Randomized 3223 Followed for 7 Months 51% response Rate 3 x 2 Experimental Design with Self-Help control 3 Counseling Protocols x Boosters or Not

  7. Telephone Counseling Protocols 5-Session Standard Protocol 2 Sessions – Before Quit Date 3 Sessions – After Quit Date Total Time = 210 Minutes 3-Session Protocol 1 Session – Before Quit Date 2 Sessions – After Quit Date Total Time = 105 Minutes 5-Session Brief Protocol 2 Sessions – Before Quit Date 3 Sessions – After Quit Date Total Time = 50 Minutes 2 Booster Sessions – 15 Minutes Each

  8. SAMPLE CHARACTERISTICS Demographics: Smoking Status: • Gender – Average Age • 70% female – • 44 years old • 30% male • 43 years old • 23 cigarettes smoked per day • 6 previous quit attempts • 94% have been smoking over 5 years • Education • 82% high school graduate or higher • 15% college graduate Depression Indicator • Sad and Blue 45% • Marital Status • 31% single • 40% married • Race/Ethnicity • 75% Anglo • 17% African-American • 2% Hispanic

  9. 30-DAY POINT-PREVALENCE CESSATION RATES AT 7 MONTHS AFTER REGISTRATION BY EXPERIMENTAL GROUP Telephone Counseling: 10.8 – 20.8% Self-Help Materials: 7.6 – 16.0% Telephone counseling significantly increases cessation rates (p<0.005)

  10. 30-Day Point-Prevalence Cessation Rates at 7 Months By Counseling Protocol ITT – Intent to treat RO – Respondent only

  11. 3 = 3 session 5S = 5 Standard 5B = 5 Brief B = Boosters Chi-Square = 12.3, df = 5, p < 0.05

  12. Quitline Benefits by Race/Ethnicity • African-American Quitline callers tend to display comparable rates of current depressive mood and comparable quit rates as European-American callers • African-American - 45.2% Sad or Blue European-American – 45.5% Sad or Blue Quit Rates as a Function of Treatment and Race/Ethnicity African-American European-American N = 6,322, 17% African-American - Clinical Trial III - Presented at the 2007 Cancer Disparities Conference, New Orleans, Louisiana ( April 2007)

  13. Conclusions from 7-month follow-up Counseling significantly increases quitting rates The number of counseling sessions available seems to be more important than the total amount of counseling time available. Booster sessions are more important for counseling protocols with shorter sessions or fewer sessions. African-Americans benefited from telephone counseling at rates comparable to European-Americans. Costs per successful quit ranged from approximately $500 for 5 session brief with boosters to $1000 for 5 session standard with boosters.

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