Smoking
Conditions
Keywords
Smoking Cessation, Telephone, Hospital Volunteers
Brief summary
The purpose of this study is to evaluate the peer telephone cessation counseling that has been and continues to be implemented at the Ann Arbor VA as part of the Tobacco Tactics intervention.
Detailed description
Background: As part of the nurse-administered Tobacco Tactics intervention, we developed a novel program to train veterans from Voluntary Services to provide peer telephone cessation counseling calls. Objectives: The objective of this study is to conduct an in-depth evaluation of the volunteer peer telephone cessation counseling that has been implemented and continues to be implemented at the Ann Arbor Veterans Affairs (VA) hospital as part of the inpatient Tobacco Tactics intervention. Methods: Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, this quasi-experimental study will collect both quantitative and qualitative data to evaluate the peer telephone cessation counseling component of the Tobacco Tactics intervention. The Reach of the program will be evaluated by determining differences in the demographics, health characteristics, and smoking characteristics of those who do and do not participate in the peer telephone cessation counseling. The Effectiveness of the program will be evaluated by determining if there were differences in quit rates between those that do and do not participate in the peer telephone cessation counseling. The Adoption and Implementation of the program will be evaluated by determining the satisfaction with the counseling, reasons for nonparticipation, the type and quality of counseling actually provided, and barriers and facilitators to implementing the counseling as perceived by staff. The Maintenance of the program will be evaluated by determining the estimated costs of implementing the peer telephone cessation counseling. Impact: The Tobacco Use/Smoking Cessation goal of the VA Substance Use Disorders (SUD) Quality Enhancement Research Initiative (QUERI) is to develop, implement and evaluate cost-effective interventions for increasing access to and use of evidence-based smoking cessation treatment. Telephone counseling has been shown to be efficacious and teaching volunteer veterans to provide this service is an option that is likely to be cost effective. Hence, evaluating the peer cessation telephone counseling program at the Ann Arbor VA will provide valuable information as to whether or not the program is a viable option for wider scale dissemination.
Interventions
BEHAVIORALPeer telephone cessation counseling
For Veterans who received the inpatient Tobacco Tactics intervention, trained volunteers initiated follow-up telephone cessation counseling at 2, 14, 21 and 60 days after in-patient discharge; three attempts were made per time point.
Sponsors
VA Office of Research and Development
Study design
Observational model
COHORT
Time perspective
CROSS_SECTIONAL
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* The inclusion criteria: veterans who received the Tobacco Tactics intervention as an inpatient in the hospital.
Exclusion criteria
* The
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Smoking Quit Rate by Number of Calls Received | 7-day point prevalence self-reported smoking quit rate 60 days after discharge | Smoking status around 60-days post-discharge (range 1 month to 5 months) was collected from electronic medical record text fields (smoked in the past 7 days-yes/no) or 60-day volunteer documentation (smoked in the last 24 hours-yes/no). When smoking status data was missing, participants were considered to be a smoker. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | 60 days after discharge | Demographics and health characteristics of those who had high participation (2-4 contacts) versus low (0 to 1 contacts) in the telephone counseling program (Reach) Row totals may vary due to missing data. |
| Participants' Attitudes About the Implementation of the Telephone Counseling | 60 days after discharge | Thirty-minute qualitative telephone interviews were conducted with Veteran smokers that participated in the volunteer peer telephone cessation counseling. |
| Cost Per Quit of Volunteer Peer Telephone Counseling | 60 days after discharge | The primary cost component of the intervention is the cost of labor by providers to train the volunteers and enter volunteer documentation into the electronic medical record. These costs were estimated using VA salary and fringe benefit information obtained from the Financial Management System (FMS). Number of hours spent by the volunteers providing telephone counseling was also tracked. Other intervention costs included nominal supplies associated with training and the intervention. Because the volunteers made their telephone calls in an unused office, the cost of space was not included. Recruitment and other research-related costs were excluded. The average cost per quit is a mean, but is reported here as a number, as no measures of dispersion were available. |
Countries
United States
Participant flow
Recruitment details
Patients who were provided with the Tobacco Tactics manual as part of their inpatient hospitalization were automatically referred to the volunteer telephone cessation counseling program.
Participants by arm
| Arm | Count |
|---|---|
| Volunteer Telephone Cessation Counseling The cohort is discharged veteran smokers who received the standard-of-care Tobacco Tactics intervention while in the hospital an follow-up volunteer peer telephone counseling | 131 |
| Total | 131 |
Baseline characteristics
| Characteristic | Volunteer Telephone Cessation Counseling |
|---|---|
| Age, Continuous | 57.8 years STANDARD_DEVIATION 9.6 |
| Race (NIH/OMB) American Indian or Alaska Native | 1 Participants |
| Race (NIH/OMB) Asian | 0 Participants |
| Race (NIH/OMB) Black or African American | 5 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 10 Participants |
| Race (NIH/OMB) White | 115 Participants |
| Sex: Female, Male Female | 6 Participants |
| Sex: Female, Male Male | 125 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 0 / 131 |
| serious Total, serious adverse events | 0 / 131 |
Outcome results
Primary
Smoking Quit Rate by Number of Calls Received
Smoking status around 60-days post-discharge (range 1 month to 5 months) was collected from electronic medical record text fields (smoked in the past 7 days-yes/no) or 60-day volunteer documentation (smoked in the last 24 hours-yes/no). When smoking status data was missing, participants were considered to be a smoker.
Time frame: 7-day point prevalence self-reported smoking quit rate 60 days after discharge
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Quit Rate With Low Participation in Counseling | Smoking Quit Rate by Number of Calls Received | 1 Participants |
| Quit Rate High Participation in Counseling | Smoking Quit Rate by Number of Calls Received | 35 Participants |
Comparison: Bivariate relationships between a patient's participation in the program and smoking status were calculated.p-value: <0.01Fisher Exact
Secondary
Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge
Demographics and health characteristics of those who had high participation (2-4 contacts) versus low (0 to 1 contacts) in the telephone counseling program (Reach) Row totals may vary due to missing data.
Time frame: 60 days after discharge
Population: Row totals may vary due to missing data.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Quit Rate With Low Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | Male | 101 participants |
| Quit Rate With Low Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | Female | 5 participants |
| Quit Rate With Low Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | Non-Hispanic White | 94 participants |
| Quit Rate With Low Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | Other race/ethnicity | 11 participants |
| Quit Rate With Low Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | Married | 36 participants |
| Quit Rate With Low Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | Not Married | 69 participants |
| Quit Rate With Low Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | High School/GED or less | 59 participants |
| Quit Rate With Low Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | Some college or more | 45 participants |
| Quit Rate With Low Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | Employed | 18 participants |
| Quit Rate With Low Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | Unemployed | 87 participants |
| Quit Rate With Low Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | Comorbid lung disease yes | 39 participants |
| Quit Rate With Low Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | No comorbid lung disease | 67 participants |
| Quit Rate With Low Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | 0-2 Comorbidities | 22 participants |
| Quit Rate With Low Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | 3 or more comorbidities | 84 participants |
| Quit Rate With Low Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | Used tobacco past 7 days | 78 participants |
| Quit Rate With Low Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | No tobacco use past 7 days | 28 participants |
| Quit Rate With Low Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | Used tobacco last 24 hours | 71 participants |
| Quit Rate With Low Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | No tobacco use past 24 hours | 35 participants |
| Quit Rate High Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | 3 or more comorbidities | 18 participants |
| Quit Rate High Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | Male | 24 participants |
| Quit Rate High Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | Unemployed | 18 participants |
| Quit Rate High Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | Female | 1 participants |
| Quit Rate High Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | No tobacco use past 24 hours | 1 participants |
| Quit Rate High Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | Non-Hispanic White | 21 participants |
| Quit Rate High Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | Comorbid lung disease yes | 2 participants |
| Quit Rate High Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | Other race/ethnicity | 4 participants |
| Quit Rate High Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | Used tobacco past 7 days | 23 participants |
| Quit Rate High Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | Married | 8 participants |
| Quit Rate High Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | No comorbid lung disease | 23 participants |
| Quit Rate High Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | Not Married | 17 participants |
| Quit Rate High Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | Used tobacco last 24 hours | 24 participants |
| Quit Rate High Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | High School/GED or less | 13 participants |
| Quit Rate High Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | 0-2 Comorbidities | 7 participants |
| Quit Rate High Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | Some college or more | 11 participants |
| Quit Rate High Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | No tobacco use past 7 days | 2 participants |
| Quit Rate High Participation in Counseling | Characteristics of Participants Stratified by High vs. Low Participation 60 Days Post Discharge | Employed | 7 participants |
p-value: <0.05Chi-squared
Comparison: T-tests, chi squares and Fishers exact tests were used to compare groups.p-value: <0.05Chi-squared
Secondary
Cost Per Quit of Volunteer Peer Telephone Counseling
The primary cost component of the intervention is the cost of labor by providers to train the volunteers and enter volunteer documentation into the electronic medical record. These costs were estimated using VA salary and fringe benefit information obtained from the Financial Management System (FMS). Number of hours spent by the volunteers providing telephone counseling was also tracked. Other intervention costs included nominal supplies associated with training and the intervention. Because the volunteers made their telephone calls in an unused office, the cost of space was not included. Recruitment and other research-related costs were excluded. The average cost per quit is a mean, but is reported here as a number, as no measures of dispersion were available.
Time frame: 60 days after discharge
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Quit Rate With Low Participation in Counseling | Cost Per Quit of Volunteer Peer Telephone Counseling | 92 dollars |
Secondary
Participants' Attitudes About the Implementation of the Telephone Counseling
Thirty-minute qualitative telephone interviews were conducted with Veteran smokers that participated in the volunteer peer telephone cessation counseling.
Time frame: 60 days after discharge
Population: Of those surveyed, 25 agreed to qualitative phone interviews.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Quit Rate With Low Participation in Counseling | Participants' Attitudes About the Implementation of the Telephone Counseling | Liked the number of calls | 14 Participants |
| Quit Rate With Low Participation in Counseling | Participants' Attitudes About the Implementation of the Telephone Counseling | Wanted to quit smoking | 19 Participants |
| Quit Rate With Low Participation in Counseling | Participants' Attitudes About the Implementation of the Telephone Counseling | Liked the program in hospital | 9 Participants |
| Quit Rate With Low Participation in Counseling | Participants' Attitudes About the Implementation of the Telephone Counseling | Calls were helpful/good/great | 23 Participants |
| Quit Rate With Low Participation in Counseling | Participants' Attitudes About the Implementation of the Telephone Counseling | Liked that someone cared | 16 Participants |
| Quit Rate With Low Participation in Counseling | Participants' Attitudes About the Implementation of the Telephone Counseling | Would have liked more calls | 12 Participants |
| Quit Rate With Low Participation in Counseling | Participants' Attitudes About the Implementation of the Telephone Counseling | Can't remember content of calls | 3 Participants |
| Quit Rate With Low Participation in Counseling | Participants' Attitudes About the Implementation of the Telephone Counseling | Calls put quitting back in head | 3 Participants |
| Quit Rate With Low Participation in Counseling | Participants' Attitudes About the Implementation of the Telephone Counseling | No difference in smoking after calls | 11 Participants |
| Quit Rate With Low Participation in Counseling | Participants' Attitudes About the Implementation of the Telephone Counseling | Increased smoking after calls | 6 Participants |
| Quit Rate With Low Participation in Counseling | Participants' Attitudes About the Implementation of the Telephone Counseling | Decreased smoking after calls | 4 Participants |
| Quit Rate With Low Participation in Counseling | Participants' Attitudes About the Implementation of the Telephone Counseling | No suggestions for changes in calls | 18 Participants |
| Quit Rate With Low Participation in Counseling | Participants' Attitudes About the Implementation of the Telephone Counseling | Increase number of calls | 6 Participants |
| Quit Rate With Low Participation in Counseling | Participants' Attitudes About the Implementation of the Telephone Counseling | Make smoking medications more accessible | 5 Participants |
| Quit Rate With Low Participation in Counseling | Participants' Attitudes About the Implementation of the Telephone Counseling | Provide more information on calls | 1 Participants |