This study, conducted in primary care clinics in Madison and Milwaukee, Wis., by researchers at the University of Wisconsin Center for Tobacco Research and Intervention (CTRI) and the University of Wisconsin Medical School-Milwaukee was designed to assess the acceptance, use and effectiveness of free smoking cessation treatments integrated into routine primary care. With 70 percent of smokers visiting their primary care physicians at least once a year, health care clinics are well-suited sites for tobacco cessation treatment.
"Lack of interest among patients has been cited as a reason for not offering cessation help to smokers," said Michael Fiore, lead researcher and CTRI director. "This study demonstrated convincingly that smokers are interested in getting help to quit. In fact, over two-thirds said, 'Yes' to offers of cessation treatment even when that was not the reason for their doctor visit. And, when offered a choice of treatment, they preferred the most intensive treatment available."
The study was designed to reduce barriers to treatment use by offering free, convenient treatment. Medical assistants at diverse clinics invited smokers to participate in a treatment program involving free nicotine replacement therapy and possible counseling. Recruitment was integrated into the regular clinic routine. Participants simply had to say "yes" when asked if they were interested in receiving cessation treatment to begin enrollment. Participants who enrolled in treatment were assigned to one of two conditions-a "random" condition or a "free choice" condition. In the "random" condition, they were randomly assigned to one of the following treatments-the nicotine patch, the patch plus the Committed Quitters (CQ) program (self-help materials and telephone counseling provided by the patch manufacturer) or the patch plus CQ plus individual counseling. In the "free choice" condition, smokers themselves selected among these three treatment options.
"We conclude from this study that smokers are willing to engage in cessation treatment," Fiore says. "Lack of easy access to free, convenient care, rather than lack of interest, may be keeping the millions of smokers who want to quit from doing so. This study provides a model for a tobacco cessation treatment referral program for primary care clinics which could be used anywhere in the country."
Of the 4,174 smokers who were invited, 68 percent accepted the invitation for treatment. Those smokers who tend to have more trouble quitting--women and African American smokers--were especially likely to accept treatment.
Of those who accepted, passed the screening, and were assigned to the "free choice" condition, 75 percent elected to receive treatment that included counseling. More than 40 percent selected face-to-face counseling.
Participants followed through with treatment at higher than expected levels, as well. Nearly 85 percent of participants picked up free nicotine patches that were available at their clinic pharmacies. Both African American smokers and other minorities were less likely to pick up their patches than were white smokers, despite the greater initial interest in treatment among African American smokers. On average, participants reported using patches for 5.7 of the eight weeks recommended.
Sixty-nine percent of eligible participants enrolled in the CQ telephone and mailing support program. For the face-to-face counseling program, 67 percent attended at least one session and 41 percent attended all four.
Six months after the quit date, 13 percent of all participants were abstinent, which is consistent with results from past nicotine patch clinical trials. This is markedly higher than the two percent to five percent long-term quit rate among smokers who try to quit on their own. The study did not find that abstinence rates were significantly related to counseling intensity. Abstinence rates were significantly lower among African Americans than white smokers. Additional research is necessary to find a better way to deliver treatments to African American smokers who accepted treatment in this study at high levels, but remained abstinent at low levels.
The findings in this study support the Public Health Service Clinical Practice Guideline: Treating Tobacco Use and Dependence recommendation that every smoker who visits a health care setting should be offered evidence-based treatment.
This research was supported by a grant from the National Cancer Institute and a Transdisciplinary Tobacco Use Research Center (TTURC) grant from the National Cancer Institute (NCI) and the National Institute on Drug Abuse (NIDA). The University of Wisconsin TTURC is one of seven TTURCs funded by NCI and NIDA to investigate new ways of combating tobacco use and nicotine addiction, using an innovative, integrated approach.
The Robert Wood Johnson Foundation also funds the TTURCs through the Partners with Tobacco Use Research Centers program. The Partners program supplements research funded by NCI and NIDA and supports tobacco-related policy research and communications activities.