Utilization of Services in a Randomized Trial Testing Phone- and Web-based Behavioral Interventions for Smoking Cessation

(1)

Utilization of Services in a Randomized Trial

Testing Phone- and Web-based Behavioral

Interventions for Smoking Cessation

Susan M. Zbikowski, Ph.D.

Society of Behavioral Medicine

(2)

Introduction

• _{Telephone counseling}

1-2

and web-based

3-6

programs have been demonstrated to be

effective

• _{Adherence to treatment programs is variable}

2

• Low utilization of web-based programs is

common

• Utilization has been demonstrated to be

associated with outcomes

1

Stead 2006;

2

Fiore 2008;

3

Cobb et al. 2005;

4

Graham et al., 2007;

5

Saul

(3)

Purpose of Present Study

• ₁

st

study to examine utilization of 3

behavioral treatments for cessation

(Web,

Phone, Phone-Web)

in a randomized trial.

1. Demonstrate the association between utilization

and cessation outcomes

2. Summarize utilization of behavioral treatments

3. Examine correlates of utilization

4. Discuss implications for improving utilization in

future studies

(4)

(5)

(6)

(7)

(8)

Measures

• Demographics

• Tobacco use measures

• Lives with a smoker

• Social support

• Quit attempts in past

• Use of cessation medications and

other aids in the past

• Motivation and confidence

• Depressive symptoms

• Perceived benefit of

pharmacotherapy, telephone

support, web-based support, and

group counseling

Follow-up Survey

(6 months after target quit date)

Baseline Survey

• 7-day point prevalence abstinence

(9)

Measures

• Number of calls- total #; proactive plus adhoc

• Phone duration- total minutes across all calls

• Number of web logins

• Web duration- total minutes for all logins

• Chantix use- average number of days used

• Computed mean, std dev, range for each utilization

variable

• _{Calls were classified: 0, 1, 2, 3, 4, or 5+ calls}

• Logins were classified: 0, 1, 2, 3-4, or 5+ logins

(10)

Utilization Predicts Abstinence at 6 Months

(Odds Ratios and 95% CI)

Models

X

2

=67(13),

Web

p <.0001

Phone

X

2

=67(13),

p <.0001

Phone-Web

X

2

=62(17),

p <.0001

# Calls

.68

(.42-1.10)

(1.47-2.28)

1.87 (1.13-1.82)

1.43 Call duration

1.03 (1.00-1.07)

(.98-1.01)

.99

(.99-1.01)

1.0 Web logins

1.16 (1.05-1.29)

---

(.95-1.15)

1.05 Web duration

1.0 (.99-1.00)

---

(.99-1.00)

.99

Days of

Chantix

(1.01-1.03)

1.02 (1.01-1.03)

1.02

(11)

Utilization of Behavioral Services and Chantix

3.7

53.9

4.1

67.7

72.5

2.4

28.5

60.0

14.4

1.6

67.6

61.5

4.2

0

10

20

30

40

50

60

70

80 # calls

Call

duration

(min)

# logins

Web

duration

(min)

Chantix

(days)

Web

Phone

Phone-Web

(12)

Predictors of Utilization by Treatment

# of Calls

Age

Comfort with Internet Tried bupropion in past

# Logins

Cessation Info from Internet Tried bupropion in past Phone can improve success

Web Duration

HSI

Use of other aids in past

Web Phone Duration

(13)

Predictors of Utilization by Treatment

Phone Duration Age Phone # of Calls Age Marital status Use of NRT in past

(14)

Predictors of Utilization by Treatment

# of Calls

Age

Tried bupropion in past

Phone Duration

Age Self-efficacy (-) Comfort with Internet (-)

Internet use/wk Tried bupropion in past

Lives with smoker (-)

# Logins

Age Self-efficacy (-) Previous quit > 6 mo (-)

Tried bupropion in past Use of other aids in past Web can improve success

Web Duration

Self-efficacy (-) Use of other aids in past Web can improve success

Social support

(15)

Conclusions

• _{Greater Chantix Use in was associated with}

increased quitting success at 6 months

• _{Utilization of Behavioral Treatments}

predicted quitting success

(16)

Implications

• _{Programs need to be tailored with}

consideration for participant characteristics

and treatment experience and expectancies.

–

_{Older age (phone use)}

–

_{Past experience with quitting (type of treatments}

and length of success)

–

_{Treatment expectancies (logins and duration)}

–

_{Low self-efficacy (phone/web duration and logins}

(17)

Acknowledgements

• _{Gary Swan, PhD; Lisa Jack,}

MA; Hal Javitz, PhD

• _{Jennifer McClure, PhD; Sheryl}

Catz, PhD; Julie Richards, MPH

• _{Mona Deprey, MS; Tim}

McAfee, MD

National Cancer Institute CA071358

Additional support provided by Pfizer

(18)

Extra slides if needed

- Calls, logins by group

-Calls and logins within Phone-Web

-Predictors slide with all findings

(19)

Calls by Behavioral Treatment

1

2

1

66

8

19

6

8

9

15

2

18

20

3

51

48

0

10

20

30

40

50

60

70 Web

Phone

Phone-Web

0 Calls

1 Call

2 Calls

3 Calls

4 Calls

5+ Calls

X

2

_{(10)= 596.8, P< .0001}

(20)

Web Logins by Behavioral Treatment

3

21

41

37

16

14

16

14

24

14

0

5

10

15

20

25

30

35

40

45 Web

Phone-Web

0 logins

1 login

2 logins

3-4 logins

5+ logins

X

2

_{(4)= 67.1, P< .0001}

(21)

Calls and Web Logins: Phone-Web

2

4

5

7

5

4

7

8

14

0

1

2

8

0

2

10

0

1

3

2

10

0

5

10

15 1 call

2 calls

3 calls

4 calls

5+ calls

5+ logins

3-4 logins

2 logins

1 login

0 logins

X

2

_{(20)= 58.3, P< .0001}

(22)

Predictors of Utilization by Treatment

# of Calls

Age

Tried bupropion in past

Phone Duration

Age Self-efficacy (-) Comfort with Internet (-)

Internet use/wk Tried bupropion in past

Lives with smoker (-)

# Logins

Age Self-efficacy (-) Previous quit > 6 mo (-)

Tried bupropion in past Use of other aids in past Web can improve success

Web Duration

Self-efficacy (-) Use of other aids in past Web can improve success

Social support Phone-Web Phone Duration Age Phone # of Calls Age Marital status Use of NRT in past # of Calls Age

Comfort with Internet Tried bupropion in past

# Logins

Cessation Info from Internet Tried bupropion in past Phone can improve success

Web Duration

HSI

Use of other aids in past

Web Phone Duration