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

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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 April 22-25, 2009

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 2007; 6 Zbikowski 2008.

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 Phone Intervention

5

6

7 Phone-Web Intervention

8 Measures Baseline Survey 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) 7-day point prevalence abstinence Chantix use (average # days)

9 Measures Treatment Utilization 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 Web X 2 =67(13), p <.0001 # Calls.68 ( ) Call duration 1.03 ( ) Web logins 1.16 ( ) Web duration 1.0 ( ) Days of Chantix 1.02 ( ) Phone X 2 =67(13), p < ( ).99 ( ) Phone-Web X 2 =62(17), p < ( ) 1.0 ( ) ( ) ( ) 1.02 ( ) 1.02 ( )

11 Utilization of Behavioral Services and Chantix Web Phone Phone- Web # calls Call duration (min) # logins Web duration (min) Chantix (days)

12 Predictors of Utilization by Treatment Web # of Calls Comfort with Internet Tried bupropion in past Phone Duration # Logins Cessation Info from Internet Tried bupropion in past Phone can improve success Web Duration HSI Use of other aids in past

13 Predictors of Utilization by Treatment Phone # of Calls Marital status Use of NRT in past Phone Duration

14 Predictors of Utilization by Treatment Phone-Web # of Calls Tried bupropion in past Phone Duration Self-efficacy (-) Comfort with Internet (-) Internet use/wk Tried bupropion in past Lives with smoker (-) # Logins 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 Several baseline variables predicted utilization

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 among Phone-Web)

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 CA 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 Web Phone Phone-Web X 2 (10)= 596.8, P< Calls 1 Call 2 Calls 3 Calls 4 Calls 5+ Calls

20 Web Logins by Behavioral Treatment logins 1 login 2 logins 3-4 logins 5+ logins Web Phone-Web X 2 (4)= 67.1, P<.0001

21 Calls and Web Logins: Phone-Web 5+ calls calls 3 calls 2 calls logins 3-4 logins 2 logins 1 login 0 logins 1 call X 2 (20)= 58.3, P<.0001

22 Predictors of Utilization by Treatment Web # of Calls Comfort with Internet Tried bupropion in past Phone Duration # Logins Cessation Info from Internet Tried bupropion in past Phone can improve success Web Duration HSI Use of other aids in past Phone # of Calls Marital status Use of NRT in past Phone Duration Phone-Web # of Calls Tried bupropion in past Phone Duration Self-efficacy (-) Comfort with Internet (-) Internet use/wk Tried bupropion in past Lives with smoker (-) # Logins 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

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