Although social support is correlated with successful tobacco cessation, interventions designed t... more Although social support is correlated with successful tobacco cessation, interventions designed to optimize social support have shown mixed results. Understanding the process of providing social support for tobacco cessation may suggest new approaches to intervention. Responsiveness theory provides a new framework for classifying supportive behaviors in the context of tobacco cessation. It proposes three main components to sustaining relationship quality when providing support to an intimate partner: showing respect, showing understanding, and showing caring. Interviews were conducted with 35 women whose husbands or domestic partners had quit smokeless tobacco and were analyzed within a responsiveness theory framework: Positive and negative instances of the three supportive components were expressed in terms of beliefs and attitudes, interactions with the chewer, and behaviors outside of the interaction context. Positive activities included respecting the chewer's decision on whether, when, and how to quit; perspective-taking and other efforts to understand his subjective experience; and expressing warmth and affection toward the chewer. Particularly problematic for the women were the challenges of respecting the chewer's autonomy (ie, negative behaviors such as nagging him to quit or monitoring his adherence to his cessation goal) and lack of understanding the nature of addiction. The findings help to confirm the potential utility of responsiveness theory for elucidating the breadth of both positive and negative forms of partner support that may be useful to guide social support interventions for tobacco cessation. The study provides a categorization system for positive and negative social support during smokeless tobacco cessation, based on responsiveness theory and interviews with 35 partners of smokeless users.
Introduction: Social support has been relatively unstudied in smokeless tobacco cessation researc... more Introduction: Social support has been relatively unstudied in smokeless tobacco cessation research; partner support could encourage quitting, buffer the stress of quitting and withdrawal, and counteract tobacco cues.
Addiction Research & Theory 22(1): 49-56, Feb 2014
The metaphors that tobacco users employ when trying to quit offer insights into the subjective ... more The metaphors that tobacco users employ when trying to quit offer insights into the subjective experience of the cessation process. A review of more than 2100 posts in an online forum for participants in a smokeless tobacco (ST) cessation study revealed metaphors covering themes such as the tobacco product itself, nicotine, addiction, the cessation process, coping with withdrawal symptoms and cravings, fellow study participants, other social relationships, slips and recoveries, and post-cessation self-image. Five metaphor families predominated, with quitting ST represented as a journey, a project, a battle, an escape from captivity, and ending a dysfunctional friendship. Tobacco and nicotine were conceptualized as an enemy, a crafty opponent, a demon, and a betraying friend. Most metaphor use was casual, but some instances were more elaborated, with multiple, apparently deliberate references to the same metaphor family in close proximity. Future research should address whether use of therapeutic metaphors can help facilitate cessation; if so, the finding would have implications both for clinical tobacco cessation services and public health interventions.
Objective. Disseminating effective interventions to health care professionals is a critical step ... more Objective. Disseminating effective interventions to health care professionals is a critical step in ensuring that patients receive needed advice and materials. This cost effectiveness analysis compared two methods of disseminating an effective protocol for smokeless tobacco cessation intervention.
This study assessed the cost-effectiveness of two low-intensity programs for quitting smokeless t... more This study assessed the cost-effectiveness of two low-intensity programs for quitting smokeless tobacco, based on results of a randomized trial with 1,069 volunteer participants. Cost data were collected for two levels of intervention: manual only (a self-help manual) and assisted self-help (the manual plus a videotape and two supportive phone calls from tobacco cessation counselors). Incremental cost-effectiveness ratios were calculated for assisted self-help vs. quitting on one's own, using the manual-only quit rate and data from another study as alternative proxies for no intervention. A threshold analysis was conducted to determine the spontaneous quit rate at which the manual-only intervention becomes more cost-effective than assisted self-help. The cost to provide and receive the assisted self-help intervention averaged US $56 per participant vs. $20 for the manual-only intervention (societal perspective, Year 2000 dollars). Estimates for incremental cost per quit for the assisted self-help intervention ranged from $922 to $1,758, depending on the proxy used for no intervention. The manual-only intervention was more cost-effective than assisted self-help if quitting among motivated chewers who do not receive treatment does not exceed 3.4%. Support from a wife or partner added little cost to a quit attempt for male chewers ($3-$4). Providing a manual, video, and brief phone counseling to smokeless tobacco users who want to quit is a reasonable use of health care resources. The self-help quitting guide also may be a cost-effective treatment, but it remains to be demonstrated whether it is more effective than quitting on one's own.
One of the keys to understanding the Doctor’s personality is his ethical stance, which influences... more One of the keys to understanding the Doctor’s personality is his ethical stance, which influences how he uses and limits his use of his vast powers. Because he focuses on responding to the needs of particular others, in whatever situation he finds himself, his ethics may characterized as an ethics of care. He strives for a mindful awareness of each person he encounters, an I-Thou stance. This non-instrumental approach towards people is closely related to his relationship with the universe in general, an openness to the extraordinary that may be described as a highly developed sense of wonder. However, experiencing wonder may be challenging for a Time Lord, because his vast range of experience and depth of intellect mean that fewer things will violate his expectations or his sense of scale. In order to experience the universe as extraordinary – which is something he values highly – he needs to take a different perspective. His empathetic connection with the experiences of his human companions lets him use the human scale as a reference point, sustaining and renewing his own sense of wonder at the universe. His companions thus do far more for him than relieve his loneliness – they help to give his life meaning.
Interactions with yellowjackets offer opportunities to reflect on what it is to encounter radical... more Interactions with yellowjackets offer opportunities to reflect on what it is to encounter radical alterity and the conditions that are necessary for the limited empathy such encounters afford us. Effort must be made to set aside automatic judgments, and neither simulation nor theorizing can be sufficient to give us reliable insights, but mindful attentiveness can at least help us attend to the possibilities of interaction and tentative interpretation.
To further our understanding of the representativeness of the smokeless tobacco (SLT) user recrui... more To further our understanding of the representativeness of the smokeless tobacco (SLT) user recruited to various treatment settings, and to suggest gaps in services available to SLT users, we first compared participants who enrolled in a self-help cessation program with two samples of nontreatment-seeking SLT users: SLT users identified through a random digit dialing (RDD) survey, and SLT users who came to 1 of 75 dental practices for a routine cleaning visit. We found that those in the self-help SLT cessation program were older, more educated, more likely to have made a serious quit attempt, and used more SLT weekly than those who did not seek treatment. Secondly, we compared SLT users seeking treatment in three different treatment settings varying in accessibility and intensity: self-help study participants, SLT users enrolled in a clinic-based study, and callers to the California Help Line for SLT cessation. Participants differed across the three studies on demographics, some measures of dependence, and history of SLT use.
This paper presents long-term outcomes of the largest clinical trial of smokeless tobacco (SLT) c... more This paper presents long-term outcomes of the largest clinical trial of smokeless tobacco (SLT) cessation reported to date. SLT users in five northwestern states were recruited to call a toll-free number, and 1,069 users were randomized to one of two self-help conditions: either a manual-only condition or an assisted self-help condition, which included the manual, a targeted video, and two support phone calls. Significant between-group differences were not found for either the 12- or 18-month point-prevalence measure of abstinence from either SLT only or all tobacco products using outcomes based on either the responder or intention-to-treat outcomes. However, using a repeated point-prevalence measure across all three assessment points, we found that significantly more assisted self-help participants reported abstinence, compared with manual-only participants. Compared with manual-only participants, those in the assisted self-help condition were significantly more likely to use recommended cessation techniques. Results demonstrate that low-cost, minimal interventions delivered by mail and phone can help a sizable proportion of individuals quit using SLT.
This study evaluated 2 methods of disseminating an empirically validated smokeless tobacco interv... more This study evaluated 2 methods of disseminating an empirically validated smokeless tobacco intervention delivered during routine dental care. Twenty cities within 12 states were stratified and then randomized to 1 of 3 groups: personalized instruction (PI), self-study (SS), or delayed training (DT) control. Dental hygienists in the SS condition were sent a manual and video. Those in the PI condition were recruited to attend a workshop. Thirty-seven percent of eligible hygienists agreed to participate. At 12 months postenrollment, hygienists in the SS and PI conditions significantly increased their "Assist" behaviors (discuss cessation techniques, help patient set a quit date, and provide cessation materials) and reported fewer perceived barriers to delivering the intervention as compared with hygienists in DT. An economic analysis suggests that SS is more cost-effective than PI.
The need for effective, low-cost self-help treatment methods for smokeless tobacco (ST) addiction... more The need for effective, low-cost self-help treatment methods for smokeless tobacco (ST) addiction becomes more evident as rates of product use and associated morbidities increase. This study evaluated two self-help methods for ST cessation. One hundred ninetyeight ST users were randomized into two conditions: half received the LifeSign, a credit cardsized computer designed for gradual ST cessation, and half received the Enough Snuff selfhelp manual and a video. Subjects in both conditions received telephone support for their quit effort. The study was conducted entirely through phone and mail, allowing delivery of the intervention to both rural and urban users. Self-reported rates of sustained abstinence (no tobacco use at two months and six months) were 24.5% for the manual/video condition, and 18.4% for the LifeSign condition.
The sizeable percentage of adults who use smokeless tobacco (ST) represents an important public h... more The sizeable percentage of adults who use smokeless tobacco (ST) represents an important public health target since the majority of ST users have a strong desire to quit, but many lack resources. We tested the impact of an interactive, tailored Web-based intervention (Enhanced Condition) versus a more linear, text-based website (Basic Condition) in a randomized trial with 2523 adult ST users. As is common in Internet-based research, there was considerable attrition: follow-up rates at 3 months, 6 months, and for both 3 and 6 months were 48%, 45% and 34%, respectively. Results using repeated point prevalence of all tobacco use at 3 and 6 months showed that participants in the Enhanced Condition quit at significantly higher rates than those in the Basic Condition. Using a Complete Case analysis, abstinence was 40.6% in the Enhanced Condition vs. 21.2% in the Basic Condition (p< .001). Using intent-to-treat analysis, quit rates were 12.6% vs. 7.9%, respectively (p< .001). Similar results were obtained for only ST use. Unobtrusive measures of program exposure indicated that program use was significantly related to outcome as well as to attrition. We conclude that a tailored, interactive Web-assisted cessation program can be an efficacious method for assisting adult ST users to quit.
Data from 363 male smokeless tobacco users and their romantic partners were analyzed to discern t... more Data from 363 male smokeless tobacco users and their romantic partners were analyzed to discern the role of support in cessation. Women reported playing a part in enrollment (71%), and more than half examined program materials or discussed cessation activities with the chewers. Women's reports of delivered support correlated substantially with men's experience of received support. Men's received positive support predicted abstinence at 6-month follow-up (odds ratio = 1.29, confidence interval = 1.03-1.61) and more than 24 hr of abstinence for those still using tobacco at 6 months (odds ratio = 1.75, confidence interval = 1.30-2.36) and moderated the effect of baseline depression and addiction on abstinence. Women played a major role through all stages of cessation.
An estimated 22% of Americans currently use smokeless tobacco (ST). Most live in small towns and ... more An estimated 22% of Americans currently use smokeless tobacco (ST). Most live in small towns and rural areas that offer few ST cessation resources. Approximately 94 million Americans use the Internet for health-related information, and on-line access is growing among lower-income and less-educated groups. As part of a randomized clinical trial to assess the reach and effectiveness of Web-based programs for delivering an ST cessation intervention, the authors developed and evaluated several methods for overcoming the recruitment challenges associated with Web-based research. This report describes and evaluates these methods. Participants were recruited through: (a) Thematic promotional "releases" to print and broadcast media, (b) Google ads, (c) placement of a link on other Web sites, (d) limited purchase of paid advertising, (e) direct mailings to ST users, and (f) targeted mailings to health care and tobacco control professionals. Combined recruitment activities resulted in more than 23,500 hits on our recruitment website from distinct IP addresses over 15 months, which yielded 2,523 eligible ST users who completed the registration process and enrolled in the study. Self-reports revealed that at least 1,276 (50.6%) of these participants were recruited via mailings, 874 (34.6%) from Google ads or via search engines or links on another Web site, and 373 (14.8%) from all other methods combined. The use of thematic mailings is novel in research settings. Recruitment of study participants went quickly and smoothly. Google ads and mailings to media outlets were the methods that recruited the highest number of participants.
While the use of smokeless tobacco products has increased, there has been a paucity of research e... more While the use of smokeless tobacco products has increased, there has been a paucity of research evaluating interventions to help users quit. This study is the first large-scale randomized trial evaluating two levels of self-help cessation intervention with adult smokeless tobacco (SLT) users. Smokeless users in five Northwest states were recruited to call a toll-free number and 1069 users were randomized to receive one of two interventions, Manual Only (MAN) or Assisted Self-Help (ASH), who received a video and two support phone calls in addition to the manual. The study demonstrated that low-cost minimal interventions done by mail and phone can help a sizable proportion of SLT users quit both SLT and all tobacco use. Follow-up data at 6 months showed that subjects in the ASH condition had a significantly higher quit rate for both smokeless (23.4% vs. 18.4%, p < 0.05) and all tobacco use (21.1% vs. 16.5%, p < 0.05), using an intent-to-treat model. Further analysis revealed that use of the recommended cessation procedures mediated the effect of intervention condition on outcomes. This may be the result of phone counselors getting subjects to carry out behavioral cessation procedures. Public health implications for this intervention are discussed.
BackgroundPublished research on the use of Web-based behavior change programs is growing rapidly.... more BackgroundPublished research on the use of Web-based behavior change programs is growing rapidly. One of the observations characterized as problematic in these studies is that participants often make relatively few website visits and spend only a brief time accessing the program. Properly structured websites permit the unobtrusive measurement of the ways in which participants access (are exposed to) program content. Research on participant exposure to Web-based programs is not merely of interest to technologists, but represents an important opportunity to better understand the broader theme of program engagement and to guide the development of more effective interventions.ObjectivesThe current paper seeks to provide working definitions and describe initial patterns of various measures of participant exposure to ChewFree.com, a large randomized controlled trial of a Web-based program for smokeless tobacco cessation.MethodsWe examined measures of participant exposure to either an Enhanced condition Web-based program (interactive, tailored, and rich-media program) or a Basic condition control website (static, text-based material). Specific measures focused on email prompting, participant visits (number, duration, and pattern of use over time), and Web page viewing (number of views, types of pages viewed, and Web forum postings).ResultsParticipants in the ChewFree.com Enhanced condition made more visits and spent more time accessing their assigned website than did participants assigned to the Basic condition website. In addition, exposure data demonstrated that Basic condition users thoroughly accessed program content, indicating that the condition provided a meaningful, face-valid control to the Enhanced condition.ConclusionsWe recommend that researchers conducting evaluations of Web-based interventions consider the collection and analysis of exposure measures in the broader context of program engagement in order to assess whether participants obtain sufficient exposure to relevant program content.
Methods. Forty-nine Oregon pediatric offices enrolled 2,901 women who were currently smoking or h... more Methods. Forty-nine Oregon pediatric offices enrolled 2,901 women who were currently smoking or had quit for pregnancy, using a brief survey at the newborn's first office visit. Randomly assigned offices provided advice and materials to mothers at each wellcare visit during the first 6 months postpartum to promote quitting or relapse prevention.
Although social support is correlated with successful tobacco cessation, interventions designed t... more Although social support is correlated with successful tobacco cessation, interventions designed to optimize social support have shown mixed results. Understanding the process of providing social support for tobacco cessation may suggest new approaches to intervention. Responsiveness theory provides a new framework for classifying supportive behaviors in the context of tobacco cessation. It proposes three main components to sustaining relationship quality when providing support to an intimate partner: showing respect, showing understanding, and showing caring. Interviews were conducted with 35 women whose husbands or domestic partners had quit smokeless tobacco and were analyzed within a responsiveness theory framework: Positive and negative instances of the three supportive components were expressed in terms of beliefs and attitudes, interactions with the chewer, and behaviors outside of the interaction context. Positive activities included respecting the chewer's decision on whether, when, and how to quit; perspective-taking and other efforts to understand his subjective experience; and expressing warmth and affection toward the chewer. Particularly problematic for the women were the challenges of respecting the chewer's autonomy (ie, negative behaviors such as nagging him to quit or monitoring his adherence to his cessation goal) and lack of understanding the nature of addiction. The findings help to confirm the potential utility of responsiveness theory for elucidating the breadth of both positive and negative forms of partner support that may be useful to guide social support interventions for tobacco cessation. The study provides a categorization system for positive and negative social support during smokeless tobacco cessation, based on responsiveness theory and interviews with 35 partners of smokeless users.
Introduction: Social support has been relatively unstudied in smokeless tobacco cessation researc... more Introduction: Social support has been relatively unstudied in smokeless tobacco cessation research; partner support could encourage quitting, buffer the stress of quitting and withdrawal, and counteract tobacco cues.
Addiction Research & Theory 22(1): 49-56, Feb 2014
The metaphors that tobacco users employ when trying to quit offer insights into the subjective ... more The metaphors that tobacco users employ when trying to quit offer insights into the subjective experience of the cessation process. A review of more than 2100 posts in an online forum for participants in a smokeless tobacco (ST) cessation study revealed metaphors covering themes such as the tobacco product itself, nicotine, addiction, the cessation process, coping with withdrawal symptoms and cravings, fellow study participants, other social relationships, slips and recoveries, and post-cessation self-image. Five metaphor families predominated, with quitting ST represented as a journey, a project, a battle, an escape from captivity, and ending a dysfunctional friendship. Tobacco and nicotine were conceptualized as an enemy, a crafty opponent, a demon, and a betraying friend. Most metaphor use was casual, but some instances were more elaborated, with multiple, apparently deliberate references to the same metaphor family in close proximity. Future research should address whether use of therapeutic metaphors can help facilitate cessation; if so, the finding would have implications both for clinical tobacco cessation services and public health interventions.
Objective. Disseminating effective interventions to health care professionals is a critical step ... more Objective. Disseminating effective interventions to health care professionals is a critical step in ensuring that patients receive needed advice and materials. This cost effectiveness analysis compared two methods of disseminating an effective protocol for smokeless tobacco cessation intervention.
This study assessed the cost-effectiveness of two low-intensity programs for quitting smokeless t... more This study assessed the cost-effectiveness of two low-intensity programs for quitting smokeless tobacco, based on results of a randomized trial with 1,069 volunteer participants. Cost data were collected for two levels of intervention: manual only (a self-help manual) and assisted self-help (the manual plus a videotape and two supportive phone calls from tobacco cessation counselors). Incremental cost-effectiveness ratios were calculated for assisted self-help vs. quitting on one's own, using the manual-only quit rate and data from another study as alternative proxies for no intervention. A threshold analysis was conducted to determine the spontaneous quit rate at which the manual-only intervention becomes more cost-effective than assisted self-help. The cost to provide and receive the assisted self-help intervention averaged US $56 per participant vs. $20 for the manual-only intervention (societal perspective, Year 2000 dollars). Estimates for incremental cost per quit for the assisted self-help intervention ranged from $922 to $1,758, depending on the proxy used for no intervention. The manual-only intervention was more cost-effective than assisted self-help if quitting among motivated chewers who do not receive treatment does not exceed 3.4%. Support from a wife or partner added little cost to a quit attempt for male chewers ($3-$4). Providing a manual, video, and brief phone counseling to smokeless tobacco users who want to quit is a reasonable use of health care resources. The self-help quitting guide also may be a cost-effective treatment, but it remains to be demonstrated whether it is more effective than quitting on one's own.
One of the keys to understanding the Doctor’s personality is his ethical stance, which influences... more One of the keys to understanding the Doctor’s personality is his ethical stance, which influences how he uses and limits his use of his vast powers. Because he focuses on responding to the needs of particular others, in whatever situation he finds himself, his ethics may characterized as an ethics of care. He strives for a mindful awareness of each person he encounters, an I-Thou stance. This non-instrumental approach towards people is closely related to his relationship with the universe in general, an openness to the extraordinary that may be described as a highly developed sense of wonder. However, experiencing wonder may be challenging for a Time Lord, because his vast range of experience and depth of intellect mean that fewer things will violate his expectations or his sense of scale. In order to experience the universe as extraordinary – which is something he values highly – he needs to take a different perspective. His empathetic connection with the experiences of his human companions lets him use the human scale as a reference point, sustaining and renewing his own sense of wonder at the universe. His companions thus do far more for him than relieve his loneliness – they help to give his life meaning.
Interactions with yellowjackets offer opportunities to reflect on what it is to encounter radical... more Interactions with yellowjackets offer opportunities to reflect on what it is to encounter radical alterity and the conditions that are necessary for the limited empathy such encounters afford us. Effort must be made to set aside automatic judgments, and neither simulation nor theorizing can be sufficient to give us reliable insights, but mindful attentiveness can at least help us attend to the possibilities of interaction and tentative interpretation.
To further our understanding of the representativeness of the smokeless tobacco (SLT) user recrui... more To further our understanding of the representativeness of the smokeless tobacco (SLT) user recruited to various treatment settings, and to suggest gaps in services available to SLT users, we first compared participants who enrolled in a self-help cessation program with two samples of nontreatment-seeking SLT users: SLT users identified through a random digit dialing (RDD) survey, and SLT users who came to 1 of 75 dental practices for a routine cleaning visit. We found that those in the self-help SLT cessation program were older, more educated, more likely to have made a serious quit attempt, and used more SLT weekly than those who did not seek treatment. Secondly, we compared SLT users seeking treatment in three different treatment settings varying in accessibility and intensity: self-help study participants, SLT users enrolled in a clinic-based study, and callers to the California Help Line for SLT cessation. Participants differed across the three studies on demographics, some measures of dependence, and history of SLT use.
This paper presents long-term outcomes of the largest clinical trial of smokeless tobacco (SLT) c... more This paper presents long-term outcomes of the largest clinical trial of smokeless tobacco (SLT) cessation reported to date. SLT users in five northwestern states were recruited to call a toll-free number, and 1,069 users were randomized to one of two self-help conditions: either a manual-only condition or an assisted self-help condition, which included the manual, a targeted video, and two support phone calls. Significant between-group differences were not found for either the 12- or 18-month point-prevalence measure of abstinence from either SLT only or all tobacco products using outcomes based on either the responder or intention-to-treat outcomes. However, using a repeated point-prevalence measure across all three assessment points, we found that significantly more assisted self-help participants reported abstinence, compared with manual-only participants. Compared with manual-only participants, those in the assisted self-help condition were significantly more likely to use recommended cessation techniques. Results demonstrate that low-cost, minimal interventions delivered by mail and phone can help a sizable proportion of individuals quit using SLT.
This study evaluated 2 methods of disseminating an empirically validated smokeless tobacco interv... more This study evaluated 2 methods of disseminating an empirically validated smokeless tobacco intervention delivered during routine dental care. Twenty cities within 12 states were stratified and then randomized to 1 of 3 groups: personalized instruction (PI), self-study (SS), or delayed training (DT) control. Dental hygienists in the SS condition were sent a manual and video. Those in the PI condition were recruited to attend a workshop. Thirty-seven percent of eligible hygienists agreed to participate. At 12 months postenrollment, hygienists in the SS and PI conditions significantly increased their "Assist" behaviors (discuss cessation techniques, help patient set a quit date, and provide cessation materials) and reported fewer perceived barriers to delivering the intervention as compared with hygienists in DT. An economic analysis suggests that SS is more cost-effective than PI.
The need for effective, low-cost self-help treatment methods for smokeless tobacco (ST) addiction... more The need for effective, low-cost self-help treatment methods for smokeless tobacco (ST) addiction becomes more evident as rates of product use and associated morbidities increase. This study evaluated two self-help methods for ST cessation. One hundred ninetyeight ST users were randomized into two conditions: half received the LifeSign, a credit cardsized computer designed for gradual ST cessation, and half received the Enough Snuff selfhelp manual and a video. Subjects in both conditions received telephone support for their quit effort. The study was conducted entirely through phone and mail, allowing delivery of the intervention to both rural and urban users. Self-reported rates of sustained abstinence (no tobacco use at two months and six months) were 24.5% for the manual/video condition, and 18.4% for the LifeSign condition.
The sizeable percentage of adults who use smokeless tobacco (ST) represents an important public h... more The sizeable percentage of adults who use smokeless tobacco (ST) represents an important public health target since the majority of ST users have a strong desire to quit, but many lack resources. We tested the impact of an interactive, tailored Web-based intervention (Enhanced Condition) versus a more linear, text-based website (Basic Condition) in a randomized trial with 2523 adult ST users. As is common in Internet-based research, there was considerable attrition: follow-up rates at 3 months, 6 months, and for both 3 and 6 months were 48%, 45% and 34%, respectively. Results using repeated point prevalence of all tobacco use at 3 and 6 months showed that participants in the Enhanced Condition quit at significantly higher rates than those in the Basic Condition. Using a Complete Case analysis, abstinence was 40.6% in the Enhanced Condition vs. 21.2% in the Basic Condition (p< .001). Using intent-to-treat analysis, quit rates were 12.6% vs. 7.9%, respectively (p< .001). Similar results were obtained for only ST use. Unobtrusive measures of program exposure indicated that program use was significantly related to outcome as well as to attrition. We conclude that a tailored, interactive Web-assisted cessation program can be an efficacious method for assisting adult ST users to quit.
Data from 363 male smokeless tobacco users and their romantic partners were analyzed to discern t... more Data from 363 male smokeless tobacco users and their romantic partners were analyzed to discern the role of support in cessation. Women reported playing a part in enrollment (71%), and more than half examined program materials or discussed cessation activities with the chewers. Women's reports of delivered support correlated substantially with men's experience of received support. Men's received positive support predicted abstinence at 6-month follow-up (odds ratio = 1.29, confidence interval = 1.03-1.61) and more than 24 hr of abstinence for those still using tobacco at 6 months (odds ratio = 1.75, confidence interval = 1.30-2.36) and moderated the effect of baseline depression and addiction on abstinence. Women played a major role through all stages of cessation.
An estimated 22% of Americans currently use smokeless tobacco (ST). Most live in small towns and ... more An estimated 22% of Americans currently use smokeless tobacco (ST). Most live in small towns and rural areas that offer few ST cessation resources. Approximately 94 million Americans use the Internet for health-related information, and on-line access is growing among lower-income and less-educated groups. As part of a randomized clinical trial to assess the reach and effectiveness of Web-based programs for delivering an ST cessation intervention, the authors developed and evaluated several methods for overcoming the recruitment challenges associated with Web-based research. This report describes and evaluates these methods. Participants were recruited through: (a) Thematic promotional "releases" to print and broadcast media, (b) Google ads, (c) placement of a link on other Web sites, (d) limited purchase of paid advertising, (e) direct mailings to ST users, and (f) targeted mailings to health care and tobacco control professionals. Combined recruitment activities resulted in more than 23,500 hits on our recruitment website from distinct IP addresses over 15 months, which yielded 2,523 eligible ST users who completed the registration process and enrolled in the study. Self-reports revealed that at least 1,276 (50.6%) of these participants were recruited via mailings, 874 (34.6%) from Google ads or via search engines or links on another Web site, and 373 (14.8%) from all other methods combined. The use of thematic mailings is novel in research settings. Recruitment of study participants went quickly and smoothly. Google ads and mailings to media outlets were the methods that recruited the highest number of participants.
While the use of smokeless tobacco products has increased, there has been a paucity of research e... more While the use of smokeless tobacco products has increased, there has been a paucity of research evaluating interventions to help users quit. This study is the first large-scale randomized trial evaluating two levels of self-help cessation intervention with adult smokeless tobacco (SLT) users. Smokeless users in five Northwest states were recruited to call a toll-free number and 1069 users were randomized to receive one of two interventions, Manual Only (MAN) or Assisted Self-Help (ASH), who received a video and two support phone calls in addition to the manual. The study demonstrated that low-cost minimal interventions done by mail and phone can help a sizable proportion of SLT users quit both SLT and all tobacco use. Follow-up data at 6 months showed that subjects in the ASH condition had a significantly higher quit rate for both smokeless (23.4% vs. 18.4%, p < 0.05) and all tobacco use (21.1% vs. 16.5%, p < 0.05), using an intent-to-treat model. Further analysis revealed that use of the recommended cessation procedures mediated the effect of intervention condition on outcomes. This may be the result of phone counselors getting subjects to carry out behavioral cessation procedures. Public health implications for this intervention are discussed.
BackgroundPublished research on the use of Web-based behavior change programs is growing rapidly.... more BackgroundPublished research on the use of Web-based behavior change programs is growing rapidly. One of the observations characterized as problematic in these studies is that participants often make relatively few website visits and spend only a brief time accessing the program. Properly structured websites permit the unobtrusive measurement of the ways in which participants access (are exposed to) program content. Research on participant exposure to Web-based programs is not merely of interest to technologists, but represents an important opportunity to better understand the broader theme of program engagement and to guide the development of more effective interventions.ObjectivesThe current paper seeks to provide working definitions and describe initial patterns of various measures of participant exposure to ChewFree.com, a large randomized controlled trial of a Web-based program for smokeless tobacco cessation.MethodsWe examined measures of participant exposure to either an Enhanced condition Web-based program (interactive, tailored, and rich-media program) or a Basic condition control website (static, text-based material). Specific measures focused on email prompting, participant visits (number, duration, and pattern of use over time), and Web page viewing (number of views, types of pages viewed, and Web forum postings).ResultsParticipants in the ChewFree.com Enhanced condition made more visits and spent more time accessing their assigned website than did participants assigned to the Basic condition website. In addition, exposure data demonstrated that Basic condition users thoroughly accessed program content, indicating that the condition provided a meaningful, face-valid control to the Enhanced condition.ConclusionsWe recommend that researchers conducting evaluations of Web-based interventions consider the collection and analysis of exposure measures in the broader context of program engagement in order to assess whether participants obtain sufficient exposure to relevant program content.
Methods. Forty-nine Oregon pediatric offices enrolled 2,901 women who were currently smoking or h... more Methods. Forty-nine Oregon pediatric offices enrolled 2,901 women who were currently smoking or had quit for pregnancy, using a brief survey at the newborn's first office visit. Randomly assigned offices provided advice and materials to mothers at each wellcare visit during the first 6 months postpartum to promote quitting or relapse prevention.
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Papers by Laura Akers