Intervention Methods

Edward Lichtenstein, Ph.D.
Senior Scientist
Oregon Research Institute

Intervention Methods

• Referral to community resources
• Mailed materials
• Internet
• IVR
• Pharmacology

Referral

• Frequently done
• Not evaluated
• Follow through unlikely

Mailings

• Written materials
• Video; CD Rom
• Quit kits (tchotchkes)

Written Materials

• Booklets ubiquitous
• One time mailing not efficacious; multiple mailings can be
• Variations in content do not make a difference
• Targeted materials useful for community relations

Video / CD Rom

• Can be targeted
• Can be tailored
• Not systematically evaluated

Internet / Websites

• Huge potential:
• Reach; tailoring; chat rooms
• Numerous tobacco websites; some interactive
• No evaluation
• ORI pilot

Internet

• A key component of comprehensive program
• Combine with quitline
• Ripe for RCT
• Quitline only vs. quitline + interactive internet

IVR

• Quitlines provide recorded messages
• Rarely use IVR
• Used with diabetes patients
• Collect monitoring info
• May be seen as impersonal

TC as Adjunct to Pharmacotherapy

• Many quitlines providing this service
• Marriage of two potent interventions
• Stead & Lancaster, 2001 Meta-Analysis
• Four RCTs:
• None found a significant effect
• Pooled OR 1.08 (CI = .82-1.43)
• "Do not exclude a small benefit"

TC & Pharmacotherapy:.Observational Studies

• Zhu et al., 2000: N = 664; 12 mo. Quit rate
• NRT + single session: 16.1%
• NRT + multiple sessions (x=4.2): 25.6% (p<.001)
• Rabius et al., 2002: N = 1168; ACS Quitline
• 3-month quit rates
• Medication + TC: 26%
• TC only: 16%  }p<.0001

TC & Pharmacotherapy: RCT

• Swan, McAfee, et al., Under review: N = 1524
• Zyban + Zyban Advantage Plan vs. Zyban + Free &: Clear TC: OR=1.21 (CI = 1.08, 1.36)
• 12 mo. (7 day pt. Prevalence)

Counseling

• TC efficacious across settings and samples
• TC quitlines are effective
• TC effectively augments hospital-initiated interventions
• TC does not augment group counseling

Counseling (Cont.)

• More research needed
• Special populations
• TC + physician advice
• Practical issues: dose; timing

Counseling Process Research

• Client subgroups
• Gender
• Addiction level
• Age
• Variations in counseling content:
• Don’t seem to make a difference
• More research needed

Counseling Process .Research (Cont.)

• Counselor skills/behavior
• Accurate empathy
• Confrontation
• Counseling relationship
• Major source of variance in therapy research

Proxy Calls, Family, Friends

• Expand service?
• Formative research needed
• RCT: intervention and evaluation via proxies
• Endpoints:
• Shift in stage / quit attempt
• Contacts with quitline
• Quits – proxy reports

How should we study TC?

• RCTs ideal; practical limitations
• Observational studies
• Huge data sets
• Quitline managers
• Limited resources for data analysis/research
• Limited expertise
• Limited incentives

How should we study TC? (Cont.)

• Establish a structure: committee/taskforce
• Bring in expertise
• Research/bio-statistics
• Counseling/psychotherapy research
• Find funding
• NIH
• Legacy foundation