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
Internet
- A key component of comprehensive program
- Combine with quitline
- Ripe for RCT
- Quitline only vs. quitline + interactive internet
IVR
- Quitlines provide recorded messages
- Used with diabetes patients
- 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