Hospitalized smokers are at high risk for complications related to continued tobacco use. Although national attention has been directed at smoking cessation for hospitalized patients, rural hospitals have been unable to implement the complete components of effective smoking cessation programs. In this competitive renewal to Kan Quit, our experienced, multidisciplinary team will build upon our strong foundation of research on smoking cessation in rural communities. Kan Quit, directed at smokers in all stages of readiness to quit, demonstrated that disease management, in which free pharmacotherapy was combined with pharmacotherapy management, could engage 78% of smokers in effective treatment. Unfortunately, free pharmacotherapy for smoking cessation is not universally available. State smoking cessation programs have limited supplies and offer limited choices;although prescription coverage for pharmacotherapy is increasingly available, it is underutilized, particularly among the high-risk population of hospitalized smokers. Grounded in the Chronic Care Model, our revised disease management program is designed to provide counseling and disease management while increasing utilization of pharmacotherapy and enhancing support from healthcare providers. In contrast to Kan Quit, our revised disease management program will take advantage of resources for pharmacotherapy already available in the community. Our specific objectives are to 1) evaluate the effectiveness of Centralized Disease Management (CDM) for smoking cessation among hospitalized rural smokers;2) test the impact of CDM on utilization of pharmacotherapy and discussions with health care providers;3) clarify how utilization of these elements may mediate the effect of CDM on smoking cessation;and 4) examine the marginal cost effectiveness of CDM for smoking cessation. This study will be conducted in 30 rural critical access hospitals in Kansas. The primary outcome is 7-day point prevalence abstinence confirmed by salivary cotinine. Hospitalized rural smokers will be randomized to either CDM or counseling (C) alone (303 in each arm). All participants will receive in-hospital telephone counseling with telephone follow-up at days 3, 7, 21, and 90. A second effort will be made to re-engage persistent or relapsed smokers 6 months later. For CDM participants, our Tobacco Treatment Specialist will also provide telephone-based disease management during the hospitalization and after discharge, including supplemental support for pharmacotherapy that is consistent with their insurance plan and guidance on establishing effective discussions with their health care provider. The Tobacco Treatment Specialist will also fax treatment recommendations, prescription requests, and counseling suggestions to the healthcare provider. The proposed research will enhance our understanding of disease management for smoking cessation and, if successful, has the potential for immediate implementation in rural critical access hospitals.

Public Health Relevance

Many hospitalized smokers do not receive effective smoking cessation treatment. In this follow-up to Kan Quit we will see if disease management for hospitalized smokers can increase use of effective pharmaco- therapy, improve communication with health care providers, and increase rates of smoking cessation.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA101963-10
Application #
8433436
Study Section
Risk, Prevention and Intervention for Addictions Study Section (RPIA)
Program Officer
Djordjevic, Mirjana V
Project Start
2003-07-09
Project End
2015-01-31
Budget Start
2013-02-01
Budget End
2015-01-31
Support Year
10
Fiscal Year
2013
Total Cost
$509,041
Indirect Cost
$169,680
Name
University of Kansas
Department
Public Health & Prev Medicine
Type
Schools of Medicine
DUNS #
016060860
City
Kansas City
State
KS
Country
United States
Zip Code
66160
Azor Hui, Siu-Kuen; Nazir, Niaman; Faseru, Babalola et al. (2013) Ongoing self-engagement in quit attempts and cessation outcomes among rural smokers who were unable to quit after 2 years of repeated interventions. J Rural Health 29:106-12
Ellerbeck, Edward F; Mahnken, Jonathan D; Cupertino, A Paula et al. (2009) Effect of varying levels of disease management on smoking cessation: a randomized trial. Ann Intern Med 150:437-46
Cupertino, A Paula; Wick, Jo A; Richter, Kimber P et al. (2009) The impact of repeated cycles of pharmacotherapy on smoking cessation: a longitudinal cohort study. Arch Intern Med 169:1928-30
Cupertino, Paula A; Richter, Kimber P; Cox, Lisa Sanderson et al. (2008) Smoking cessation pharmacotherapy preferences in rural primary care. Nicotine Tob Res 10:301-7
Berg, Carla J; Sanderson Cox, Lisa; Mahnken, Jonathan D et al. (2008) Correlates of self-efficacy among rural smokers. J Health Psychol 13:416-21
Cox, Lisa Sanderson; Cupertino, Ana-Paula; Mussulman, Laura M et al. (2008) Design and baseline characteristics from the KAN-QUIT disease management intervention for rural smokers in primary care. Prev Med 47:200-5
Sarkar, Fazlul H; Li, Yiwei (2008) NF-kappaB: a potential target for cancer chemoprevention and therapy. Front Biosci 13:2950-9
Hutcheson, Tresza D; Greiner, K Allen; Ellerbeck, Edward F et al. (2008) Understanding smoking cessation in rural communities. J Rural Health 24:116-24
Cupertino, A Paula; Mahnken, Jonathan D; Richter, Kimber et al. (2007) Long-term engagement in smoking cessation counseling among rural smokers. J Health Care Poor Underserved 18:39-51
Berg, Carla J; Cox, Lisa Sanderson; Nazir, Niaman et al. (2006) Correlates of home smoking restrictions among rural smokers. Nicotine Tob Res 8:353-60