Healthcare systems have tremendous potential to deliver evidence-based smoking cessation treatment to the roughly 25 million US smokers who receive primary care each year, but dissemination of smoking cessation treatment innovations has been slow and implementation of best-practices poses major challenges. For treatment advances to have a substantial impact on smoking prevalence and smoking-related morbidity and mortality, the reach of cessation treatments must increase; too few patients who smoke are offered quitting assistance, and only 5% of US smokers trying to quit use both counseling and pharmacotherapy, the recommended cessation treatment. This project seeks to generate a deeper understanding of factors associated with the reach and implementation of a comprehensive program (the Comprehensive Chronic Care for Smoking Program, CCCSTOP) for adult primary care patients who smoke that is being evaluated in this Program Project. The program is designed to motivate quitting (in those not initially willing to quit) and to help those ready to quit achieve abstinence. The key components of CCCSTOP are: systematic assessment of smoking status at primary care visits; automatic referral of patients who smoke to a centralized care manager who delivers proactive smoking interventions (unless patients opt out); coordination of pharmacotherapy and counseling with primary care providers and the state quitline; and screening and referring medically eligible patients who want help quitting to centralized intensive pharmacotherapy and counseling services. The current project will examine the reach and implementation of key facets of the program using assessments guided by the RE-AIM planning and evaluation framework and the PRISM approach to assessing intervention-translation context. Multilevel, multimethod data will be collected to address the following aims: 1) to evaluate the reach, representativeness of reach, and maintenance of reach across time in the 16 clinics that will host the project in 2 healthcare systems; 2) to evaluate intervention fidelity, adaptations, maintenance, correlates, and outcomes across patient groups, personnel, roles, and sites; and 3) to examine the extent to which implementation is associated with the key outcome of public health interest in this project: abstinence from smoking. Data to support these aims will be collected from electronic health records of patient smoking and smoking-related intervention exposure; patient ratings of satisfaction; front-line clinic staff and clinician surveys, interviews, observation, and performance metrics; in-depth interviews with and direct observation of care managers who will engage smokers and deliver interventions; and semi-structured interviews with clinic- and system-level leaders who influence adoption and implementation decisions. This project will cut across ecological levels (patient to system) using mixed methods in 2 separate implementation cohorts. This will advance our understanding of challenges in implementing systematic, sustained efforts to expand the reach and effectiveness of smoking cessation treatment, and thereby reduce morbidity and mortality related to smoking.

Public Health Relevance

Far too few patients receive smoking treatment in primary care. This project will identify challenges healthcare systems encounter when trying to deliver high quality smoking cessation treatment to smokers and identify ways to address these challenges to ensure that all patients who smoke are offered high-quality help in quitting smoking.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Research Program Projects (P01)
Project #
Application #
Study Section
Special Emphasis Panel (ZCA1)
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Wisconsin Madison
United States
Zip Code
Berg, Kristin M; Smith, Stevens S; Piper, Megan E et al. (2018) Identifying Differences in Rates of Invitation to Participate in Tobacco Treatment in Primary Care. WMJ 117:111-115
Schlam, Tanya R; Cook, Jessica W; Baker, Timothy B et al. (2018) Can we increase smokers' adherence to nicotine replacement therapy and does this help them quit? Psychopharmacology (Berl) 235:2065-2075
Nahum-Shani, Inbal; Smith, Shawna N; Spring, Bonnie J et al. (2018) Just-in-Time Adaptive Interventions (JITAIs) in Mobile Health: Key Components and Design Principles for Ongoing Health Behavior Support. Ann Behav Med 52:446-462
Nahum-Shani, Inbal; Dziak, John J; Collins, Linda M (2018) Multilevel factorial designs with experiment-induced clustering. Psychol Methods 23:458-479
Berg, Kristin M; Jorenby, Douglas E; Baker, Timothy B et al. (2018) Triple Smoking Cessation Therapy with Varenicline, Nicotine Patch and Nicotine Lozenge: A Pilot Study to Assess Tolerability, Satisfaction, and End-of-Treatment Quit Rates. J Smok Cessat 13:145-153
Deng, Sien; E McCarthy, Danielle; E Piper, Megan et al. (2018) Extreme Response Style and the Measurement of Intra-Individual Variability in Affect. Multivariate Behav Res 53:199-218
Hartz, Sarah M; Horton, Amy C; Hancock, Dana B et al. (2018) Genetic correlation between smoking behaviors and schizophrenia. Schizophr Res 194:86-90
Piper, Megan E; Cook, Jessica W; Schlam, Tanya R et al. (2018) A Randomized Controlled Trial of an Optimized Smoking Treatment Delivered in Primary Care. Ann Behav Med 52:854-864
Han, Jeong Yeob; Hawkins, Robert; Baker, Timothy et al. (2017) How Cancer Patients Use and Benefit from an Interactive Cancer Communication System. J Health Commun 22:792-799
Baker, Timothy B; Smith, Stevens S; Bolt, Daniel M et al. (2017) Implementing Clinical Research Using Factorial Designs: A Primer. Behav Ther 48:567-580

Showing the most recent 10 out of 70 publications