Cigarette smoking and complications from cigarette smoking disproportionately affect people living in rural communities. Previous strategies to promote smoking cessation have largely been urban-based, involved short term interventions, enrolled smokers already motivated to quit, and been poorly integrated into primary care practice. Nicotine addiction may be better conceptualized as a chronic illness that might be most effectively addressed using newer models of chronic disease management. A disease management approach to smoking cessation would provide support for multiple quit attempts, treat smokers of all stages of readiness to quit, and coordinate cessation efforts with primary health care providers. The primary aim of this study is to assess the effectiveness of both high and low intensity, disease management programs for nicotine dependence. In this study, we will recruit 750 smokers from 20 rural, primary care clinics in Kansas. Subjects will be randomly assigned to one of three study arms, each providing 20 months of treatment: C (comparison group), LDM (low-intensity disease management) or HDM (high-intensity disease management). Participant's in-group C will receive health educational mailings and an offer for free nicotine replacement therapy (six weeks) or bupropion (seven weeks) every 6 months (months 0, 6, 12, and 18). Participants in LDM will receive the same interventions as C plus a low-intensity disease management program that includes a single telephone counseling session using motivational interviewing (MI)at months 0, 6, 12, and 18 to encourage a cessation attempt and also includes coordination of smoking assessments and pharmacotherapy with the patient's physician. HDM participants will receive C plus a high intensity disease management program that includes up to six telephone-based MI counseling sessions at months 0, 6, 12, and 18 to encourage a smoking cessation attempt and to prevent relapse after a quit attempt, as well as coordination of smoking assessments, quit attempts, and pharmacotherapy with the patient's physician. The primary outcome of the study is 7-day point prevalence abstinence from cigarettes at 2 years after enrollment. Secondary outcomes include: 1) number of quit attempts and 2) progress in stage of change. If successful, this intervention will provide a generalizable model for addressing nicotine dependence that could improve long-term management of smoking in primary care.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
3R01CA101963-04S1
Application #
7287675
Study Section
Social Sciences, Nursing, Epidemiology and Methods 4 (SNEM)
Program Officer
Ogunbiyi, Peter
Project Start
2003-07-09
Project End
2008-06-30
Budget Start
2006-08-01
Budget End
2007-06-30
Support Year
4
Fiscal Year
2006
Total Cost
$73,207
Indirect Cost
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
Jiang, Yu; Simon, Steve; Mayo, Matthew S et al. (2015) Modeling and validating Bayesian accrual models on clinical data and simulations using adaptive priors. Stat Med 34:613-29
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
Cupertino, Ana-Paula; Berg, Carla; Gajewski, Byron et al. (2012) Change in self-efficacy, autonomous and controlled motivation predicting smoking. J Health Psychol 17:640-52
Yeh, Hung-Wen; Ellerbeck, Edward F; Mahnken, Jonathan D (2012) Simultaneous evaluation of abstinence and relapse using a Markov chain model in smokers enrolled in a two-year randomized trial. BMC Med Res Methodol 12:95
Cox, Lisa Sanderson; Wick, Jo A; Nazir, Niaman et al. (2011) Predictors of early versus late smoking abstinence within a 24-month disease management program. Nicotine Tob Res 13:215-20
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
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

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