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Grant Details

Grant Number: 3R01CA071358-09S1 Interpret this number
Primary Investigator: Swan, Gary
Organization: Sri International
Project Title: Treatment of Nicotine Dependence in Health Care Setting
Fiscal Year: 2009
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Abstract

DESCRIPTION (provided by applicant): The purpose of this revised application is to expand and continue the research begun in the previous funding period, Treatment of Nicotine Dependence in an HMO Setting, in which 1,524 individuals enrolled in a health care system received treatment with bupropion SR and behavioral counseling and were then followed for 12 months after their target quit date to determine smoking status. The results of this study demonstrate that: (1) an effectiveness trial can be conducted in a large health care system; (2) 150 and 300 mg doses of bupropion SR are equally effective for smoking cessation at 12 month follow-up; (3) proactive telephonic based (PTB) treatment is more effective than a tailored mailing (TM) program; (4) female gender, lower education, and higher levels of depression are independent risk factors for post-treatment smoking; and (5) there is substantial heterogeneity in treatment outcome among women and men at one year follow-up. In addition, cost-effectiveness analyses showed that 150 mg bupropion SR is more cost effective than the 300 mg dose from both the payer (i.e., employer) and societal perspectives. The next generation of this research program will evaluate the effectiveness of three different intervention approaches in combination with 150 mg bupropion SR: a proactive telephone-based (PTB) tobacco cessation program, a web-based (WB) tobacco cessation program, and a combined PTB+WB program. Participants (n=1,200) will be randomized to one of the three behavioral treatment conditions, receive an eight week course of 150 mg bupropion SR, and then followed at various points throughout a 12-month period to determine indices of medication adherence, treatment utilization, point-prevalent smoking outcomes and continuous nonsmoking. The specific aims of this project are: (1) To determine the relative effectiveness of each version of the behavioral treatment in combination with 150 mg bupropion SR; (2) To determine group differences in adherence to both the bupropion SR and behavioral conditions; (3) To examine heterogeneity in responsiveness to the three treatment conditions with Classification and Regression Tree (CART) Analysis; (4) To characterize process variables related to recruitment, implementation, barriers to treatment, exposure to intervention, satisfaction with treatment, treatment contamination, and program maintenance; (5) To determine the cost-effectiveness of the different delivery modes offered in the proposed trial; and (6) To disseminate the results of the proposed trial to the adult GHC consumers (approximately 500,000), providers, and other key stakeholders in GHC's integrated care model (n=1,400).

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Publications

Canary in a coal mine? Interest in bupropion SR use among smokers in the COMPASS trial.
Authors: McClure JB, Jack L, Deprey M, Catz S, McAfee T, Zbikowski S, Westbrook E, Swan G
Source: Nicotine Tob Res, 2008 Dec;10(12), p. 1815-6.
PMID: 19023832
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Predictors of 12-month outcome in smokers who received bupropion sustained-release for smoking cessation.
Authors: Swan GE, Jack LM, Javitz HS, McAfee T, McClure JB
Source: CNS Drugs, 2008;22(3), p. 239-56.
PMID: 18278978
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Joint effect of dopaminergic genes on likelihood of smoking following treatment with bupropion SR.
Authors: Swan GE, Jack LM, Valdes AM, Ring HZ, Ton CC, Curry SJ, McAfee T
Source: Health Psychol, 2007 May;26(3), p. 361-8.
PMID: 17500623
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Tailoring nicotine replacement therapy: rationale and potential approaches.
Authors: McClure JB, Swan GE
Source: CNS Drugs, 2006;20(4), p. 281-91.
PMID: 16599646
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Financial burden of tobacco use: an employer's perspective.
Authors: Javitz HS, Zbikowski SM, Swan GE, Jack LM
Source: Clin Occup Environ Med, 2006;5(1), p. 9-29, vii.
PMID: 16446251
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Smoking cessation treatment: pharmacogenetic assessment.
Authors: Munaf˛ MR, Lerman C, Niaura R, Shields AE, Swan GE
Source: Curr Opin Mol Ther, 2005 Jun;7(3), p. 202-8.
PMID: 15977416
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Dopamine receptor DRD2 genotype and smoking cessation outcome following treatment with bupropion SR.
Authors: Swan GE, Valdes AM, Ring HZ, Khroyan TV, Jack LM, Ton CC, Curry SJ, McAfee T
Source: Pharmacogenomics J, 2005;5(1), p. 21-9.
PMID: 15492764
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Return on investment of different combinations of bupropion SR dose and behavioral treatment for smoking cessation in a health care setting: an employer's perspective.
Authors: Javitz HS, Swan GE, Zbikowski SM, Curry SJ, McAfee TA, Decker D, Patterson R, Jack LM
Source: Value Health, 2004 Sep-Oct;7(5), p. 535-43.
PMID: 15367249
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Cost-effectiveness of different combinations of bupropion SR dose and behavioral treatment for smoking cessation: a societal perspective.
Authors: Javitz HS, Swan GE, Zbikowski SM, Curry SJ, McAfee TA, Decker DL, Patterson R, Jack LM
Source: Am J Manag Care, 2004 Mar;10(3), p. 217-26.
PMID: 15032259
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Heterogeneity in 12-month outcome among female and male smokers.
Authors: Swan GE, Javitz HS, Jack LM, Curry SJ, McAfee T
Source: Addiction, 2004 Feb;99(2), p. 237-50.
PMID: 14756716
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Bupropion SR and counseling for smoking cessation in actual practice: predictors of outcome.
Authors: Swan GE, Jack LM, Curry S, Chorost M, Javitz H, McAfee T, Dacey S
Source: Nicotine Tob Res, 2003 Dec;5(6), p. 911-21.
PMID: 14668075
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Effectiveness of bupropion sustained release for smoking cessation in a health care setting: a randomized trial.
Authors: Swan GE, McAfee T, Curry SJ, Jack LM, Javitz H, Dacey S, Bergman K
Source: Arch Intern Med, 2003 Oct 27;163(19), p. 2337-44.
PMID: 14581254
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Bupropion SR and smoking cessation in actual practice: methods for recruitment, screening, and exclusion for a field trial in a managed-care setting.
Authors: Jack LM, Swan GE, Thompson E, Curry SJ, McAfee T, Dacey S, Bergman K
Source: Prev Med, 2003 May;36(5), p. 585-93.
PMID: 12689804
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A meta-analysis of estimated genetic and environmental effects on smoking behavior in male and female adult twins.
Authors: Li MD, Cheng R, Ma JZ, Swan GE
Source: Addiction, 2003 Jan;98(1), p. 23-31.
PMID: 12492752
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