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Grant Details

Grant Number: 5R01CA141596-03 Interpret this number
Primary Investigator: Tindle, Hilary
Organization: University Of Pittsburgh
Project Title: Connect to Quit: Coordinated Care for Smoking Cessation Among Low Income Veterans
Fiscal Year: 2012
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Abstract

DESCRIPTION (provided by applicant): Despite a reduction in smoking prevalence in the general United States adult population over the past 4 decades, the prevalence of smoking remains high among low income adults and low income veterans of the United States military. Despite the highly-advanced, population-based approach to tobacco control in the Veterans Administration (VHA) health care system, low income smokers remain difficult to treat. A pervasive, nationwide lack of approach to smoking as a chronic disease, with high relapse rates and multiple quit attempts per smoker even in the best of circumstances, is a critical deficit in the current standard of care for low income smokers, who are even less likely than wealthier individuals to quit smoking, and more likely to relapse when they do quit. The goal of this application is to examine the effectiveness of an intervention designed to reduce smoking in low income adults within a regional United States Veterans Administration (VHA) health care system. We propose a pro-active, personalized, coordinated system of care (Connect to Quit (CTQ)) which is rooted in the Chronic Care Model. CTQ treats smoking as a chronic condition that, like hypertension or diabetes, requires long term treatment with appropriate combinations of behavioral therapy and pharmacotherapy. CTQ will be evaluated in the context of 3 VA Pittsburgh Healthcare System (VAPHS) medical practices which care for ~2,400 low-income smokers, 93% of whom report an annual household income below $36,000 (27% make < $10K; 37% make from $10-$19,999K; 23% make from $20-$29,999K; and only 13% make > $30,000). Approximately 40 Primary Care Providers (PCPs, including non-physicians) in VAPHS (and their low income patients making < $36,000/year) will be invited to be randomized to either CTQ or Usual Care (UC, existing VHA services, without additional CTQ services). Desire to quit smoking is not required for participation in the study, as the point of CTQ is to engage smokers at every level of readiness to quit. Approximately 480 low income smokers in each group are expected to enroll and be followed for a minimum of 2 years. Investigators will measure abstinence (biochemically-validated 30 day point-prevalence) at the end of 2 years and over a 2-year period (measured every 6 months). Direct and indirect costs of care will be assessed to calculate the incremental cost per successful quit of CTQ vs. UC. Investigators will explore mediating effects of process measures related to treatment utilization and behavioral processes (of enrolled patients and providers) on the impact of CTQ. This proposal is led by Dr. Tindle, a new investigator, and represents a collaborative effort by investigators with complementary expertise, experience, and positioning to execute the study. The conservatively-estimated impact of CTQ to increase abstinence by ~5% above and beyond UC (representing a 50-100% increase in cessation) at two years would result in ~50,000 fewer low income smokers in the national VA population of low income veterans, and ~300,000 fewer if projected nationally to all low-income smokers. PUBLIC HEALTH RELEVANCE: Smoking is the leading preventable cause of disease and death in the United States and in the world, yet smoking remains common among people with low income, such as low income veterans of the United States military. This project will test how well a program called "Connect to Quit" helps low income veterans quit smoking. The program treats smoking as an ongoing health condition that, like high blood pressure or diabetes, needs a combination of ongoing support, classes, and medication. The results of this project will improve our understanding of how to help low income veterans successfully quit smoking.

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Publications

Smoking patterns and stimulus control in intermittent and daily smokers.
Authors: Shiffman S, Dunbar MS, Li X, Scholl SM, Tindle HA, Anderson SJ, Ferguson SG
Source: PLoS One, 2014;9(3), p. e89911.
EPub date: 2014 Mar 5.
PMID: 24599056
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Cue reactivity in non-daily smokers: effects on craving and on smoking behavior.
Authors: Shiffman S, Dunbar MS, Kirchner TR, Li X, Tindle HA, Anderson SJ, Scholl SM, Ferguson SG
Source: Psychopharmacology (Berl), 2013 Mar;226(2), p. 321-33.
EPub date: 2012 Nov 11.
PMID: 23142992
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Cigarette smoking exposure and heart failure risk in older adults: the Health, Aging, and Body Composition Study.
Authors: Gopal DM, Kalogeropoulos AP, Georgiopoulou VV, Smith AL, Bauer DC, Newman AB, Kim L, Bibbins-Domingo K, Tindle H, Harris TB, Tang WW, Kritchevsky SB, Butler J
Source: Am Heart J, 2012 Aug;164(2), p. 236-42.
PMID: 22877810
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Smoking motives of daily and non-daily smokers: a profile analysis.
Authors: Shiffman S, Dunbar MS, Scholl SM, Tindle HA
Source: Drug Alcohol Depend, 2012 Dec 1;126(3), p. 362-8.
EPub date: 2012 Jul 9.
PMID: 22784601
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Smoker reactivity to cues: effects on craving and on smoking behavior.
Authors: Shiffman S, Dunbar M, Kirchner T, Li X, Tindle H, Anderson S, Scholl S
Source: J Abnorm Psychol, 2013 Feb;122(1), p. 264-80.
EPub date: 2012 Jun 18.
PMID: 22708884
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Characteristics and smoking patterns of intermittent smokers.
Authors: Shiffman S, Tindle H, Li X, Scholl S, Dunbar M, Mitchell-Miland C
Source: Exp Clin Psychopharmacol, 2012 Aug;20(4), p. 264-77.
EPub date: 2012 Mar 5.
PMID: 22390208
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Social networks, social support and burden in relationships, and mortality after breast cancer diagnosis.
Authors: Kroenke CH, Michael Y, Tindle H, Gage E, Chlebowski R, Garcia L, Messina C, Manson JE, Caan BJ
Source: Breast Cancer Res Treat, 2012 May;133(1), p. 375-85.
EPub date: 2012 Feb 14.
PMID: 22331479
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Optimism, response to treatment of depression, and rehospitalization after coronary artery bypass graft surgery.
Authors: Tindle H, Belnap BH, Houck PR, Mazumdar S, Scheier MF, Matthews KA, He F, Rollman BL
Source: Psychosom Med, 2012 Feb-Mar;74(2), p. 200-7.
EPub date: 2012 Jan 27.
PMID: 22286847
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A review of smoking cessation interventions for smokers aged 50 and older.
Authors: Zbikowski SM, Magnusson B, Pockey JR, Tindle HA, Weaver KE
Source: Maturitas, 2012 Feb;71(2), p. 131-41.
EPub date: 2011 Dec 29.
PMID: 22209349
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Psychological and social characteristics associated with religiosity in Women's Health Initiative participants.
Authors: Schnall E, Kalkstein S, Fitchett G, Salmoirago-Blotcher E, Ockene J, Tindle HA, Thomas A, Hunt JR, Wassertheil-Smoller S
Source: J Relig Health, 2012 Mar;51(1), p. 20-31.
PMID: 22069057
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Validating smoking data from the Veteran's Affairs Health Factors dataset, an electronic data source.
Authors: McGinnis KA, Brandt CA, Skanderson M, Justice AC, Shahrir S, Butt AA, Brown ST, Freiberg MS, Gibert CL, Goetz MB, Kim JW, Pisani MA, Rimland D, Rodriguez-Barradas MC, Sico JJ, Tindle HA, Crothers K
Source: Nicotine Tob Res, 2011 Dec;13(12), p. 1233-9.
EPub date: 2011 Sep 12.
PMID: 21911825
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Prevention of bacterial pneumonia in HIV infection: focus on smoking cessation.
Authors: Crothers K, Tindle HA
Source: Expert Rev Anti Infect Ther, 2011 Jul;9(7), p. 759-62.
PMID: 21810046
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Association of active and passive smoking with risk of breast cancer among postmenopausal women: a prospective cohort study.
Authors: Luo J, Margolis KL, Wactawski-Wende J, Horn K, Messina C, Stefanick ML, Tindle HA, Tong E, Rohan TE
Source: BMJ, 2011 Mar 1;342, p. d1016.
EPub date: 2011 Mar 1.
PMID: 21363864
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