Grant Details
Grant Number: |
5R01CA262319-02 Interpret this number |
Primary Investigator: |
Salloum, Ramzi |
Organization: |
University Of Florida |
Project Title: |
Phone Enabled Implementation of Cessation Support (PHOENICS) |
Fiscal Year: |
2023 |
Abstract
PROJECT SUMMARY
The objective of this proposal is to evaluate the comparative effectiveness of promising multi-component
interventions for implementing evidence-based tobacco treatment in Lebanon’s national system of safety net
primary healthcare centers, which serves more than 50% of the population. This objective is directly
responsive to NCI Notice of Special Interest (NOT-CA-20-025): Dissemination and Implementation Science for
Cancer Prevention and Control in Low Resource Environments. The tobacco use burden in Lebanon is
exceptionally high: 35% of adults are current cigarette smokers, 39% are waterpipe smokers, and 5% are dual
smokers. The WHO endorses three interventions as the standard of practice for population-level tobacco
dependence treatment: smoking cessation advice integrated into primary care settings; easily-accessible
phone-based counseling; and low-cost nicotine replacement therapy (NRT). However, the evidence for these
interventions comes primarily from high-income countries and they have rarely been evaluated in low- and
middle-income countries (LMICs). Further, recommended interventions are not integrated as a routine part of
primary care in Lebanon, as is the case in other low-resource settings. Addressing this evidence-to-practice
gap requires research on multilevel interventions and contextual factors for implementing integrated, scalable,
and sustainable cessation treatment within low-resource settings. We will conduct a group-randomized trial
comparing three arms: 1) Ask about tobacco use, advise to quit, assist with brief counseling (AAA) as standard
care; 2) Ask, advise, connect to phone-based counseling (AAC); and 3) AAC+NRT. Our central hypothesis is
that connecting patients to phone-based counseling with NRT is the most effective alternative. Our hybrid
design is informed by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework which
emphasizes key steps and multilevel factors to optimize implementation success. We will pursue the following
specific aims: 1) adapt and tailor an existing smoking cessation program to deliver phone-based counseling to
smokers in Lebanon; 2) test the effectiveness and cost-effectiveness of a referral-based program that delivers
smoking cessation services to primary care patients; and 3) identify the multilevel determinants of
implementation and sustainability using mixed methods. The proposed project addresses the evidence-to-
practice gap in the provision of tobacco dependence treatment within low-resource settings by developing and
testing contextually-tailored multilevel interventions and optimizing implementation success and sustainability.
This research is significant for its potential to guide the large-scale adoption of cost-effective strategies for
implementing tobacco dependence treatment in low-resource settings thereby reducing tobacco-related
morbidity and mortality.
Publications
An effectiveness-implementation hybrid trial of phone-based tobacco cessation interventions in the Lebanese primary healthcare system: protocol for project PHOENICS.
Authors: Salloum R.G.
, Romani M.
, Bteddini D.S.
, El-Jardali F.
, Lee J.H.
, Theis R.
, LeLaurin J.H.
, Hamadeh R.
, Osman M.
, Abla R.
, et al.
.
Source: Implementation science communications, 2023-06-26; 4(1), p. 72.
EPub date: 2023-06-26.
PMID: 37365656
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