Grant Number:	6R01CA141596-07 Interpret this number
Primary Investigator:	Tindle, Hilary
Organization:	Vanderbilt University Medical Center
Project Title:	Connect to Quit: Coordinated Care for Smoking Cessation Among Low Income Veterans
Fiscal Year:	2014

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.




Does laboratory cue reactivity correlate with real-world craving and smoking responses to cues?
Authors: Shiffman S. , Li X. , Dunbar M.S. , Tindle H.A. , Scholl S.M. , Ferguson S.G. .
Source: Drug and alcohol dependence, 2015-10-01; 155, p. 163-9.
EPub date: 2015-07-29.
PMID: 26277429
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Cue reactivity in converted and native intermittent smokers.
Authors: Shiffman S. , Dunbar M.S. , Kirchner T.R. , Li X. , Tindle H.A. , Anderson S.J. , Scholl S.M. , Ferguson S.G. .
Source: Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 2015 Jan; 17(1), p. 119-23.
EPub date: 2014-08-28.
PMID: 25168030
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A randomized controlled pilot trial of the functional assessment screening tablet to engage patients at the point of care.
Authors: Hess R. , Tindle H. , Conroy M.B. , Clark S. , Yablonsky E. , Hays R.D. .
Source: Journal of general internal medicine, 2014 Dec; 29(12), p. 1641-9.
EPub date: 2014-08-08.
PMID: 25103125
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Craving in intermittent and daily smokers during ad libitum smoking.
Authors: Shiffman S. , Dunbar M.S. , Li X. , Scholl S.M. , Tindle H.A. , Anderson S.J. , Ferguson S.G. .
Source: Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 2014 Aug; 16(8), p. 1063-9.
EPub date: 2014-03-11.
PMID: 24619094
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Smoking patterns and stimulus control in intermittent and daily smokers.
Authors: Shiffman S. , Dunbar M.S. , Li X. , Scholl S.M. , Tindle H.A. , Anderson S.J. , Ferguson S.G. .
Source: PloS one, 2014; 9(3), p. e89911.
EPub date: 2014-03-05.
PMID: 24599056
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Cue reactivity in non-daily smokers: effects on craving and on smoking behavior.
Authors: Shiffman S. , Dunbar M.S. , Kirchner T.R. , Li X. , Tindle H.A. , Anderson S.J. , Scholl S.M. , Ferguson S.G. .
Source: Psychopharmacology, 2013 Mar; 226(2), p. 321-33.
EPub date: 2012-11-11.
PMID: 23142992
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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: Journal of abnormal psychology, 2013 Feb; 122(1), p. 264-80.
EPub date: 2012-06-18.
PMID: 22708884
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Smoking motives of daily and non-daily smokers: a profile analysis.
Authors: Shiffman S. , Dunbar M.S. , Scholl S.M. , Tindle H.A. .
Source: Drug and alcohol dependence, 2012-12-01; 126(3), p. 362-8.
EPub date: 2012-07-09.
PMID: 22784601
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Cigarette smoking exposure and heart failure risk in older adults: the Health, Aging, and Body Composition Study.
Authors: Gopal D.M. , Kalogeropoulos A.P. , Georgiopoulou V.V. , Smith A.L. , Bauer D.C. , Newman A.B. , Kim L. , Bibbins-Domingo K. , Tindle H. , Harris T.B. , et al. .
Source: American heart journal, 2012 Aug; 164(2), p. 236-42.
PMID: 22877810
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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: Experimental and clinical psychopharmacology, 2012 Aug; 20(4), p. 264-77.
EPub date: 2012-03-05.
PMID: 22390208
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Social networks, social support and burden in relationships, and mortality after breast cancer diagnosis.
Authors: Kroenke C.H. , Michael Y. , Tindle H. , Gage E. , Chlebowski R. , Garcia L. , Messina C. , Manson J.E. , Caan B.J. .
Source: Breast cancer research and treatment, 2012 May; 133(1), p. 375-85.
EPub date: 2012-02-14.
PMID: 22331479
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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 H.A. , Thomas A. , Hunt J.R. , Wassertheil-Smoller S. .
Source: Journal of religion and health, 2012 Mar; 51(1), p. 20-31.
PMID: 22069057
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Optimism, response to treatment of depression, and rehospitalization after coronary artery bypass graft surgery.
Authors: Tindle H. , Belnap B.H. , Houck P.R. , Mazumdar S. , Scheier M.F. , Matthews K.A. , He F. , Rollman B.L. .
Source: Psychosomatic medicine, 2012 Feb-Mar; 74(2), p. 200-7.
EPub date: 2012-01-27.
PMID: 22286847
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A review of smoking cessation interventions for smokers aged 50 and older.
Authors: Zbikowski S.M. , Magnusson B. , Pockey J.R. , Tindle H.A. , Weaver K.E. .
Source: Maturitas, 2012 Feb; 71(2), p. 131-41.
EPub date: 2011-12-29.
PMID: 22209349
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Validating smoking data from the Veteran's Affairs Health Factors dataset, an electronic data source.
Authors: McGinnis K.A. , Brandt C.A. , Skanderson M. , Justice A.C. , Shahrir S. , Butt A.A. , Brown S.T. , Freiberg M.S. , Gibert C.L. , Goetz M.B. , et al. .
Source: Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 2011 Dec; 13(12), p. 1233-9.
EPub date: 2011-09-12.
PMID: 21911825
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Prevention of bacterial pneumonia in HIV infection: focus on smoking cessation.
Authors: Crothers K. , Tindle H.A. .
Source: Expert review of anti-infective therapy, 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 K.L. , Wactawski-Wende J. , Horn K. , Messina C. , Stefanick M.L. , Tindle H.A. , Tong E. , Rohan T.E. .
Source: BMJ (Clinical research ed.), 2011-03-01; 342, p. d1016.
EPub date: 2011-03-01.
PMID: 21363864
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