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Grant Details

Grant Number: 5R01CA201873-04 Interpret this number
Primary Investigator: Dziura, James
Organization: Yale University
Project Title: Optimizing Tobacco Dependence Treatment in the Emergency Department
Fiscal Year: 2019


Abstract Tobacco use remains the leading cause of preventable death in the United States. Smoking is increasingly a disease of medically underserved populations, including individuals of lower socioeconomic status and those with behavioral or substance use disorders. Emergency departments (EDs), to which Americans paid 130 million visits in 2013, are excellent clinical settings in which to identify smokers, initiate treatment, and refer for aftercare. Our previous work has demonstrated the efficacy of a multicomponent intervention in promoting tobacco abstinence at 3 months. The intervention included a full package of evidence-based treatments, including initiation of nicotine replacement therapy in the ED, provision of 6 weeks of patches and gum, a brief motivational interview, active referral to a state smokers' quitline, and a brochure with information on the health risks of smoking. A subsequent pilot study demonstrated the feasibility and potential efficacy of an intervention that included short-message-service (SMS) texting to subject cellphones to promote tobacco abstinence. While efficacious, it is not clear which components of the intervention had the greatest impact, which combinations of therapy might work best, or which are generalizable to all EDs. In order to design an intervention that is clinically effective, cost-effective, and practicable, we propose to disentangle the effects of these components and assemble an intervention that maximizes clinical efficacy, feasibility, and acceptability, given a cost- effectiveness constraint and findings from qualitative analysis. The methodology we propose using is the Multiple Optimization Strategy (MOST), a clinical trials design that uses principles adapted from industrial engineering. We propose an innovative 16-arm full-factorial design in a cohort of 1056 adult smokers in an urban ED, to test the efficacy of four key components: motivational interviewing, initiation of nicotine replacement medication, quitline referral, and texting. All subjects will receive a smoking cessation brochure. At the trial's completion, we will use a novel mixed-methods approach to identify components that were efficacious within the proposed cost constraint, along with feasibility and acceptability to subjects. We will assemble components found to be clinically efficacious, cost-effective, and feasible/acceptable into a multicomponent package for testing in a future randomized clinical trial. Study Aim (1) is to conduct the factorial experiment; Aim (2) is to analyze trial results to identify the effective components, and Aim (3) is to lay the groundwork for the subsequent clinical trial testing this multicomponent intervention, versus a control condition. The multicomponent intervention, once disseminated and implemented, can transform the care of the tens of millions of smokers who visit U.S. EDs. Our team includes an outstanding array of experts with deep experience in trial design, including the developer of MOST, emergency department-based investigation, tobacco dependence treatment, texting, health economics, and qualitative methods.  


Cost-Effectiveness of Smoking Cessation Approaches in Emergency Departments.
Authors: Miller T.R. , Johnson M.B. , Dziura J.D. , Weiss J. , Carpenter K.M. , Grau L.E. , Pantalon M.V. , Abroms L. , Collins L.M. , Toll B.A. , et al. .
Source: American journal of preventive medicine, 2023 Jul; 65(1), p. 39-44.
EPub date: 2023-01-28.
PMID: 36710199
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Successful Optimization of Tobacco Dependence Treatment in the Emergency Department: A Randomized Controlled Trial Using the Multiphase Optimization Strategy.
Authors: Bernstein S.L. , Dziura J. , Weiss J. , Brooks A.H. , Miller T. , Vickerman K.A. , Grau L.E. , Pantalon M.V. , Abroms L. , Collins L.M. , et al. .
Source: Annals of emergency medicine, 2023 Feb; 81(2), p. 209-221.
EPub date: 2022-12-28.
PMID: 36585318
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A qualitative study of smokers' assessments of four smoking cessation interventions delivered in a hospital emergency department.
Authors: Grau L.E. , Jurczak E. , Zahid M. , Brooks A.H. , Weiss J. , O'Leary T.K. , Pham T. , Bernstein S.L. .
Source: Drug and alcohol dependence, 2022-08-01; 237, p. 109512.
EPub date: 2022-05-27.
PMID: 35714533
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Advances in clinical trials methodology: Intervention optimization approaches in emergency medicine.
Authors: Bernstein S.L. , Carter P.M. , Meurer W. , Walton M.A. , Kidwell K.M. , Cunningham R.M. , Dziura J. , Collins L.M. .
Source: The American journal of emergency medicine, 2022 Mar; 53, p. 6-11.
EPub date: 2021-12-18.
PMID: 34968972
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Ask about smoking, not quitting: a chronic disease approach to assessing and treating tobacco use.
Authors: Bernstein S.L. , Toll B.A. .
Source: Addiction science & clinical practice, 2019-09-02; 14(1), p. 29.
EPub date: 2019-09-02.
PMID: 31474229
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National medical expenditures by smoking status in American adults: an application of Manning's two-stage model to nationally representative data.
Authors: Swedler D.I. , Miller T.R. , Ali B. , Waeher G. , Bernstein S.L. .
Source: BMJ open, 2019-07-16; 9(7), p. e026592.
EPub date: 2019-07-16.
PMID: 31315859
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Tobacco dependence treatment in the emergency department: A randomized trial using the Multiphase Optimization Strategy.
Authors: Bernstein S.L. , Dziura J. , Weiss J. , Miller T. , Vickerman K.A. , Grau L.E. , Pantalon M.V. , Abroms L. , Collins L.M. , Toll B. .
Source: Contemporary clinical trials, 2018 Mar; 66, p. 1-8.
EPub date: 2017-12-27.
PMID: 29287665
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Assessing the National Cancer Institute's SmokefreeMOM Text-Messaging Program for Pregnant Smokers: Pilot Randomized Trial.
Authors: Abroms L.C. , Chiang S. , Macherelli L. , Leavitt L. , Montgomery M. .
Source: Journal of medical Internet research, 2017-10-03; 19(10), p. e333.
EPub date: 2017-10-03.
PMID: 28974483
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Recruiting pregnant smokers from Text4baby for a randomized controlled trial of Quit4baby.
Authors: Leavitt L. , Abroms L. , Johnson P. , Schindler-Ruwisch J. , Bushar J. , Singh I. , Cleary S.D. , McInvale W. , Turner M. .
Source: Translational behavioral medicine, 2017 Jun; 7(2), p. 157-165.
PMID: 27909881
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Feasibility and Acceptability of a Text Messaging Program for Smoking Cessation in Israel.
Authors: Abroms L. , Hershcovitz R. , Boal A. , Levine H. .
Source: Journal of health communication, 2015 Aug; 20(8), p. 903-9.
EPub date: 2015-05-21.
PMID: 25996261
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Text2Quit: results from a pilot test of a personalized, interactive mobile health smoking cessation program.
Authors: Abroms L.C. , Ahuja M. , Kodl Y. , Thaweethai L. , Sims J. , Winickoff J.P. , Windsor R.A. .
Source: Journal of health communication, 2012; 17 Suppl 1(Suppl 1), p. 44-53.
PMID: 22548598
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iPhone apps for smoking cessation: a content analysis.
Authors: Abroms L.C. , Padmanabhan N. , Thaweethai L. , Phillips T. .
Source: American journal of preventive medicine, 2011 Mar; 40(3), p. 279-85.
PMID: 21335258
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