- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03077737
Reducing Tobacco Use Disparities Among Low-Income Adults
January 13, 2022 updated by: Brian Hitsman, Northwestern University
Reducing Tobacco Use Disparities Among Adults In Safety Net Community Health Centers
Most smokers, especially those who are poor, do not receive smoking cessation treatment during their healthcare visits.
This study is evaluating a novel population health management intervention for low-income smokers.
Automated via an EHR system, which is bidirectionally linked with the Illinois Tobacco Quitline, the intervention comprises a mailed letter and text messaging designed to motivate low-income patients, most of whom are not ready to quit, to accept and use proactive quitline treatment.
Increased access to free effective treatment via the integration of healthcare systems and state quitline services may be especially significant in its impact on low-income smokers who are underserved and who carry a much greater burden of tobacco-related disease.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Detailed Description
An estimated 26 million smokers still receive no treatment for their smoking during their primary care visits.
Given the persistent clinical system, provider, and patient barriers to addressing smoking in primary care, especially for poor populations, an electronic health record (EHR)-automated population health management approach that directly links the healthcare system with public health services to engage all smokers may increase access to effective treatment.
Increased access is especially significant for low-income smokers who are underserved and who carry a disproportionate burden of tobacco-related disease.
While 90% of smokers are not ready to quit, many are interested in cutting down, and smoking reduction increases the likelihood of future quit attempts and smoking cessation.
Based on self-determination theory, population outreach targeted to low-income smokers that offers them the choice to either quit or cut down as a first step towards cessation may increase their engagement in and utilization of smoking cessation treatment and likelihood of achieving abstinence.
This 2-group randomized controlled trial will evaluate the effectiveness of a population health management intervention for smoking cessation in low-income smokers.
Participants will be 530 diverse, low-income smokers of a large Federally Qualified Health Center (FQHC) in Chicago identified using its EHR system.
Automated via the EHR system, participants will be mailed a letter on behalf of their providers that encourages smoking cessation or smoking reduction as a first step to quitting (Choose to Change; N=265).
The letter will be paired with 5 text messages 2-3 days apart that are designed to reinforce the central messaging of the letter ("Choose to change and make your own goal").
All components of the Choose to Change intervention will be offered in English and Spanish.
Two weeks after letter mailing and automated electronic referral, participants will receive a call from the Illinois Tobacco Quitline and offered free behavioral counseling and free nicotine replacement therapy (NRT; patch, gum, or lozenge) for smoking cessation or reduction.
Treatment will continue as either accepted or initiated by participants for 28 weeks.
Treatment outcomes will be transmitted directly from the Quitline server to the EHR system.
Choose to Change will be compared with Enhanced Usual Care (N=265), in which an electronic referral for proactive Quitline treatment is made during a clinic visit.
The primary study outcomes will be treatment engagement (initial counseling call completed) at 6 weeks, utilization (one or more additional counseling calls completed) at 14 weeks, and smoking cessation (bioverified 7-day point-prevalence abstinence) at 28 weeks.
An exploratory aim is to examine moderators of intervention effects.
An EHR-automated population health management intervention targeted to low-income smokers could reduce critical disparities in treatment access, utilization, and cessation.
If determined to be effective, the Choose to Change intervention could be readily disseminated to 11 other FQHCs in Chicago, comprising 85 clinical sites that care for almost 500,000 low-income patients.
Study Type
Interventional
Enrollment (Actual)
190
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
Illinois
-
Chicago, Illinois, United States, 60611
- Northwestern University Feingberg School of Medicine, Dept. of Preventive Medicine
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
Yes
Genders Eligible for Study
All
Description
Inclusion criteria
- Men and women who are 18 years of age or older
- A patient who receives healthcare at one of the seven Near North Health Service Corporation community health centers in Chicago
- Daily or weekly cigarette smoker
- One or more healthcare visits within the past 12 months
Exclusion criteria
- Language preference other than English or Spanish for their healthcare
- No telephone number or address listed in the EHR system
- Lives with another patient who is already enrolled in the study
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Population health management
Population health management for smoking cessation in low-income smokers: the Choose to Change intervention
|
Population-based letter outreach automated via the electronic health record system and text messaging targeted to low-income smokers.
Paired with automated electronic referral for proactive quitline treatment (behavioral counseling plus nicotine replacement therapy).
|
Active Comparator: Enhanced usual care
Usual clinic-based care enhanced by an EHR system that can deliver an electronic referral for quitline treatment
|
Enhanced usual care based on Ask, Advise and Refer in which an electronic referral for proactive quitline treatment (behavioral counseling plus nicotine replacement therapy) is made during a clinic visit.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Quitline Treatment Engagement
Time Frame: Week 6
|
The number of participants who accepted the quitline call and accepted treatment as defined by enrolling in treatment and completing the first counseling session.
Participants who returned a quitline call, enrolled in treatment, and completed the first counseling session were also counted as having engaged in treatment.
|
Week 6
|
Quitline Treatment Utilization
Time Frame: Week 14
|
The number of participants who completed one or more additional quitline counseling calls.
|
Week 14
|
Smoking Cessation at Week 28 (32 Weeks After Enrollment)
Time Frame: Week 28
|
Self-reported seven-day point-prevalence abstinence at week 28.
Number of participants who reporting smoking cessation at week 28.
Participants were classified as abstinent if they reported not smoking (not even a puff of a cigarette) for at least 7 days prior to the assessment.
|
Week 28
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Smoking Cessation at Week 14 (18 Weeks After Enrollment)
Time Frame: Week 14
|
Self-reported seven-day point-prevalence abstinence at week 14.
Participants were classified as abstinent if they reported not smoking (not even a puff of a cigarette) for at least 7 days prior to the assessment.
|
Week 14
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Brian Hitsman, PhD, Northwestern University Feinberg School of Medicine
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
General Publications
- Williams GC, McGregor HA, Sharp D, Levesque C, Kouides RW, Ryan RM, Deci EL. Testing a self-determination theory intervention for motivating tobacco cessation: supporting autonomy and competence in a clinical trial. Health Psychol. 2006 Jan;25(1):91-101. doi: 10.1037/0278-6133.25.1.91.
- Yarnall KS, Pollak KI, Ostbye T, Krause KM, Michener JL. Primary care: is there enough time for prevention? Am J Public Health. 2003 Apr;93(4):635-41. doi: 10.2105/ajph.93.4.635.
- Hiscock R, Bauld L, Amos A, Fidler JA, Munafo M. Socioeconomic status and smoking: a review. Ann N Y Acad Sci. 2012 Feb;1248:107-23. doi: 10.1111/j.1749-6632.2011.06202.x. Epub 2011 Nov 17.
- Piper ME, Baker TB, Mermelstein R, Collins LM, Fraser DL, Jorenby DE, Smith SS, Christiansen BA, Schlam TR, Cook JW, Oguss M, Fiore MC. Recruiting and engaging smokers in treatment in a primary care setting: developing a chronic care model implemented through a modified electronic health record. Transl Behav Med. 2013 Sep;3(3):253-63. doi: 10.1007/s13142-012-0178-8.
- Hughes JR, Carpenter MJ. Does smoking reduction increase future cessation and decrease disease risk? A qualitative review. Nicotine Tob Res. 2006 Dec;8(6):739-49. doi: 10.1080/14622200600789726.
- Jamal A, Dube SR, Malarcher AM, Shaw L, Engstrom MC; Centers for Disease Control and Prevention (CDC). Tobacco use screening and counseling during physician office visits among adults--National Ambulatory Medical Care Survey and National Health Interview Survey, United States, 2005-2009. MMWR Suppl. 2012 Jun 15;61(2):38-45.
- Boyle RG, Solberg LI, Fiore MC. Electronic medical records to increase the clinical treatment of tobacco dependence: a systematic review. Am J Prev Med. 2010 Dec;39(6 Suppl 1):S77-82. doi: 10.1016/j.amepre.2010.08.014.
- Baker DW, Parker RM, Williams MV, Clark WS, Nurss J. The relationship of patient reading ability to self-reported health and use of health services. Am J Public Health. 1997 Jun;87(6):1027-30. doi: 10.2105/ajph.87.6.1027.
- Lindson-Hawley N, Aveyard P, Hughes JR. Gradual reduction vs abrupt cessation as a smoking cessation strategy in smokers who want to quit. JAMA. 2013 Jul 3;310(1):91-2. doi: 10.1001/jama.2013.6473.
- Williams GC, Niemiec CP, Patrick H, Ryan RM, Deci EL. The importance of supporting autonomy and perceived competence in facilitating long-term tobacco abstinence. Ann Behav Med. 2009 Jun;37(3):315-24. doi: 10.1007/s12160-009-9090-y. Epub 2009 Apr 17.
- Landon BE, Grumbach K, Wallace PJ. Integrating public health and primary care systems: potential strategies from an IOM report. JAMA. 2012 Aug 1;308(5):461-2. doi: 10.1001/jama.2012.8227. No abstract available.
- Hitsman B, Matthews PA, Papandonatos GD, Cameron KA, Rittner SS, Mohanty N, Long T, Ackermann RT, Ramirez E, Carr J, Cordova E, Bridges C, Flowers-Carson C, Giachello AL, Hamilton A, Ciecierski CC, Simon MA. An EHR-automated and theory-based population health management intervention for smoking cessation in diverse low-income patients of safety-net health centers: a pilot randomized controlled trial. Transl Behav Med. 2022 Oct 7;12(9):892-899. doi: 10.1093/tbm/ibac026.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
April 21, 2017
Primary Completion (Actual)
August 31, 2018
Study Completion (Actual)
August 31, 2018
Study Registration Dates
First Submitted
March 1, 2017
First Submitted That Met QC Criteria
March 7, 2017
First Posted (Actual)
March 13, 2017
Study Record Updates
Last Update Posted (Actual)
January 21, 2022
Last Update Submitted That Met QC Criteria
January 13, 2022
Last Verified
January 1, 2022
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 5U54CA203000 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Nicotine Dependence
-
Washington University School of MedicineNational Cancer Institute (NCI); National Institutes of Health (NIH)CompletedSmoking | Smoking Cessation | Tobacco Use | Tobacco Smoking | Tobacco Use Cessation | Nicotine Dependence | Tobacco Dependence | Smoking, Tobacco | Nicotine Use Disorder | Nicotine Dependence, Cigarettes | Smoking, Cigarette | Nicotine Dependence Tobacco Product | Tobacco; Use, Rehabilitation | Smoking (Tobacco) Addiction and other conditionsUnited States
-
University of California, San FranciscoNational Institute on Drug Abuse (NIDA); National Institutes of Health (NIH)WithdrawnCardiovascular Risk Factor | Nicotine Dependence | Nicotine Dependence, Cigarettes | Nicotine Withdrawal | Tobacco ToxicityUnited States
-
University of VermontNational Institute on Drug Abuse (NIDA)CompletedNicotine Dependence, CigarettesUnited States
-
Freedom Laser, Inc.NST Consultants, Inc.Completed
-
University of VermontNational Institute of General Medical Sciences (NIGMS)CompletedNicotine Dependence, CigarettesUnited States
-
Milton S. Hershey Medical CenterCompleted
-
University of OsloCharles University, Czech Republic; The Research Council of NorwayRecruitingNicotine Dependence, CigarettesCzechia, Norway
-
University of OsloCharles University, Czech Republic; The Research Council of NorwayRecruiting
-
Duke UniversityNational Institute on Drug Abuse (NIDA)CompletedNicotine Dependence, CigarettesUnited States
-
Milton S. Hershey Medical CenterTerminatedNicotine Dependence, CigarettesUnited States
Clinical Trials on Choose to Change
-
Woman's Health University Hospital, EgyptUnknown
-
University of British ColumbiaCanadian Institutes of Health Research (CIHR); Active Aging SocietyCompletedAging | Loneliness | Mobility Limitation | Physical Inactivity | Social IsolationCanada
-
University of British ColumbiaCanadian Institutes of Health Research (CIHR); Active Aging SocietyActive, not recruitingAging | Loneliness | Mobility Limitation | Sedentary Behaviour | Social Isolation | Social ConnectednessCanada
-
University of British ColumbiaCanadian Institutes of Health Research (CIHR); Public Health Agency of Canada... and other collaboratorsNot yet recruitingAging | Sedentary Behavior | Loneliness | Mobility Limitation | Physical Inactivity | Social IsolationCanada
-
University Hospital, LinkoepingRecruiting
-
Public Health Management CorporationDepartment of Health and Human ServicesCompletedPregnancy in AdolescenceUnited States
-
University of British ColumbiaCanadian Institutes of Health Research (CIHR); Active Aging SocietyActive, not recruitingAging | Sedentary Behavior | Loneliness | Mobility Limitation | Social IsolationCanada
-
Vanderbilt UniversityCompletedParkinson DiseaseUnited States
-
Tulane University School of MedicineOhio State University; Minds at WorkCompleted
-
University of AarhusChild and Youth, Aarhus MunicipalityCompletedPediatric ObesityDenmark