[More] evidence to support oral health promotion services targeted to smokers calling tobacco quitlines in the United States.

BACKGROUND: Prior research demonstrated a need and opportunity to target smokers calling a free, state-funded tobacco quitline to provide behavioral counseling for oral health promotion; however, it is unclear whether these results generalize to tobacco quitline callers of higher socioeconomic status receiving services through commercially-funded quitlines. This knowledge will inform planning for a future public oral health promotion program targeted to tobacco quitline callers. METHODS: We surveyed smokers (n = 455) who had recently received tobacco quitline services through their medical insurance. Participants were asked about their self-reported oral health indicators, key behavioral risk factors for oral disease, motivation for changing their oral self-care behavior, and interest in future oral health promotion services. Where applicable, results were compared against those from a representative sample of callers to a free, state-funded quitline (n = 816) in the same geographic region. RESULTS: Callers to a commercially-funded quitline had higher socioeconomic status, were more likely to have dental insurance, and reported better overall oral health indicators and routine self-care (oral hygiene, dental visits) than callers to a state-funded quitline. Nevertheless opportunities for oral health promotion were identified. Nearly 80% of commercial quitline callers failed to meet basic daily hygiene recommendations, 32.8% had not visited the dentist in more than a year, and 63.3% reported daily alcohol consumption (which reacts synergistically with tobacco to increase oral cancer risk). Nearly half (44%) were interested in learning how to improve their oral health status and, on average, moderately high levels of motivation for oral health care were reported. Many participants also had dental insurance, eliminating an important barrier to professional dental care. CONCLUSIONS: Future public oral health promotion efforts should focus on callers to both free state-supported and commercially-funded tobacco quitlines. While differences exist between these populations, both groups report behavioral risk factors for oral disease which represent important targets for intervention.

The effect of program design on engagement with an internet-based smoking intervention: randomized factorial trial.

BACKGROUND: Participant engagement influences treatment effectiveness, but it is unknown which intervention design features increase treatment engagement for online smoking cessation programs. OBJECTIVE: We explored the effects of 4 design features (ie, factors) on early engagement with an Internet-based, motivational smoking cessation program. METHODS: Smokers (N=1865) were recruited from a large health care organization to participate in an online intervention study, regardless of their interest in quitting smoking. The program was intended to answer smokers' questions about quitting in an effort to motivate and support cessation. Consistent with the screening phase in the multiphase optimization strategy (MOST), we used a 2-level, full-factorial design. Each person was randomized to 1 of 2 levels of each factor, including message tone (prescriptive vs motivational), navigation autonomy (dictated vs not), proactive email reminders (yes vs no), and inclusion of personally tailored testimonials (yes vs no). The effects of each factor level on program engagement during the first 2 months of enrollment were compared, including number of visits to the website resulting in intervention content views (as opposed to supplemental content views), number of intervention content areas viewed, number of intervention content pages viewed, and duration of time spent viewing this content, as applicable to each factor. RESULTS: Adjusting for baseline readiness to quit, persons who received content written in a prescriptive tone made the same number of visits to the website as persons receiving content in a motivational tone, but viewed 1.17 times as many content areas (95% CI 1.08-1.28; P<.001) and 1.15 times as many pages (95% CI 1.04-1.28; P=.009). Time spent viewing materials did not differ among groups (P=.06). Persons required to view content in a dictated order based on their initial readiness to quit made the same number of visits as people able to freely navigate the site, but viewed fewer content areas (ratio of means 0.80, 95% CI 0.74-0.87; P<.001), 1.17 times as many pages (95% CI 1.06-1.31; P=.003), and spent 1.37 times more minutes online (95% CI 1.17-1.59; P<.001). Persons receiving proactive email reminders made 1.20 times as many visits (95% CI 1.09-1.33; P<.001), viewed a similar number of content areas as persons receiving no reminders, viewed 1.58 times as many pages (95% CI 1.48-1.68; P<.001), and spent 1.51 times as many minutes online (95% CI 1.29-1.77; P<.001) as those who did not receive proactive emails. Tailored testimonials did not significantly affect engagement. CONCLUSIONS: Using a prescriptive message tone, dictating content viewing order, and sending reminder emails each resulted in greater program engagement relative to the contrasting level of each experimental factor. The results require replication, but suggest that a more directive interaction style may be preferable for online cessation programs. TRIAL REGISTRATION: clinicaltrials.gov NCT00992264; http://clinicaltrials.gov/ct2/show/NCT00992264 (Archived by WebCite at http://www.webcitation.org/6F7H7lr3P).

Pharmacogenetic smoking cessation intervention in a health care setting: a pilot feasibility study.

INTRODUCTION: There is increasing evidence that response to pharmacological treatment for nicotine dependence may be moderated by genetic polymorphisms. However, the feasibility, acceptability, and impact of genetically tailoring treatment in real-world clinical settings are unknown. METHODS: We conducted a multiphased, mixed-methods feasibility study with current smokers to develop and evaluate a patient-centered, theoretically grounded personalized medicine treatment protocol. The initial research phase included formative work to develop intervention materials. The second phase included a randomized pilot trial to evaluate the intervention. Trial participants (n = 36) were genotyped for ANKK1 rs1800497 and were randomized to receive genetic feedback (GF) plus standard behavioral counseling (BC) for smoking cessation or BC without GF. All participants received genetically tailored pharmacotherapy (nicotine patch or bupropion). RESULTS: The intervention was feasible to implement and was acceptable to participants based on satisfaction ratings and objective measures of participation. There was no evidence that the GF resulted in adverse psychological outcomes (e.g., depression, fatalism, reduced perceived control over quitting, differential motivation for quitting) based on quantitative or qualitative outcomes. CONCLUSIONS: Study results suggest that it is feasible to offer treatment within a health care setting that includes genetically tailored pharmacotherapy and doing so had no apparent adverse psychological impacts. Further evaluation of pharmacogenetically tailored smoking cessation interventions appears warranted.

A survey of adult awareness and use of medicine containing acetaminophen.

PURPOSE: To compare awareness, use of acetaminophen, and preferences for receiving information aimed at reducing acetaminophen overdose. METHODS: A survey of health plan enrollees identified from automated pharmacy data who were long-term and acute users of opioids with acetaminophen (n = 720 each cohort), and a general population cohort (n = 360) during the 2010-2011 cold/flu season. A 74% response rate was achieved. Differences were tested across the three cohorts, and by level of education, using age-adjusted regression models. RESULTS: Use of over-the-counter or prescription medicine containing acetaminophen in the prior 2 weeks was reported by 84% in the long-term opioid cohort, 76% in the acute opioid cohort, and 36% in the general population, but use of over-the-counter medicine with acetaminophen did not differ across the cohorts (30-34%). All three cohorts were unlikely to correctly identify drugs containing acetaminophen, but the opioid cohorts performed slightly better than the general population. Those with higher education performed slightly better when asked to identify acetaminophen products than those with no college education. The average usual daily acetaminophen dose (mg/day) reported was highest in the long-term opioid cohort (1185), followed by the acute opioid cohort (1010), and the general population (891)-p < 0.001. Estimated supratherapeutic exposure (>4000 mg/day) was rare but three to five times more common in the opioid cohorts than in the general population. CONCLUSIONS: Acetaminophen use is common, and supratherapeutic exposure may be of concern in users of opioids. Knowledge of which drugs contain acetaminophen appears inadequate; better labeling and proactive education from professionals may be impactful.

Understanding oral health promotion needs and opportunities of tobacco quitline callers.

OBJECTIVE: Improving oral health and oral health care are important public health goals. Tobacco users and smokers are at particularly high risk for oral disease and warrant targeted intervention efforts. We assessed the need for and acceptability of targeting tobacco quitline callers for an oral health promotion intervention. METHODS: We surveyed 816 Washington State Quitline callers to assess their oral health, relevant self-care behaviors, and interest in oral health promotion intervention. RESULTS: Most respondents were female, cigarette smokers, of low socioeconomic status, with no dental insurance. Of the respondents, 79.3% (n=647) had some or all of their natural teeth (e.g., dentate); however, most of these respondents failed to meet recommendations for daily oral hygiene (brushing and flossing) (83.9%, n=543) and had no dental visits in the past year (52.6%, n=340). Similar findings were observed among respondents with no insurance. Many respondents were interested in learning more about how to improve their oral health (57.4%, n=468), willing to speak with a quitline coach about improving their oral health (48.2%, n=393), and open to receiving additional oral health information by mail (62.7%, n=512) or the Internet (50.0%, n=408). People who were receptive to learning how to improve their oral health were significantly more likely to be nonwhite, have a low income, have no dental insurance, and not have visited a dentist in the past year. CONCLUSION: There is a need and an opportunity to target quitline callers for oral health promotion services, as those most in need of these services were open to receiving them.