UW-CTRI colleagues presented their research findings at the Annual Meeting of the Society for Research on Nicotine and Tobacco (SRNT) in San Antonio, Texas. See what they presented below.
Researcher Dr. Adrienne Johnson co-chaired a pre-conference session called Tobacco Treatments that Work for Priority Populations. During that pre-conference, Research Director Dr. Danielle McCarthy presented preliminary results from a study involving the Wisconsin Tobacco Quit Line in her presentation, Improving Quitline Services for Socioeconomically Disadvantaged Clients. The study tested four factors:
- Counseling intensity: One vs. four proactive quit coaching calls.
- Medication intensity: Two weeks of single NRT vs. four weeks of combination nicotine-replacement medications.
- Texting support: Referral to SmokefreeTXT vs. none.
- Incentives: Participants received $30 for completing each coaching call and texting program vs. none. The incentives didn’t change the percentage of people who took one call from the Quit Line, but did slightly elevate the uptake for the four-call program, especially on calls four and five. While about 70 percent of the control group completed a milestone for the texting program, nearly 90 percent of the incentive group completed it. “Retention rates were pretty good, especially with an incentive,” McCarthy said.
McCarthy said 349 of the 1135 participants (30.7%) reported no smoking in the last week. Follow-up completion rates were more than 90 percent, demonstrating the great work of the study team, McCarthy said. Next steps include analyzing the data to determine if the interventions improved health equity, efficiency and abstinence.
Dr. Julie Kirsch presented Smoking and Sociodemographic Factors Associated with Hospital Mortality and Readmission Among Inpatients with COVID-19. She discussed her findings from the COVID EHR Cohort at the University of Wisconsin (CEC-UW), which includes 21 participating healthcare systems sharing data on COVID-19 readmissions, the second-largest in the nation. Kirsch found that current and former smoking were related to higher all-cause 60-day readmission risk. Patients who were readmitted were more likely to be male, urban residing, insured through Medicaid, Medicare and other types of government insurance, and reside in areas with higher social deprivation. Effect sizes were modest, but robust to inclusion of comorbidity history and patient factors. “These findings indicate that post-acute care planning should prioritize patients who smoke and who have greater social vulnerabilities,” Kirsch said.
Odds of 60-day Readmission: Smoking status and Obesity
Karen Conner presented Smoking Status, Nicotine Replacement, Vaccination and COVID-19 Hospital Outcomes in the CEC-UW Project: An Update Including 41,354 Additional Patients. She said inpatient mortality was similar for never smokers and current smokers after adjustment for age, sex, race, ethnicity, BMI, insurance type, and comorbidities. Former smokers and patients with missing smoking status had a higher adjusted odds of death than those who never smoked. Nicotine replacement therapy (NRT) prescriptions for current smokers was associated with lower odds of death than those who were not prescribed NRT. COVID-19 vaccination reduced odds of death overall, an effect not moderated by smoking status.
Dr. Jennifer Betts presented her poster, Contextual Factors Associated with Use of Either Tobacco or Electronic Cigarettes in Dual Users. She studied people who both smoke and vape, and assessed relationships between momentary contextual factors and the choice to smoke or vape. The results suggested that dual users may vape as a substitute when there are smoking restrictions. However, in other situations, dual users exhibited product-specific motivation for tobacco and e-cigarettes, such as in certain social situations or when experiencing craving for that product. Betts said this indicates that dual users may not view these products as interchangeable. “This information contributes to the development of a theoretical framework of dual use of tobacco and e-cigarettes,” Betts said.
Dr. Adrienne Johnson also presented her poster, Motivating Change in Older Adults: Motivational Cigarette Smoking Cessation Message Testing. She conducted 820 online surveys with adults ages 50 to 80 to test the impact of a hope-based motivating message to quit smoking versus a fear-based motivating message. Compared to the control, the fear-based message showed significantly greater improvement in motivation to quit. The Hope message did not statistically differ from the control message.
Dr. Megan Piper presented The Real-World Impact of Three Alternate Nicotine-Delivery Products on Combustible Cigarette Use, part of the symposium called Individualizing Tobacco Treatment to Increase Quit Rates. She found that very-low nicotine cigarettes (VLNCs) and e-cigarettes reduced the number of conventional cigarettes smoked compared to no study product. VLNCs and e-cigs didn’t differ much in their ability to reduce smoking. Adding active nicotine patches to VLNCs or e-cigs didn’t reduce smoking more than VLNCs or e-cigs alone. “There is a clear need to address the impact of smoking cues as part of smoking cessation treatment,” Piper said.
Dr. Adrienne Johnson presented her poster, Culturally Specific Messaging to Motivate Cessation in African American Older Adults Who Smoke Cigarettes. She worked with Lorraine Lathen, director of the Wisconsin African American Tobacco Prevention Network, to conduct focus groups with African Americans 50 to 80 years old. “Older adult African Americans want to quit, but need more help to do so,” Johnson said. Focus group participants said that existing ads to quit smoking do not represent or connect with them. They said willpower would be very important to their quit attempts. They were open to using treatments to quit smoking but weren’t sure how to access them. They suggested messages be tailored for older African Americans.
Mark Zehner presented a poster by a team of UW-CTRI researchers, $100 vs. $0 to Engage in Telephone Counseling: A Randomized, Placebo-Controlled Test of Modest Financial Incentives to Improve Engagement in Evidence-Based Tobacco Treatment. The goal was to test the hypothesis that offering incentives to use phone counseling to help people quit smoking would increase completion of counseling and that moderate incentives ($25 per call completed, up to $50) would work almost as well as larger incentives ($50 per call, up to $100), relative to a no-incentive control condition. They found that, actually, offering incentives to complete phone cessation counseling did not increase counseling completion or later smoking abstinence relative to a no-incentive control condition. They observed no significant dose-response effect of incentive magnitude ($50 vs. $100). He noted, though, that most patients in this study had already received mailings, electronic messages, and/or calls offering cessation treatment in the 1-2 years before study launch. “This may have reduced sensitivity to the incentive manipulation,” Zehner said.
Rates of Enrollment by Financial Incentive Condition
Editor’s note: Special thanks to Dr. Jesse Kaye for his assistance with taking pictures at the conference.