2018 Report

THANK YOU: UW-CTRI is grateful to its partners, including the National Institutes of Health, Centers for Disease Control, Centers for Medicare and Medicaid Services, ClearWay Minnesota, Food and Drug Administration, Health Resources and Services Administration, US Department of Veterans Affairs, UW Department of Family Medicine, UW Institute for Clinical and Translational Research, UW Department of Medicine, UW School of Medicine and Public Health, Wisconsin Department of Health Services, the Wisconsin Partnership Program and the Wisconsin Women’s Health Foundation.

Published Papers

Note: Names in bold are current UW-CTRI employees.

Allen AM, Carlson S, Eberly LE, Hatsukami D, Piper ME. Use of Hormonal Contraceptives and Smoking Cessation: A Preliminary Report. Addictive Behaviors. 2018;76:236-42.

• Summary: This preliminary study examined differences in withdrawal symptoms and cessation between women using hormonal contraceptives (HC), women not using hormonal contraceptives (no-HC) and men. Compared to both no-HC and men, the HC group had significantly greater withdrawal. During the first week of attempted abstinence, craving declined in HC and in men, but increased in no-HC. At end of treatment, the HC group was at 3.73 times higher odds of being abstinent compared to men. However, there were no group differences in abstinence rates by 26 weeks after the quit date and beyond.

Baker TB, Fraser DL, Kobinsky K, Adsit R, Smith SS, Khalil L, Alaniz KM, Sullivan TE, Johnson ML, Fiore MC. A Randomized Controlled Trial of Financial Incentives to Low Income Pregnant Women to Engage in Smoking Cessation Treatment: Effects on Post-Birth Abstinence. Journal of Consulting and Clinical Psychology. 2018;86(5):464-73.

• Summary: In this study of more than 1,000 pregnant women who smoked, moderate incentive payments for engagement in smoking treatment (a mean of ≈$214 paid) increased low-income pregnant smokers’ engagement and success in smoking-cessation treatment.

Berg KM, Smith SS, Piper ME, Fiore MC, Jorenby DE. Tobacco Treatment in Primary Care: Identifying Differences in Rates of Invitation to Participate. Wisconsin Medical Journal. 2018;117(3):111-115.

• Summary: This secondary analysis assessed the differences in rates of invitation to receive tobacco treatment, based on patient characteristics from 11 primary-care clinics from two health systems in Wisconsin from 2010-2013. The study found a significant difference in smoking cessation invitation rates amongst groups, despite efforts to invite all smokers. The average invitation rate by the two health systems was 67%.

Berg KM, Jorenby DE, Baker TB, Fiore MC. Triple Smoking Cessation Therapy with Varenicline, Nicotine Patch and Nicotine Lozenge: A Pilot Study to Assess Tolerability, Satisfaction and End-of-Treatment Quit Rates. Journal of Smoking Cessation. 2018;13(3):145-153.

• Summary: This observational study examined ‘triple therapy’ (varenicline + nicotine patch + nicotine lozenge) in 36 smokers trying to quit. Researchers explored tolerability, via adverse events (AEs) elicited at each of nine phone assessments. Secondary outcomes included satisfaction rates, medication changes and self-reported quit rates at week 12. Thirty-five of 36 participants reported at least one AE. Participants were highly satisfied with their medications, and 58% reported quitting at 12 weeks, with 38% reporting prolonged abstinence.

Buckless B, McCann M, Christiansen B, Forster J, Joseph A, Rhodes K. Feasibility of a Systems Approach to Treat Commercial Tobacco Dependence within American Indian Health Clinics. American Indian and Alaska Native Mental Health Research  . 2018;25(3)52-77.

• Summary: Three American Indian health clinics in Minnesota implemented an evidence-based tobacco dependence treatment intervention that included provider education and customized clinical-system tools. Clinic staff were assessed with pre/post-training evaluations and annual assessments. Results indicated self-reported improvements in the rate of identifying smoking status (57% to 89%), documenting smoking status (from 60% to 80%), and providing evidence-based treatments such as pharmacotherapy (from 36% to 78%).

Burgess-Hull A, Roberts L, Piper M, Baker T. The Social Networks of Smokers Attempting to Quit: An Empirically Derived and Validated Classification. Psychology of Addictive Behaviors. 2018 Feb;32(1):64-75.

• Summary: This study suggests that network features, especially those entailing exposure to smoking cues and contexts, heighten risk for smoking-cessation failure. The Socially Disconnected subgroup was characterized by little social interaction, low levels of stress, and low exposure to social environmental smoking cues, and had the highest probability of successful cessation at one week compared with other subgroups. At six months posttreatment, its members had higher quit rates than members of the High Stress/High Contact subgroup and the Risky Friends and Low Contact subgroup.

Buu A, Hu Y-H, Piper ME, Lin H-C. The Association Between E-Cigarette Use Characteristics and Combustible Cigarette Consumption and Dependence Symptoms: Results from a National Longitudinal Study. Addictive Behaviors. 2018;84:69-74.

• Summary: Higher frequency of e-cigarette use was associated with lower consumption of combustible cigarettes and dependence symptoms, controlling for baseline cigarette use and other confounders. Given the frequency of e-cigarette use, the feature of voltage adjustment was not significantly associated with any of the cigarette use outcomes. E-cigarette flavoring, on the other hand, was associated with lower quantity of cigarette use. Exclusive smokers who start using e-cigarettes do indeed change the frequency and quantity with which they smoke cigarettes. E-cigarette use may also help reduce dependence symptoms.

Chen L-S, Zawertaillo L, Piasecki TM, Kapiro J, Foreman M, Elliott HR, David SP, Bergen AW, Baurley JW, Tyndale RF, Baker TB, Bierut LJ, Saccone NL. Leveraging Genomic Data In Smoking Cessation Trials In the Era of Precision Medicine: Why and How. Nicotine and Tobacco Research. 2018;20(4):414-424.

• Summary: This article outlines a framework for the consistent integration of biological data/samples into smoking-cessation pharmacotherapy trials, aligned with the objectives of the recently unveiled Precision Medicine Initiative. The goal was to support treatment researchers to consider biosample collection and genotyping for their existing samples—as well as integrating genetic analyses into their study design in order to realize precision medicine in the treatment of nicotine dependence.

Christiansen BA, Carbin J, TerBeek E, Fiore MC. Helping Smokers with Severe Mental Illness Who Do Not Want to Quit. Substance Use and Misuse. 2018;53(6):949-962.

• Summary: Brief, motivational interventions increased both engagement in quit-smoking treatment as well as abstinence among smokers with significant mental illness. Compared to control participants, smokers receiving the intervention were more likely to be abstinent three months after quitting (biochemically verified, intent to treat, 8.5% vs. 1.0%). They were also more likely to accept four more quitting preparation sessions (intent to treat, 50.8% vs 29.2%) but were not more likely to call a telephone tobacco quit line.

Deng S, Piper ME, McCarthy DE, Baker TB, Bolt DM. Extreme Response Style and the Measurement of Intra-Individual Variability in Affect. Multivariate Behavioral Research. 2018 Mar-Apr;53(2):199-218.

• Summary: Extreme response style (ERS) is the tendency for survey respondents to use extreme answers (all 1’s or all 7’s on a 1-7 rating scale) when they answer questions. This can skew results for researchers. In this paper that looked at how to identify and control for ERS, researchers studied the rating scale responses of individual patients during a quit attempt. Researchers found that being able to factor in individual’s actual tendency to use extreme responses strengthens the relation between people’s emotional ratings and the likelihood that they will return to smoking.

Glasheen C, Johnson EO, Saccone NL, Lutz SM, Baker TB, McNeil DW, Marazita ML, Hokanson JE, Bierut LJ, Hancock DB. Is the Fagerström Test for Nicotine Dependence Invariant Across Secular Trends in Smoking? A Question for Cross-Birth Cohort Analysis of Nicotine Dependence. Drug and Alcohol Dependence. 2018 Feb 6;185:127-132.

• Summary: Researchers examined the measurement invariance of the Fagerström Test for Nicotine Dependence (FTND) across different cohorts of smokers. That is, whether they measure the same thing (invariance) or different things (non-invariance) when used in different groups. An example of measurement non-invariance would be if an IQ test in English were used with English speakers in one sample and with primarily Spanish speakers in a second sample. Researchers found non-invariance likely has a negligible impact on research results when different types of smokers are combined.

Gorrilla A. The Importance of Smoking Cessation to Reducing Cardiovascular Disease Risk. Pharmacy Society of Wisconsin. 2018;1:32-38.

• Summary: This article reviews the literature on how smoking contributes to cardiovascular disease (CVD), the benefits of cessation to reducing CVD risk, and provides an overview of treatments for tobacco dependence. It covers updates in the treatment of tobacco use for patients with CVD, including the safety of pharmacotherapy for patients with CVD, and how to address electronic nicotine-delivery systems in treatment.

Keller P, Boyle RG, Lien RK, Christiansen B, Kobinsky K. Engaging Smokeless Tobacco Users in Population-Based Cessation Services: Findings from an Observational Study. Journal of Public Health Management and Practice. Epub 2018 June 7.

• Summary: Although telephone quitlines are effective for helping smokeless tobacco (ST) users quit, ST users are underrepresented among quitline participants. After ClearWay Minnesota implemented multiple changes to its quitline service (QUITPLAN® Services), utilization increased dramatically, including by ST users. A 2-week starter kit of nicotine replacement therapy and the ability to register for services online were popular among Minnesotans reporting ST use. This study suggests that quitline services can be designed to increase participation by ST users.

McCarthy DE, Cook JW, Leyro TM, Minami H, Bold KW (2018). Affective Determinants of Smoking. Chapter in the book, Affective Determinants of Health-Related Behavior. Edited by Williams DM, Rhodes RE, Conner MT. New York: Oxford University Press. pp. 286-310.

• Summary: Individual differences in affective processing, such as anhedonia, anxiety sensitivity, distress intolerance, and emotion dysregulation enhance risk for tobacco use and moderate affect–smoking relations. The strength of affect–smoking relations seems to depend on methodological and contextual factors in important ways. Extant and developing treatments targeting affective processes show promise as tobacco cessation interventions. Theoretical models and empirical evidence support the importance of affective processes in smoking and suggest potential affect-focused interventions.

McCarthy DE, Minami H, Bold K, Yeh V, Chapman G. Momentary Assessment of Impulsive Choice and Impulsive Action: Reliability, Stability, and Correlates. Addictive Behaviors. 2018 Aug;83:130-135. Epub 2017 Nov 22.

• Summary: Impulsivity is associated with substance use, including tobacco use. The degree to which impulsivity fluctuates over time within persons—and the degree to which such intra-individual changes can be measured reliably and validly in outpatient assessments—is not known, however. Researchers collected valid data on impulsive choice at 70% of scheduled reports and valid data on impulsive action on 55% of scheduled reports, on average. Results suggest that meaningful variance in impulsive choice and action can be captured, but that additional measure refinement is needed.

McCarthy DE, Versella, MV. Quitting Failure and Success With and Without Using Medication: Latent Classes of Abstinence and Adherence to Nicotine Monotherapy, Combination Therapy, and Varenicline. Nicotine & Tobacco Research. 2018 August 9.

• Summary: Secondary analyses of a three-arm randomized comparative trial of nicotine patch, varenicline, and combination nicotine patch and lozenge among 1086 adult daily smokers were conducted. Adherence varied across treatments, and was lowest for nicotine lozenge in combination nicotine-replacement therapy. Varenicline, as well as combination nicotine patch + lozenge, are less likely to be used as directed and may not increase first-month abstinence better than patch alone when taken adherently.

Minami H, Mindt M, Fine M, Hecht J, Bloom E, Vieira C, McCarthy DE, Brown R, Nahvi S, Donnelly R, Brinkman H, Wetter D, D’Aquila E, McClain L, Kennedy K, Arnsten J, Price L, Thomas J. Rationale, Design and Pilot Feasibility Results of a Smartphone-Assisted, Mindfulness-Based Intervention for Smokers with Mood Disorders: Project mSMART MIND. Contemporary Clinical Trials. 2018 Mar;66:36-44.

• Summary: Researchers developed a smartphone-assisted mindfulness intervention to quit smoking, as well as the design and methods of an ongoing pilot randomized-controlled trial targeting smokers receiving outpatient psychiatric treatment. Results from the pilot feasibility study (N=8) showed that participants practiced mindfulness an average of 3.4 times/day (≥3min), completed 72% of prompted reports, and submitted 68% of requested CO videos. Participants reported that daily mindfulness practice was helpful for both managing mood and quitting smoking.

Mitchell CC, Piper ME, Korcarz CE, Hanson K, Weber J, Fiore MC, Baker TB, Stein JH. Echogenicity of the Carotid Arterial Wall in Active Smokers. Journal of Diagnostic Medical Sonography. 2018 May;34(3):161-168.

• Summary: This pilot study evaluated new methodology to better understand specific ways smoking might affect cardiovascular health. While factors such as smoking, weight, and age were associated with the health of patients’ carotid artery walls, smoking heaviness was not associated with carotid wall health when controlling for all other risk factors. This study demonstrated that testing carotid artery wall health in relation to smoking is feasible.

Mundt MP, Baker TB, Fraser DL, Smith SS, Piper ME, Fiore MC. Paying Low-Income Smokers to Quit? Cost-effectiveness of Incentivizing Wisconsin Tobacco Quit Line Engagement for Medicaid Recipients Who Smoke. Value in Health. September 2018.

• Summary: Researchers found the use of modest financial incentives to engage with the Wisconsin Tobacco Quit Line is a cost-effective option for increasing smoking quit rates among Medicaid recipients. The “Striving to Quit” study randomized 1,900 Medicaid recipients to either a control group or to a group offering financial incentives to take up to five calls from the quit line. Because of financial incentives, 22 percent of the incentive-group participants had biochemically verified abstinence at six months compared to 14 percent of control group participants.

 

Piper ME, Baker TB, Benowitz NL, Kobinsky K, Jorenby DE. Dual Users Compared to Smokers; Demographics, Dependence, and Biomarkers. Nicotine & Tobacco Research. 2018. 2018 Oct 26.

• Summary: In this community sample, dual users are supplementing their smoking with e-cigarette use. Dual users, versus smokers, smoked fewer cigarettes per day and delayed their first cigarette of the day, but did not differ in quitting intentions. Dual users were more likely to be white, younger, have more than a high school education and have a psychiatric history. Dual users also smoked significantly fewer cigarettes and had lower levels of NNAL (a carcinogen), but they did not differ from exclusive smokers in carbon monoxide or cotinine levels, suggesting that they supplemented their nicotine intake via e-cigarettes.

Piper ME, Cook JW, Schlam TR, Jorenby DE, Smith SS, Collins LM, Mermelstein R, Fraser D, Fiore MC, Baker TB. A Randomized Controlled Trial of an Optimized Smoking Treatment Delivered in Primary Care. Annals of Behavioral Medicine. 2018 Sep 13;52(10):854-864.

• Summary: Participants who got the abstinence-optimized treatment (3 weeks of pre-quit mini-lozenges, 26 weeks of nicotine patch + mini-lozenges, three in-person and eight phone counseling sessions, and 7–11 automated calls to prompt medication use) had significantly higher self-reported quit rates than recommended usual care (10 minutes of in-person counseling, 8 weeks of nicotine patch, and referral to quitline services). A smoking-cessation treatment optimized via Multiphase Optimization Strategy (MOST) meaningfully enhanced cessation rates among smokers seen in primary care clinics.

Piper ME, Schlam TR, Fraser D, Oguss M, Cook JW. Implementing Factorial Experiments In Real-World Settings: Lessons Learned While Engineering an Optimized Smoking Cessation Treatment. Chapter in the book, Optimization of Behavioral, Biobehavioral, and Biomedical Interventions: Advanced Topics. Edited by Collins LM, Kugler KC. New York, NY: Springer; 2018; pp. 23-45.

• Summary: The multiphase optimization strategy (MOST) is an efficient method to engineer effective treatment packages. MOST helps researchers understand intervention component effects and how these components can best be combined into an optimized treatment package and then evaluated. This chapter provides evidence for the feasibility of conducting large factorial experiments in real-world settings and shares strategies for successfully carrying out this type of research. It includes practical information on implementation considerations.

Schlam TR, Cook JW, Baker TB, Hayes-Birchler T, Bolt DM, Smith SS, Fiore MC, Piper ME. Can We Increase Smokers’ Adherence to Nicotine Replacement Therapy and Does This Help Them Quit? Psychopharmacology. 2018 Apr 25. Jul;235(7):2065-2075.

• Summary: Researchers described what are, to the best of the team’s knowledge, the most comprehensive data collected to date on adherence to nicotine-replacement therapy. The study found low adherence overall. Adherence to the patch and nicotine gum was strongly related to abstinence, but the causal basis of this relation is unclear. The study also found that e-Monitoring Counseling slightly increased gum use but did not increase abstinence. Extended-length medication (26 weeks) increased abstinence, compared to standard-length medication (8 weeks).

Shirley D, Thibodeau L, Catz SL, McCoy K, Jorenby DE, Safdar N, Sosman JM. Cessation-related Information, Motivation, and Behavioral Skills in Smokers Living with HIV. AIDS Care. 2018;30(2):131-139.

• Summary: Forty percent of individuals living with HIV are smokers. Researchers surveyed patients from two Wisconsin HIV-care clinics regarding smoking, using open-ended interviews. Eighty percent of the individuals reported negative feelings toward their doctor’s means of addressing their smoking. In addition, 70 percent of the participants said they never heard of, nor considered, how smoking affected their HIV medications. Use of aids to quit smoking or a telephone-based wellness intervention were acceptable to most. Providing HIV-specific information during tobacco treatment is critical.

Srivastava B, Ramsey AT, McIntosh LD, Bailey TC, Fisher SL, Fox L, Castro M, Ma Y-J, Baker TB, Chen L-S, Bierut LJ. Tobacco Use Prevalence and Smoking Cessation Pharmacotherapy Prescription Patterns Among Hospitalized Patients by Medical Specialty. Nicotine and Tobacco Research. 2018 Feb 22.

• Summary: Researchers identified substantial variation in prescribing practices for patients who smoke across different medical specialties and demographic groups. This suggests the need for an electronic medical record protocol that facilitates consistent tobacco-cessation pharmacotherapy treatment. It’s underutilized during hospitalization, and prescription rates vary greatly across medical specialties and patient characteristics. Hospitals may benefit from implementing policies and practices that standardize and automate the offer of smoking pharmacotherapy for all hospitalized patients who use tobacco.

Teitelbaum A, Murphy S, Akk G, Baker TB, Germann A, von Weymarn L, Bierut L, Goate A, Kharasch ED, Bloom AJ. Nicotine Dependence is Associated with Functional Variation in FMO3, an Enzyme that Metabolizes Nicotine in the Brain. Pharmacogenomics Journal. 2018;18(1):136-143.

• Summary: Surprisingly, allele rs2266780 was associated with reduced nicotine dependence, specifically with a longer time to first cigarette, but not with reduced cigarette consumption. Researchers demonstrate, for the first time, nicotine N-oxidation in the human brain, mediated by FMO3 and FMO1. They show that nicotine-N-oxide modulates human α4β2 nicotinic receptor activity in vitro. These results indicate possible mechanisms for associations between the FMO3 genotype and smoking behaviors, and suggest nicotine N-oxidation as a novel target to enhance smoking cessation.

Wong S-W, Lin H-C, Piper ME, Siddiqui A, Buu A. Measuring Characteristics of E-Cigarette Consumption Among College Students. American Journal of College Health. 2018 Jul 6:1-10.

• Summary: College students who vape found some of the consumption questions in national surveys difficult to answer. Switching nicotine levels, mixing flavors, co-using with alcohol and marijuana, using with others who were vaping or drinking, and vaping in a car or indoor space were all common. The participants defined “regular user” based on ownership of a device rather than on quantity/frequency. A comprehensive e-cigarette consumption measure should cover the complex characteristics that are potentially associated with negative health consequences such as flavorings, co-use and social contexts.

In Press

Croyle RT, Morgan GD, Fiore MC. Addressing a Core Gap in Cancer Care—The NCI Moonshot Program to Help Oncology Patients Stop Smoking. New England Journal of Medicine.

Matheny JD, Stevens EM, Chen S, Christiansen BA, Kowitt SD, Osman A, Vidrine D. The RICO Verdict and Corrective Statements as Catalysts for Public Policy. Tobacco Regulatory Science.

Piper ME, Brown DC, Hendershot TP, Swan GE, PhenX TRR Host, Social/Cognitive Working Group. PhenX: Host: Social/Cognitive Measures for Tobacco Regulatory Research. Tobacco Control.

Research Presentations and Posters

Baker T, Fraser D, Kobinsky K, Smith S, Fiore M, Adsit R, Khalil L, Alaniz K, Sullivan T. Using Modest Financial Incentives to Low-Income Pregnant Women to Engage in Smoking Cessation and Improve Post-Birth Abstinence. University of Wisconsin Department of Medicine Research Day. Poster. Madison, WI. June 2018.

Berg K, Gruber S, Jorenby D. Helping Women Veterans Quit Smoking: Back to Basics. Society for Research on Nicotine and Tobacco (SRNT) Annual Conference. Poster. Baltimore, MD. February 2018.

Berg K, Gruber S, Jorenby D. Helping Women Veterans Quit Smoking: Back to Basics. University of Wisconsin Department of Medicine Research Day. Poster. Madison, WI. June 2018.

Boyle R, Keller P, Christiansen B. Offering Choices Engages More Smokeless Tobacco Users in a Quitline. Ninth Annual Summit on Smokeless Tobacco Prevention. Presentation. Sacramento, California. October 2018.

Bringgold W, Berg K, Piper M, Jorenby D. Does Dual Use of Electronic Cigarettes and Conventional Cigarettes Confer a Pulmonary Health Advantage? A Baseline Cohort Analysis. Society for Research on Nicotine and Tobacco (SRNT) Annual Conference. Poster. Baltimore, MD. February 2018.

Bringgold W, Berg K, Piper M, Jorenby D. Does Dual Use of Electronic Cigarettes and Conventional Cigarettes Confer a Pulmonary Health Advantage? A Baseline Cohort Analysis. University of Wisconsin Department of Medicine Research Day. Poster. Madison, WI. June 2018.

Christiansen B, Reeder K, Baker T, Fiore M. Automating a Motivational Intervention for Low Income Smokers: A Pilot Feasibility Study. Society for Research on Nicotine and Tobacco (SRNT) Annual Conference. Poster. Baltimore, MD. February 2018.

Christiansen B. Hearing from Consumers: My Tobacco Recovery Story. NAMI Wisconsin Conference. Presentation. Elkhart Lake, WI. April 2018.

D’Angelo H, Adsit R, Morgan G, Rolland B, Rosenblum M, Fiore M. The National Cancer Institute Cancer Center Cessation Initiative (C3I): Examining the Baseline Characteristics and Reach of Tobacco Treatment Programs within NCI-Designated Cancer Centers in the C3I. American Association for Cancer Research (AACR) Conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved. Poster. New Orleans, LA. November 2018.

D’Angelo H, Adsit R, Morgan G, Rolland B, Rosenblum M, Fiore M. The National Cancer Institute Cancer Center Cessation Initiative (C3I): Examining the Baseline Characteristics and Reach of Tobacco Treatment Programs within NCI-Designated Cancer Centers in the C3I. 11th Annual Conference on the Science of Dissemination and Implementation in Health. Poster. Washington, DC. December 2018.

Fiore MC. Comprehensive Chronic Care Smoking Treatment System (CCCSTS) Implementation Program. Primary Care Conference. Madison, WI. January 2018.

Fiore MC. Treating GHC Patients Who Smoke—An Epic-Based Workflow. Group Health Cooperative of South-Central Wisconsin. Madison, WI. January 2018.

Fiore MC. Eliminating Tobacco Dependence from our Society 25 Years of Progress at the UW-Center for Tobacco Research and Intervention. University of Wisconsin Department of Medicine Leadership Retreat. Fontana, WI. February 2018.

Fiore M, McCarthy D, Adsit R, Zehner M, Gorrilla A, Hayden K, Skora A, Baker T. Seizing Electronic Health Record Technology to Promote Tobacco Cessation—A Randomized Trial of Primary Care Closed-Loop Referral (“EReferral”) to a State Quitline. Society for Research on Nicotine and Tobacco (SRNT) Annual Conference. Poster. Baltimore, MD. February 2018.

Fiore MC. Smoking Cessation: An Evidence-Based 2018 Update. Continuing Professional Development—New Developments in Cardiology. Milwaukee, WI. March 2018.

Fiore MC. Tobacco Treatment at UW-Health—From Guidelines to System-Wide Implementation. Madison, WI. August 2018.

Fiore MC, Coates K, Wallenkamp H, Schroeder M, Russell J. Systematic Approach to Universal Smoking Cessation Treatment: Registries, BPA’s and Population Health. Epic Users Group Meeting. Verona, WI. August 2018.

Fiore MC. Expanding the Reach & Effective of Cessation Medications: Potential New Indications & Label Changes. Cessation Forum. Madison, WI. September 2018.

Fiore MC. Using EHR Technology to Facilitate Smoking Cessation Treatment: Registries, BPAs and Population Health. Group Health Cooperative of South-Central Wisconsin. Madison, WI. October 2018.

Fiore MC. Treating Tobacco Use: A 2019 Update. UW Children’s Hospital Pediatric Cardiology. Madison, WI.

Fiore MC. Treating Tobacco Dependence—Health Services Research at the University of Wisconsin Center for Tobacco Research and Intervention. University of Wisconsin Department of Medicine Health Services and Care Research (HSCR) Program Seminar Series. Madison, WI. December 2018.

Fraser D, Baker T, Kobinsky K, Smith S, Fiore M, Adsit R, Khalil L, Alaniz K, Sullivan T. Using Modest Financial Incentives to Low Income Pregnant Women to Engage in Smoking Cessation and Improve Post-Birth Abstinence. Academy Health Conference. Seattle, WA. June 2018.

Jorenby D, Piper M, Smith S, Collins L, Fiore M, Baker T. Distinct Behavioral Treatment Fidelity in a Smoking Cessation Treatment Study. Society for Research on Nicotine and Tobacco (SRNT) Annual Conference. Poster. Baltimore, MD. February 2018.

Jorenby D. ENDS: Science, Regulation & Policy, Wisconsin Cancer Council Policy Committee Meeting. Madison, WI. August 2018.

Jorenby D. Smoking and Behavioral Health. American Psychological Association National Webinar. September 2018.

Kim N, McCarthy D, Schlam T. An Examination of Candidate Mediators of Maintenance Counseling and Adherence-Focused Interventions Effects on Abstinence in Adult Daily Smokers. Society for Research on Nicotine and Tobacco (SRNT) Annual Conference. Poster. Baltimore, MD. February 2018.

Kim N, McCarthy D, Schlam T. An Examination of Candidate Mediators of Maintenance Counseling and Adherence-Focused Interventions Effects on Abstinence in Adult Daily Smokers. University of Wisconsin Department of Medicine Research Day. Presentation. Madison, WI. June 2018.

Kim N, McCarthy D. Disparities in Beliefs About the Addictiveness of Diverse Tobacco Products: Findings from the 2015 Health Information National Trends Survey (HINTS-FDA 2015). American Public Health Association (APHA) Annual Meeting. Poster. San Diego, CA. November 2018.

Manning K, Garey L, McCarthy DE, Gallagher MW, Shepherd JM, Orr MF, Schmidt NB, Rodic B, Zvolensky M J. Understanding Quit Patterns: Subgroups, Predictors, and Long-Term Abstinence. Society for Research on Nicotine and Tobacco-Europe. Poster. Munich, Germany. September 2018.

Mundt MP, Zakletskaia LI, Baker TB, Fraser DL, Smith SS, Fiore MC. Financial Incentives to Medicaid Smokers for Engaging in Quit Line Treatment: Maximizing Return on Investment. North American Primary Care Research Group (NAPCRG) Conference. Poster. Chicago, IL. November 2018.

Mundt MP. Paying Low-Income Smokers to Quit? The Cost-Effectiveness of Incentivizing Tobacco Quit Line Engagement for Medicaid Recipients Who Smoke. UW Carbone Cancer Center (UWCCC) Grand Rounds. Madison, WI. October 2018.

Mundt MP, Zakletskaia LI, Baker TB, Fraser DL, Smith SS, Fiore MC. Maximizing Return on Investment for Financial Incentives to Low-Income Smokers to Engage in Evidence-Based Tobacco Treatment. European Health Economics Association (EuHEA) Conference. Presentation. Maastricht, Netherlands. July 2018.

Oguss M, McCarthy D, Fraser D, Piper M, Cook J, Schlam T, Baker T, Fiore M. Primary Care Clinic Staff Attitudes Addressing Tobacco Use Before and After Implementing a Smoking Treatment Referral Program. Society for Research on Nicotine and Tobacco (SRNT) Annual Conference. Poster. Baltimore, MD. February 2018.

Oguss M, McCarthy D, Fraser D, Piper M, Cook J, Schlam T, Baker T, Fiore M. Referral to Randomized Smoking Reduction and Cessation Treatments in Primary Care Clinics: Electronic vs. Fax Referral. Society for Research on Nicotine and Tobacco (SRNT) Annual Conference. Presentation. Baltimore, MD. February 2018.

Piper M, Smith S, Collins L, Bolt D, Fraser D, Mundt M, Fiore M and Baker T. Optimizing Smoking Treatment on Both Effectiveness and Cost as Part of the Multiphase Optimization Strategy (MOST). Society for Research on Nicotine and Tobacco (SRNT) Annual Conference. Presentation. Baltimore, MD. February 2018.

Piper M, Baker T, Fiore M, Smith S, Kobinsky K, Benowitz N, Jorenby D. Smokers and Dual Users: Dependence and Cessation Motivation. Society for Research on Nicotine and Tobacco (SRNT) Annual Conference. Presentation. Baltimore, MD. February 2018.

Piper M. Social Networks After Quit Attempts. 2018 Annual First Breath Tobacco Cessation Conference sponsored by the Wisconsin Women’s Health Foundation. Johnson Creek, WI. March 2018.

Piper M, Smith S, Collins L, Bolt D, Fraser D, Mundt M, Fiore M, Baker T. Optimizing Smoking Treatment On Both Effectiveness and Cost as Part of the Multiphase Optimization Strategy (MOST). Society for Prevention Research Annual Meeting. Presentation. Washington, D.C. June 2018.

Piper M, Baker T, Fiore M, Smith S, Kobinsky K, Benowitz N, Jorenby D. Smokers and Dual Users: Dependence, Biomarkers and Cessation Motivation. University of Wisconsin Department of Medicine Research Day. Madison, WI. June 2018.

Piper M. Using the Phase-Based Model to Guide Treatment Development and Evaluation. Society for Research on Nicotine and Tobacco Treatment Research Network. Webinar.

Schlam T, Baker T. Playing Around with Quitting Smoking: A Randomized Pilot Trial of Mobile Games as an Urge Response Strategy. Society for Research on Nicotine and Tobacco (SRNT) Annual Conference. Poster. Baltimore, MD. February 2018.

Schlam T, Cook J, Baker T, Piper M, Mermelstein R. Engagement in Smoking Reduction Treatment in Primary Care Among Smokers Initially Unwilling to Quit. Society for Research on Nicotine and Tobacco (SRNT) Annual Conference. Presentation. Baltimore, MD. February 2018.

Schlam T, Baker T, Cook J, Hayes-Birchler T, Bolt D, Smith S, Fiore M, Piper M. Can We Increase Smoking Cessation Medication Adherence and Does It Matter? Society for Research on Nicotine and Tobacco (SRNT) Annual Conference. Presentation. Baltimore, MD. February 2018.

Schlam T, Cook J, Smith S, Baker T, Piper M. How Distress Tolerance and Anxiety Sensitivity Relate to Tobacco Dependence, Withdrawal and Smoking Cessation. Presentation. Society for Research on Nicotine and Tobacco (SRNT) Annual Conference. Presentation. Baltimore, MD. February 2018.

Schlam T, Baker T. Playing Around with Quitting Smoking: A Randomized Pilot Trial of Mobile Games as an Urge Response Strategy. University of Wisconsin Department of Medicine Research Day. Madison, WI. June 2018.

Zehner M, Adsit R, McCarthy D, Baker T, Fiore MC. Increasing Clinician-Initiated Smoking Cessation Treatment: A Randomized Trial of Implementation of EHR-Based Referral vs. Fax-Based Referral to a Tobacco Quit Line from Primary Care Clinics. 11th Annual Conference on the Science of Dissemination and Implementation in Health. Washington, DC. December 2018.

Active Studies

Quitting Using Intensive Treatments Study (QUITS). (Status: Recruiting and seeing patients) This study began recruiting pilot patients in fall 2017 and began full recruitment January 2018 in the Madison and Milwaukee areas. UW-CTRI is partnering with the UW Department of Medicine Cardiology Division on the study. Participants will get free medication and coaching, thanks to a $7 million four-year grant from the National Heart, Lung, and Blood (NHLBI) Institute to UW-CTRI and the UW Department of Medicine.

The study is designed to answer two key questions: 1) whether adding the nicotine patch to varenicline (Chantix) can boost quit rates; and 2) whether extending varenicline or varenicline + nicotine patch treatment for six months (rather than the standard three months) can boost quit rates. All participants will receive coaching to quit smoking.

“We expect both treatment enhancements (either adding the nicotine patch or extending treatment for 6 months) will yield higher cessation rates among people trying to quit,” said UW-CTRI Research Director Dr. Tim Baker. “Smokers and their clinicians are calling for cessation treatment options that can substantially increase our current modest quit rates, and we believe the proposed enhancements will do just that.” June 2017-May 2021, $7 million. Funded by NHLBI. Drs. Timothy Baker and James Stein, PIs.

Transforming the Treatment of Tobacco Use in Health Care: Seizing the Potential of the Electronic Health Record (EHR) to Deliver Comprehensive Chronic Care Treatment for Smoking. (Status: Several projects ongoing) This study, funded by a R35 grant to Dr. Michael Fiore, is designed to overcome barriers to effective treatment of smokers in the primary-care setting. This research is intended to develop and apply innovative, efficient, and powerful research methods to translate efficacious treatments into clinical use. Projects have included:

Project 1a. Tobacco Cessation Quitline eReferral. This study is a two-group, non-blinded, randomized, controlled trial to assess the impact of an EHR-based eReferral system relative to the current standard Fax referral method concluded in Year 3. UW-CTRI partnered with Ascension WI-Wheaton Franciscan Healthcare and Gundersen Health System on the clinical trial to test eReferrals versus fax referrals. The trial, known as the Quit Line Referral Method Study, included 23 clinics, a dozen from Wheaton Franciscan Healthcare and 11 from Gundersen Health System. In each system, half of the clinics tested the closed-loop, HIPAA-compliant eReferral to the Quit Line, while the others operated the Fax to Quit program. Across both healthcare systems, eReferral produced referral rates that were 3-4 times higher than those produced by Fax to Quit. While the rates improved, challenges include increasing enrollment rates as well as sustaining use outside of a research study.

Project 1b. SmokefreeTXT Pilot. This pilot project integrates NCI’s SmokefreeTXT program that sends text messages to participants’ phone to inspire and support an attempt to quit smoking. At two participating Gundersen Health System clinics, if a patient was ready to quit smoking, the “best practice alert” in the EHR prompted clinicians to refer to SmokefreeTXT via an eReferral order. Data from this small pilot study indicated feasibility of the approach, and present questions on which members of a care team may be best suited to intervene with this approach.

Project 2. Tolerability of 3 Medications for Smoking Cessation. A single-group, open-label, pilot study of 37 patients explored the tolerability and feasibility of combining varenicline with combination nicotine-replacement medications. Researchers completed final follow-up assessments and data analyses. See page 2 above for the manuscript published by the Journal of Smoking Cessation.

Project 3. Comprehensive Chronic Care Smoking Treatment System. Given that only about half of smokers in America are advised to quit during clinic visits, UW-CTRI has teamed with Epic and GHC-SCW in a program designed to reach out to all GHC patients who smoke. GHC Tobacco Cessation Outreach Specialists Katherine Coates and Hannah Wallenkamp are ensuring their patients have the tools they need to quit smoking for good. They reach out:

• At least annually to all GHC patients identified as smokers, with an invitation to receive cessation help, even if they don’t visit the clinic.
• Within a week after clinic visits in which patients neither addressed nor endorsed willingness to quit at that time.
• Three times to patients who are making a quit attempt and at least once to patients attempting to reduce their smoking, with potential to offer ongoing reduction-goal support calls as requested.

All six GHC primary-care sites are actively participating in this project.

Project 4. Tablet Technology Pilot Project with Low-Income Smokers. In order to continue to test the integration and scalability of technology-assisted interventions and to reach out to potential treatment delivery sites that serve populations who smoke at a higher rate, IRB approval was obtained for a tablet-based smoking-cessation intervention for clients at two Salvation Army sites. Following the intervention, staff and clients were interviewed about their experiences, receiving the intervention via a tablet.

August 2015-July 2022. $6.1 million. Funded by the National Cancer Institute of the National Institutes of Health. Dr. Michael Fiore, PI.

Exhale Study. (Status: Retention and long-term follow-up) As the federal government considers how to regulate electronic cigarettes (e-cigs), the University of Wisconsin was awarded a $3.7 million, 5-year grant from the National Cancer Institute as well as the Food and Drug Administration to study them over five years. This research is providing in-depth, longitudinal information, based on real-time reports, which addresses key priorities that may inform regulatory and health concerns, including understanding the relations between vaping and nicotine dependence; changes in rates of smoking conventional cigarettes; health outcomes such as evidence of exposure to carcinogens, as well as acute and long-term pulmonary health; attempts to quit smoking and the success of those attempts. Specifically, researchers have identified and are tracking over time 150 participants who exclusively smoke cigarettes and 250 participants who both smoke and vape. Researchers have used smart phones and other tools to collect information on patterns of use of these products, levels of addiction, withdrawal symptoms, success quitting versus relapse, lifestyle factors, carcinogen exposure, and how one group of participants compares to the other over time. This research is providing essential information to inform regulatory bodies, as well as researchers, clinicians, and tobacco users, about the patterns of real-world e-cig use and how such use is related to conventional smoking and the health risks caused by it. March 2015–February 2020, $3.7 million. Funded by the National Cancer Institute of the National Institutes of Health, and the Food and Drug Administration. Dr. Megan Piper and Dr. Douglas Jorenby, PIs.

Breaking Addiction to Tobacco for Health (BREATHE). (Status: Recruitment complete; seeing patients) UW-CTRI has received a $12 million 5-year grant from the National Cancer Institute of the National Institutes of Health. The grant will fund research designed to test new phased-based treatments to help patients in the Milwaukee and Madison areas quit smoking. Partners in this research include colleagues from Penn State University and the University of Illinois-Chicago, as well as Aurora Health Care, Dean Health System, and Epic. Under the BREATHE project, any smoker who visits a participating clinic, regardless of the initial reason for the visit, is invited to get treatment through BREATHE. This study implements both an electronic health records (EHR) system that increases smokers’ recruitment into treatment as well as a highly effective chronic-care treatment with intervention components for all smokers. First, the EHR system will be implemented in 18 clinics in 2 health-care systems and experimentally evaluated on its ability to increase the recruitment of smokers into chronic-care treatment (Project 1). Then, using highly efficient research methods, researchers will experimentally compare multiple intervention components and identify especially effective interventions for every phase of smoking treatment. This package of components will: increase quitting motivation amongst smokers initially unwilling to quit and prepare them for cessation (Project 2), enhance quitting success and prevent relapse when smokers are ready to quit (Project 3), and re-engage relapsed smokers in treatment and restore their abstinence (Project 4). Our highly integrated research projects will thus implement a powerful new EHR strategy to efficiently recruit primary-care patients who smoke into chronic-care treatment. BREATHE researchers will combine data from all projects and produce an optimized, comprehensive, chronic-care treatment for smoking that can be readily implemented in primary care settings by project end. Thus, this research will simultaneously advance both smoking treatment and treatment research methods. June 2014-July 2019, $12 million. Funded by the National Cancer Institute of the National Institutes of Health. Michael Fiore and Tim Baker, PIs.

PTSD and Veterans Merit Award. (Status: Recruitment complete) UW-CTRI Researcher Dr. Jessica Cook leads this merit award research at the William S. Middleton Memorial Veterans Hospital in Madison, Wisconsin. The primary objective of this research is to produce an empirically validated treatment that increases smoking cessation in veterans with posttraumatic stress disorder (PTSD), one that can be easily integrated into smoking cessation clinics and/or mental health clinics within VA facilities. PTSD is highly prevalent in the VA patient population and is associated with a rate of smoking (53% – 66%) that far exceeds that of VA enrollees in general (22%). PTSD is also associated with unusually high rates of failure to quit smoking. The disparity in smoking-cessation outcomes amongst veterans with PTSD may occur because standard smoking-cessation treatment does not address PTSD-specific vulnerabilities. Veterans with smoking-PTSD comorbidity may respond better to treatment that addresses their PTSD and associated affective symptoms, because such symptoms can both reinforce smoking and undermine quit attempts. Recent evidence shows that behavioral activation therapy (BA), a behavioral treatment that increases engagement in reinforcing activities, significantly reduces PTSD symptoms. BA may improve smoking cessation outcomes amongst veterans with PTSD because it reduces overall PTSD symptom severity and affective distress (low positive affect, high negative affect), which can cause smoking relapse. The funded research will determine whether BA, as an adjunct to standard smoking-cessation treatment, (ST+BA) is superior to a comparably intense combination of standard smoking cessation treatment + health and smoking education (ST+HSE) in improving smoking cessation outcomes among veterans with PTSD. The HSE intervention is intended to constitute a credible intervention that controls for contact time. Secondary objectives are to determine if BA improves PTSD symptomatology and associated affective distress, and to identify potential mediators of BA on smoking outcomes. A total of 120 veterans with PTSD who are motivated to quit smoking will attend an initial diagnostic and baseline assessment session. Those who are interested, eligible, and who provide consent will be randomly assigned to receive ST+BA or ST+HSE and will be contacted by their individual study therapist to schedule the first treatment session. Participants will be stratified into treatment groups based on: 1) Major depressive disorder (MDD; present versus absent), and 2) PTSD symptom severity. All participants will receive eight individual sessions of ST+BA or ST+HSE. All participants will receive 20 minutes of identical standard smoking cessation treatment in each of the eight sessions. Those in the ST+BA condition will receive an additional 30 minutes of behavioral activation therapy; those in the ST+HSE condition will receive an additional 30 minutes of health education and information about smoking. All participants will receive 8 weeks of the nicotine patch. Smoking-cessation outcomes will be assessed 2, 4, 8, 16, and 26 weeks after the quit date. This research has important clinical and public health significance because smoking is especially common among veterans with PTSD, and it is the leading preventable cause of disease and disability. Reducing smoking rates among veterans with PTSD would result in substantially lower smoking-related illness and death in this vulnerable group of smokers. It would also reduce tobacco-related health-care costs charged to the VA. The grant will support a researcher and a study counselor. Jan. 2014-Sept. 2019, $770,500. Funded by the United States Department of Veterans Affairs. Jessica Cook, PI.

Genetically Informed Smoking Cessation Trial. (Status: Recruiting patients) This randomized clinical trial is the first genetic study to look at nicotine-replacement therapy (NRT) vs. varenicline head-to-head, and how participants with different genetics respond to the medications. Led by Li-Shiun Chen with collaboration from UW-CTRI Research Director Dr. Tim Baker and UW-CTRI Director of Clinical Services Dr. Doug Jorenby, the researchers hope to determine whether genetic markers can be used to optimize smoking cessation pharmacotherapy to enhance efficacy, medication adherence, and reduce side effects. The researchers’ recent work, which suggests that the nicotinic receptor gene CHRNA5 alters the response to NRT, has been replicated in a meta-analysis. This study of 720 smokers uses a stratified randomization trial design based on a subject’s pertinent genotype for smoking cessation. Specifically, in Aim 1, researchers will determine if CHRNA5 genotype moderates the effect of medication (combination NRT, varenicline, vs. placebo) on abstinence. In Aim 2, researchers will determine if CHRNA5 genotype predicts medication adherence and side effects. In Aim 3, researchers will incorporate multiple genotypes and other predictors in order to develop a clinical treatment assignment algorithm for cessation success. This work could result in improved physician care of patients who smoke, overall smoking cessation success, and prevention of cancer, heart, and lung disease. Sept. 2014-July 2019, $90,000. Funded by the National Institutes of Health. Li-Shiun Chen, PI. Douglas Jorenby, co-PI.

Improving Quitline Support Study (IQS). (Status: Recruiting participants) Over the past five decades, overall smoking prevalence has fallen, but socioeconomic disparities in tobacco use and its burden have grown substantially. Prevention and treatment advances have disproportionately benefited more advantaged smokers. This project will evaluate promising strategies to enhance quit-smoking success among low-income smokers. The project will enroll 1,408 Medicaid-eligible or uninsured smokers who have recently enrolled in the Wisconsin Tobacco Quit Line, but who report continued smoking four months after engaging in standard Quit Line services. These smokers will be invited to participate in an experiment that will evaluate the value of augmenting standard Quit Line treatment with more intensive counseling, more intensive nicotine replacement, NCI’s SmokefreeTXT text support program, and/or financial incentives for using Quit Line and SmokefreeTXT support. Analyses will examine the main and interactive effects of these four treatment components at 26 weeks, as well as other quit-smoking outcomes in this at-risk population. August 2017-July 2022, $3 million. Funded by the National Cancer Institute of the National Institutes of Health. Drs. Danielle McCarthy and Michael Fiore, PIs.

First Breath Families: Helping Low-Income Moms Quit Smoking and Babies Grow Up Smoke-Free. (Status: Assisting with implementation) The Wisconsin Women’s Health Foundation (WWHF) has received a $1 million grant from the Wisconsin Partnership Program to significantly expand efforts to bring quit-smoking services to high-risk individuals, families and communities across Wisconsin. UW-CTRI is collaborating with WWHF on this project, to be provided during five years to First Breath Families. The group will also seek systems changes that will provide sustainable funding for these services. Tobacco use during pregnancy remains one of Wisconsin’s leading preventable causes of poor birth outcomes and, in some communities, up to one-in-three women smoke during pregnancy. The First Breath Families team will collaborate with local agencies that serve pregnant and postpartum women and their families, provide statewide access to local WWHF Quit Coaches, and develop participant-informed services. January 2018-December 2022. $1,000,000. Funded by the Wisconsin Partnership Program/Oversight & Advisory Committee (WPP/OAC). Drs. Bruce Christiansen and Michael Fiore, Academic Partners. Lisette Kahlil, Wisconsin Women’s Health Foundation Community Lead.

Smoking Cessation – Bucket Approach Training Module Development. (Status: Developing online training) UW-CTRI Researcher Dr. Bruce Christiansen has been awarded a one-year grant from the Wisconsin Department of Health Services to create an online training based on his “Bucket Approach” to help patients with serious or significant mental illness to quit smoking. Since behavioral health practitioners are busy people, the Bucket Approach is concrete, easy to follow, and brief to implement. Christiansen will collaborate with UW-CTRI Communications Director Chris Hollenback to create videos for the online training, which will offer Continuing Education Credits via the UW training site that training for behavioral health providers on how to help all behavioral health patients quit smoking. The focus for the new training will be on reaching out to Wisconsin Community Support Programs (CSP) and Comprehensive Community Services (CCS) Systems. CSPs work with patients with serious mental illness typically at discrete treatment sites. CCSs generally treat patients with less-serious but still significant mental illness using network models. Both types of programs are county-based. The Bucket Approach is designed to tailor the intervention to various motivational statuses of patients with serious mental illness. October 2018-September 2019. $112,000. Funded by the State of Wisconsin Department of Health Services. Dr. Bruce Christiansen, PI.

Recently Completed Studies

Pilot Study of Practice Quitting Smoking and Paced Cigarette Puffing. One goal of this study was to collect pilot data that could be used to improve study procedures. Another goal was to demonstrate the feasibility and safety of remote monitoring of abstinence and paced puffing among adults who smoke daily and agree to practice quitting 4 times, for up to one full day each time. Procedures to be evaluated and improved included:

1. Assessing participant levels of carbon monoxide (CO) remotely with a personal CO-monitor, smartphone app, and video chat.
2. Supervising paced puffing and assessing subjective reactions to paced puffing in real time via video chat or phone.
3. Verifying adherence to paced-puffing instructions not to inhale. This will be done by assessing change in CO from immediately before to immediately after puffing each of a maximum of three cigarettes per paced-puffing session.

Specific aims were:

1. To assess the success of remote monitoring of abstinence by tracking: participant response rates and practice-quitting adherence rates.
2. To assess the success of remote monitoring of paced puffing by tracking: the number of paced-puffing trials in which CO increased by 5 or more parts per million and monitoring failure rates (e.g., due to signal loss or other procedural failure). Descriptive data regarding the number of paced puffing trials completed (out of a maximum of three per session), and reasons for discontinuation will be computed as well.
3. To refine remote monitoring procedures using qualitative feedback from participants about study technology and procedures.

July 2018-Sept 2018, $3000. Funded by the University of Wisconsin. Dr. Danielle McCarthy, PI.

Oncology and Primary Care Pilot Study. For this pilot study, researchers conducted focus groups with smokers as well as interviews with healthcare staff in oncology settings and primary care settings. The overarching goal of the proposed research was to develop a novel intervention to increase engagement in, and access to, evidence-based smoking-cessation treatment within a clinic setting with minimal staff burden. The research provided the necessary foundation to develop a novel intervention known as the Learn, Connect and Quit (LCQ) mobile application. Using focus groups, researchers have been:

1. Determining the feasibility and acceptability of using mobile technology within the clinic exam room to present treatment-engagement focused content to oncology and primary care patients.
2. Identifying key content and design features to maximize utilization of the mobile technology and engagement in evidence-based treatment.
3. Developing pilot content and determining the acceptability and engagement with the content.

April 2017–March 2018, $25,000. Funded by University of Wisconsin Carbone Cancer Center’s (UWCCC), and the National Cancer Institute of the National Institutes of Health. Dr. Megan Piper, PI.

Disseminating and Implementing a Smoking Cessation Program for Pregnant and Postpartum Women. First Breath (FB) is a program administered by the Wisconsin Women’s Health Foundation (WWHF) to help pregnant women quit smoking. While FB is successful helping women quit during pregnancy, it is unable to provide support after a woman delivers. This is very unfortunate because about 85% of women relapse and resume smoking when they return home with their new infant. Recently, UW-CTRI partnered with WWHF on a new program, Striving to Quit (STQ), to address this gap in FB by extending the program to help the new mother stay quit after she returns home with her baby. STQ was conducted as a rigorous research study. Unknown was whether STQ would produce similarly positive outcomes when disseminated and implemented in more real-world contexts. This grant was designed to address these issues:

1. Evaluate STQ in more real-world settings.
2. See if STQ produces better outcomes than FB.
3. Identify barriers to expanding STQ throughout Wisconsin so more pregnant women who smoke can benefit.

WWHF and UW-CTRI have continued their productive partnership for this project. In addition, four key stakeholder groups have been involved throughout the project:

1. Most importantly, women enrolled in STQ have served in focus groups that will provide candid guidance and feedback regarding smoking cessation education materials, challenges to maintaining smoke-free homes, perceptions of the intervention, unmet needs, and barriers to staying quit.
2. Discussion groups with current FB Providers have identified key clinical barriers to dissemination. This will be followed by a statewide survey to all FB Providers.
3. Health Educators who delivered STQ were observed to ensure that the program was delivered as designed. Results of interviews with these Health Educators have been used to develop statewide training materials.
4. Stakeholders who set state policies and payment structures have formed a “Sustainability Planning Committee” because their decisions are key to securing sustained statewide financial support of STQ.

This project aimed to have a substantial impact on the greatest preventable cause of poor birth outcomes in Wisconsin. Researchers expect the findings to inform public policies regarding the need to embrace smoking-cessation programs that begin during pregnancy and extend them into the postnatal period. October 2016-March 2018. $150,000. Funded by University of Wisconsin Institute for Clinical and Translational Research (UW-ICTR). Dr. Michael Fiore, PI. Lisette Kahlil, WWHF Community Partner Lead.