UW-CTRI has recently completed three studies, with data under analysis for dissemination.
- Options Study. The Options Study has been conducted by UW-CTRI in the Madison and Milwaukee areas. Participants temporarily switch from just smoking to alternative products. These products include Juul e-cigarettes or cigarettes with very low nicotine content. Participants will get paid up to $380. All study participants were who didn’t want to quit smoking, but were willing to switch from their cigarettes to something new for a week. The four weeks of the study had different goals:
- Week 1: Try out the study product they were randomly assigned to use: Juul e-cigarettes, VLN cigarettes or no alternative product. They could smoke their own cigarettes as usual.
- Week 2 (Switch Week): Don’t smoke their own cigarettes but use a patch (active or placebo) and their assigned study product.
- Week 3: Smoke their own cigarettes and use their study product as much as they want.
- Week 4 (Switch Week): Don’t smoke their own cigarettes but use a patch (if they had an active patch with nicotine in Week 2 they now had a placebo patch with no nicotine or vice versa) and their assigned study product.
Researchers will examine how well Juul or low-nicotine cigarettes can substitute for regular smoking, and how nicotine patches factor into it and why. May 2019-April 2022, $1.4 million. Funded by NCI and FDA. Dr. Megan Piper, PI.
- Transforming the Treatment of Tobacco Use in Healthcare: Seizing the Potential of the Electronic Health Record (EHR) to Deliver Comprehensive Chronic Care Treatment for Smoking. This R35 grant to Dr. Michael Fiore was designed to offer flexibility to researchers in the quest to overcome barriers in helping primary-care patients quit smoking. In other words, it sparked innovation to translate efficacious treatments into clinical use. Projects have included:
- Tobacco Cessation Quitline eReferral. This study was 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. 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. A main outcomes paper was published in the Journal of the American Medical Informatics Association.
- SmokefreeTXT Pilot. This pilot project integrated 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 electronic health records (EHR) prompted clinicians to refer to SmokefreeTXT via an eReferral order. Data from this small pilot study indicated feasibility of the approach, and presented questions on which members of a care team may be best suited to intervene with this approach. Based on study findings, researchers reported in a paper in Translational Behavioral Medicine that interoperable eReferral via outpatient EHR to SmokefreeTXT was feasible and acceptable to clinic staff, enrolled roughly 3% of people who smoke, and the individual clinic context and implementation approach may influence reach.
- 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. An innovative “triple therapy” of three FDA-approved medications taken together—along with coaching on how to quit smoking—appeared to be safe and showed promise, according to a UW-CTRI research paper published in the Journal of Smoking Cessation.
- Comprehensive Chronic Care Smoking Treatment System. Given that only about half of people who smoke 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 ensured patients had the tools they needed to quit smoking for good. All six GHC primary-care sites were actively participating in this project.
- Tablet Technology Pilot Project with Low-Income People Who Smoke. A tablet-based smoking-cessation intervention for clients was pilot tested at two Salvation Army sites. The goals were to gauge 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. Following the intervention, researchers interviewed staff and clients about their experiences, affirming acceptability of the tablet intervention.
- Learn, Connect, and Quit. Researchers conducted a pilot of a tablet app featuring videos for people who smoke visiting one primary-care clinic. Unfortunately, clinic staff gave the tablet to patients much less frequently than researchers anticipated. Of the 30 patients who engaged with the app, 15 watched at least 1 video: 10 watched 1 video, 3 watched 2 videos and 2 watched 3 videos.
- Financial Incentives for Smoking Treatment Engagement. Building upon the robust treatment program implemented at Group Health Cooperative-South Central Wisconsin (GHC), this project evaluated modest financial incentives to people who smoke who engaged in quit planning with the GHC Tobacco Cessation Outreach Specialists. More than 500 patients who smoked were randomized to three different incentive levels to encourage engagement in quit-smoking treatment planning over the phone.
August 2015-July 2022, $6.1 million. Funded by the National Cancer Institute of the National Institutes of Health. Dr. Michael Fiore, PI.
- Quit Line eReferral with Feedback and Nicotine Patch Sampling. UW-CTRI partnered with Ascension Wisconsin to develop strategies to enhance system-wide implementation of electronic referral (eReferral) to the Wisconsin Tobacco Quit Line for adult primary care patients who smoke. UW-CTRI continues to work with 32 Ascension clinics to evaluate the effectiveness of monthly implementation feedback and provision of free nicotine patch samples in an ongoing experiment to identify strategies that increase the reach of Quit Line treatment. November 2019-February 2022, $150,000. Funded by the UW Institute for Clinical and Translational Research. Dr. Danielle McCarthy, PI.