Welcome to the official website of Breaking Addiction to Tobacco for Health 2 (BREATHE 2). This study is the first ever to compare the most effective treatments to help people quit smoking in real-world clinics, with a goal of tailoring and optimizing these treatments to individual smokers.
UW-CTRI is partnering with two health systems, Aurora Health Care and UW Health, to treat more than 4,000 clinic patients. BREATHE 2 has begun at St. Luke’s Medical Center, part of the Aurora system.
BREATHE 2 will reach out to patients listed as smokers in electronic health records at participating clinics to help those who are ready to quit and motivate those who aren’t.
The innovative experiment will be the first to experimentally compare the two most effective interventions available—varenicline (Chantix) vs. combination nicotine-replacement medications—and determine whether they are enhanced by type of counseling (in-person vs. phone), or by extra medication before quitting or after the standard treatment.
“About 25 million smokers in America make a primary care visit each year,” said Principal Investigator Dr. Tim Baker. “But only about five percent of smokers who try to quit use the cessation counseling and medication we know can help. In this study, we’ll reach out to them and offer these treatments.”
This study will investigate how best to match treatments to smokers, given their readiness to quit. “We know the majority of smokers who visit primary care clinics want to quit; most of them have already tried and are often discouraged,” Fiore said. “But smoking remains the leading preventable cause of death and disease in America. We will be offering something for everyone. For those not ready to quit, this includes incentives, tailored outreach and, if they decide to quit later, state of the art medication and quitline coaching.”
This will be the study first ever to use a factorial experiment to evaluate four interventions intended to increase use of tools we know have helped people to quit:
Reminder of access to intensive treatment.
Reaching out to patients via electronic medical records to access quit-tobacco resources.
Proactive care management provided via telephone.
This research will develop a chronic care quit-smoking treatment using factorial designs to develop the best treatments for all smokers. It will use the RE-AIM research constructs to translate these results into real-world healthcare changes. Here’s how:
R: Increase Reach by using a more inclusive opt-out recruitment strategy to contact clinic patients and offer help.
E: Augment treatment Effectiveness by optimizing intervention components that work especially well together for smokers who are ready to quit and those who are not.
A: Bolster Adoption by developing the chronic-care program within two healthcare systems and using their patient populations, personnel, and resources (e.g., EHRs). Engineer the chronic-care program to produce benefits of great appeal to potential adopters (e.g., cost-effectiveness, little impact on clinic workflow).
I: Foster Implementation potential by evaluating all potential chronic-care program components to ensure they are feasible with regard to cost, staffing needs, training required, and resource requirements.
M: Finally, enhance Maintenance by developing treatments engineered to maintain patients’ behavior change and that are easy and inexpensive to continue by healthcare systems and staff.
BREATHE 2 has four main parts:
Ultimately, BREATHE 2 should greatly expand the reach and effectiveness of smoking treatment in healthcare, meaningfully reduce smoking prevalence in healthcare populations, and thereby reduce cancer morbidity and mortality.