billie bonevski university of newcastle faculty of health school of medicine and public health
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The Call it Quits trial: A community welfare service case-worker delivered smoking cessation intervention. Billie Bonevski University of Newcastle Faculty of Health School of Medicine and Public Health. Newcastle. The Call it Quits Team. - PowerPoint PPT PresentationTRANSCRIPT
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The Call it Quits trial: A community welfare service case-worker delivered smoking cessation intervention
Billie Bonevski
University of Newcastle
Faculty of Health
School of Medicine and Public Health
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Newcastle2
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The Call it Quits Team
• The University of Newcastle: Laura Twyman, Chris Paul, Cate D’Este, Jamie Bryant
• University College London: Robert West
• University of Nebraska: Mohammad Siapush
• Illawarra Translational Cancer Research Unit: Afaf Girgis
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Overview
1. Rationale for tackling tobacco amongst socially disadvantaged
2. Describe the Tackling Tobacco Program formative research• What are the opportunities and barriers?
• Is data collected in this setting accurate?
• Do clients smoke and do they want to quit?
• Is a smoking intervention feasible?
• Is a smoking intervention effective?
3. Baseline results from the Call it Quits Trial
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Smoking rates over time by SEIFA quintile
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Changes in smoking prevalence (daily and occasional) from 1998 to 2010 by socioeconomic quintile (1 - most disadvantaged, to 5 - least disadvantaged: AIHW National Drug Household Surveys 1998, 2001, 2004, 2007, 2010
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Smoking rates 2010 - group comparisons 6
27.6%
19.6%
24.6%
12.5%
37.60%
17.40%
0%
5%
10%
15%
20%
25%
30%
35%
40%
General population (15.1%)
Smoking prevalence in the Australian general population compared with selected disadvantaged groups: AIHW National Drug Household Survey 2010
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Smoking and disadvantage
• Compared to more advantaged groups, disadvantaged smokers:– are more addicted1
– report lower self efficacy for quitting1
– smoke more cigarettes per day (17.9 vs. 10.9 for least disadvantaged)2
– are less likely to make a quit attempt 3, 4
– are less likely to plan a quit attempt in the next 6 months 4
– are less likely to receive health provider advice to quit smoking5
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1. Siahpush, McNeill, Borland, 2006; 2. AIHW, 2004; 3. Siahpush, Yong, Borland, Reid, Hammond, 2009; 4. Reid, Hammond, Boudreau, Fong, Siahpush, 2010; 5. Browning, Ferketich, Salsberry, Wewers, 2008.
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Addressing smoking amongst disadvantaged groups
• National Preventive Health Taskforce recommendations:
– “tailor services for indigenous smokers and other highly disadvantaged groups”
– “resources for professionals to encourage and assist smokers in psychiatric and correctional facilities”
– “Implement programs to subsidise nicotine replacement therapy for people who are homeless and other highly disadvantaged people in financial stress”
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9Tackling Tobacco
• Led by the Cancer Council NSW• Reduce smoking among most disadvantaged population groups
in NSW by engaging with the non-government community service sector– Reframe smoking as a social justice issue
– Make the provision of quit support part of routine care
• Research driven
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Why the community social service sector?
• Access and reach– More than 5,000 services in Australia
– More than 4 million instances of service
– Single parents 12 times more likely to use, Indigenous Australians 6.5 times more likely to use
• Holistic approach• Personalised and tailored support• Sustainable and cost effective• Being recognised internationally as a novel and potentially
suitable setting (Christiansen et al., 2010, American Journal of Preventive Medicine)
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11Tackling Tobacco Research
Focus groups with clients
Cross sectional client survey
Focus groups with staff
Call it Quits
RCT Pilot Study
Cancer Council NSW Tackling Tobacco Program
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What are the barriers and opportunities? 12
Bryant, Bonevski, Paul, et al. Delivering smoking cessation support to disadvantaged groups: A qualitative study of the potential of community welfare organisations. Health Education Research, 2010 25(6):979-990.
Bryant, Bonevski Paul et al. Developing cessation interventions for the social and community service setting: A qualitative study of barriers to quitting among disadvantaged Australian smokers BMC Public Health 2011, 11:493
Bonevski B, Bryant J, Paul C. Encouraging smoking cessation in socially disadvantaged groups: a qualitative study of the financial aspects of cessation. Drug and Alcohol Review, 2010, 30(4):411-418.
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Staff Focus Groups (n = 43) • Willingness to address smoking• Appropriateness with role• Brief intervention approaches preferred
“We provide an access point for them and a place where they feel comfortable and safe to go, rather than having to go somewhere strange with different people”
• Barriers– Addressing smoking often not a priority– Inadequate time, skills, and confidence
“I don’t know how well skilled I am, how confident I would feel giving advice about stopping smoking.”
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Client focus groups (n = 32)
“I reckon it would be alright as long as we weren’t feeling like we were getting pestered”
“Yep. I reckon it’s good. At least it’s [quit support] there instead of them not supporting it at all”
“Yeah, it would be alright, they could ask…”
Barriers to quitting:– Lack of support and services– Financial cost of quitting (eg, NRT)
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Is data collected in this setting accurate?
• 383 clients completed a 60-item touch screen computer survey and CO breathanalysis (69% consent rate)
• Touch screen computer smoking survey and CO breathanalysis as gold standard– Sensitivity = 94%– Specificity = 93%
• Computer survey was easy to complete (88%)• Computer survey was enjoyable (79%)
Bryant J, Bonevski B, Paul C. Assessing smoking status in disadvantaged populations: Is computer administered self report an accurate and acceptable measure? BMC Medical Research Methodology 2011, 11:153
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April 22, 2023
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Do clients smoke and do they want to quit?• Smoking variables
– 53.5% daily smoking– 7.9% occasional smoking– 17 cigarettes per day– $46 per week
• Of current smokers:– 56.6% were ‘very’ or ‘quite’ interested in quitting– 70% intended to quit in next 6 months– 52.8% wanted support from staff at the SCSO to quit smoking
Bryant J, Bonevski B, Paul C. A survey of smoking prevalence and interest in quitting among social and community service organisation clients: a unique opportunity for reaching the highly disadvantaged. BMC Public Health 2011, 2011, 11:827
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Is a quit support intervention feasible?
• Pre-post pilot study
1. Test feasibility and acceptability of integrating the delivery of smoking cessation support into usual care at a community service organisation
2. Assess the impact of the program on client smoking
• One SCSO providing a Personal Helpers and Mentors program.
• N = 20 clients
Bryant J, Bonevski B, Paul C, Hull P, O’Brien J. Implementing a smoking cessation program in social and community service organisations: A feasibility and acceptability trial. Drug and Alcohol Review, 2011, DOI: 10.1111/j.1465-3362.2011.00391.x
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Intervention
• One day staff training + booster session– Rationale for incorporating smoking cessation into usual care– Heaviness of smoking index– 5A’s brief intervention– Brief motivational interviewing– NRT
• Free NRT
• Quit ‘Buddy’ system
• Brief advice and motivational interviewing at every visit or where deemed appropriate
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Acceptability to Clients 20
Strongly Agree or
Agree
%
Neutral
%
Strongly Disagree /Disagree
%
Talking to my support worker about my smoking was helpful
92 8 0
Talking to my support worker about my smoking made me think about quitting
90 10 0
I did not like being asked about my smoking by my support worker
0 10 90
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Cessation Results
• (70%) of clients initiated NRT use during the program
• At 6 months follow-up
– No participants reported seven day point prevalence abstinence
– Significant reduction in the number of cigarettes smoked - from 20.5 cigarettes per day at baseline to 15 cigarettes per day (p= 0.04).
– Non-significant reduction in dollars spent on tobacco from $70.95 at baseline to $60.69.
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Next Steps
• Support workers are interested in training and willing to provide support
• Clients of SCSO are interested in quitting and willing to be involved in a cessation program
• May decrease smoking behaviours
• A methodologically rigorous and powered randomised controlled trial is needed to determine effectiveness
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Call it Quits – A RCT of a case worker delivered intervention
• Aim: Evaluate the efficacy of a caseworker-delivered cessation intervention at increasing smoking cessation rates
– Clients randomised to intervention or usual care control – Intervention group to receive 2 face-to-face counselling sessions, free NRT,
‘Quit Buddy’, telephone follow-up
• Primary outcome: CO validated continuous abstinence at 6 months follow up
Bonevski B, Paul C, D’Este C, Sanson-Fisher R, West R, Girgis A, Siahpush M, Carter R. RCT of a client-centred, case worker delivered smoking cessation intervention for a socially disadvantaged population. BMC Public Health 2011, 11:70
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Call it Quits – Progress to date24
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CiQ Study Participants (n = 384)
Sociodemographic Variables n (%)
Gender
Female 188 (49)
Age
Mean (SD) 38 years (11)
Indigenous Status
Indigenous Australian 58 (15)
Education
Completed Year 10 or below 245 (64)
Housing
Supported Accommodation/no home/street living 207 (54)
Income level
$400 per week or less 307 (80)
Income source
Centrelink 364 (95)
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CiQ – Psycho-social variables (n = 384)
Psychosocial variables n (%)
Financial stress
Scores ≥ 4 343 (89)
Depression
Scores ≥ 10 228 (59)
Anxiety
Scores ≥ 3 216 (56)
Resilience
Mean (SD) 2.9 (1)
Social support (family & friend contact)
No/Less than once a month 115 (30)
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Prevalence rates in current sample n (%)
Tobacco use (both daily and occasional)
384 (74)
Risky alcohol users 242 (63)
Concurrent users 190 (46)
27CiQ Trial – tobacco and alcohol use (n= 384)
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CiQ Trial – Quit attempts (total n = 384)
n (%)
Smokers - ever made a quit attempt n = 384
Yes 334 (87)
Smokers - quit attempt in the last 12 months n = 334
Min, Max 0 – 24
Median 1
Mean (SD) 1.8 (2.1)
Two or more quit attempts 167 (50)
Zero or one quit attempt 167 (50)
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Next steps
• Continued recruitment to December 2013
• Continued analysis of baseline data
• 1 Month outcomes
• Trial concludes July 2014
• Main 6 month outcomes
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THANK YOU
Cancer Council NSW:Jon O’Brien, Phil Hull
Anglicare clients and staff
Funding:•Cancer Council NSW•Cancer Institute NSW•NHMRC•University of Newcastle•HMRI