Simultaneous vs. sequential treatment for smoking and weight management in tobacco quitlines

6 and 12 month outcomes from a randomized trial

Terry Bush*, Jennifer Lovejoy, Harold Javitz, Alula Jimenez Torres, Ken Wassum, Marcia M. Tan, Bonnie Spring

*Corresponding author for this work

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Smoking cessation often results in weight gain which discourages many smokers from quitting and can increase health risks. Treatments to reduce cessation-related weight gain have been tested in highly controlled trials of in-person treatment, but have never been tested in a real-world setting, which has inhibited dissemination. Methods: The Best Quit Study (BQS) is a replication and "real world" translation using telephone delivery of a prior in-person efficacy trial. Design: randomized control trial in a quitline setting. Eligible smokers (n = 2540) were randomized to the standard 5-call quitline intervention or quitline plus simultaneous or sequential weight management. Regression analyses tested effectiveness of treatments on self-reported smoking abstinence and weight change at 6 and 12 months. Results: Study enrollees were from 10 commercial employer groups and three state quitlines. Participants were between ages 18-72, 65.8% female, 68.2% white; 23.0% Medicaid-insured, and 76.3% overweight/obese. The follow-up response rate was lower in the simultaneous group than the control group at 6 months (p = 0.01). While a completers analysis of 30-day point prevalence abstinence detected no differences among groups at 6 or 12 months, multiply imputed abstinence showed quit rate differences at 6 months for:simultaneous (40.3%) vs. sequential (48.3%), p = 0.034 and simultaneous vs. control (44.9%), p = 0.043. At 12 months, multiply imputed abstinence, was significantly lower for the simultaneous group (40.7%) vs. control (46.0%), p < 0.05 and vs. sequential (46.3%), p < 0.05. Weight gain at 6 and 12 months was minimal and not different among treatment groups. The sequential group completed fewer total calls (3.75) vs. control (4.16) and vs. simultaneous group (3.83), p = 0.01, and fewer weight calls (0.94) than simultaneous (2.33), p < 0.0001. The number of calls completed predicted 30-day abstinence, p < 0.001, but not weight outcomes. Discussion: This study offers a model for evaluating population-level public health interventions conducted in partnership with tobacco quitlines. Conclusions: Simultaneous (vs. sequential) delivery of phone/web weight management with cessation treatment in the quitline setting may adversely affect quit rate. Neither a simultaneous nor sequential approach to addressing weight produced any benefit on suppressing weight gain. This study highlights the need and the challenges of testing intensive interventions in real-world settings. Trial registration: ClinicalTrials.gov Identifier: NCT01867983. Registered: May 30, 2013.

Original languageEnglish (US)
Article number678
JournalBMC Public Health
Volume18
Issue number1
DOIs
StatePublished - May 31 2018

Fingerprint

Tobacco
Smoking
Weights and Measures
Weight Gain
Withholding Treatment
Medicaid
Smoking Cessation
Telephone
Health Status
Public Health
Regression Analysis
Control Groups
Health
Population

Keywords

  • Quitlines
  • Smoking
  • Weight management

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Bush, Terry ; Lovejoy, Jennifer ; Javitz, Harold ; Torres, Alula Jimenez ; Wassum, Ken ; Tan, Marcia M. ; Spring, Bonnie. / Simultaneous vs. sequential treatment for smoking and weight management in tobacco quitlines : 6 and 12 month outcomes from a randomized trial. In: BMC Public Health. 2018 ; Vol. 18, No. 1.
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abstract = "Background: Smoking cessation often results in weight gain which discourages many smokers from quitting and can increase health risks. Treatments to reduce cessation-related weight gain have been tested in highly controlled trials of in-person treatment, but have never been tested in a real-world setting, which has inhibited dissemination. Methods: The Best Quit Study (BQS) is a replication and {"}real world{"} translation using telephone delivery of a prior in-person efficacy trial. Design: randomized control trial in a quitline setting. Eligible smokers (n = 2540) were randomized to the standard 5-call quitline intervention or quitline plus simultaneous or sequential weight management. Regression analyses tested effectiveness of treatments on self-reported smoking abstinence and weight change at 6 and 12 months. Results: Study enrollees were from 10 commercial employer groups and three state quitlines. Participants were between ages 18-72, 65.8{\%} female, 68.2{\%} white; 23.0{\%} Medicaid-insured, and 76.3{\%} overweight/obese. The follow-up response rate was lower in the simultaneous group than the control group at 6 months (p = 0.01). While a completers analysis of 30-day point prevalence abstinence detected no differences among groups at 6 or 12 months, multiply imputed abstinence showed quit rate differences at 6 months for:simultaneous (40.3{\%}) vs. sequential (48.3{\%}), p = 0.034 and simultaneous vs. control (44.9{\%}), p = 0.043. At 12 months, multiply imputed abstinence, was significantly lower for the simultaneous group (40.7{\%}) vs. control (46.0{\%}), p < 0.05 and vs. sequential (46.3{\%}), p < 0.05. Weight gain at 6 and 12 months was minimal and not different among treatment groups. The sequential group completed fewer total calls (3.75) vs. control (4.16) and vs. simultaneous group (3.83), p = 0.01, and fewer weight calls (0.94) than simultaneous (2.33), p < 0.0001. The number of calls completed predicted 30-day abstinence, p < 0.001, but not weight outcomes. Discussion: This study offers a model for evaluating population-level public health interventions conducted in partnership with tobacco quitlines. Conclusions: Simultaneous (vs. sequential) delivery of phone/web weight management with cessation treatment in the quitline setting may adversely affect quit rate. Neither a simultaneous nor sequential approach to addressing weight produced any benefit on suppressing weight gain. This study highlights the need and the challenges of testing intensive interventions in real-world settings. Trial registration: ClinicalTrials.gov Identifier: NCT01867983. Registered: May 30, 2013.",
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Simultaneous vs. sequential treatment for smoking and weight management in tobacco quitlines : 6 and 12 month outcomes from a randomized trial. / Bush, Terry; Lovejoy, Jennifer; Javitz, Harold; Torres, Alula Jimenez; Wassum, Ken; Tan, Marcia M.; Spring, Bonnie.

In: BMC Public Health, Vol. 18, No. 1, 678, 31.05.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Simultaneous vs. sequential treatment for smoking and weight management in tobacco quitlines

T2 - 6 and 12 month outcomes from a randomized trial

AU - Bush, Terry

AU - Lovejoy, Jennifer

AU - Javitz, Harold

AU - Torres, Alula Jimenez

AU - Wassum, Ken

AU - Tan, Marcia M.

AU - Spring, Bonnie

PY - 2018/5/31

Y1 - 2018/5/31

N2 - Background: Smoking cessation often results in weight gain which discourages many smokers from quitting and can increase health risks. Treatments to reduce cessation-related weight gain have been tested in highly controlled trials of in-person treatment, but have never been tested in a real-world setting, which has inhibited dissemination. Methods: The Best Quit Study (BQS) is a replication and "real world" translation using telephone delivery of a prior in-person efficacy trial. Design: randomized control trial in a quitline setting. Eligible smokers (n = 2540) were randomized to the standard 5-call quitline intervention or quitline plus simultaneous or sequential weight management. Regression analyses tested effectiveness of treatments on self-reported smoking abstinence and weight change at 6 and 12 months. Results: Study enrollees were from 10 commercial employer groups and three state quitlines. Participants were between ages 18-72, 65.8% female, 68.2% white; 23.0% Medicaid-insured, and 76.3% overweight/obese. The follow-up response rate was lower in the simultaneous group than the control group at 6 months (p = 0.01). While a completers analysis of 30-day point prevalence abstinence detected no differences among groups at 6 or 12 months, multiply imputed abstinence showed quit rate differences at 6 months for:simultaneous (40.3%) vs. sequential (48.3%), p = 0.034 and simultaneous vs. control (44.9%), p = 0.043. At 12 months, multiply imputed abstinence, was significantly lower for the simultaneous group (40.7%) vs. control (46.0%), p < 0.05 and vs. sequential (46.3%), p < 0.05. Weight gain at 6 and 12 months was minimal and not different among treatment groups. The sequential group completed fewer total calls (3.75) vs. control (4.16) and vs. simultaneous group (3.83), p = 0.01, and fewer weight calls (0.94) than simultaneous (2.33), p < 0.0001. The number of calls completed predicted 30-day abstinence, p < 0.001, but not weight outcomes. Discussion: This study offers a model for evaluating population-level public health interventions conducted in partnership with tobacco quitlines. Conclusions: Simultaneous (vs. sequential) delivery of phone/web weight management with cessation treatment in the quitline setting may adversely affect quit rate. Neither a simultaneous nor sequential approach to addressing weight produced any benefit on suppressing weight gain. This study highlights the need and the challenges of testing intensive interventions in real-world settings. Trial registration: ClinicalTrials.gov Identifier: NCT01867983. Registered: May 30, 2013.

AB - Background: Smoking cessation often results in weight gain which discourages many smokers from quitting and can increase health risks. Treatments to reduce cessation-related weight gain have been tested in highly controlled trials of in-person treatment, but have never been tested in a real-world setting, which has inhibited dissemination. Methods: The Best Quit Study (BQS) is a replication and "real world" translation using telephone delivery of a prior in-person efficacy trial. Design: randomized control trial in a quitline setting. Eligible smokers (n = 2540) were randomized to the standard 5-call quitline intervention or quitline plus simultaneous or sequential weight management. Regression analyses tested effectiveness of treatments on self-reported smoking abstinence and weight change at 6 and 12 months. Results: Study enrollees were from 10 commercial employer groups and three state quitlines. Participants were between ages 18-72, 65.8% female, 68.2% white; 23.0% Medicaid-insured, and 76.3% overweight/obese. The follow-up response rate was lower in the simultaneous group than the control group at 6 months (p = 0.01). While a completers analysis of 30-day point prevalence abstinence detected no differences among groups at 6 or 12 months, multiply imputed abstinence showed quit rate differences at 6 months for:simultaneous (40.3%) vs. sequential (48.3%), p = 0.034 and simultaneous vs. control (44.9%), p = 0.043. At 12 months, multiply imputed abstinence, was significantly lower for the simultaneous group (40.7%) vs. control (46.0%), p < 0.05 and vs. sequential (46.3%), p < 0.05. Weight gain at 6 and 12 months was minimal and not different among treatment groups. The sequential group completed fewer total calls (3.75) vs. control (4.16) and vs. simultaneous group (3.83), p = 0.01, and fewer weight calls (0.94) than simultaneous (2.33), p < 0.0001. The number of calls completed predicted 30-day abstinence, p < 0.001, but not weight outcomes. Discussion: This study offers a model for evaluating population-level public health interventions conducted in partnership with tobacco quitlines. Conclusions: Simultaneous (vs. sequential) delivery of phone/web weight management with cessation treatment in the quitline setting may adversely affect quit rate. Neither a simultaneous nor sequential approach to addressing weight produced any benefit on suppressing weight gain. This study highlights the need and the challenges of testing intensive interventions in real-world settings. Trial registration: ClinicalTrials.gov Identifier: NCT01867983. Registered: May 30, 2013.

KW - Quitlines

KW - Smoking

KW - Weight management

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