Nancy E. Hood

Clinical Faxed Referrals to a Tobacco Quitline: Reach, Enrollment, and Participant Characteristics

BACKGROUND Faxed referrals from healthcare providers may provide a sustainable, low-cost mechanism for enrolling tobacco users in statewide quitlines, but few studies have evaluated implementation in real-world settings. This study evaluated the reach rates, enrollment rates, and participant characteristics of faxed referrals to the Ohio Tobacco Quit Line. METHODS This observational study analyzed reach and enrollment rates from June 2006 to October 2007. Demographics and tobacco-use characteristics of 1616 Quit Line enrollees recruited through faxed referrals were compared to those of enrollees who were not fax-referred. RESULTS A total of 6951 faxed referrals were received during the study period, increasing from an average of 68 per month before promotional initiatives to 412 per month during the study period. However, almost 60% of fax-referred individuals could not be reached for enrollment. Compared to other enrollees (n=36,273), fax-referred enrollees (n=1616) were more likely to be women, aged >/=35 years, have less than a high school education, have at least one comorbid condition, and be uninsured or publicly insured. CONCLUSIONS Faxed referrals from healthcare providers are widely promoted to increase quitline participation and to assist providers in implementing cessation treatment. This study found low enrollment rates from faxed referrals; substantial efforts led to relatively few patients receiving quitline services. However, faxed referrals may reach populations who traditionally have less access to cessation aids. More research is needed to determine how to efficiently and effectively solicit faxed referrals from healthcare providers and to increase quitline enrollment rates among fax-referred smokers as well as to determine the extent to which faxed referrals influence quit outcomes.

Survey of community engagement in NIH-funded research.

Community engagement is an innovative and required component for Clinical and Translational Science Awards (CTSAs) funded by the National Institutes of Health (NIH). However, the extent of community engagement in NIH‐funded research has not been previously examined. This study assessed baseline prevalence of community engagement activities among NIH‐funded studies at a large Midwestern university with a CTSA. An online survey was e‐mailed to principal investigators of recent NIH‐funded studies (N = 480). Investigators were asked to identify what types of community engagement activities had occurred for each study. Responses were received for 40.4% (194/480) of studies. Overall, 42.6% reported any community engagement activities. More collaborative types of engagement (e.g., community advisory board) were less common than activities requiring less engagement (e.g., sharing study results with community members). Studies with more collaborative community engagement were less likely to be described as basic or preclinical research compared to all other studies. Given NIHs inclusive call for community engagement in research, relatively few NIH‐funded studies reported community engagement activities, although this study used a broad definition of community and a wide range of types of engagement. These findings may be used to inform the goals of CTSA community engagement programs. Clin Trans Sci 2010; Volume *: 1–4

Individual, Social, and Environmental Factors Associated With Support for Smoke-Free Housing Policies Among Subsidized Multiunit Housing Tenants

INTRODUCTION Mandatory smoke-free policies in subsidized, multiunit housing (MUH) may decrease secondhand smoke exposure in households with the highest rates of exposure. Ideally, policies should be based on a strong understanding of factors affecting support for smoke-free policies in the target population to maximize effectiveness. METHODS A face-to-face survey was conducted from August to October 2011 using a stratified random sample of private subsidized housing units in Columbus, OH, without an existing smoke-free policy (n = 301, 64% response rate). Lease holders were asked to report individual, social, and environmental factors hypothesized to be related to support for smoke-free policies. Multiple logistic regression models were used to identify factors independently associated with policy support. RESULTS Most tenants supported smoke-free policies in common areas (82.7%), half supported policies inside units (54.5%), and one third supported a ban outside the building (36.3%). Support for smoke-free policies in units and outdoors was more common among nonsmokers than smokers (71.5% vs. 35.7%, p < .001 and 46.2% vs. 25.4%, p < .001, respectively). Several individual and social, but no environmental, factors were independently associated with policy support. Smokers who intended to quit within 6 months or less were more likely than other smokers to support in-unit policies (45.3% vs. 21.1%; p = .003). CONCLUSIONS More than half of subsidized MUH tenants supported smoke-free policies inside their units. Strategies to address individual- and social-level barriers to behavior change should be implemented in parallel with smoke-free policies. Policies should be evaluated with objective measures to determine their effectiveness.

Smoking Cessation Treatment Preferences, Intentions, and Behaviors Among a Large Sample of Colorado Gay, Lesbian, Bisexual, and Transgendered Smokers

INTRODUCTION Little is known about preferences, intentions, and behaviors regarding evidence-based cessation treatment for smoking cessation among gay, lesbian, bisexual, and transgendered (GLBT) adults. METHODS We obtained and analyzed questionnaire responses from GLBT smokers (n= 1,633) surveyed in 129 GLBT-identified Colorado venues and online during 2007. RESULTS Most respondents (80.4%) smoked daily. Nearly one-third smoked 20 or more cigarettes/day. Fewer than half (47.2%) had attempted quitting in the previous year, and only 8.5% were preparing to quit in the next month. More than one-fourth (28.2%) of quit attempters had used nicotine replacement therapy (NRT), and a similar proportion said they intended to use NRT in their next quit attempt. Lesbians were significantly less likely than gay men to have used or intend to use NRT. One-fourth of respondents said they were uncomfortable talking to their doctor about quitting smoking. Four factors (daily smoking, ever having used NRT, a smoke-free home rule, and comfort asking ones doctor for cessation advice) were associated with preparation to quit smoking. CONCLUSIONS GLBT self-identification was not associated with lower than average acceptance of evidence-based smoking cessation strategies, especially NRT, but a large minority of GLBT smokers were unlikely to seek cessation assistance through clinical encounters. Public health campaigns should focus on supporting motivation to quit and providing nonclinical access to evidence-based treatments.

Associations between self-reported in-home smoking behaviours and surface nicotine concentrations in multiunit subsidised housing

Introduction Smoke-free policies are being increasingly promoted and adopted in subsidised multiunit housing to address disparities in residential secondhand smoke exposure. In order to inform the planning and evaluation of these policies, this study examined associations between self-reported in-home smoking and surface nicotine concentrations. Methods A face-to-face, cross-sectional survey was conducted from August to October 2011 with leaseholders in a probability sample of private subsidised housing units in Columbus, Ohio, without an existing smoke-free housing policy (n=301, 64% response rate). After the survey, a wipe sample was collected from a wood surface in the living room to measure surface nicotine concentrations (n=279). Results In-home smoking was reported by 56.6% of respondents. Geometric mean surface nicotine concentrations differed between non-smoking and smoking homes (11.4 vs 90.9 μg/m2; p<0.001), and between homes with complete, partial and no voluntary home smoking restrictions (8.9 vs 56.3 vs 145.6 μg/m2; p<0.001). Surface nicotine concentrations were moderately correlated (r=.52) with the total number of cigarettes smoked indoors per week. Smoking behaviours of respondents, other household members and visitors, and length of stay were independently associated with surface nicotine concentrations in a multivariable model, explaining 52% of the variance. Conclusions Surface nicotine concentrations were significantly associated with a range of self-reported in-home smoking behaviours. This measure should be considered for evaluating changes in in-home smoking behaviours after implementation of smoke-free policies by subsidised housing providers. More research is needed about how surface nicotine concentrations differ over space, time and various indoor surfaces.

Smoking Behaviors and Cessation Interests Among Multiunit Subsidized Housing Tenants, Columbus, Ohio, 2011

Introduction Cessation services have been recommended to complement smoke-free policies in subsidized multiunit housing, but little is known about smoking- and cessation-related characteristics among subsidized housing tenants. This study examined smoking behaviors and cessation-related interests in a population of subsidized housing tenants. Methods A face-to-face survey was conducted in August to October 2011 with a probability sample of private subsidized housing lease holders in Columbus, Ohio (N = 301, 64% response rate). Results Almost half (47.5%) of respondents were current smokers, including smokers of cigarettes or small cigars. Smokers were less likely than nonsmokers to have health insurance and more likely to be at risk for food insecurity. Among smokers, 20.3% did not smoke daily and 35.0% smoked 5 or fewer cigarettes per day. More than half (61.3%) purchased single cigarettes in the past month, with higher rates among nondaily smokers. Most smokers intended to quit within 6 months or less (60.1%) and were interested in using nicotine replacement therapy (NRT) (65.0%). Most respondents had Medicaid but only 30.4% knew Medicaid covered cessation medications. Conclusions This population of subsidized housing tenants had high rates of smoking, including light smoking. Interest in NRT was high and access can be improved by increasing awareness of Medicaid coverage among clients and health care providers. However, more research is needed about scalable, evidence-based cessation strategies for low-socioeconomic status and light smokers. Strategies to address environmental factors such as availability of single cigarettes should also be considered in parallel with smoke-free policies.

Treatment adherence in a lay health adviser intervention to treat tobacco dependence

Lay health advisers (LHAs) are increasingly used to deliver tobacco dependence treatment, especially with low-socioeconomic status (SES) populations. More information is needed about treatment adherence to help interpret mixed evidence of LHA intervention effectiveness. This study examined adherence to behavioral counseling and nicotine patches in an LHA intervention with 147 Ohio Appalachian female daily smokers. Participants were randomly selected from clinics and randomized to the intervention condition of a randomized controlled trial. Overall, 75.5% of participants received all seven planned LHA visits, 29.3% used patches for >7 weeks and approximately half received high average ratings on participant responsiveness. Depressive symptoms and low nicotine dependence were associated with lower patch adherence while high poverty-to-income ratio was associated with high responsiveness. Compared with those with fewer visits, participants who received all visits were more likely to be abstinent (22.5 versus 2.8%, P=0.026) or have attempted quitting (85.0 versus 47.4%, P=0.009) at 3 months. High participant responsiveness was associated with 12-month abstinence. LHA interventions should focus on improving adherence to nicotine patches and managing depression because it is an independent risk factor for low adherence.

Enabling distributed electronic research data collection for a rural Appalachian tobacco cessation study

Tobacco use is increasingly prevalent among vulnerable populations, such as people living in rural Appalachian communities. Owing to limited access to a reliable internet service in such settings, there is no widespread adoption of electronic data capture tools for conducting community-based research. By integrating the REDCap data collection application with a custom synchronization tool, the authors have enabled a workflow in which field research staff located throughout the Ohio Appalachian region can electronically collect and share research data. In addition to allowing the study data to be exchanged in near-real-time among the geographically distributed study staff and centralized study coordinator, the system architecture also ensures that the data are stored securely on encrypted laptops in the field and centrally behind the Ohio State University Medical Center enterprise firewall. The authors believe that this approach can be easily applied to other analogous study designs and settings.

Randomised trial of two nicotine patch protocols distributed through a state quitline

Background Most telephone quitlines provide free nicotine replacement therapy (NRT). An 8-week course is recommended, but few users complete it. Information is needed to help quitlines distribute NRT cost-effectively. Design Randomised two-group trial. Setting/participants Colorado QuitLine callers who smoked 16–20 cigarettes per day at enrolment and who were eligible for and agreed to receive free NRT. Intervention Provision of 4-week versus 8-week NRT supply; the 8-week supply was shipped in halves and required participants to request the second half (split-shipment protocol). Enrolment occurred during March 2010–February 2011, follow-up concluded in November 2011, and analysis was performed in 2012. Main outcome measures Point abstinence (7 and 30 day) and prolonged abstinence (6 month) from tobacco use. Results Overall, 1495 study participants were enrolled and 57.7% completed follow-up. Abstinence rates did not differ significantly between study conditions: 13.8% versus 12.4% in 4-week versus 8-week arms, respectively, (30-day point abstinence, non-respondents treated as smokers). NRT duration was similar in both groups, due in part to purchase of additional patches in the 4-week group. About one-third of the 8-week group requested the full 8-week supply and had higher abstinence rates. Cost per quit was lower in the 4-week (compared to 8-week) group. Conclusions A randomised trial did not find worse cessation outcomes among quitline users who received half the minimum recommended course of NRT, but offering the full recommended course using a split-shipment protocol may be reasonably cost-effective and supportive of NRT adherers. Trial registration number NCT01889771.

Affordable Housing and Health: A Health Impact Assessment on Physical Inspection Frequency

OBJECTIVES To characterize the prevalence of health-related housing quality exposure for the vulnerable populations that live in affordable housing. DESIGN Retrospective cross-sectional study. SETTING Affordable housing properties in Ohio inspected between 2007 and 2011. PARTICIPANTS Stratified random sample of physical inspection reports (n = 370), including a case study of properties receiving multiple inspections (n = 35). MAIN OUTCOME MEASURES Health-related housing factors, including mold, fire hazard, and others. RESULTS The majority of affordable housing property inspections (85.1%) included at least 1 health-related housing quality issue. The prevalence of specific health-related violations was varied, with appliance and plumbing issues being the most common, followed by fire, mold, and pest violations. Across funding agencies, the actual implementation of inspection protocols differed. CONCLUSIONS The majority of physical inspections identified housing quality issues that have the potential to impact human health. If the frequency of physical inspections is reduced as a result of inspection alignment, the most health protective inspection protocol should be selected for funding agency inspections; a standardized physical inspection tool is recommended to improve the consistency of inspection findings between mandatory physical inspections in order to promote optimum tenant health.