By Holla Aprea Gibbons
November 2, 2009
A partnership of organizations in Washington, DC, will explore how effectively new media tools help District residents quit smoking. The American Legacy Foundation's Schroeder Institute for Tobacco Research and Policy Studies received nearly $980,000 in American Recovery and Reinvestment Act (ARRA) funds from the National Institute on Drug Abuse to carry out a randomized controlled trial to study the effectiveness of Mobile Quitline Enhancement (MQE), an Internet-based mobile phone technology to be provided through the DC Tobacco Quitline.
The quitline provides free support to those who want to stop smoking and are motivated to seek cessation services. Currently, resources include a series of five phone counseling sessions and an 8-week course of nicotine replacement therapy (NRT), in either lozenge or patch form. MQE services are designed to assist quitline counselors, giving users the opportunity to share real-time information about their quit attempt through daily assessments. This provides counselors with accurate and timely data between phone sessions, allowing them to tailor their intervention.
Approximately 800 quitline callers will be selected to take part in the trial. Of these, 500 participants will be randomly assigned to receive mobile phones equipped with MQE software and Internet access, allowing them to send updates on factors such as cravings and potential lapses directly to a quitline database. The other 300 participants will receive standard quitline services.
The study will compare the two groups to evaluate MQE's impact on cessation rates. It will also examine whether MQE users choose to use cessation support resources more often than MQE nonusers, and whether differences in NRT use impact overall cessation outcomes.
Smoking prevalence in the District of Columbia varies by ward.
MQE will allow counselors to save time spent on detailed discussions of users' smoking behavior during the weeks between calls to the quitline, since the system provides counselors with specific information about their clients' ongoing progress with cessation. It will also allow counselors to provide customized support based on each participant's behavior.
Dr. Thomas Kirchner, an investigator at the Schroeder Institute for Tobacco Research and Policy Studies, will lead the initiative. He points out that Web-based mobile technologies hold tremendous potential to address the challenges quitters face during smoking cessation.
"It is important for cessation-support services to take situational circumstances into account. Mobile devices enable existing systems to do precisely that–to consider momentary circumstances," Dr. Kirchner said. "They provide tailored relapse prevention support wherever and whenever it happens. One way to think about these devices is that they are a distress beacon the user can activate to receive support."
The American Legacy Foundation will collaborate on this project with the DC Department of Health, DC Cancer Consortium, American Lung Association of DC Tobacco Free Families Initiative, and the Georgetown University Lombardi Health Disparities Initiative.
"This project spearheads a new local partnership that is totally focused on improving health outcomes among underserved DC residents," said Dr. Kirchner. "We're excited to work hand-in-hand with local partners. We are all working to sustain these systems well past the ARRA window," he explained.
Ashley Ross, tobacco control program manager at the DC Department of Health, agreed. "We're excited about this opportunity on a number of levels. Any opportunity to increase effectiveness and help more people quit is something we want to do. It really helps us crack the code for how we can continue to offer effective, sustainable cessation services," Ms. Ross said.
"[MQE] provides a unique protocol for the underserved smoker," said Debra Annand, lead advisor for the American Lung Association of DC and for the quitline. "We plan to assess how these extra interventions can improve quit attempts for underserved and underinsured smokers."
Smoking prevalence varies across the city–from as low as 10 percent in Ward 3 to as high as 26 percent in Ward 8. Overall, smoking prevalence is much higher in Wards 5 through 8; and it is here where the majority of the quitline's outreach is focused, and where residents also generally have lower socioeconomic status. The quitline addresses this disparity and tailors services to meet the needs of those individuals.
Ms. Ross notes that MQE technology could have implications for these communities beyond this study. "We can start to think about the quitline less as a destination, and more as a vehicle. We are reaching communities most in need, connecting with them and helping them build their own capacity–not just with cessation but also with other risk behaviors."
This article originally appeared in the NCI Cancer Bulletin.