Article Figures & Data
Figures
- Figure 1.
Study flow diagram.
Tables
ESP (n = 61) CTHS (n = 62) Mean (SD) Mean (SD) or % n or % n P value Age (years) 51.62 11.71 52.70 12.99 0.63 Gender 0.10 Man 42.6% 26 37.1% 23 Woman 50.8% 31 59.7% 37 Female-to-male 6.6% 4 0.0% 0 Unknown/Prefer not to Answer 0.0% 0 3.2% 2 Hispanic or Latinx 8.2% 5 11.5% 7 0.54 Race (not mutually exclusive categories) Native American or Alaska Native 9.8% 6 8.2% 5 0.75 Asian 6.6% 4 1.6% 1 0.17 Black or African American 18.0% 11 16.4% 10 0.81 Native Hawaiian or Pacific Islander 0.0% 0 9.8% 6 0.01 White 65.6% 40 52.5% 32 0.14 Unknown/prefer not to answer 8.2% 5 16.1% 10 0.18 Education 0.21 Less than high school 4.9% 3 6.5% 4 High school or GED 32.8% 20 45.2% 28 Some college 49.2% 30 30.6% 19 College graduate or more 13.1% 8 17.7% 11 BMI 33.74 12.34 29.11 7.63 0.01 BMI categories 0.31 Below 18.5 0.0% 0 4.8% 3 18.5 – 24.9 24.6% 15 27.4% 17 25.0 – 29.9 26.2% 16 27.4% 17 30.0 and above 49.2% 30 40.3% 25 On how many of the past 30 days did you smoke cigarettes? 0.48 1 to 7 days 13.3% 8 5.1% 3 8 to 15 days 5.0% 3 6.8% 4 16 to 25 days 6.7% 4 6.8% 4 Every day or nearly every day 75.0% 45 81.4% 48 On a typical day when you smoke, how many cigarettes do you smoke? (Cigarettes per day) 11.75 7.02 11.66 7.41 0.95 Minutes to first cigarette after waking up 0.43 Less than 30 minutes 63.3% 38 51.6% 32 31 to 60 minutes 23.3% 14 30.6% 19 More than 60 minutes 13.3% 8 17.7% 11 In 6 months from today, how confident are you that you will be smoke free (not smoking 30+ days; scale 0 to 10)? 6.02 3.31 6.11 2.93 0.84 Stages of change 0.36 Pre-contemplation 6.6% 4 6.4% 4 Contemplation 16.4% 10 8.1% 5 Preparation 77.0% 47 85.5% 53 Use of E-cigarettes or vaping or Juul 16.4% 10 8.2% 5 0.17 Use of other nicotine (e.g., cigars, chewing tobacco) 24.6% 15 16.1% 10 0.24 How many years have you smoked regularly? 0.70 Less than 5 years 3.3% 2 3.3% 2 5 to 10 years 11.7% 7 15.0% 9 11 to 20 years 15.0% 9 21.7% 13 More than 20 years 70.0% 42 60.0% 36 Abbreviations: ESP, enhanced standard program; CTHS, connection to health for smokers; SD, standard deviation; GED, general educational diploma; BMI, body mass index.
- Table 2.
Outcomes by Intervention Group (Missing Data Filled in with “Conservative Value” e.g., Did Not Quit Smoking)*
Outcome ESP
Mean (SD) or % (n)CTHS
Mean (SD) or % (n)P value Adjusted P value Number of follow-up appts (0 to 10 weeks) Number of follow-up appointments 1.67 (1.59) 2.08 (1.97) 0.21 0.11 ≥ 2 follow-up appointments 41.0% (25) 62.9% (39) 0.02 0.01 Prescribed any nicotine replacement medication 60.7% (37) 74.2% (46) 0.11 0.08 Smoking quit attempts (during follow-up period) ≥ 1 Quit attempts made 59.7% (36) 56.5% (35) 0.77 0.66 Quit attempt for ≥ 24 hours (daily smokers only) 40.0% (18) 33.3% (16) 0.51 0.52 Quit attempt for ≥ 7 days 31.1% (19) 22.6% (14) 0.28 0.25 Smoking: Cutting back Evidence of any amount of cutting back 60.7% (37) 59.7% (37) 0.91 0.57 Average percentage decrease in # cigarettes 30% (51) 22% (47) 0.34 0.36 Cut back by ≥ 50% of baseline cigarettes 37.7% (23) 30.6% (19) 0.41 0.46 Smoking: Status at follow-up (10 weeks or later) Not smoking at follow-up (1+ days) 37.7% (23) 29.0% (18) 0.31 0.18 Not smoking at follow-up (7+ days) 24.6% (15) 12.9% (8) 0.10 0.03 *Adjusted P values are regression models adjusting for the following covariates based on baseline differences including: baseline daily versus not daily smoker, number of cigarettes smoked on the days you smoked, confidence in being smoke free in the next 6 months, stage of change, time to first cigarette (< vs ≥ 30 minutes), BMI, and self-identified race (Pacific Islander/Native Hawaiian vs else).
Abbreviations: ESP, enhanced standard program; CTHS, connection to health for smokers; SD, standard deviation; BMI, body mass index.
Quit Attempt Not Smoking at follow-up (7+ days) OR (95% CI) p OR (95% CI) P Age 1.02 (0.99–1.05) 0.23 1.02 (0.97–1.06) 0.45 Gender (Man) 0.55 (0.23–1.34) 0.19 0.68 (0.22–2.16) 0.52 Race (non-Hispanic White) 0.77 (0.33–1.82) 0.55 1.92 (0.62–5.98) 0.26 Daily smoker 1.62 (0.55–4.75) 0.38 1.98 (0.47–8.34) 0.35 # of cigarettes per day 0.97 (0.91–1.03) 0.25 0.99 (0.92–1.06) 0.56 Confidence smoke free in 6 months 1.17 (1.02–1.34) 0.02 1.19 (0.99–1.43) 0.06 Intervention group (1 = ESP; 2 = CTHS) 0.83 (0.37–1.88) 0.66 0.32 (0.11–0.95) 0.04 Prescribed any nicotine replacement medication 2.44 (0.95–6.30) 0.06 4.70 (1.11–19.98) 0.04 *Potential interactions examined included age, daily smoking status, number of cigarettes per day, confidence in being smoke free in 6 months, education level, stage of change with regard to smoking cessation, time to first cigarette (<30 minutes vs ≥30 minutes), number of follow-up primary care appointments during the intervention (<2 vs ≥2), and prescription of any smoking cessation product during the intervention.
Abbreviations: OR, odds ratio; CI, confidence interval; ESP, enhanced standard program; CTHS, connection to health for smokers.
- Table 4.
Summary of Qualitative Interviews with Clinic Administrators (n = 5), Health Educators (n = 5), and Patients (n = 31) Regarding Enhanced Standard Program (ESP) and Connection to Health for Smokers Program (CTHS)
Clinic Administrators Both Programs Aligned Well with Clinical Priorities.
Both programs were feasible to implement with existing clinic resources.
Health educators became more skilled in delivering smoking cessation services by participating in this research.
CTHS required a steeper learning curve but provided more support for ongoing patient engagement, which was viewed as positive.
Greater integration with the electronic health record both for referrals into these programs and for follow-up would be required to optimize sustainability.Health Educators Both programs were well-accepted by health educators.
Health educators appreciated the training on principles of smoking cessation required for implementation of both programs, and on the benefits of smoking plans informed by social and behavioral determinants of health that was required for implementation of CTHS.
CTHS was a more satisfying for most staff because it was perceived as more holistic and tailored to individual patient needs.
ESP was perceived as easier to implement but not necessarily appropriate for all patients.
Opportunities to improve efficiency and combine elements of each into a single improved program were identified.Patient Participants Patients in both programs reported high levels of satisfaction, especially with the degree of caring and sensitivity to challenges they faced in quitting smoking, and the level of follow up they received. They did not generally recall discussing a connection between smoking and other social and behavioral determinants of health with the health educator. Some indicated a desire for a program that would have more sustained engagement over a longer period of time to encourage them to reach their goals. Most patients in both arms indicated that this was the first time they had participated in an organized smoking cessation program.
ESP patients focused program feedback on factual information that they learned from the program. Some appreciated the information, but others reported it was not new.
CTHS patients focused program feedback on the detailed action plans they
developed. Most appreciated the action planning process but not all were able to achieve their chosen goals.
