Abstract
Objective: To describe the experience of uninsured and Medicaid Oregon tobacco users who registered in Free & Clear (F&C), a telephone based cessation programme including five scheduled outbound calls.
Design and setting: Using a retrospective cohort design, 1334 (423 uninsured, 806 Medicaid, and 105 commercially insured) Oregon tobacco users who registered in F&C between 18 November 1998 and 28 February 2000 were identified and followed for 12 months post-registration; 648 (48.6%) were successfully contacted at 12 months. Information was collected from the F&C database. Unconditional logistic regression, adjusted for race and education, was used.
Results: The seven day quit rate at 12 months, assuming non-respondents were smokers, was 14.8% (95% confidence interval (CI) 13.0 to 16.9). This rate was significantly higher among commercially insured participants (v Medicaid but not uninsured) and among participants who completed ⩾ 5 calls (v < 5 calls). The quit rate for those contacted at 12 months was 30.6% (95% CI 27.0% to 34.3%) and varied, however not significantly, by insurance and number of calls. After adjustment, respondents who completed ⩾ 5 calls were 60% more likely to quit tobacco (odds ratio (OR) 1.6, 95% CI 0.9 to 3.1), and uninsured respondents who completed ⩾ 5 calls were 70% more likely to quit tobacco (OR 1.7, 95% CI 0.9 to 3.5), relative to those who completed < 5 calls, but the difference was not significant.
Conclusions: The quit rates are similar to those reported in efficacy trials. The observed variation in quitting tobacco for respondents by number of calls completed and by insurance merits further investigation concentrating on increasing compliance with the call schedule, particularly for the uninsured.
Full Text
The Full Text of this article is available as a PDF (136.5 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Ahluwalia J. S., McNagny S. E., Clark W. S. Smoking cessation among inner-city African Americans using the nicotine transdermal patch. J Gen Intern Med. 1998 Jan;13(1):1–8. doi: 10.1046/j.1525-1497.1998.00001.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Caraballo R. S., Giovino G. A., Pechacek T. F., Mowery P. D. Factors associated with discrepancies between self-reports on cigarette smoking and measured serum cotinine levels among persons aged 17 years or older: Third National Health and Nutrition Examination Survey, 1988-1994. Am J Epidemiol. 2001 Apr 15;153(8):807–814. doi: 10.1093/aje/153.8.807. [DOI] [PubMed] [Google Scholar]
- Carr R. M., Christiansen B., Jehn L., Matitz D. Meeting the challenge of tobacco use within the Medicaid population. WMJ. 2001;100(3):59–66. [PubMed] [Google Scholar]
- Centers for Disease Control and Prevention (CDC) State medicaid coverage for tobacco-dependence treatments--United States, 1998 and 2000. MMWR Morb Mortal Wkly Rep. 2001 Nov 9;50(44):979–982. [PubMed] [Google Scholar]
- Cummings K. M., Hyland A., Ockene J. K., Hymowitz N., Manley M. Use of the nicotine skin patch by smokers in 20 communities in the United States, 1992-1993. Tob Control. 1997;6 (Suppl 2):S63–S70. doi: 10.1136/tc.6.suppl_2.s63. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Curry S. J., Grothaus L. C., McAfee T., Pabiniak C. Use and cost effectiveness of smoking-cessation services under four insurance plans in a health maintenance organization. N Engl J Med. 1998 Sep 3;339(10):673–679. doi: 10.1056/NEJM199809033391006. [DOI] [PubMed] [Google Scholar]
- Jaén C. R., Cummings K. M., Shah D., Aungst W. Patterns of use of a free nicotine patch program for Medicaid and uninsured patients. J Natl Med Assoc. 1997 May;89(5):325–328. [PMC free article] [PubMed] [Google Scholar]
- McClain M. R., Srinivasan S. R., Chen W., Steinmann W. C., Berenson G. S. Risk of type 2 diabetes mellitus in young adults from a biracial community: the Bogalusa Heart Study. Prev Med. 2000 Jul;31(1):1–7. doi: 10.1006/pmed.2000.0682. [DOI] [PubMed] [Google Scholar]
- Orleans C. T., Schoenbach V. J., Wagner E. H., Quade D., Salmon M. A., Pearson D. C., Fiedler J., Porter C. Q., Kaplan B. H. Self-help quit smoking interventions: effects of self-help materials, social support instructions, and telephone counseling. J Consult Clin Psychol. 1991 Jun;59(3):439–448. doi: 10.1037//0022-006x.59.3.439. [DOI] [PubMed] [Google Scholar]
- Parnes Bennett, Main Deborah S., Holcomb Sherry, Pace Wilson. Tobacco cessation counseling among underserved patients: a report from CaReNet. J Fam Pract. 2002 Jan;51(1):65–69. [PubMed] [Google Scholar]
- Solomon L. J., Scharoun G. M., Flynn B. S., Secker-Walker R. H., Sepinwall D. Free nicotine patches plus proactive telephone peer support to help low-income women stop smoking. Prev Med. 2000 Jul;31(1):68–74. doi: 10.1006/pmed.2000.0683. [DOI] [PubMed] [Google Scholar]
- Wadland W. C., Soffelmayr B., Ives K. Enhancing smoking cessation of low-income smokers in managed care. J Fam Pract. 2001 Feb;50(2):138–144. [PubMed] [Google Scholar]
- Wadland W. C., Stöffelmayr B., Berger E., Crombach A., Ives K. Enhancing smoking cessation rates in primary care. J Fam Pract. 1999 Sep;48(9):711–718. [PubMed] [Google Scholar]
- Windsor R. A., Woodby L. L., Miller T. M., Hardin J. M., Crawford M. A., DiClemente C. C. Effectiveness of Agency for Health Care Policy and Research clinical practice guideline and patient education methods for pregnant smokers in medicaid maternity care. Am J Obstet Gynecol. 2000 Jan;182(1 Pt 1):68–75. doi: 10.1016/s0002-9378(00)70492-3. [DOI] [PubMed] [Google Scholar]