Fax to Quit: Linking Smokers Visiting Clinics to State Quitlines

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DESCRIPTION (provided by applicant): In America today, tobacco use stands out as a condition of unique lethality, prevalence, and neglect, despite the availability of effective interventions. This troubling set of circumstances highlights the need to disseminate effective interventions so as to meaningfully reduce tobacco use prevalence. Among available evidence-based treatment options, telephone quitlines may offer the greatest unrealized promise to help a large proportion of U.S. smokers to successfully quit. Telephone quitlines are effective treatments for tobacco dependence. As a result of strong empirical support, all 50 states now provide statewide quitline services. Yet the reach, or population penetrance, of quitlines has been low (1-3% of smokers annually) and traditional means of boosting quitline use - paid media campaigns and medication give-aways linked to quitline use - are often prohibitively expensive for states struggling with declining tobacco control funding. Fax to Quit - a strategy to link state quitlines to the 70% of smokers who visit a primary care physician each year - has been identified as a means of increasing quitline reach at potentially lower cost. Operationally, every tobacco user making a primary care visit is asked if s/he is interested in quitting and receiving quitline counseling. If s/he agrees, a referral is faxed (or transmitted electronically) to the state quitline, which then proactively contacts the tobacco user. The potential of this strategy has led more than 40 states to implement some form of Fax to Quit. Yet, this promising approach has not been adequately evaluated and some evidence indicates that Fax to Quit referral and connection rates are often low. This proposal is designed to systematically evaluate two forms of Fax to Quit: Fax to Quit alone (FQ) and Fax to Quit plus Enhanced Academic Detailing (FQ + EAD) with EAD comprising ongoing training/technical assistance and performance feedback. After collecting baseline rates of quitline referrals, 40 clinics will be randomized to receive either FQ or FQ + EAD. Clinic referral rates, quitline-patient contacts, and "quality contacts" (when referrals result in the individual enrolling in quitline counseling services) will be measured. In addition, a qualitative research component will evaluate key aspects of the two interventions and an economic analysis will compare the cost of the two Fax to Quit interventions to the costs of media and other current quitline promotional strategies. The proposal is designed to meet the research objectives of this RFA; to conduct translational research using an evidence-based intervention that has the potential to foster the Healthy People 2010 goals of enhanced health promotion and disease prevention.