Comparative Effectiveness of Web-based Mobile Support for the DC Tobacco Quitline

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DESCRIPTION (provided by applicant): The application, titled Comparative Effectiveness of Web-based Mobile Support for the DC Tobacco Quitline, addresses Broad Challenge Area (05) Comparative Effectiveness Research, and Specific Challenge Topic 05-DA- 102 Treatment of Substance Abuse and Related Health Consequences Using Web-Based Technologies. Many national consensus documents, including the 2007 National Institutes of Health (NIH) State-of-the-Science Conference and 2008 Clinical Practice Guideline, emphasize the enormous potential to maximize the reach, use, and population impact of smoking cessation interventions via tobacco quitlines. The national network of tobacco-cessation quitlines provides a population-level framework for dissemination, yet quitline effectiveness remains modest, producing only a small impact (reach x efficacy / cost) on smoking prevalence in the U.S. While their potential to improve cessation rates via community outreach is widely acknowledged, it is also true that tobacco quitlines are principally a time-limited counseling service, providing what amount to "booster" sessions as smokers attempt to initiate and maintain abstinence between a handful of calls. As they stand, quitlines are neither intended nor staffed to provide intensive, momentary support following the dozens of temptations and lapses that typically characterize a cessation attempt. The proposed project is an additive two-group randomized controlled trial to test whether the addition of a web-based mobile quitline enhancement (MQE) system improves abstinence rates at 1-, 3-, 6-, and 9-months relative to standard care provided by the Washington D.C. Quitline (DCQL) program. This MQE system is designed to fill the gaps between quitline calls with ready access to a menu of evidenced-based treatment components, while also providing DCQL counselors with detailed information about their clients' ongoing progress with cessation - two developments that constitute a major advance over standard quitline programming. Participants will be 700 smokers who contact the DCQL and are randomized to receive either standard DCQL programming (N=300) or DCQL plus MQE (N=400). Participants assigned to standard DCQL programming will receive 6 proactive counseling sessions and free nicotine replacement therapy (NRT). Participants assigned to DCQL plus MQE will also receive mobile access to the MQE system via a web-enabled cellular telephone provided by the study. Relative to usual care, we expect that MQE will improve outcomes by improving delivery, utilization and thereby effectiveness of DCQL programming. This project is well suited for American Recovery and Reinvestment Act (ARRA) funds because it represents an extraordinary opportunity to jump-start a collaborative effort that spearheads the use of web-enabled mobile devices to enhance the efficiency, fidelity, and impact of an established tobacco quitline program that benefits underserved communities in Washington D.C. To meet this challenge our transdisciplinary team brings expertise in tobacco control, behavioral informatics, data analysis, and clinical health psychology together with solid collaborative relationships across the DC Tobacco Consortium. As such, the project is positioned to take full advantage of DCQL infrastructure to conduct a randomized trial in an accelerated timeframe. The study is unconventional and innovative in the way it leverages web-based ecological assessment methodology to literally "close the loop" between research and practice. Bolstering the effectiveness of tobacco quitlines is a critical and timely endeavor, promising to expand the potential public health impact of this "broad reach" treatment modality. Many national consensus documents emphasize the enormous potential to maximize the reach, use, and population impact of smoking cessation interventions via tobacco quitlines. The population impact of quitlines remains small (reach x efficacy / cost), because while their potential for outreach is unrivaled, they are principally a time-limited counseling service, neither intended nor staffed to provide intensive, momentary support following the dozens of temptations and lapses that typically characterize a cessation attempt. The proposed project represents an extraordinary opportunity to spearhead the use of web-enabled mobile devices to directly supplement and thereby enhance the efficiency, fidelity, and impact of an established community-based tobacco quitline program that targets underserved communities in Washington D.C.; bolstering the effectiveness of tobacco quitlines via web-based mobile technologies is a critical and timely endeavor, promising to expand the potential public health impact of this "broad reach" treatment modality.