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Cancer Control Research

5R01CA140256-02
Toll, Benjamin Andrew
ADVANCING TOBACCO & CANCER CONTROL: REDUCING ALCOHOL USE TO PROMOTE SMOKING CESSA

Abstract

DESCRIPTION (provided by applicant): substantial body of evidence shows that telephone counseling for smoking cessation is effective and reaches a large number of smokers interested in quitting smoking. For instance, the NY Quitline received over 279,000 contacts (calls & online requests) last year. In addition, daily smokers are at heightened risk for hazardous drinking and alcohol diagnoses. Indeed, pilot data from a large subsample of NY Quitline callers (N = 30,667) from this past year revealed that 24.28% (7,389/30,438) met criteria for hazardous drinking, as defined by NIAAA guidelines. Data from NY Quitline callers and from a Yale clinical trial revealed that risky drinking was associated with poor treatment outcomes, and data from our consultant, Dr. Kahler, showed that smoking cessation treatment including a brief alcohol intervention can increase smoking quit rates. Moreover, the Clinical Practice Guidelines for smoking cessation suggest that smokers should consider limiting/abstaining from alcohol use while quitting smoking. However, to our knowledge this is untested in the context of a population based quitline, and cessation outcomes might be enhanced if counselors were trained to advise callers to limit or abstain from alcohol use in the midst of their quit attempt. Thus, building on a pre-existing relationship between our research group at Yale and the research group at the Roswell Park Cancer Institute/NY Quitline, we plan to conduct a developmental study to: 1) create and beta test an alcohol counseling protocol with 25 Quitline callers and 2) train Quitline Specialists to provide an alcohol intervention using at least 100 pilot Quitline callers to ensure that Specialists in the alcohol intervention + standard care condition provide counseling that addresses hazardous drinking with a high level of alcohol intervention strategies and skill. After this phase of the study is complete, a developmental randomized clinical trial will be conducted with 1,950 NY Quitline callers who drink at hazardous levels to compare practical counseling + smoking cessation print materials added to standard care (PC + SC condition) to alcohol intervention counseling + alcohol-focused print materials added to standard care (AI + SC condition). Efficacy data from this trial will be used to determine effect size estimates for both 1-week and 6-month self-reported point prevalence abstinence rates. Reduction in alcohol consumption and reduced drinking as a mediator of smoking cessation outcome will be secondary outcomes. Other mediators and moderators of alcohol intervention effects will also be examined as an exploratory outcome. If the effect size estimates are sufficiently large and medically important to pursue a definitive trial, these data will be used to propose a full scale multi-site large study. If an alcohol intervention is shown to enhance treatment outcome in a large-scale study, alcohol interventions with quitline counselors could be translated for use by the entire NY state quitline and other quitlines across the country. This may increase the effectiveness of quitline interventions and thus has the potential to reach millions of smokers, thereby bolstering tobacco and cancer control efforts across the United States. PUBLIC HEALTH RELEVANCE: Studying ways to improve telephone quitline counseling for smokers may improve tobacco control interventions by enhancing quit rates of callers to quitlines. As telephone quitlines have the potential to reach millions of smokers annually, better interventions can greatly impact tobacco and cancer control efforts in the United States.


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