Okay – so it’s been a while since our last post. Time flies when you’re having fun planning a conference! You may remember that our goal was to explore 20 questions and we are on question number 14. With just weeks to go before we meet in Kansas City, we have four more posts to go! Questions 18, 19 and 20 will be revealed and answered in NAQC’s Vision Café!

For question 14 we turned to Dr. Susan Zbikowski. Dr. Zbikowski is Senior Vice President of Research, Training & Evaluation at Alere Wellbeing and has extensively studied and published and presented research on technology enhanced treatments for tobacco cessation. Specifically we wanted to know her thoughts on ongoing research that is most likely to advance quitlines and the cessation agenda. Thankfully, she had this to share:

Perhaps one of the greatest advancements in the tobacco cessation field in the past two decades is that research demonstrated phone-based counseling was effective. This research and funding that came from the master settlement agreement (as well as other resources) became a catalyst for change – resulting in a proliferation of quitlines in North America. The field needs to continue to innovate and advance. I am greatly concerned about the current trends of exploring less intensive, less effective treatment options. The quitline community needs to decide what it wants to achieve from a research agenda- is the goal to develop more cost effective treatments that can be delivered to more people even if the rate of success if lower? Or is the goal to have a more effective treatment that can produce better outcomes, but potentially with added costs?

I think it is important for the membership to pause, reflect, and prioritize. Below are other topics for consideration.

Should priority populations receive different treatments?

I am often asked by my colleagues and the funders of quitlines if special services (i.e., targeted protocols) should be delivered to priority populations such as ethnic minorities, individuals with chronic medical conditions, LGBT individuals, individuals with mental health concerns, and other groups. I would say that quitline services should not be changed until there is clear evidence that the results are lower than expected. There is a difference between delivering culturally appropriate services and targeted protocols. While many of these groups/ populations experience health disparities, more research is needed to evaluate the reach and effectiveness of quitlines with these groups before developing and delivering new interventions. This can be readily achieved if states or national organizations provide funding to evaluate outcomes with large enough samples

We need to improve the number of people using assistance when quitting.

We should celebrate the fact that quitlines are the most widely used publically funded/available treatment. Approximately 10% of all tobacco users have used a quitline at some time. But we can do better. I continue to be amazed by the statistic that the majority of tobacco users try to quit without assistance and that most will fail. Tobacco control leaders have the opportunity to advance the field by focusing on this population- those who attempt to quit without assistance. More work is needed to improve awareness of effective treatments and the availability of more funding to support demand. This alone can have a large public health benefit. The recent CDC-sponsored national tobacco education campaign is proof that demand could be increased.

We may be neglecting another population.

A new priority population may be emerging- non-daily smokers. Recent research suggests that nearly 25-30% of US adult smokers are non-daily smokers, yet use of quitlines among this population is quite low. Although this population doesn’t smoke as much as daily smokers, research has shown they are dependent on tobacco and may struggle with quitting. Research is needed to increase awareness and use of quitlines among this population. Be sure to join the semi-facilitated networking session on this topic at the conference! Bring data to share if you have it!

Stop diluting treatments, but continue to study how to effectively design and use novel treatment approaches.

With rare exceptions, interventions typically are successful with 25% of tobacco users. There is a need to examine novel approaches to treatment. While many new treatment modalities have emerged in recent years (web, text), none of these approaches achieve outcomes that are superior to phone-based or in person treatments. Thus, more research is needed to determine how these approaches can be most effectively combined with other treatments and/or matched to subsets of tobacco users to achieve better outcomes.

Are we ready for the aging population of smokers?

Cigarette smoking poses substantial health risks at any age, but smoking is particularly dangerous for older smokers, who are at greater risk of cardiovascular disease, respiratory conditions, and cancer. There are 3.8 million smokers aged 65+ (a 9.5% smoking rate). With the population of older adults expected to double by 2050, the total absolute number of older adult smokers is expected to rise substantially; presenting a significant public health problem. Late last year, my colleagues and I conducted a systematic review of the literature on effective treatment for older adult smokers (Zbikowski et al., 2012, Maturitas). While our review supports intervening with older smokers to aid cessation we were somewhat surprised that quit rates from these studies and the relative effectiveness of different intervention approaches (e.g., behavioral, medication, provider) were no different than the general literature on smoking cessation. This is concerning due to the health consequences of continued smoking for this population. Thus, significant opportunities for innovation and improvement remain.

Understanding the state of research funding in the U.S.

It is more difficult than ever to get research funded. Pay lines have declined over the past decade. Typically only studies in the top 7^th percentile or better are funded. Researchers have fewer opportunities to apply for funding as well- a specific grant idea/application can only be submitted twice rather than three times as in the past. And, nearly 50% of applications are rejected without being scored. Lastly, researchers have to propose incredibly novel studies ("Innovation” is a NIH requirement) in order to secure funding. While novel interventions should benefit the quitline community; it is not that simple. For example, subtle variations on previously conducted research or approaches to optimize or improve upon existing treatment are often not seen as novel. In addition, while NIH is seeking novelty they appear less willing to take risks on funding large studies without proof of concept, acceptability of treatment, developed treatments, and proof of initial efficacy. I am concerned about the ability to advance a quitline research agenda without devoted funding coming from sources other than NIH.