Original Article
Effectiveness of group behavioral counseling on long-term quit rates in primary health care
Abstract
Background: Smoking is a major cause of cancer and related death. Although systems change, brief clinician intervention, and intensive behavioral counseling promote smoking cessation, few studies measure their combined effect on long-term quit rates. The present study examined data for tobacco users in primary care referred for group behavioral counseling that did or did not attend counseling and compared their long-term post-treatment quit status.
Methods: A retrospective, cohort study design was used to analyze electronic data covering from 2005 to 2009 for a cohort of 8,549 tobacco users in Louisiana’s seven-facility public hospital system. Descriptive statistics and logistic regression analysis were used to compare the control (scheduled only) and intervention (scheduled and attended) group characteristics and sustained quit rates at least 1-year after the intervention.
Results: Attendees of group behavioral counseling with follow-up information (n=2,060, 42%) were primarily female (72%), white (64%), between 45 and 59 years old (60%), and uninsured (58%). Adjusting for demographics and insurance status, attendees had significantly higher long-term quit rates (18%, P<0.001) compared to non-attendees (12%). Logistic regression analysis indicated that attendees had greater odds [adjusted odds ratio (AOR)=1.52; 95% confidence interval (CI) =1.21, 1.90] of sustained abstinence than non-attendees. Compared to uninsured patients, commercially insured patients had higher sustained quit rates (AOR =1.49, 95% CI =1.08, 2.05).
Conclusions: A guideline-based, comprehensive tobacco control program implemented in primary care clinics in a public hospital system resulted in substantial long-term quit rates. When access to free group behavioral counseling was made available to smokers of low socioeconomic status, nearly half of those with follow-up information attended counseling. Those who attended had higher abstinence rates than non-attendees. Thus, healthcare systems have an opportunity to integrate screening and onsite behavioral counseling using systems changes that help patients quit smoking and enhance transdisciplinary, translational behavioral research toward guideline integration.
Methods: A retrospective, cohort study design was used to analyze electronic data covering from 2005 to 2009 for a cohort of 8,549 tobacco users in Louisiana’s seven-facility public hospital system. Descriptive statistics and logistic regression analysis were used to compare the control (scheduled only) and intervention (scheduled and attended) group characteristics and sustained quit rates at least 1-year after the intervention.
Results: Attendees of group behavioral counseling with follow-up information (n=2,060, 42%) were primarily female (72%), white (64%), between 45 and 59 years old (60%), and uninsured (58%). Adjusting for demographics and insurance status, attendees had significantly higher long-term quit rates (18%, P<0.001) compared to non-attendees (12%). Logistic regression analysis indicated that attendees had greater odds [adjusted odds ratio (AOR)=1.52; 95% confidence interval (CI) =1.21, 1.90] of sustained abstinence than non-attendees. Compared to uninsured patients, commercially insured patients had higher sustained quit rates (AOR =1.49, 95% CI =1.08, 2.05).
Conclusions: A guideline-based, comprehensive tobacco control program implemented in primary care clinics in a public hospital system resulted in substantial long-term quit rates. When access to free group behavioral counseling was made available to smokers of low socioeconomic status, nearly half of those with follow-up information attended counseling. Those who attended had higher abstinence rates than non-attendees. Thus, healthcare systems have an opportunity to integrate screening and onsite behavioral counseling using systems changes that help patients quit smoking and enhance transdisciplinary, translational behavioral research toward guideline integration.
