Susan Zbikowski at Consumer Centric Health, Model for Change '11

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A weight concern intervention for smokers. One of the single greatest challenges in tobacco cessation treatment is that the majority of patients/participants relapse after successfully quitting. This …

A weight concern intervention for smokers. One of the single greatest challenges in tobacco cessation treatment is that the majority of patients/participants relapse after successfully quitting. This presents a study of a solution to a common reason for relapse;
Weight Concerns

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  • “Usual care” : 5 calls and guide versus “Intervention” : Standard care plus 3 weight coach calls with tailored materials2000 callers successfully recruited and randomized in 9 monthsScreened nearly 8000 53% were determined to be eligible. 2771 said yes to the study offer and 72% were randomized (47.2% of eligible)
  • 5 counseling calls, materials, cessation medication if eligible Evidence-based, incorporates PHS Guidelines and Social Cognitive Theory Cognitive Behavioral Counseling Planning, Skill Development, Social Support
  • Table 1 shows that the 2 groups :were very satisfied with the OKHL Had great quit rates at 6 months & a 3.5% higher quit rate in the intervention groupHowever, these outcomes did not differ significantly between groups. Intervention Tobacco Calls: 2.8 (1.7)Intervention Tobacco + Weight: 4.1 (2.5)Control: 3.0 calls (1.6)
  • Significance of the study: 1-collaboration between funder (Ok) and researchers to bring research to practice; 2-demonstrated feasibiltiy and acceptability. Gaps: 1-no long term outcomes; 2-dk if its content or offering more calls; 3-can we do better than 3.5% difference in QR?; 4-what about helping people who are already on a diet (diabetes) and have been told to lose weight? 5-whats the next logical study?
  • Public Health significance: a low-cost, population based cessation approach that addressed weight gain concerns can improve cessation and prevent weight gainpromotion of this approach has the potential for obtaining more quit attempts and more calls to the quitline among smokers who worry about weight gain
  • Largest provider of tobacco cessation services in US25 years of clinical and scientific excellenceFlagship programsQuit For Life: phone, web, text, materials, and medsMind & Body: phone, web, measurement tools


  • 1. Consumer-Centric Health Models for Change ‘11
  • 2. A Weight Concern Intervention for SmokersSusan M Zbikowski, PhDAlere Wellbeing (formerly Free & Clear)
  • 3. One of the single greatest challenges in tobacco cessation treatment is that the majority of patients/participants relapse after successfully quitting.
  • 4. A solution to a common reason for relapse Weight Concerns
  • 5. Need for Specialized Counseling for Weight Concerns of Smokers  Average smoker gains 8-15 pounds after quitting  Concerns about weight gain after quitting is common 1) 50% of women 2) 26% of men 3) Even higher among quitlines callers  Fear of weight gain can: 1) lead to smokers not attempting to quit 2) hinder adherence to cessation programs 3) lead to early relapse  Weight loss while quitting is a controversial topic
  • 6. Weight 2Quit Study Randomized Control Trial with the Oklahoma Helpline
  • 7. ‘Weigh2Quit’ Study Methods Assess weight/height, w Transfer to Coach Smokers calling eight to obtain consent the Oklahoma concerns, eligibili and administer Helpine (OKHL) ty and interest in baseline survey the study Randomization to groups and deliver intervention call #1
  • 8. Study Hypotheses 1. cessation 2. satisfaction with the helpline 3. post quit weight gain 4. weight concerns
  • 9. Standard Treatment
  • 10. ‘Weigh2Quit’ Intervention
  • 11. Intervention Content Body Image & Maladaptive beliefs about weight Increase Motivation and Confidence in physical Quitting activity smoking Coaches focus on Acceptance of Encourage post quit healthy snacks weight gain Discourage dietary restriction while quitting
  • 12. Weight-Related Characteristics of Randomized Participants 100% Weight Concerns 76% believe they are overweight 76% reported weight gain in prior quit attempts (avg. 17lbs) 40% reported dieting while quitting tobacco Expect to gain 19 lbs 57% only willing to gain 10 lbs
  • 13. RESULTS: Hypothesis 1 & 2 - Increase satisfaction and cessation *6-month results; responder quit rates
  • 14. RESULTS: Post-quit weight change *Among those quit 30+ days at follow-up (N=350) P= 0.0004
  • 15. RESULTS: Post-quit weight change Among those quit 30+ days at follow-up (N=350) *P= 0.011 **P=.09
  • 16. RESULTS: Change in weight concerns *Among those quit 30+ days at follow-up (N=350) P= 0.0004
  • 17. Other Results  Significant reduction in weight concerns and negative attitudes about weight gain.  Intervention effects did not vary as a function of age, gender or tobacco status at baseline  Intervention stronger for Whites/ Caucasians smokers with higher baseline self-efficacy smokers with diabetes
  • 18. Emerging Practice Validated Tailored Intervention Quit &Weight Concerns Product Development and Scaling Adaptation by Client QL Excellent Infrastructure for Testing Emerging Practices and improving our outcomes
  • 19. The complexity of helping people achieve health behavior change Target Multiple Populations Tools & Techniques Multiple Behaviors Health Behavior Change
  • 20. Innovation and Future Directions • Measure outcomes across BMI spectrum Obesity • Determine if there is a need for tailored treatments Weight • Weight Concerns RCT with smokers with diabetes Concerns • Enhanced intervention for smokers with diabetes vs STD and UC Diabetes • Cessation counseling plus M&B concepts • Tobacco cessation and weight loss Multiple Behaviors • Simultaneous vs sequential
  • 21. Collaborating Organizations  Alere Wellbeing (formerly Free & Clear)  The Oklahoma Tobacco Settlement Endowment Trust (TSET)*  Tobacco Use Prevention Service - Oklahoma State Department of Health*  Chronic Disease Program  The University of Oklahoma * Funders of the Oklahoma Helpline and this study.
  • 22. Weight2Quit Collaborators  Terry Bush PhD, Lead Investigator1  Susan Zbikowski PhD1,Co Investigator  Mona Deprey MS1, Research Staff  Barbara Cerutti MS1, Research Staff  Michele D. Levine PhD, University of Pittsburgh, Co Investigator  Laura Beebe PhD, University of Oklahoma, Co Investigator  Tim McAfee MD1, now at CDC, Co Investigator 1: Alere Wellbeing, (formerly Free & Clear), Seattle, WA
  • 23. Thank you.
  • 24. Alere Wellbeing “Bringing together science, technology, and human interaction to help people identify health risks and modify behaviors so they may avoid chronic illness and live longer, more vital lives.”