Re-Enrollment Among Diverse Groups

Article Highlights

Study Title
Telephone-based tobacco cessation treatment re-enrollment among diverse groups
Study Authors
Beatriz H. Carlini, PhD., MPH, Susan M. Zbikowski, PhD, Harold S. Javitz, PhD, T. Mona Deprey, MS, Sharon E. Cummings, PhD, Shu-Hong Zhu, PhD
Publication Date
2008
 

Overview

Telephone based Quitlines are an effective approach to tobacco cessation, available throughout the US and used by ethnically diverse individuals.  On average, 1% of the smokers in the U.S. enroll in quitline services; this translates to an approximate volume of 400,000 tobacco users per year. Many quitline participants, however, will relapse after they originally quit.

In recognizing the chronic nature of tobacco dependence, quitlines allow tobacco participants to seek support for multiple quit attempts, often needed for achieving long-term abstinence. However, little is known about how often tobacco users take advantage of this opportunity.

This study is the first of its kind and investigates how communication strategies influence quitline re-enrollment among tobacco users of diverse ethnic identities. With that in mind, the study had a couple of objectives: first, to ascertain the rate of re-enrollment in state quitlines when no special effort is made to get former participants to use quitline services again. A second objective was to determine how the spontaneous re-enrollment rate could be modified by reaching out to former participants through mailed and phone invitations.  The re-enrollment efforts were focused on four specific populations (non-Hispanic white, Latino/Hispanic, African American, and Native American).

Design

The sample population consisted of 2400 tobacco users who were previously enrolled in both the Oklahoma and New Mexico Helplines during 2006, with oversampling of ethnic populations.  The study began between November 2006 and January 2007; and consisted of participants receiving either no invitation to re-enroll or an invitation to re-enroll into services in three possible modalities: a generic mailer about re-enrolment; an ethnic-specific mailer about re-enrollment, or an ethnic specific mailer about re-enrollment and a proactive telephone cal utilizing motivational interviewing with a trained Tobacco Cessation Quit Coach.. 

Findings

The study found a spontaneous re-enrollment rate of 0.54% per 30 days, in the 252 priors to the intervention period. Mailers, both generic and ethnic specific did not significantly change this rate; the addition of the proactive telephone calls did increase re-enrollment to 6.93% per 30 days.  No significant differences were found among the subpopulations studied.  Re-contacting the sample population was a significant challenge. We found that 16% had invalid addresses; 29.1% had invalid telephone numbers and overall. Moreover, 37.9% of subjects could not be reached after five call attempts.

Conclusions

This study showed that former quitline users will re-enroll without any special prompt from the quitline itself; however, re-enrollment can be higher when proactively prompted. A re-enrollment can be an effective way to initiate a new quit attempt after relapse. In this study, it was determined that mailing invitations did not significantly impact re-enrollment, telephone recruitment on the other hand showed an increase of 12 times that of the mailings alone.  At the same time, the study also showed that smokers of ethnic minorities are just as likely to re-enroll, both on their own and when invited by telephone, and the ethnic-specific outreach had little impact on their willingness to re-enroll.