Study Results
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Basic Information
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COMPLETED
PHASE4
529 participants
INTERVENTIONAL
2020-12-10
2025-05-08
Brief Summary
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Detailed Description
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Recruitment and Participants: Participants (N=608) will be primary care patients from 12 primary care clinics in two Wisconsin healthcare systems. Smokers will be identified via the healthcare system electronic health record (EHR). All EHR-identified smokers in a clinic will receive a mailed invitation to find out more about smoking treatment by calling a healthcare system Care Manager (CM). In addition, using an opt-out strategy, Medical Assistants (MAs), using an EHR-guided prompt, will inform all identified smokers seen at in-person or tele-health visits that they will be contacted by the CM unless the participant indicates s/he wants to opt-out. The participant contact information will then be automatically sent to the CM unless the participant opts out; the investigators have developed and used this workflow successfully in their past research. The CM will call and tell patients about the smoking cessation options available for them including the availability of this smoking cessation study. If patients are interested, the CM will obtain oral assent for screening and sharing contact, primary care team, and screening data with the research team before screening patients for eligibility. Eligible patients will learn more about the study and have a chance to ask questions and provide verbal informed consent. Finally, participants will complete a brief series of questions and then the CM will schedule a call with the study staff (i.e., a Health Counselor) in the database to initiate treatment and complete study assessments. Participants interested in quitting but not eligible for this study will be electronically referred to the Wisconsin Tobacco Quit Line and/or their primary care provider (PCP) by the CM.
Those who agree to and pass the screening for the inclusion/exclusion criteria for study participation will be asked to complete an oral consent and HIPAA authorization process next. After the patient provides oral consent, the CM will notify the patient's PCP via EHR that the patient has volunteered for a study with C-NRT or varenicline. The PCP will notify the CM via the EHR that the patient is medically eligible to receive either agent, as required by the collaborating healthcare systems. This will occur within 5 business days. The PCP will be notified via EHR of the patient's treatment assignment and of study-related serious adverse events or adverse events that prompt medication discontinuation that may occur. Care coordination with the PCP will occur via Tobacco Care Manager entry of data in the patient EHR.
Procedures and Measures: At the second study call, participants (N=608) will be randomized to one level of each of 4 factors: 1) Medication Type (Varenicline vs. C-NRT), 2) Preparation Medication (4 weeks vs. Standard), 3) Medication Duration (Extended vs. Standard), and 4) Counseling (Intensive vs. Minimal). Participants will be told their treatment condition at Call 2, set a target quit date (TQD), and instructed how to use their study medications. Medications will be mailed following this call, along with a handout that describes: 1) when to begin taking study medication; 2) the type and doses involved; 3) how and when to obtain the next month's medication; and 4) complete instructions on proper medication use, including information from the package insert and contact information if they have questions regarding their medication and/or symptoms they experience. Participants will be mailed all Preparation Medication as well as one month of post-quit study medication after Call 2. They will need to call in to a study line to request that more medication be mailed to them (Standard Duration participants will call one time to receive their final 2 months of medication; Extended Duration participants will call once to get 2 additional months of medication and again to get the remaining 3 months of study medication). Participants will also receive a counseling handout with their medications; those randomized to intensive counseling will receive a Quit Plan listing their target quit day and when they start the medications and those randomized to minimal counseling will receive the mobile health (mHealth) handout.
Participants will complete phone assessments one week pre-quit, during the first week post-target quit date (TQD) and at Weeks 2, 4, 12, 20, 26, and 52 post-TQD.
Outcomes: The primary outcome for this study is biochemically confirmed, point-prevalence abstinence at 12 months post-TQD (Primary Aim 1). The secondary outcome is cost effectiveness in which the costs of implementing each intervention (minus research-related costs) will be computed from a payer perspective. Costs will be combined with the intent-to-treat biochemically verified 7-day point prevalence abstinence at 12 months post-TQD to determine the cost per quit.
Conditions
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Study Design
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RANDOMIZED
FACTORIAL
TREATMENT
NONE
Study Groups
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12-week Varenicline with Minimal Counseling
Participants randomized to this intervention will receive one 0.5 mg pill for the first 3 days, starting 1 week prior to the target quit day (TQD). They will then use one 0.5 mg pill twice daily for the next 4 days. After the first week of study medication ramp up, participants will use one 1 mg pill twice daily until 11 weeks post-TQD. Participants randomized to this intervention will receive a brief (15-30 minute) phone or video counseling session 1 week prior to the TQD to promote engagement with free mobile health resources and then a brief (10-20 minute) follow-up phone or video session during the first week post-TQD to mimic a nurse or clinician follow-up after a quit attempt.
Standard Duration Varenicline
12 weeks of varenicline
Minimal Counseling
2 brief phone or video counseling sessions
12-week Varenicline with 4-Week Preparation Varenicline and Minimal Counseling
Participants randomized to this intervention will receive one 0.5 mg pill for the first 3 days, starting 4 week prior to the target quit day (TQD). They will then use one 0.5 mg pill twice daily for the next 4 days. After the first week of study medication ramp up, participants will use one 1 mg pill twice daily for the next 3 weeks pre-TQD and until 12 weeks post-TQD. Participants randomized to this intervention will receive a brief (15-30 minute) phone or video counseling session 1 week prior to the TQD to promote engagement with free mobile health resources and then a brief (10-20 minute) follow-up phone or video session during the first week post-TQD to mimic a nurse or clinician follow-up after a quit attempt.
Preparation Varenicline and Standard Duration Varenicline
16 weeks of varenicline starting 4 weeks pre-quit
Minimal Counseling
2 brief phone or video counseling sessions
24-week Varenicline with Minimal Counseling
Participants randomized to this intervention will receive one 0.5 mg pill for the first 3 days, starting 1 week prior to the target quit day (TQD). They will then use one 0.5 mg pill twice daily for the next 4 days. After the first week of study medication ramp up, participants will use one 1 mg pill twice daily until 23 weeks post-TQD. Participants randomized to this intervention will receive a brief (15-30 minute) phone or video counseling session 1 week prior to the TQD to promote engagement with free mobile health resources and then a brief (10-20 minute) follow-up phone or video session during the first week post-TQD to mimic a nurse or clinician follow-up after a quit attempt.
Extended Duration Varenicline
24 weeks of varenicline
Minimal Counseling
2 brief phone or video counseling sessions
24-week Varenicline with 4-Week Preparation Varenicline and Minimal Counseling
Participants randomized to this intervention will receive one 0.5 mg pill for the first 3 days, starting 4 weeks prior to the target quit day (TQD). They will then use one 0.5 mg pill twice daily for the next 4 days. After the first week of study medication ramp up, participants will use one 1 mg pill twice daily for the next 3 weeks pre-TQD and until 24 weeks post-TQD. Participants randomized to this intervention will receive a brief (15-30 minute) phone or video counseling session 1 week prior to the TQD to promote engagement with free mobile health resources and then a brief (10-20 minute) follow-up phone or video session during the first week post-TQD to mimic a nurse or clinician follow-up after a quit attempt.
Preparation Varenicline and Extended Duration Varenicline
28 weeks of varenicline starting 4 weeks pre-quit
Minimal Counseling
2 brief phone or video counseling sessions
12-week Varenicline with Intensive Counseling
Participants randomized to this intervention will receive one 0.5 mg pill for the first 3 days, starting 1 week prior to the target quit day (TQD). They will then use one 0.5 mg pill twice daily for the next 4 days. After the first week of study medication ramp up, participants will use one 1 mg pill twice daily until 11 weeks post-TQD. Participants randomized to this intervention will receive four 15-20 minute phone or video counseling sessions (1 prior to the TQD, 1 during the first week post-TQD and during Weeks 2 and 4 post-TQD). The counseling is designed to produce intra-treatment support and skill training, consistent with the Public Health Service (PHS) Clinical Practice Guideline.
Standard Duration Varenicline
12 weeks of varenicline
Intensive Counseling
4 phone or video counseling sessions
12-week Varenicline with 4-Week Preparation Varenicline and Intensive Counseling
Participants randomized to this intervention will receive one 0.5 mg pill for the first 3 days, starting 4 week prior to the target quit day (TQD). They will then use one 0.5 mg pill twice daily for the next 4 days. After the first week of study medication ramp up, participants will use one 1 mg pill twice daily for the next 3 weeks pre-TQD and until 11 weeks post-TQD. Participants randomized to this intervention will receive four 15-20 minute phone or video counseling sessions (1 prior to the TQD, 1 during the first week post-TQD and during Weeks 2 and 4 post-TQD). The counseling is designed to produce intra-treatment support and skill training, consistent with the Public Health Service (PHS) Clinical Practice Guideline.
Preparation Varenicline and Standard Duration Varenicline
16 weeks of varenicline starting 4 weeks pre-quit
Intensive Counseling
4 phone or video counseling sessions
24-week Varenicline with Intensive Counseling
Participants randomized to this intervention will receive one 0.5 mg pill for the first 3 days, starting 1 week prior to the target quit day (TQD). They will then use one 0.5 mg pill twice daily for the next 4 days. After the first week of study medication ramp up, participants will use one 1 mg pill twice daily until 23 weeks post-TQD. Participants randomized to this intervention will receive four 15-20 minute phone or video counseling sessions (1 prior to the TQD, 1 during the first week post-TQD and during Weeks 2 and 4 post-TQD). The counseling is designed to produce intra-treatment support and skill training, consistent with the Public Health Service (PHS) Clinical Practice Guideline.
Extended Duration Varenicline
24 weeks of varenicline
Intensive Counseling
4 phone or video counseling sessions
24-week Varenicline with 4-Week Preparation Varenicline and Intensive Counseling
Participants randomized to this intervention will receive one 0.5 mg pill for the first 3 days, starting 4 weeks prior to the target quit day (TQD). They will then use one 0.5 mg pill twice daily for the next 4 days. After the first week of study medication ramp up, participants will use one 1 mg pill twice daily for the next 3 weeks pre-TQD and until 24 weeks post-TQD. Participants randomized to this intervention will receive four 15-20 minute phone or video counseling sessions (1 prior to the TQD, 1 during the first week post-TQD and during Weeks 2 and 4 post-TQD). The counseling is designed to produce intra-treatment support and skill training, consistent with the Public Health Service (PHS) Clinical Practice Guideline.
Preparation Varenicline and Extended Duration Varenicline
28 weeks of varenicline starting 4 weeks pre-quit
Intensive Counseling
4 phone or video counseling sessions
12-week C-NRT with Minimal Counseling
Participants randomized to this intervention will receive 12 weeks of nicotine patches and nicotine mini-lozenges to use starting on their quit day. Participants who smoke more than 10 cigarettes/day will start with a 21 mg patch for 8 weeks, and then titrate down to a 14 mg patch for 2 weeks and then a 7 mg patch for 2 weeks. Participants who smoke 5-10 cigarettes/day will be given 10 weeks of 14 mg patches and then 2 weeks of 7 mg patches. Participants will receive 2 mg mini-lozenges. Participants randomized to this intervention will receive a brief (15-30 minute) phone or video counseling session 1 week prior to the TQD to promote engagement with free mobile health resources and then a brief (10-20 minute) follow-up phone or video session during the first week post-TQD to mimic a nurse or clinician follow-up after a quit attempt.
Standard Duration Combination NRT
12 weeks of nicotine patch + nicotine mini-lozenge
Minimal Counseling
2 brief phone or video counseling sessions
12-week C-NRT with 4-Week Preparation C-NRT and Minimal Counseling
Participants randomized to this intervention will receive 14 mg patches starting 4 weeks prior to the target quit day (TQD). Then, starting on the TQD, participants will receive 12 weeks of nicotine patches and nicotine mini-lozenges. Participants who smoke \>10 cigarettes/day will start with a 21 mg patch for 8 weeks, and then titrate down to a 14 mg patch for 2 weeks and then a 7 mg patch for 2 weeks. Participants who smoke 5-10 cigarettes/day will be given 10 weeks of 14 mg patches and then 2 weeks of 7 mg patches. Participants will receive 2 mg mini-lozenges. Participants will receive a brief 15-30 minute phone or video counseling session 1 week prior to the TQD to promote engagement with free mobile health resources and then a brief (10-20 minute) follow-up phone or video session during the first week post-TQD to mimic a nurse or clinician follow-up after a quit attempt.
Preparation Combination NRT and Standard Duration Combination NRT
16 weeks of nicotine patch + nicotine mini-lozenge starting 4 weeks pre-quit
Minimal Counseling
2 brief phone or video counseling sessions
24-week C-NRT with Minimal Counseling
Participants randomized to this intervention will receive 24 weeks of nicotine patches and nicotine mini-lozenges, starting on the target quit day (TQD). Participants who smoke more than 10 cigarettes/day will start with a 21 mg patch for 20 weeks, and then titrate down to a 14 mg patch for 2 weeks and then a 7 mg patch for 2 weeks. Participants who smoke 5-10 cigarettes/day will be given 22 weeks of 14 mg patches and then 2 weeks of 7 mg patches. Participants will receive 2 mg mini-lozenges. Participants randomized to this intervention will receive a brief (15-30 minute) phone or video counseling session 1 week prior to the TQD to promote engagement with free mobile health resources and then a brief (10-20 minute) follow-up phone or video session during the first week post-TQD to mimic a nurse or clinician follow-up after a quit attempt.
Extended Duration Combination NRT
24 weeks of nicotine patch + nicotine mini-lozenge
Minimal Counseling
2 brief phone or video counseling sessions
24-week C-NRT with 4-Week Preparation C-NRT and Minimal Counseling
Participants randomized to this intervention will receive 14 mg patches starting 4 weeks prior to the target quit day (TQD). Then, starting on the TQD, participants will receive 24 weeks of nicotine patches and nicotine mini-lozenges. Participants who smoke more than 10 cigarettes/day will start with a 21 mg patch for 20 weeks, and then titrate down to a 14 mg patch for 2 weeks and then a 7 mg patch for 2 weeks. Participants who smoke 5-10 cigarettes/day will be given 22 weeks of 14 mg patches and then 2 weeks of 7 mg patches. Participants will receive 2 mg mini-lozenges. Participants will receive a brief (15-30 minute) phone or video counseling session 1 week prior to the TQD to promote engagement with free mobile health resources and then a brief (10-20 minute) follow-up phone or video session during the first week post-TQD to mimic a nurse or clinician follow-up after a quit attempt.
Preparation Combination NRT and Extended Duration Combination NRT
28 weeks of nicotine patch + nicotine mini-lozenge starting 4 weeks pre-quit
Minimal Counseling
2 brief phone or video counseling sessions
12-week C-NRT with Intensive Counseling
Participants randomized to this intervention will receive 12 weeks of nicotine patches and nicotine mini-lozenges to use starting on their quit day. Participants who smoke more than 10 cigarettes/day will start with a 21 mg patch for 8 weeks, and then titrate down to a 14 mg patch for 2 weeks and then a 7 mg patch for 2 weeks. Participants who smoke 5-10 cigarettes/day will be given 10 weeks of 14 mg patches and then 2 weeks of 7 mg patches. Participants will receive 2 mg mini-lozenges. Participants randomized to this intervention will receive four 15-20 minute phone or video counseling sessions (1 prior to the TQD, 1 during the first week post-TQD and during Weeks 2 and 4 post-TQD). The counseling is designed to produce intra-treatment support and skill training, consistent with the Public Health Service (PHS) Clinical Practice Guideline.
Standard Duration Combination NRT
12 weeks of nicotine patch + nicotine mini-lozenge
Intensive Counseling
4 phone or video counseling sessions
12-week C-NRT with 4-Week Preparation C-NRT and Intensive Counseling
Participants randomized to this intervention will receive 14 mg patches starting 4 weeks prior to the target quit day (TQD). Starting on the TQD, participants will receive 12 weeks of nicotine patches and nicotine mini-lozenges. Participants who smoke \>10 cigarettes/day will start with a 21 mg patch for 8 weeks, and then titrate down to a 14 mg patch for 2 weeks and then a 7 mg patch for 2 weeks. Participants who smoke 5-10 cigarettes/day will be given 10 weeks of 14 mg patches and then 2 weeks of 7 mg patches. Participants will receive 2 mg mini-lozenges. Participants will receive four 15-20 minute phone or video counseling sessions (1 prior to the TQD, 1 during the first week post-TQD and during Weeks 2 and 4 post-TQD). The counseling is designed to produce intra-treatment support and skill training, consistent with the Public Health Service (PHS) Clinical Practice Guideline.
Preparation Combination NRT and Standard Duration Combination NRT
16 weeks of nicotine patch + nicotine mini-lozenge starting 4 weeks pre-quit
Intensive Counseling
4 phone or video counseling sessions
24-week C-NRT with Intensive Counseling
Participants randomized to this intervention will receive 24 weeks of nicotine patches and nicotine mini-lozenges, starting on the target quit day (TQD). Participants who smoke more than 10 cigarettes/day will start with a 21 mg patch for 20 weeks, and then titrate down to a 14 mg patch for 2 weeks and then a 7 mg patch for 2 weeks. Participants who smoke 5-10 cigarettes/day will be given 22 weeks of 14 mg patches and then 2 weeks of 7 mg patches. Participants will receive 2 mg mini-lozenges. Participants randomized to this intervention will receive four 15-20 minute phone or video counseling sessions (1 prior to the TQD, 1 during the first week post-TQD and during Weeks 2 and 4 post-TQD). The counseling is designed to produce intra-treatment support and skill training, consistent with the Public Health Service (PHS) Clinical Practice Guideline.
Extended Duration Combination NRT
24 weeks of nicotine patch + nicotine mini-lozenge
Intensive Counseling
4 phone or video counseling sessions
24-week C-NRT with 4-Week Preparation C-NRT and Intensive Counseling
Participants randomized to this intervention will receive 14 mg patches starting 4 weeks prior to the target quit day (TQD). Starting on the TQD, participants will receive 24 weeks of nicotine patches and nicotine mini-lozenges. Participants who smoke \>10 cigarettes/day will start with a 21 mg patch for 20 weeks, and then titrate down to a 14 mg patch for 2 weeks and then a 7 mg patch for 2 weeks. Participants who smoke 5-10 cigarettes/day will be given 22 weeks of 14 mg patches and then 2 weeks of 7 mg patches. Participants will receive 2 mg mini-lozenges. Participants will receive four 15-20 minute phone or video counseling sessions (1 prior to the TQD, 1 during the first week post-TQD and during Weeks 2 and 4 post-TQD). The counseling is designed to produce intra-treatment support and skill training, consistent with the Public Health Service (PHS) Clinical Practice Guideline.
Preparation Combination NRT and Extended Duration Combination NRT
28 weeks of nicotine patch + nicotine mini-lozenge starting 4 weeks pre-quit
Intensive Counseling
4 phone or video counseling sessions
Interventions
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Preparation Varenicline and Standard Duration Varenicline
16 weeks of varenicline starting 4 weeks pre-quit
Preparation Varenicline and Extended Duration Varenicline
28 weeks of varenicline starting 4 weeks pre-quit
Standard Duration Varenicline
12 weeks of varenicline
Extended Duration Varenicline
24 weeks of varenicline
Preparation Combination NRT and Standard Duration Combination NRT
16 weeks of nicotine patch + nicotine mini-lozenge starting 4 weeks pre-quit
Preparation Combination NRT and Extended Duration Combination NRT
28 weeks of nicotine patch + nicotine mini-lozenge starting 4 weeks pre-quit
Standard Duration Combination NRT
12 weeks of nicotine patch + nicotine mini-lozenge
Extended Duration Combination NRT
24 weeks of nicotine patch + nicotine mini-lozenge
Intensive Counseling
4 phone or video counseling sessions
Minimal Counseling
2 brief phone or video counseling sessions
Eligibility Criteria
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Inclusion Criteria
* Able to read, write, and speak English
* If currently using nicotine replacement therapy (NRT), agreeing to use only study medication for the duration of the study
* Medically eligible to use study medications
* If the participant is a woman of childbearing potential, using an approved method of birth control during treatment
Exclusion Criteria
* Suicidal ideation in the last 12 months or any suicide attempts in the past 10 years
18 Years
ALL
Yes
Sponsors
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National Cancer Institute (NCI)
NIH
University of Wisconsin, Madison
OTHER
Responsible Party
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Principal Investigators
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Megan E Piper, PhD
Role: STUDY_DIRECTOR
University of Wisconsin, Madison
Locations
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University of Wisconsin Center for Tobacco Research and Intervention
Madison, Wisconsin, United States
UW Center for Tobacco Research and Intervention
Milwaukee, Wisconsin, United States
Countries
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References
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Theodoulou A, Chepkin SC, Ye W, Fanshawe TR, Bullen C, Hartmann-Boyce J, Livingstone-Banks J, Hajizadeh A, Lindson N. Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2023 Jun 19;6(6):CD013308. doi: 10.1002/14651858.CD013308.pub2.
Provided Documents
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Document Type: Study Protocol
Document Type: Statistical Analysis Plan
Document Type: Informed Consent Form
Other Identifiers
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A534253
Identifier Type: OTHER
Identifier Source: secondary_id
SMPH/MEDICINE/MEDICINE*G
Identifier Type: OTHER
Identifier Source: secondary_id
Protocol Version 10/9/2023
Identifier Type: OTHER
Identifier Source: secondary_id
2019-0054
Identifier Type: -
Identifier Source: org_study_id
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