Public health impact of a novel smoking cessation outreach program in Ontario, Canada

Article


Selby, Peter, Voci, Sabrina, Zawertailo, Laurie, Baliunas, Dolly, Dragonetti, Rosa and Hussain, S.. 2018. "Public health impact of a novel smoking cessation outreach program in Ontario, Canada." BMC Public Health. 18 (1). https://doi.org/10.1186/s12889-018-6012-6
Article Title

Public health impact of a novel smoking cessation outreach program in Ontario, Canada

ERA Journal ID13449
Article CategoryArticle
AuthorsSelby, Peter, Voci, Sabrina, Zawertailo, Laurie, Baliunas, Dolly, Dragonetti, Rosa and Hussain, S.
Journal TitleBMC Public Health
Journal Citation18 (1)
Article Number1117
Number of Pages11
Year2018
PublisherBioMed Central Ltd.
Place of PublicationUnited Kingdom
ISSN1471-2458
Digital Object Identifier (DOI)https://doi.org/10.1186/s12889-018-6012-6
Web Address (URL)https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-6012-6
Abstract

Background
Provision of evidence-based smoking cessation treatment may contribute to health disparities if barriers to treatment are greater for more disadvantaged groups. We describe and evaluate the public health impact of a novel outreach program to improve access to smoking cessation treatment in Ontario, Canada.

Methods
We partnered with Public Health Units (PHUs) located across the province to deliver single-session workshops providing standardized evidence-based content and 10 weeks (2007–2008) or 5 weeks (2008–2016) of nicotine replacement therapy (NRT). Participants completed a baseline assessment and were followed up by phone or e-mail at 6 months. We used the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework to evaluate the public health impact of the program from 2007 to 2016. Given the iterative design and changes in implementation over time, data is presented annually or bi-annually.

Results
There were 26,122 enrollments from 2007 to 2016. Between 31 and 442 workshops were held annually. The annual reach was estimated to be 0.1–0.3% of eligible smokers in Ontario. Participants were older, smoked more heavily, had a lower household income, were more likely to be female and be diagnosed with a mood or anxiety disorder, and less likely to have a postsecondary degree compared to average Ontario smokers eligible for participation. The intervention was effective; at 6-month follow-up 22–33% of respondents reported abstinence from smoking. Adoption by PHUs was 81% by the second year of operation and remained high (72–97%) thereafter, with the exception of 2009–2010 (33–56%) when the program was temporarily unavailable to PHUs due to lack of funding. Implementation at the organizational level was not tracked; however, at the individual level, approximately half of participants used most or all of the NRT received. On average, maintenance of the program was high, with PHUs conducting workshops for 7 of the 10 years (2007–2016) and 4 of the 5 most recent years (2012–2016).

Conclusions
The smoking cessation program had a high rate of adoption and maintenance, reached smokers over a large geographic area, including individuals more likely to experience disparities, and helped them make successful quit attempts. This novel model can be adopted in other jurisdictions with limited resources.

KeywordsSmoking cessation; Smoking; Tobacco; Nicotine replacement therapy
ANZSRC Field of Research 2020420699. Public health not elsewhere classified
Byline AffiliationsCentre for Addiction and Mental Health, Canada
University of Toronto, Canada
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