1. Telephone counseling versus text messaging for supporting post-discharge quit attempts among hospitalized smokers in Brazil: a feasibility study Érica Cruvinel, Dra.Kimber Richter, Dr. Fernando Colugnati, Rafaella Russi, Juliana Oliveira, Taynara Formagini, Denislaine Honorato, Ana Lúcia Vargas, Ligia Amaral, Dr.Telmo Mota Ronzani. Psychology Departament, UFJF, Minas Gerais, Brazil AMERSA 38th Annual National Conference November 6-8, 2014

2. Background  Hospitalization is a good time to quit smoking: ▪ Many hospitals restrict or prohibit smoking; ▪ Patients in contact with health professionals ▪ Teachable moment: may boost receptivity to smoking cessation by increasing perceived vulnerability  Hospitalized smokers must receive inpatient treatment and post-discharge follow up for at least 1 month to successfully be quit at 12 months post-discharge (RR=1.37; 95% CI 1.27-1.48; Rigotti, 2012)

3. Background  The Cochrane database of systematic reviews – Tobacco addiction group (Rigotti, 2012) (50 studies were included)  42 gave post-discharge support  29 were by phone support 2 internet, e-mail, IVR system  Motivational Interview(MI)  Text message

4. Background  Brazilian National Program - free treatment (counseling and RNT) - Primary Care Clinics (INCA, 2001).  Little research exists regarding the best way to support patients post-discharge in the Brazilian health care system.

5. Objective To conduct a pilot study comparing the effectiveness of two ways of providing outpatient support versus a control condition.

6. Methods Study context  CREPEIA (Centro de Referência em Pesquisa, Intervenção e Avaliação em Álcool e Outras Drogas)  CIPIT (Centro Interdisciplinar de pesquisa e Intervenção em Tabagismo)  UKanQuit (KU Medical Center), Kansas, U.S. CIPIT

7. Methods Design  All patients admitted to the University Hospital of Juiz de Fora (HU/UFJF) in Minas Gerais were screened for past 30- day tobacco use Inclusion Criteria  Past 30-day tobacco use  Over 18 Yrs old  Cell phone  Physically and Cognitively able

8. Methods Exclusion Criteria  Significant co-morbidity or issue that would prevent participation (e.g., acute life-threatening medical illness, communication barriers, altered mental status, etc.)  Intensive care Randomization  Modified cluster randomization  Random list from R program

9. Methods Control Group Standard bedside treatment (Brief intervention + NRT) (All Groups Received) Motivational Interviewing Group  Weekly frequency – By phone  Theoretical approach - Miller & Rollnick, 2001  Guided by readiness to quit stages Text Message Group  One message weekly  Personalized message  160 characters

10. Assessed for Eligibility (55) Enrolled & Randomized (n=33) Excluded (n=22): 5 Not eligible 1Declined to participate 16 Other TEXT MESSAGE (n=12 allocated) Sessions Done Participants % (No.) ______________________________ THE ALL OF 12 PATIENTS RECEIVED 4 TEXT MESSAGES 1 Month Assessment 36.4% Completed (n=4 ) 7 - Unreachable* 1 Month Assessment 66.7 % Completed (n=8) 4 - Unreachable 1 Month Assessment 80.0% Completed (n=8) 2 - Unreachable 3 Month Assessment 36.4% Completed (n=4) 7 - Unreachable* 3 Month Assessment 50.0% Completed (n=6) 6 - Unreachable ** 3 Month Assessment 50% Completed (n=5) 5 - Unreachable*** MI (n=11 allocated) Sessions Done Participants % (No.) ______________________________ ≥ 1 63.6 (7) 1 ≥ 2 45.5 (5) ≥ 3 45.5 (5) 4 27.3 (3) CONTROL (n=10 allocated) Sessions Done Participants % (No.) ______________________________ ___ ___ ___ Included in ITT analysis (n=11) Included in ITT analysis (n=12) Included in ITT analysis (n=10)

11. Results Tobacco prevalence among all patients screened: 16.4% Table 1: Baseline Caracteristics (n = 33) SociodemographicsM I (N=11)Text (N=12)Control (N=10) Age, mean (SD), yrs55.44 (12.27)47.5 (9.95)44.1 (14.8) Female, n (%)7 (63.6%)4 (33.3%)3 (30%) High school education or Less, n (%)9 (81.8%)8(66.7%)5 (50%) Mental Health Co-Morbidities PHQ-2, Depression ≥ 3 n (%)7 (63.6%)7 (58.3%)5 (50%) AUDIT C, high risk drinking ≥ 4, n (%)7 (63.6%)6 (50%)7 (70%) Current Smoking Average no. days smoked in the past 30 days, mean (SD) 23.27 (9)23.82 (6,3)24 (12.13) Current cigarettes per day, mean (SD)17.7 (10.7)11.92 (5.8)17.1 (16.7) Smoking History Other householder smoke n (%)3 (27.3%)7 (58.3%)7 (70%) Planning to stay quit or try to quit after discharge n (%) 9 (81.8%)10 (83.3%)6 (60%)

12. Results - Quit rates Table 2: Quit Rates for Interventions and Control Groups Motivational Interview (n = 11) Text Message (n = 12) Control (n =10) Outcome at the 1-month follow-up Prevalence cessation, n (%)2 (18.2%)1 (8.3%)1 (10%) Outcome at the 3-month follow-up Prevalence cessation, n (%)2 (18.2%)1 (8.3%)1 (10%)

13. Results: Implementation variables Table 3: Implementation variables - Motivational Interview and Text Message pos-discharge follow up Motivational Interview (n = 11) Number of patients contacted at the first MI call, n (%)7 (63.7%) Patients contacted that received at least 3 MI calls5 (71.4%) Patients contacted that received 4 MI calls3 (42.8%) First Call duration - Min, mean (SD)12 (8.56) Perception about number of calls, (just right) n (%)2 (67%) Perception about duration of calls, (just right time) n (%)(3) 100% Text message (n = 12) Own a cell phone, n (%)8 (66.7%) Perception about message content (useful or a really useful) n (%)6 (75%) Perception about number of text message (just right number), n (%)4 (57.1%)

14. CATEGORIESno. (%)Examples (All messages end with: For help call: (CIPIT Phone number) Health15 (41.6)I am worried about smoking because I had heart surgery Bad taste and smell 4 (11.1)I don't like how cigarettes make my hair and clothes stink Cost3 (8.3)My smoking routine bothers me because some days I have money and other days not Personal or family well- being 3 (8.3)I think my smoking interferes with the wellbeing of my children and boyfriend Other11[Weight loss, smoke irritation, self-esteem, shame] Total36 Text messages to self

15. Lessons from Pilot  Text messaging and Motivational Interviewing are feasible and are good potential resources for Brazilian health care system  Learned numerous strategies to make study more pragmatic, especially MI arm  Changes in inclusion criteria will decrease drop outs

16. Thank you! ecruvinel@yahoo.com.br Acknowledgments: CNPQ, CAPES, FAPEMIG