This clinical trial record represents Aim 3 of Alzheimer's Disease and Related Dementias (ADRD) Prevention Messaging to Increase Smoking Cessation Attempts in Older Adult Smokers. The objective of this research is to develop and test a readily translatable Stage 1 motivational intervention for smoking cessation in older adults consisting of 1) a novel patient-informed motivational message promoting smoking cessation and 2) clear access routes to evidence-based treatments for smoking cessation within a healthcare setting.~Aim 1: Develop motivational interventions that include motivational and access messages~Aim 2: Evaluate motivational intervention content using an online survey~Aim 3: Examine the feasibility and preliminary effectiveness of a new OSMI in real-world clinical settings compared to treatment as usual and a control message~Overview. Aim 3 will use a pre-post design to assess feasibility and preliminary effectiveness of one novel OSMI (identified in Aim 2) presented in a 1st clinic, one control motivational message with a standard health-and Evidenced-Based Smoking Treatment (EBST) access-related content (i.e., Quitting smoking is the best thing you can do for your health. Call 1-800-QUIT-NOW for help.) in a 2nd clinic, and a 3rd clinic serving as a no-intervention control. The motivational interventions will be delivered via multiple routes at both treatment clinics (i.e., mailer, in-clinic poster, and telephone calls from UW-CTRI staff) to ensure maximum saturation. These delivery routes are consistent with chronic care approaches to treatment currently implemented in UW-Health clinics.~Participants. Patients from three UW-Health primary care clinics (N=150) who are ages 50-80, report being a current smoker at their clinic visit (confirmed via EHR), and do not hold a current diagnosis of dementia or mild cognitive impairment (MCI) (confirmed via EHR), will be eligible to participate. Each wave of data collection will be conducted separately, allowing, but not requiring, participants to be in multiple waves within their clinic.~Setting/Recruitment. UW-Health is an integrated health system caring for more than 600,000 patients each year at seven hospitals and 86 clinics (26 Primary Care Clinics serving adults). The three UW-Health clinics selected will be chosen based on maximum representation of older adult smokers and prioritized subgroups (African-Americans, women, those with psychiatric comorbidities, and low socioeconomic status (SES) smokers). Potentially eligible participants will be identified via an EHR registry at the beginning of each wave. Prior to wave 1, potential participants will be sent an opt-out letter informing them of potential upcoming calls from University of Wisconsin - Center for Tobacco Research and Intervention (UW-CTRI) staff to discuss their smoking beliefs and behaviors over the next 6 months. If they do not want to receive these calls, they can call a provided number and let staff know that they do not want to be contacted.~Procedure and Assessments. The study will include three separate waves: Wave 1 (baseline; months 1-3), Wave 2 (intervention implementation; months 4-6), and Wave 3 (follow-up; months 7-9). During Wave 1, 25 participants from each of the three clinics will provide informed consent and complete a telephone assessment (lasting ~25 minutes) 4-6 days after their primary care visit. Wave 2 telephone assessments will occur 4-6 days after intervention exposure. Health Belief Model (HBM) constructs assessed include: perceived severity (e.g., impact of smoking on ADRD/cancer/stroke/etc. risk; personal risk for ADRD/cancer/stroke/etc.), perceived benefits (i.e., efficacy of EBSTs; impact of quitting on ADRD/cancer/stroke risk), perceived barriers (i.e., knowledge of how to access EBSTs in healthcare setting), and self-efficacy (i.e., confidence in ability to quit in the next 30 days). At the end of each wave, an EHR review of eligible patients who had primary care visits during that wave will be conducted.~Analyses. This study will evaluate feasibility and preliminary effects of the OSMI and inform power analyses for a future R01 application. Preliminary effectiveness will be evaluated by descriptively comparing primary (1) and secondary (2) outcomes longitudinally (Wave 1 vs. 2) within clinics, as well as cross-sectionally comparing Wave 2 data across clinic sites (Intervention Message Clinic vs. Control Message Clinic; Intervention Message Clinic vs. Control Clinic (treatment as usual (TAU)); TAU vs. Control Message Clinic). Feasibility during Wave 2 will be assessed via receipt and comprehension of messages. The HBM outcomes will be compared longitudinally (Wave 1 vs. 2) within clinics to identify potential mechanisms of action for the interventions and identify potential changes to the interventions prior to a larger randomized controlled trial (RCT). The EHR data will be critically evaluated to determine what available EHR data are markers of response to motivational interventions, which will inform the use of EHR data in a larger R01 application.~Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) domains preliminarily assessed will include (1) Reach: patient rate of intervention receipt including what delivery modality (i.e., mailer, poster, call), how often it was seen/received recollection, and comprehension of motivational and access message; (2) Efficacy on smoking-cessation related beliefs and intentions (i.e., motivation to quit, quit attempts, and use of EBSTs in the healthcare setting); and (3) Maintenance: duration of Wave 3 to assess the duration of potential impact of the intervention to guide whether the duration of exposure (3 months) will need to be modified in future studies for optimized effectiveness.
The purpose of this study is to examine the feasibility and preliminary effectiveness of a new Older Smoker Motivational Intervention (OSMI) in real-world clinical settings compared to treatment as usual and a control message.150 participants will be recruited from three UW Health primary care clinics. Participation will include up to 2 interviews by telephone.