Implementing an Adolescent and Young Adult (AYA) mHealth Vaping Cessation Program Into Oncology Clinics
Study Details
Study Description
Brief Summary
The purpose of this study is to understand e-cigarette use and interest in quitting by exploring e vaping behaviors among a cohort of AYA survivors (N=500). The investigators will also examine demographic, medical, and psychosocial factors associated with vaping behaviors.
Primary Objectives:
Phase 1:
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Identify characteristics of adolescent and young adult childhood cancer survivors (AYA CCS) nicotine vaping behaviors (e.g., e-cigarette use, interest in quitting, and quit attempts) and associations with demographic (e.g., sex, race, socioeconomic status, LGBTQ+ identification), cancer-specific (e.g., diagnosis, treatment factors), and psychosocial and behavioral factors.
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Develop strategies to improve implementation of an evidence-based, mHealth vaping cessation program within an AYA oncology clinic.
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Use qualitative interviews to explore patient preferences regarding program implementation (e.g., timing of assessment of vaping behavior, confidentiality, referral approach) and identify barriers to uptake.
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Interview and/or ask healthcare providers (e.g., practitioners, advanced practice providers, social workers practicing in AYA oncology settings) to complete open-ended questionnaires related to current processes (e.g., workflow), needs, and barriers for assessing e-cigarette use and vaping cessation referral processes. Evaluate healthcare providers' information needs, preferences, and tools needed for integrating ecigarette assessment and cessation program referrals into current practice.
Phase 2:
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Develop and test vaping assessment and referral implementation processes (developed from Objectives 1 & 2)., and uptake of an established mHealth vaping cessation program
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Using qualitative and quantitative measures, we will assess the reach (% of eligible AYA CCS that enrolled in mHealth program), adoption (% providers making referrals), strategy potential (provider/patient perceptions of referral process;
St. Jude Children's Research Hospital IRB NUMBER: 23-1300 IRB APPROVAL DATE:
06/02/2023 SJTIQ Page 2 Revision 0.1 05-18-23 Protocol document date: 05-18-23 appropriateness of program for patients), and maintenance (barriers/facilitators to implementation) of the program.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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Detailed Description
Phase 1:
To understand the needs and interest of the targeted population, this mixed method project will first examine e-cigarette use and interest in quitting among a cohort of AYA survivors who range in age from 13-24 on the day of consent and are at least 3 months post treatment completion. The study team will also explore demographic, medical, and psychosocial factors associated with vaping behaviors (Objective 1). Research participants will complete study assessments via REDCap, a HIPAA-compliant, password-protected, data collection and storage platform. AYA survivors who endorse current vaping and desire to quit (N=25) and healthcare providers engaged in AYA oncology care (N=15), will be asked to complete questionnaires related to attitudes, beliefs, and knowledge about e-cigarette use. The participants will also be asked to provide feedback on preferences for systematically integrating e-cigarette use screening and referral processes within AYA oncology clinic systems. The study team will also seek provider feedback on current processes (e.g., workflow), needs, and barriers for assessing ecigarette use and providing vaping cessation referrals (Objective 2).
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| GROUP I: (survey, interview) Participants complete surveys and may also complete an interview in support of intervention development while on study. |
Outcome Measures
Primary Outcome Measures
- E-cigarette use and behaviors. [Baseline]
As with the primary TIQ trial protocol, current e-cigarette use and history (frequency and rate, motivation and contemplation to quit and quitting history) will be assessed. Questions will also assess nicotine dependence with the PROMISE-E and items from the Texas Adolescent and Tobacco Marketing Surveillance; other substance use (other tobacco products, alcohol) will also be assessed. Related to e-cigarette use, we will also ask about motivation to use or quit e-cigarettes and potential barriers to quitting (e.g., social influences). Contemplation to quit vaping will be assessed using a 1-item question in which participants will indicate their contemplation stage for quitting vaping We will assess perceived level of social support, perceived social norms, and perceived self-efficacy for quitting.
- Patient Preferences for E-Cigarette Use Assessment and Referral Processes [Baseline]
Semi-structured interviews will assess preferences for assessment of e-cigarette use within oncology clinic settings and referral for cessation programs.
- Healthcare Provider Perceptions of Barriers to E-Cigarette Assessment and Referral Processes. [Baseline]
Questionnaires will assess current processes and barriers to vaping assessments and referral to cessation programs, as well as information needs, preferences, and required tools. Interviews will be made available as open-ended questionnaires that can be completed via REDCap should providers prefer this approach over recorded interviews.
- Patient Post-Intervention Interviews [Baseline]
Interviews will assess patient experience with vaping cessation assessment, referral processes, and program interaction to inform modifications needed to implementation processes.
- Healthcare Provider Post-Intervention Interviews [Baseline]
Interviews will assess provider experience, barriers, and facilitators of developed implementation strategies.
- Satisfaction Survey [Baseline]
This survey will evaluate patient participant perspectives on satisfaction of TIQ programming including types of messages and frequency of messaging, and the degree the program was helpful in reducing vaping.
- Patient Perspectives of Program Implementation Potential [Baseline]
The Acceptability of Intervention Measure and Intervention Appropriateness Measures will be administered to evaluate implementation potential of the vaping cessation program. These brief 4-item questionnaires were designed to test implementation outcomes related to program acceptability and appropriateness. They are considered strong indicators of future implementation success and will be used to inform modifications. Items on this assessment are routinely modified to match the specific implementation programming, and for this study were modified slightly to gauge participant perceptions of This is Quitting.
- Healthcare Provider Perspectives of Program Implementation Potential [Baseline]
The Feasibility of Intervention will be administered to healthcare providers to assess the potential utility and modifications needed for the developed implementation strategies. This brief 4-item questionnaire was designed to test implementation outcomes related to program feasibility. This questionnaire is considered a strong indicators of future implementation success and will be used to inform modifications for large scale testing of implementation processes in future research. Items on this assessment are routinely modified to match the specific implementation programming, and for this study were modified slightly to gauge healthcare provider perceptions of vaping assessment and referral processes to This is Quitting.
Secondary Outcome Measures
- E-cigarette expectancies [Baseline and follow-up]
Similar to the framework used by Harrell et al. positive (e.g., negative affect reduction, stimulation/state enhancement, stress reduction) and negative consequences (e.g., cost, addiction) associated with e-cigarette use will be evaluated using a 15-item questionnaire derived from the Smoking Consequences Questionnaire-Adult (SCQ-A). In addition items related to having had cancer were included in the questionnaire in line with prior research (e.g., "E-cigarettes help me reduce cancer-related stress."). Response options range on a 7-point Likert scale from "very strongly disagree" to "very strongly agree.
- Patient-Provider E-Cigarette Communication [Baseline]
Three items were modified from previous research to assess patient-provider communication surrounding e-cigarette use including interest, comfort, and importance of these discussions. Questions also assess if patients discussed e-cigarette use and were helped with quitting. For each question, participants can respond on a 4-point Likert scale.
- Centrality of Events (CES) [Baseline]
CES is a 20-item self-report questionnaire that assesses the extent to which the most stressful or impactful traumatic event experienced in participants' lives serves as a pivotal point in the development of their identity or influences their attribution of meaning to other events in their lives. For this questionnaire, participants will specifically answer questions about their cancer experience. Of the 20 items, 8 items assess the extent to which an event has become a reference point for the participant, 6 items assess the extent to which the event is central to participants' identity, and 6 items assess the extent to which participants think the event was a turning point in their life story. Questions are answered on a 5-point Likert scale ranging from " Totally Disagree" to "Totally Agree." No items are reverse coded and higher scores indicate greater centrality of the traumatic event to the participant.
- Cancer-Related Worry [Baseline]
Cancer-related worry and fear of cancer recurrence will be assessed using the Cancer Worry Scale. The 6-item assessment measures participant fears of relapse, late-effects, and fertility concerns. Participants respond on a 4-point Likert scale with response options ranging from "strongly disagree" to "strongly agree." This measure has been successfully used with both adolescent and young adult populations and will inform the extent to which cancer-related worry is associated with e-cigarette use.
- PROMIS profiles [Baseline]
The Patient Reported Outcome Measurement Information System (PROMIS) Profile will be administered to assess self-reported physical functioning mobility, anxiety, depressive symptoms, fatigue, peer relationships, pain interference, and pain intensity over a 7-day period. Participants <18 will complete the self-reported pediatric version (49 items), and participants ≥ 18 will complete the adult version (43 items). Items are summed and T-scored, have a mean of 50 and a standard deviation of 10. This assessment will help inform psychological components associated with vaping behaviors and interest in quitting that may support implementation processes.
- Social Influence and Support [Baseline]
Social support is a known protective factor against substance use, and social media influence can promote substance use. We will implement assessments to explore the association of social influence on vaping behaviors using the Multidimensional Scale of Perceived Social Support (MSPSS). The MSPSS is a 12-item self-report questionnaire that assesses perceived support from friends, family, and a significant other. Questions are answered on 7-point Likert scale from "very strongly disagree" to "very strongly agree." Higher scores are indicative of more social support. Additional items will be administered to assess social media influence on vaping behaviors.
- Dietary Behaviors [Baseline]
The Investigators will use several brief dietary assessment to explore associations within this study. Rapid Easting Assessment for Participants is used to quickly assess nutrient intake/diet quality in a clinical and research settings. It is completed for the previous week's food intake and scored by summing responses from 'usually/often' to 'rarely/never or does not apply to me'. Possible scores ranged from 13 to 39 with a higher score indicating a higher diet quality. There is an additional 3-question section at the end about cooking/shopping and willingness to change eating habits. The Binge Eating Scale includes 16 multiple choice items assessing the presence of certain binge eating behaviors which may be indicative of an eating disorder. Scores are summed for a maxi
- Physical Activity Screener [Baseline]
Research has highlighted links between smoking cessation and increased physical activity in the general AYA population, and physical activity may be an important determinant in supporting vaping cessation. Understanding physical activity behaviors may provide additional mechanisms to improve vaping behaviors. As such, we will administer the International Physical Activity Questionnaire (IPAQ) short form is a 7-item self-reported questionnaire that assesses perceived health-related physical activity. Questions are answered based on the amount of reported minutes and/or hours per days participants engage in physical activity. Physical activity level is scored and categorized within three levels of activity: vigorous, moderate, and walking intensity. Scores can be converted to metabolic equivalents.
- Healthcare Provider Characteristics [Baseline]
General demographic data will be gathered about health care providers including provider type (e.g., physician, psychologist, nurse practitioner), gender identity, and years of independent practice.
- Healthcare Provider Attitudes, Beliefs, Knowledge, and Communication about E-cigarettes [Baseline]
Items were modified from previous research to assess patient-doctor communication surrounding e-cigarette use including interest, comfort, and importance of these discussions. Questions also assessed for discussions related to use, referral for quitting support, and attitudes/beliefs about e-cigarette risk.
Eligibility Criteria
Criteria
Inclusion Criteria:
Study Participants
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Research participant is 13 to 24 years old at enrollment
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Research participant is followed by St. Jude Children's Research Hospital (SJCRH)
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Research participant has a diagnosis of malignancy or a CNS neoplasm
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Research participant has been identified by the Transition Oncology Program (TOP) as a patient transitioning off active cancer therapy and/or followed by After Completion of Therapy (ACT) Clinic, and/or participating in the St. Jude Lifetime Cohort Study (SJLIFE)
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Research participant is in remission and at least 3 months from having completed cancer-directed therapy
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Participant can speak and read English
Healthcare Providers
- Engaged in the healthcare of survivors seen through TOP, ACT, or SJLIFE
Exclusion Criteria:
Study Participants
- Significant psychiatric or neurologic disorders that would impair compliance with study protocol as indicated by the medical chart
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | St. Jude Children's Research Hospital | Memphis | Tennessee | United States | 38105 |
Sponsors and Collaborators
- St. Jude Children's Research Hospital
Investigators
- Principal Investigator: Rachel Webster, PhD, St. Jude Children's Research Hospital
Study Documents (Full-Text)
None provided.More Information
Additional Information:
Publications
None provided.- SJTIQ
- NCI-2023-04799