Using a Pragmatic Randomized Rollout Trial to Evaluate Implementation Strategies to Promote Smoking Treatment and Cancer Prevention for Salvation Army Clients

ABSTRACT / PROJECT SUMMARY The prevalence of combustible cigarette tobacco use remains high among socioeconomically disadvantaged Americans despite declines in the broader population. Socioeconomic inequities in tobacco use rates and tobacco cessation success have grown over recent decades. Disadvantaged adults who use tobacco are

therefore a high-priority population, but we have made too little progress in engaging this population in evidence-based tobacco cessation treatment. Community agencies that provide support services to disadvantaged individuals have the potential to reach people who use tobacco and engage them in high-quality

cessation treatment to prevent cancer. The Salvation Army is a community agency with national and international reach and a commitment to discouraging tobacco use and promoting the health and wellbeing of the diverse communities they serve. The Salvation Army will partner in the proposed project to refine and

evaluate implementation strategies designed to help their staff connect their clients with free evidence-based tobacco treatment from the Wisconsin Tobacco Quit Line. Salvation Army social service leaders, staff, and clients will help to refine and adapt quitline referral implementation strategies with promising preliminary data to

enhance their fit and sustainability in the usual context of Salvation Army services. Pragmatic research methods will be used to evaluate two promising implementation strategies designed to promote quitline referrals: 1) a low-intensity, sustained collaborative approach to implementation support for Salvation Army

staff (vs. a usual care approach offering initial training with minimal technical support), and 2) modest, immediate incentives for clients to connect with the quitline (vs. no incentive). Both the collaborative sustained implementation support for staff and client incentives will be refined in the 2-year UG3 phase, along with

pragmatic study measures and procedures. In the UH3 phase, the target implementation strategies refined in the pilot phase will then be evaluated in a pragmatic randomized rollout trial in which 8 sites are randomized to sustained collaborative implementation support for staff and 8 sites are randomized to usual implementation

training for staff, and all 16 sites will start without client incentives for immediate quitline connections, and will then introduce incentives at randomly assigned timepoints, as in a stepped-wedge design. Inclusion criteria for sites, staff, and clients will be minimal to enhance external validity, and data on the primary outcome (whether

or not a referral occurred) will be gathered from Salvation Army service records and quitline records in the course of usual care. This will be supplemented by mixed method assessments conducted by researchers that will not affect the context of intervention implementation. This pragmatic program of research has the potential

to identify staff- and client-focused strategies that can enhance Salvation Army efforts to support tobacco cessation among their clients. Leaders at the Salvation Army are committed to helping their clients quit tobacco, and to applying the lessons learned in the proposed project more broadly in the region and nation.