The comparative effectiveness of two brief tobacco interventions in the U.S. Air Force: Perceived harm and intentions-to-use of tobacco products
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Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, United States
Center for Addiction and Prevention Research, Department of Public Health Sciences, University of Virginia, Charlottesville, United States
Organizational Wellness and Learning Systems, Fort Worth, United States
School of Public Health, Georgia State University, Atlanta, United States
Zoran Bursac   

Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N. Pauline, Suite 633 Memphis, TN 38105, United States
Publish date: 2018-06-01
Tob. Induc. Dis. 2018;16(June):26
Brief health prevention programs have been shown efficacious in prevention of tobacco use initiation and re-initiation in the US Air Force. In this manuscript we apply a comparative effectiveness assessment of two published studies, based on testing the equality of effect sizes for perceived harm and intentions-to-use for five tobacco products.

We calculate and compare the effect sizes from the brief tobacco intervention (BTI) study (N=1055) with those of the anti-tobacco media campaign (MEDIA) study (N=665), for perceived harm and intentions-to-use of cigarettes, smokeless tobacco, cigarillos, e-cigarettes and hookah, among Airmen in the US Air Force Technical Training. Univariate and multivariate parametric and non-parametric methods and models were applied to compare the outcomes between the interventions. In addition, we calculate and report the cost of each intervention per Airman.

Effect sizes for perceived harm were 0.24–0.99 for BTI and 0.17–0.33 for MEDIA, while intentions-to-use effect sizes were 0.14–0.34 for BTI and 0.01– 0.07 for MEDIA, depending on the product. BTI intervention effects sizes were significantly greater than MEDIA intervention for all products, mainly among past users, and for both perceived harm (all p<0.0001) and intentions-to-use (all p<0.01). Cost per Airmen was comparable between the two interventions, .90 for BTI and .52 for MEDIA.

Direct comparison suggests that BTI produced effect sizes of significantly higher magnitude in the desired direction for perceived harm and intentions-to-use, for five tobacco products most commonly used by the Airmen, and mainly among past users.

U.S. Department of Health and Human Services. The Health Consequences of Smoking-50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2014.
U.S. Department of Health and Human Services. Reducing the Health Consequences of Smoking: 25 Years of Progress. A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 1989.
Ling PM, Glantz SA. Why and How the Tobacco Industry Sells Cigarettes to Young Adults: Evidence from Industry Documents. American Journal of Public Health. 2002;92(6):908-916. doi:10.2105/ajph.92.6.908
Substance Abuse and Mental Health Services Administration. Results from the 2013 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services; 2013.
Adelman W. Trajectories, health, safety, and well-being of young adults in the military. IOM/NRC Workshop on Improving the Health, Safety, and Well-Being of Young Adults. Washington, DC: 2013.
Department of Defense. 2011 DoD Survey of Health Related Behaviors Among Active Duty Personnel. Washington, DC: Department of Defense; 2013.
Little MA, Derefinko KJ, Bursac Z, et al. Prevalence and Correlates of Tobacco and Nicotine Containing Product Use in a Sample of United States Air Force Trainees. Nicotine and Tobacco Research. 2016;18(4):416-23. doi:10.1093/ntr/ntv090
Haddock CK, O’Byrne KK, Klesges RC, Talcott GW, Lando H, Peterson AL. Relapse to Smoking After Basic Military Training in the US Air Force. Military Medicine. 2000:165(11):884-888. doi:10.1093/milmed/165.11.884
National Cancer Institute. Tobacco Control Monograph 19: The Role of the Media in Promoting and Reducing Tobacco Use. Bethesda, MD: National Cancer Institute; 2008.
Haddock CK, Hoffman K, Taylor JE, Schwab L, Poston WS, Lando HA. An analysis of messages about tobacco in the Military Times magazines. Nicotine and Tobacco Research. 2008;10(7):1191-7. doi:10.1080/14622200802163126
Haddock CK, Parker LC, Taylor JE, Poston WS, Lando H, Talcott GW. An analysis of messages about tobacco in military installation newspapers. American Journal of Public Health. 2005;95(8):1458. doi:10.2105/ajph.2004.048454
Richardson AK, Green M, Xiao H, Sokol N, Vallone D. Evidence for truth: The Young Adult Response to a Youth-Focused Anti-Smoking Media Campaign. American Journal of Preventive Medicine. 2010;39(6):500-06. doi:10.1016/j.amepre.2010.08.007
Little MA, Talcott GW, Bursac Z, et al. Efficacy of a Brief Tobacco Intervention for Tobacco and Nicotine Containing Products in the United States Air Force. Nicotine and Tobacco Research. 2016;18(5): 1142-9. doi:10.1093/ntr/ntv242
Popova L, Linde BD, Bursac Z, et al. Testing Anti-smoking Messages for Air Force Trainees. Tobacco Control. 2015;25(6). doi:10.1136/tobaccocontrol-2015-052477
Brewer NT, Chapman GB, Gibbons FX, Gerrard M, McCaul KD, Weinstein ND. Meta-analysis of the Relationship Between Risk Perception and Health Behavior: The Example of Vaccination. Health Psychology. 2007;26(2):136. doi:10.1037/0278-6133.26.2.136
Webb TL, Sheeran P. Does changing behavioral intentions engender behavior change? A meta-analysis of the experimental evidence. Psychological bulletin. 2006;132(2):249. doi:10.1037/0033-2909.132.2.249
Andrews JA, Tildesley E, Hops H, Duncan SC, Severson HH. Elementary school age children's future intentions and use of substances. Journal of Clinical Child and Adolescent Psychology. 2003;32(4):556-567. doi:10.1207/s15374424jccp3204_8
Ayanian JZ, Cleary PD. Perceived risks of heart disease and cancer among cigarette smokers. JAMA. 1999;281(11):1019-1021. doi:10.1001/jama.281.11.1019
Choi WS, Gilpin EA, Farkas AJ, Pierce JP. Determining the probability of future smoking among adolescents. Addiction. 2001;96(2):313-323. doi:10.1046/j.1360-0443.2001.96231315.x
Maher R, Rickwood D. The theory of planned behavior, domain specific self-efficacy and adolescent smoking. Journal of Child and Adolescent Substance Abuse. 1997;6:57-76. doi:10.1300/j029v06n03_04
Norman N, Tedeschi J. Self-presentation, reasoned action, and adolescents: decisions to smoke cigarettes. Journal of Applied Social Psychology. 1989;19:543-558. doi:10.1111/j.1559-1816.1989.tb00269.x
Tan AS, Bigman CA. E-Cigarette Awareness and Perceived Harmfulness: Prevalence and Associations with Smoking-Cessation Outcomes. American Journal of Preventive Medicine. 2014;47(2):141-149. doi:10.1016/j.amepre.2014.02.011
Little MA, Derekinfo KJ, Colvin L, et al. The prevalence of e-cigarette in a sample of US Air Force recruits. American Journal of Preventive Medicine. 2015;49(3):402-408. doi:10.1016/j.amepre.2015.02.019
Klesges RC, Haddock CK, Lando H, Talcott GW. Efficacy of forced smoking cessation and an adjunctive behavioral treatment on long-term smoking rates. J Consult Clin Psychol. 1999;67(6):952-958. doi:10.1037//0022-006x.67.6.952
Klesges RC, DeBon M, Vander Weg MW, et al. Efficacy of a tailored tobacco control program on long-term use in a population of U.S. military troops. J Consult Clin Psychol. 2006;74(2):295-306. doi:10.1037/0022-006x.74.2.295
Linde BD, Ebbert JO, Pasker CK, et al. Prevalence and predictors of hookah use in US Air Force military recruits. Addict Behav. 2015;47:5-10. doi:10.1016/j.addbeh.2015.03.012
Miller WR, Rollnick S. Motivational interviewing: Preparing people for change. 3rd ed. New York, NY: Guilford Press; 2012.
California Department of Health Services, Tobacco Control Section. In: California Department of Health Services,Tobacco Control Section, ed. A model for change: the California experience in tobacco control. 1998.
Stevens C. Designing an effective counteradvertising campaign‐California. Cancer. 1998;83(S12A):2736-2741.
Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ: Erlbaum; 1988.
Dwass M. Some k-Sample Rank-Order Tests. In: Olkin I, Ghurye SG, Hoeffding W, Madow WG, and Mann HB, eds. Contributions to Probability and Statistics: Essays in Honor of Harold Hotelling. Stanford, CA: Stanford University Press; 1960.
Steel RGD. A Rank Sum Test for Comparing All Pairs of Treatments. Technometrics. 1960;2:197-207. doi:10.1080/00401706.1960.10489894
Critchlow DE, Fligner MA. On Distribution-Free Multiple Comparisons in the One-Way Analysis of Variance. Communications in Statistics-Theory and Methods. 1991;20:127-139. doi:10.1080/03610929108830487
Heckman CJ, Egleston BL, Hofmann MT. Efficacy of motivational interviewing for smoking cessation: a systematic review and meta-analysis. Tobacco Control. 2010;19(5):410-416. doi:10.1136/tc.2009.033175
Martins RK, and McNeil DW. Review of Motivational Interviewing in promoting health behaviors. Clinical Psychology Review. 2009;29(4):283-293. doi:10.1016/j.cpr.2009.02.001
Ajzen I. The Theory of Planned Behavior. Organ Behav Human Decis Process. 1991;50(2):179-211. doi:10.1016/0749-5978(91)90020-t