Phone Enabled Implementation of Cessation Support (PHOENICS)
Faculty Information
Name:
Dr. Ramzi Salloum
Email
rsalloum@ufl.edu
Phone
(352) 294-4997
Faculty Department/Division
Health Outcomes and Biomedical Informatics
This project is primarily:
Translational
Research Project Description:
The tobacco use burden in Lebanon is exceptionally high: 35% of adults are current cigarette smokers, 39% are waterpipe smokers, and 4% are dual smokers. Lebanon has the highest incidence of lung cancer for females and second highest for males in the Eastern Mediterranean Region and public resources to support smoking cessation are scarce. The World Health Organization (WHO) endorses three cost-effective interventions as the standard of practice for population-level tobacco dependence treatment: smoking cessation advice integrated into primary care settings; easily-accessible and free phone-based counseling; and low-cost pharmacotherapy. However, much of the existing evidence base for tobacco treatment interventions comes from high-income countries and has not been rigorously tested and tailored to low-resource contexts. This study is significant for its potential to guide large-scale adoption of tobacco treatment guidelines in Lebanon’s safety net primary care system, as a model for similar efforts to improve preventive practices in clinical settings across other low-resources settings worldwide and in the US.
The objective of this NCI/NIH-funded project is to evaluate the comparative effectiveness of promising multi-component interventions for implementing evidence-based tobacco treatment in Lebanon’s national system of safety net primary healthcare (PHC) centers. In Aim 1 of the study, we adapted and tailored an existing smoking cessation program to the primary health care context by conducting baseline clinic assessments, provider surveys (n=107) and provider interviews (n=24) with the participating clinics. In Aim 2 of the study, we are testing the effectiveness of a referral-based smoking cessation program to primary care patients via 3-arm group-randomized trial of 1,500 patients across 24 clinics comparing: (1) AAA [brief “Ask, Advise, Assist” cessation counseling by the primary care provider], (2) AAC [AAA with provider referral to cessation counseling], and (3) AAC+NRT [AAC with NRT pharmacotherapy to assist with cessation]. This trial is actively enrolling in Beirut, Lebanon and anticipated to complete data collection in 2027. In Aim 3 of the project, we are evaluating the implementation process using mixed methods to measure fidelity, adaptations, and sustainability capacity, and contextual factors that influence implementation. We anticipate beginning data collection with providers and health system administrators from the Phase 1 and 2 clinics who have already completed recruitment.
Medical students will have the opportunity to collaborate on the ongoing analysis of Aim 1 and 3 quantitative and/or qualitative data and contribute to publications and conference presentations. We anticipate publishing multiple papers each project year. Prior publications include: Salloum, R.G., Romani, M., Bteddini, D.S. et al. An effectiveness-implementation hybrid trial of phone-based tobacco cessation interventions in the Lebanese primary healthcare system: protocol for project PHOENICS. Implement Sci Commun 4, 72 (2023). https://doi.org/10.1186/s43058-023-00456-w. There are currently four manuscripts actively being developed by the research team.
Does this project have an international component or travel?
Yes
If your project has an international component please give details (where, when, data collection involved, etc.):
Study enrollment and data collection occurs in Lebanon, led by the American University of Beirut (AUB); however, there is no travel anticipated for the student and analysis occurs collaboratively between UF and AUB.