# Teachable Moment to Opt-Out of Tobacco (TeaM OUT): A Stepped Wedge Cluster Randomized Trial

> **NIH VA I01** · PORTLAND VA MEDICAL CENTER · 2022 · —

## Abstract

Background: Cigarette smoking is the leading cause of preventable disease in the U.S. Despite decades of
slowly declining cigarette use, many older adults still actively smoke. Among Veterans, 22% overall and 17% of
those over 50 years old actively smoked in 2015. It is notoriously difficult to quit, despite widespread
knowledge among adults about the health hazards of persistent smoking and a frequent desire to quit. Given
the prevalence and persistence of tobacco addiction, the U.S. Preventive Services Task Force (USPSTF)
recommends that health care professionals offer cessation interventions at every health care encounter.
Significance/Impact: The Teachable Moment to Opt-Out of Tobacco (TeaM OUT) intervention is specifically
designed to increase motivation to quit, reduce roadblocks, and increase access to smoking cessation
resources. It is especially focused connecting older active smokers not yet ready to quit to smoking cessation
services. TeaM OUT has the potential to result in more frequent and longer periods of abstinence from
smoking in this hard-to-reach population.
Innovation: TeaM OUT combines a teachable moment with an opt-out, proactive approach to connect patients
to existing cessation services using interactive voice response (IVR) technology. IVR is a proactive and
affordable way to reach more older active smokers more frequently.
Specific Aims: Aim 1: Among patients recently diagnosed with a pulmonary nodule, evaluate the
effectiveness of a proactive, teachable moment-based, smoking cessation outreach intervention (TeaM OUT)
on increasing engagement with smoking cessation resources compared to Enhanced Usual Care. Aim 2:
Evaluate the association of receipt of TeaM OUT with nicotine abstinence (seven-day point prevalence and
biochemically-measured) and quit motivation compared to Enhanced Usual Care. Aim 3: Qualitatively elicit
perspectives from key stakeholders to inform acceptability and utility, implementation barriers and facilitators,
and scalability of TeaM OUT.
Methodology: In aim 1, we use pulmonary nodule registries to identify participants from three VA facilities (VA
Portland, Minneapolis VA, Charleston VA). Patients with pulmonary nodules will be contacted after a stepped-
wedged randomization at the clinical level. Participants in the intervention arm are called by the IVR Quitline,
whereas participants the control arm must proactively choose to call the quitline. Options selected on the
quitline will be recorded and analyzed using logistic regression to test if the quitline increases engagement with
smoking cessation services. For aim 2, a subsample of participants in aim 1 will be contacted to complete
additional surveys for 56 weeks after nodule identification. We will measure nicotine abstinence, quit
motivation, and communication and analyze the measures using multivariable, multi-level hierarchical logistic
regression. In aim 3, we will qualitatively assess TeaM OUT by interviewing patient participants twice d...

## Key facts

- **NIH application ID:** 10247534
- **Project number:** 5I01HX003105-02
- **Recipient organization:** PORTLAND VA MEDICAL CENTER
- **Principal Investigator:** Christopher G. Slatore
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2020-10-01 → 2024-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10247534

## Citation

> US National Institutes of Health, RePORTER application 10247534, Teachable Moment to Opt-Out of Tobacco (TeaM OUT): A Stepped Wedge Cluster Randomized Trial (5I01HX003105-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10247534. Licensed CC0.

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