Osteoporosis International

, Volume 28, Issue 10, pp 3055–3060 | Cite as

The effects of a patient activation intervention on smoking and excessive drinking cessations: results from the PAADRN randomized controlled trial

  • F. D. WolinskyEmail author
  • Y. Lou
  • S. W. Edmonds
  • K. G. Saag
  • D. W. Roblin
  • N. C. Wright
  • M. P. Jones
  • P. Cram
  • on behalf of the PAADRN Investigators
Short Communication



Patients may exhibit risky bone health behaviors. In a large pragmatic clinical trial, we tested whether a tailored patient activation DXA result letter accompanied by a bone health brochure led to smoking and excessive drinking cessations. The intervention did not, however, alter these risky bone health behaviors.


Besides dual-energy x-ray absorptiometry (DXA) screening and pharmacotherapy when indicated, beneficial bone health behaviors including proper calcium and vitamin D intake and weight-bearing and muscle-strengthening exercise should be encouraged. Similarly, risky bone health behaviors like smoking and excessive drinking should be discouraged. We examined whether a direct-to-patient activation intervention led to smoking and excessive drinking cessations.


The Patient Activation after DXA Result Notification (PAADRN) pragmatic clinical trial enrolled 7749 patients between February 2012 and August 2014. Interviews occurred at baseline and 12 and 52 weeks later. Intervention subjects were mailed an individually tailored DXA results letter accompanied by a bone health educational brochure 4 weeks post-DXA. Usual care subjects were not sent these materials. Smoking and excessive drinking were assessed by self-report at each interview. Intention-to-treat linear probability models were used.


Mean age was 66.6 years, 83.8% were women, and 75.3% were Non-Hispanic-Whites. Smoking was reported at baseline by 7.6% of the intervention group vs. 7.7% of the usual care group (p = 0.873). Excessive drinking was reported at baseline by 6.5% of the intervention group vs. 6.5% of the usual care group (p = 0.968). Intention-to-treat analyses indicated no significant differences between the intervention vs. usual care groups at either 12 or 52 weeks post-DXA (all p values ≥ 0.346).


An individually tailored DXA result letter accompanied by an educational brochure did not lead to smoking or excessive drinking cessations in patients who received DXA.

Trial Registration: identifier NCT01507662.


Clinical trials Drinking DXA Osteoporosis Smoking 


Compliance with ethical standards


This work was supported by R01 AG033035 (Cram/Wolinsky) from the NIA at NIH. Dr. Cram is supported by a K24 AR062133 award from NIAMS at the NIH. Dr. Saag is supported by a K24 AR052361 award from the NIAMS at the NIH.

Conflicts of interest

F. D. Wolinsky, Y. Lou, S. W. Edmonds, D. W. Roblin, M. P. Jones, and P. Cram, have no conflicts of interest. N. C. Wright has received unrestricted grant support from Amgen for work unrelated to this project. K. G. Saag has received grants from Amgen, Eli Lilly and Merck and has served as a paid consultant to Amgen, Eli Lilly, and Merck unrelated to this project.


  1. 1.
    Burge R, Dawson-Hughes B, Solomon D et al (2014) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 22:465–475. doi: 10.1359/jbmr.061113 CrossRefGoogle Scholar
  2. 2.
    (2011) Screening for osteoporosis: U.S. preventive services task force recommendation statement. Ann Intern Med 154:356–364. doi:  10.7326/0003-4819-154-5-201103010-00307
  3. 3.
    Cosman F, de Beur SJ, LeBoff MS et al (2014) Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int 25:2359. doi: 10.1007/s00198-014-2794-2 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    SAMSA-HRSA Center for Integrated Health Solutions. Screening, Brief Intervention, and Referral to Treatment (SBIRT). Accessed 27 Feb 2017
  5. 5.
    Curtis J, Laster A, Becker DJ et al (2009) The geographic availability and associated utilization of dual-energy x-ray absorptiometry (DXA) testing among older persons in the United States. Osteoporos Int 20(9):1553–1561CrossRefPubMedGoogle Scholar
  6. 6.
    National Center for Quality Assurance (2014) Proposed changes to existing measure for HEDIS 2015: Osteoporosis Testing in Older Women (OTO). Accessed 27 Feb 2017
  7. 7.
    Liu Z, Weaver J, de Papp A et al (2016) Disparities in osteoporosis treatments. Osteoporos Int 27:509–519CrossRefPubMedGoogle Scholar
  8. 8.
    Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733CrossRefPubMedGoogle Scholar
  9. 9.
    Bailey RL, Dodd KW, Goldman JA et al (2010) Estimation of total usual calcium and vitamin D intakes in the United States. J Nutr 140:817–822. doi: 10.3945/jn.109.118539 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Brownson RC, Jones DA, Pratt M, Blanton C, Heath GW (2000) Measuring physical activity with the behavioral risk factor surveillance system. Med Sci Sports Exerc 32:1913–1918CrossRefPubMedGoogle Scholar
  11. 11.
    Jamal A, King BA, Neff LJ et al (2016) Cigarette Smoking Among Adults—United States, 2005–2015. MMWR Morb Mortal Wkly Rep 65:1205–1211. doi: 10.15585/mmwr.mm6544a2 Accessed 2017 Feb 27CrossRefPubMedGoogle Scholar
  12. 12.
    Kanny D, Liu Y, Brewer RD, Garvin WS, Balluz L (2012) Vital signs: binge drinking prevalence, frequency, and intensity among adults—United States, 2010. MMWR Morb Mortal Wkly rep 61:14–19Google Scholar
  13. 13.
    Edmonds SW, Wolinsky FD, Christensen AJ et al (2012) The PAADRN study: a design for a randomized controlled practical clinical trial to improve bone health. Contemp Clin Trials 34:90–100. doi: 10.1016/j.cct.2012.10.002 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Cram P, Wolinsky FD, Lou Y et al (2016) Patient-activation and guideline-concordant pharmacological treatment after bone density testing: the PAADRN randomized controlled trial. Osteoporos Int 27:3513–3524. doi: 10.1007/s00198-016-3681-9 CrossRefPubMedGoogle Scholar
  15. 15.
    Edmonds SW, Cram P, Lou Y et al (2016) Effects of a DXA result letter on satisfaction, quality of life, and osteoporosis knowledge: a randomized controlled trial. BMC Musculoskelet Disord 17:369. doi: 10.1186/s12891-016-1227-0 CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Bandura A (1977) Self-efficacy: toward a unifying theory of behavioral change. Psychol rev 84:191–215CrossRefPubMedGoogle Scholar
  17. 17.
    Bandura A (1977) Social learning theory. Prentice Hall, Englewood CliffsGoogle Scholar
  18. 18.
    Bandura A (1986) Social foundations of thought and action: a social cognitive theory. Prentice Hall, Englewood CliffsGoogle Scholar
  19. 19.
    Edmonds SW, Solimeo SL, Lu X, Roblin DW, Saag KG, Cram P (2014) Developing a bone mineral density test result letter to send to patients: a mixed-methods study. Patient Prefer Adherence 8:827–841. doi: 10.2147/PPA.S60106 CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Edmonds SW, Solimeo SL, Nguyen VT et al (2017) Understanding preferences for osteoporosis information to develop an osteoporosis-patient education brochure. Permanente J 21:16–24. doi: 10.7812/TPP/16-024 CrossRefGoogle Scholar
  21. 21.
    Prochaska JO, DiClemente CC, Norcross JC (1992) In search of how people change: application to addictive behaviors. Am Psychol 47:1102–1114CrossRefPubMedGoogle Scholar
  22. 22.
    Krantz DS, Baum A, Wideman MV (1980) Assessment of preferences for self-treatment and information in health care. J Pers Soc Psychol 39:977–990CrossRefPubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2017

Authors and Affiliations

  • F. D. Wolinsky
    • 1
    • 2
    • 3
    Email author
  • Y. Lou
    • 4
  • S. W. Edmonds
    • 2
    • 3
    • 5
  • K. G. Saag
    • 6
  • D. W. Roblin
    • 7
    • 8
  • N. C. Wright
    • 6
    • 9
  • M. P. Jones
    • 4
  • P. Cram
    • 2
    • 10
    • 11
  • on behalf of the PAADRN Investigators
  1. 1.Department of Health Management and PolicyUniversity of IowaIowa CityUSA
  2. 2.Department of Internal MedicineUniversity of IowaIowa CityUSA
  3. 3.College of NursingUniversity of IowaIowa CityUSA
  4. 4.Department of BiostatisticsUniversity of IowaIowa CityUSA
  5. 5.CADRE, Iowa City VA Healthcare SystemIowa CityUSA
  6. 6.Department of Internal MedicineUniversity of AlabamaBirminghamUSA
  7. 7.Kaiser PermanenteAtlantaUSA
  8. 8.Department of Health Management and PolicyGeorgia State UniversityAtlantaUSA
  9. 9.Department of EpidemiologyUniversity of AlabamaBirminghamUSA
  10. 10.Department of MedicineUniversity of TorontoTorontoCanada
  11. 11.Division of General Internal Medicine and GeriatricsMt. Sinai/UHN HospitalsTorontoCanada

Personalised recommendations