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Kalkhoran S, Streck JM, Kruse GR, Rigotti NA, Perez GK, Regan S, Ponzani CJ, Muzikansky A, Park ER, Ostroff JS. Longitudinal Electronic Cigarette Use Among Patients Recently Diagnosed With Cancer Enrolled in a Smoking Cessation Trial. Nicotine Tob Res 2022; 24:970-977. [PMID: 35134988 PMCID: PMC9199950 DOI: 10.1093/ntr/ntac031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 01/14/2022] [Accepted: 02/02/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Many cancer patients who smoke report concurrent e-cigarette use. Using a mixed-methods approach, we aimed to (1) describe longitudinal e-cigarette use over 6 months after a cancer diagnosis and (2) assess the association between e-cigarette use and smoking cessation, among cancer patients in a smoking cessation trial. AIMS AND METHODS Data were from a 2-site randomized controlled trial of Standard (brief counseling) versus Intensive treatment (sustained counseling plus smoking cessation medication) in individuals who smoke recently diagnosed with cancer. Participants (n = 303) reported e-cigarette use at baseline, 3 months, and 6 months. Biochemically-verified past 7-day cigarette abstinence was collected at 6 months. Qualitative interviews at 6 months explored factors related to e-cigarette use. RESULTS E-cigarette use prevalence was highest between baseline and 3 months (16%) and declined over time. Participants using e-cigarettes at follow-up had higher baseline cigarette dependence and smoked more heavily. Multivariable analyses found no significant association between follow-up e-cigarette use and 6-month cigarette abstinence. E-cigarette use at follow-up was higher in the Standard versus Intensive treatment group (p = .003 and .001 at 3 and 6 mo, respectively). Smoking cessation and health concerns were primary reasons for using e-cigarettes. CONCLUSIONS Among individuals who smoke recently diagnosed with cancer and enrolled in a smoking cessation intervention trial, e-cigarette use during trial participation was not associated with smoking abstinence. Individuals who chose to use e-cigarettes were less likely to be receiving intensive cessation support as part of the trial. Further studies are needed to evaluate the association between e-cigarette use and smoking cessation in cancer patients. IMPLICATIONS E-cigarette use was not associated with cigarette abstinence at 6 months among adults who smoke recently diagnosed with cancer enrolled in a smoking cessation trial. Individuals with easier access to evidence-based smoking cessation treatment may be less likely to use e-cigarettes.
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Affiliation(s)
- Sara Kalkhoran
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- The Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Joanna M Streck
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Health Promotion and Resiliency Intervention Research (HPRIR) Program, Massachusetts General Hospital, Boston, MA, USA
| | - Gina R Kruse
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- The Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- The Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Giselle K Perez
- Harvard Medical School, Boston, MA, USA
- The Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Health Promotion and Resiliency Intervention Research (HPRIR) Program, Massachusetts General Hospital, Boston, MA, USA
| | - Susan Regan
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Colin J Ponzani
- The Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | | | - Elyse R Park
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- The Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Health Promotion and Resiliency Intervention Research (HPRIR) Program, Massachusetts General Hospital, Boston, MA, USA
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Weng X, Lau OS, Ng CH, Li WHC, Lam TH, Wang MP. Effect of a workplace mobile phone-based instant messaging intervention on smoking cessation: a cluster-randomized controlled trial. Addiction 2022; 117:1758-1767. [PMID: 35037319 DOI: 10.1111/add.15804] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 12/23/2021] [Indexed: 01/02/2023]
Abstract
AIMS To test the effectiveness of intractive, instant messaging chat-based mobile phone support versus text-based mobile phone support integrated with brief interventions on self-reported smoking abstinence in workplaces. DESIGN A two-arm parallel cluster-randomized controlled trial with follow-up to 12 months. SETTING Seventy-five companies in Hong Kong, China. PARTICIPANTS Daily cigarette adult smokers (92.0% male, 90.9% not ready to quit within the next 30 days) from 75 companies (clusters). INTERVENTIONS Participants were cluster-randomized to receive text-based support (TBS, n = 375; 38 clusters) or chat-based support (CBS, n = 304; 37 clusters). TBS participants received automated and fix-scheduled text messages on cessation advice and support. CBS participants received fix-scheduled text messages and additional real-time psychosocial and cessation support via instant messaging services (e.g. WhatsApp) by counsellors. Both groups received a 1-hour health talk at baseline and brief telephone counselling at 1 week and 1, 3, 6 and 12 months. MEASUREMENTS The primary outcome was self-reported 7-day point-prevalence abstinence at 6 months post-treatment initiation. Secondary outcomes included 7-day point-prevalence abstinence at 12 months, repeated 7-day point-prevalence abstinence, smoking reduction, quit attempts and intervention engagement, defined as having read text messages and/or engaged in conversation with counsellors. FINDINGS By intention-to-treat assuming that dropouts were smoking, self-reported abstinence was not significantly different between the CBS and TBS groups at 6 months [18.8 versus 21.6%, risk ratio (RR) = 0.87, 95% confidence interval (CI) = 0.61, 1.23, retention = 71.3%] and 12 months (21.4 versus 24.0%, RR = 0.90, 95% CI = 0.66, 1.21, retention = 70.8%). The repeated 7-day point-prevalence abstinence, smoking reduction and quit attempts were similar between the groups. The participants who were engaged in the text- and/or chat-based interventions had greater abstinence (adjusted RR = 2.91, 95% CI = 1.87, 4.52) at 6 months compared with unengaged participants. CONCLUSIONS Compared with a text messaging mobile phone intervention, a chat-based instant messaging mobile phone intervention did not improve smoking abstinence over 12 months in workplaces. Engagement in text-based or chat-based interventions was associated with higher quit rates compared with non-engagement.
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Affiliation(s)
- Xue Weng
- Institute of Advanced Studies in Humanities and Social Sciences, Beijing Normal University at Zhuhai, Zhuhai, China.,School of Nursing, the University of Hong Kong, Hong Kong SAR, China
| | - Oi Sze Lau
- The Lok Sin Tong Benevolent Society Kowloon, Hong Kong SAR, China
| | - Chak Hang Ng
- The Lok Sin Tong Benevolent Society Kowloon, Hong Kong SAR, China
| | - William Ho Cheung Li
- Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Tai Hing Lam
- School of Public Health, the University of Hong Kong, Hong Kong SAR, China
| | - Man Ping Wang
- School of Nursing, the University of Hong Kong, Hong Kong SAR, China
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Jacob P, Chan L, Cheung P, Bello K, Yu L, StHelen G, Benowitz NL. Minor Tobacco Alkaloids as Biomarkers to Distinguish Combusted Tobacco Use From Electronic Nicotine Delivery Systems Use. Two New Analytical Methods. Front Chem 2022; 10:749089. [PMID: 35720984 PMCID: PMC9198481 DOI: 10.3389/fchem.2022.749089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
Biomarkers for the use of electronic nicotine delivery systems (ENDS) are desirable for studies of the health effects of electronic cigarettes and related devices. However, the aerosols inhaled from these devices do not contain substances that are unique to this class of products, i.e., substances that are not present in cigarette smoke or those that do not have common environmental or dietary sources. Consequently, identifying selective biomarkers for ENDS use remains a challenge. If co-use of conventional tobacco products can be definitively ruled out, then nicotine and its metabolites are suitable for assessing exposure. Self-reports from questionnaires are often used to obtain information on product use. But self-reports may not always be accurate, and are not amenable to obtaining quantitative information on exposure. An alternative approach is to use selective biomarkers for conventional tobacco products to definitively rule out their use. In this article, we describe two new LC-MS/MS methods for the minor tobacco alkaloids anabasine, anatabine, nicotelline, anatalline, and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), a tobacco-specific nitrosamine metabolite, all biomarkers that are selective for the use of conventional tobacco products. Applications of these biomarkers in studies of ENDS use and dual use of ENDS and conventional tobacco products are also discussed.
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204
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Yousefi PD, Suderman M, Langdon R, Whitehurst O, Davey Smith G, Relton CL. DNA methylation-based predictors of health: applications and statistical considerations. Nat Rev Genet 2022; 23:369-383. [PMID: 35304597 DOI: 10.1038/s41576-022-00465-w] [Citation(s) in RCA: 78] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 12/12/2022]
Abstract
DNA methylation data have become a valuable source of information for biomarker development, because, unlike static genetic risk estimates, DNA methylation varies dynamically in relation to diverse exogenous and endogenous factors, including environmental risk factors and complex disease pathology. Reliable methods for genome-wide measurement at scale have led to the proliferation of epigenome-wide association studies and subsequently to the development of DNA methylation-based predictors across a wide range of health-related applications, from the identification of risk factors or exposures, such as age and smoking, to early detection of disease or progression in cancer, cardiovascular and neurological disease. This Review evaluates the progress of existing DNA methylation-based predictors, including the contribution of machine learning techniques, and assesses the uptake of key statistical best practices needed to ensure their reliable performance, such as data-driven feature selection, elimination of data leakage in performance estimates and use of generalizable, adequately powered training samples.
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Affiliation(s)
- Paul D Yousefi
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, University of Bristol, Bristol, UK
| | - Matthew Suderman
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, University of Bristol, Bristol, UK
| | - Ryan Langdon
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, University of Bristol, Bristol, UK
| | - Oliver Whitehurst
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, University of Bristol, Bristol, UK
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, University of Bristol, Bristol, UK
| | - Caroline L Relton
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, University of Bristol, Bristol, UK.
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205
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Shuter J, Chander G, Graham AL, Kim RS, Stanton CA. Randomized Trial of a Web-Based Tobacco Treatment and Online Community Support for People With HIV Attempting to Quit Smoking Cigarettes. J Acquir Immune Defic Syndr 2022; 90:223-231. [PMID: 35175971 PMCID: PMC9203899 DOI: 10.1097/qai.0000000000002936] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 02/02/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Persons with HIV (PWH) in the United States (US) smoke cigarettes at approximately triple the rate of the general adult population and are less successful in their quit attempts than other smokers. This randomized trial tested whether a novel web-based cessation program for PWH yielded higher cigarette quit rates compared with a control program. SETTING Two urban HIV care sites in NYC and Baltimore. METHODS Between 2016 and 2020, 506 PWH were randomized to either Positively Smoke Free on the Web (PSFW+; N = 255), a multimodal platform, interactive web intervention hosted within an online social network to support quitting among PWH who smoke, and an attention-matched web-based control intervention (American Heart Association Getting Healthy; N = 251). All participants were offered 12 weeks of nicotine patch. Our primary outcome was biochemically confirmed exhaled carbon monoxide < 10 parts per million (ppm) 7-day point prevalence abstinence at 6 months. RESULTS Participants were middle-aged (mean 50.2 years; range 23-73 years), 57% male, 19% Latinx, 83% Black, and 13% White. At 6 months, a significantly greater percentage of PSFW+ participants (14.9%) achieved biochemically confirmed 7-day point prevalence abstinence in intent-to-treat analysis compared with 8.8% of American Heart Association Getting Healthy participants [odds ratio =1.82 (95% confidence interval =1.04 to 3.18), P = 0.03]. CONCLUSIONS PSFW+ is a promising cessation intervention composed of empirically tested content and real-time social support through an online social network that was found to promote abstinence. This digital approach has broad reach and scalability, can be easily integrated into comprehensive HIV care, and represents an advance in the fight against tobacco use among PWH.
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Affiliation(s)
- Jonathan Shuter
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
- Division of Infectious Diseases, Albert Einstein College of Medicine, Bronx, NY
| | | | - Amanda L Graham
- Innovations Center, Truth Initiative, Washington, DC
- Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Ryung S Kim
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Cassandra A Stanton
- Behavioral Health and Health Policy Practice, Rockville, MD; and
- Department of Oncology, Georgetown University Medical Center, Washington, DC
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206
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Borrelli B, Endrighi R, Jurasic MM, Hernandez H, Jones E, Ospina J, Cabral HJ, Quintiliani LM, Werntz S. A smoking cessation induction intervention via virtual reality headset during a dental cleaning: protocol for a randomized controlled trial. BMC Public Health 2022; 22:1074. [PMID: 35641925 PMCID: PMC9158367 DOI: 10.1186/s12889-022-13427-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 05/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Effective smoking cessation programs exist but are underutilized by smokers, especially by disadvantaged smokers. Cessation interventions in dental settings have been shown to be effective, but are not consistently delivered due to provider burden and lack of training, especially on how to counsel smokers who are not motivated to quit. METHODS This study is a 2-arm, phase III longitudinal randomized controlled efficacy trial to motivate utilization of evidenced based treatments (EBTs) for smoking cessation (e.g., state quitline, clinic-based counseling, the National Cancer Institute's text message program, and pharmacotherapy). Patients attending an urban dental clinic (n = 376) will be randomized to an intervention group (INT; smoking cessation induction video delivered via VR headset during their teeth cleaning, brochure about EBTs, and a 4-week text message program) or control group (CTRL; relaxation video delivered via VR headset during teeth cleaning, the same brochure as INT, and assessment-only text messages). Assessments will occur at baseline, immediately after the clinic appointment, one-month post-appointment and 3-and 6 months later. We hypothesize INT will be more likely to contact EBTs vs CTRL and have greater utilization rates of EBTs. Secondary objectives are to test the efficacy of INT on point-prevalence smoking abstinence, quit smoking attempts, and motivation to quit vs. CTRL. DISCUSSION Incorporating smoking cessation into a dental clinic visit and targeting all smokers, regardless of motivation to quit, provides proactive reach to cigarette smokers who otherwise may not seek treatment for smoking. TRIAL REGISTRATION NCT04524533 Registered August 24, 2020.
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Affiliation(s)
- B Borrelli
- Center for Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University, 560 Harrison Avenue, 3rd Floor, Boston, MA, 02118, USA.
| | - R Endrighi
- Center for Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University, 560 Harrison Avenue, 3rd Floor, Boston, MA, 02118, USA
| | - M M Jurasic
- Department of General Dentistry and Health Policy and Health Services Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA
| | - H Hernandez
- Center for Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University, 560 Harrison Avenue, 3rd Floor, Boston, MA, 02118, USA
| | - E Jones
- Center for Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University, 560 Harrison Avenue, 3rd Floor, Boston, MA, 02118, USA
| | - J Ospina
- Center for Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University, 560 Harrison Avenue, 3rd Floor, Boston, MA, 02118, USA
| | - H J Cabral
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA, 02118, USA
| | - L M Quintiliani
- Section of General Internal Medicine, School of Medicine, Boston University, Boston Medical Center, Boston, MA, 02118, USA
| | - S Werntz
- President, Agile Health, Inc, Lincolnshire, IL, 60069, USA
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207
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Businelle MS, Garey L, Gallagher MW, Hébert ET, Vujanovic A, Alexander A, Kezbers K, Matoska C, Robison J, Montgomery A, Zvolensky MJ. An Integrated mHealth App for Smoking Cessation in Black Smokers With Anxiety: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e38905. [PMID: 35635746 PMCID: PMC9153912 DOI: 10.2196/38905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 04/24/2022] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Black smokers have greater difficulty in quitting and higher rates of smoking-related diseases and disabilities than the general population. The smoking disparities experienced by this group are, in part, a consequence of multiple chronic life stressors (eg, racial discrimination) that engender increased exposure to interoceptive stress symptoms (eg, anxiety), which can ultimately lead to smoking as a means of immediate emotion regulation. OBJECTIVE This study aimed to culturally adapt and initially test a novel mobile intervention (ie, Mobile Anxiety Sensitivity Program for Smoking [MASP]) that targets anxiety sensitivity (AS; a proxy for difficulty and responsivity to interoceptive stress) among Black smokers. The MASP intervention is culturally informed to address interoceptive stress management difficulties among Black smokers and is thus hypothesized to facilitate smoking cessation. METHODS In phase 1, a total of 25 Black smokers with elevated AS will be administered MASP for 6 weeks. Following the completion of phase 1, we will further refine the MASP based on qualitative and quantitative data from participants to produce the final MASP iteration. In phase 2, a total of 200 Black smokers with elevated AS will be enrolled and randomly assigned to receive nicotine replacement therapy and either the smartphone-based National Cancer Institute QuitGuide app for standard mobile smoking cessation treatment or the MASP intervention. All participants in phases 1 and 2 will be enrolled remotely and will complete a web-based study screener; smartphone-based baseline assessment; daily smartphone-based ecological momentary assessments for 6 weeks; phone-based end-of-treatment qualitative interviews; and smartphone-based follow-up assessments at postbaseline weeks 1, 2 (quit date), 3, 4, 5, 6, 28, and 54 (weeks 28 and 54 follow-ups will be completed by phase 2 participants only). The MASP intervention is intended to offset barriers to treatment and encourage treatment engagement via smartphones. RESULTS This project was funded in September 2020. Phase 1 data collection began in January 2022. Phase 2 data collection is scheduled to begin in July 2022. CONCLUSIONS If successful, data from this study will support culturally informed treatment approaches for Black smokers and, pending findings of efficacy, provide an evidence-based mobile intervention for smoking cessation that is ready for dissemination and implementation. TRIAL REGISTRATION ClinicalTrials.gov NCT04838236; https://clinicaltrials.gov/ct2/show/NCT04838236. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/38905.
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Affiliation(s)
- Michael S Businelle
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- HEALTH Institute, University of Houston, Houston, TX, United States
| | - Lorra Garey
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Matthew W Gallagher
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
- Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, TX, United States
| | - Emily T Hébert
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Austin, TX, United States
| | - Anka Vujanovic
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Adam Alexander
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Krista Kezbers
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Cameron Matoska
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Jillian Robison
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Audrey Montgomery
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Michael J Zvolensky
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
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208
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Vickerman KA, Carpenter KM, Miles LN, Hsu JM, Watt KA, Brandon TH, Hart JT, Javitz HS, Wagener TL. A randomized pilot of a tailored smoking cessation quitline intervention for individuals who smoke and vape. Nicotine Tob Res 2022; 24:1811-1820. [PMID: 35575085 DOI: 10.1093/ntr/ntac129] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 02/09/2022] [Accepted: 05/13/2022] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Although e-cigarettes are not a federally approved tobacco cessation aid in the US, many smokers use them to quit or cut down on smoking. Tailored behavioral support could improve rates of complete smoking cessation for those individuals. A novel behavioral treatment to help dual cigarette and e-cigarette users quit smoking was tested in a randomized pilot with a state tobacco quitline. METHOD 96 dual users of cigarettes and e-cigarettes were recruited from incoming state quitline callers and randomized to receive enhanced e-cigarette coaching (EEC) or quitline treatment as usual (TAU) to examine EEC feasibility and acceptability. Outcomes at 3 months were treatment satisfaction, engagement, beliefs, and smoking cessation. This pilot was not powered to detect differences in quit rates. RESULTS 69% responded to the 3-month survey. EEC treatment satisfaction was noninferior to TAU: 93.8% (30/32) of EEC and 73.5% (25/34) of TAU reported being "very satisfied" or "satisfied" with treatment. EEC participants completed more coaching calls than TAU (M=3.4 vs. M=2.7, p=0.03), and the majority in both groups elected to receive nicotine replacement therapy (EEC: 100%, TAU: 94%, p=0.24). With missing data imputed as smoking, intent to treat 7-day point prevalence smoking abstinence rates were 41.3% (19/46) for EEC and 28.0% (14/50) for TAU, p=0.20. CONCLUSIONS The EEC quitline intervention for dual cigarette and e-cigarette users demonstrated high levels of treatment satisfaction and engagement. This pilot was not powered to detect significant differences in smoking cessation; however, cessation rates were promising and warrant evaluation in a fully powered trial. IMPLICATIONS If this scalable behavioral treatment to help dual cigarette and e-cigarette users quit smoking proves to be effective in a larger trial, quitlines could implement this harm reduction approach to improve outcomes for callers who already use e-cigarettes and are planning to use them while quitting smoking.
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Affiliation(s)
| | | | | | | | - Karen A Watt
- Optum Health, 11000 Optum Circle, Eden Prairie, MN
| | - Thomas H Brandon
- H Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa FL
| | - Jonathan T Hart
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK
| | | | - Theodore L Wagener
- Ohio State University Comprehensive Cancer Center, Wexner Medical Center, 3650 Olentangy River Rd, Columbus, OH
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Caron KT, Zhu W, Bernert JT, Wang L, Blount BC, Dortch K, Hunter RE, Harmon T, Akins JR, Tsai J, Homa DM, Pirkle JL, Sosnoff CS. Geometric Mean Serum Cotinine Concentrations Confirm a Continued Decline in Secondhand Smoke Exposure among U.S. Nonsmokers-NHANES 2003 to 2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105862. [PMID: 35627398 PMCID: PMC9140715 DOI: 10.3390/ijerph19105862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 11/16/2022]
Abstract
The objective of this study was to examine long-term trends in serum cotinine (COT) concentrations, as a measure of secondhand smoke (SHS) exposure, in U.S. nonsmokers using data from the National Health and Nutrition Examination Surveys (NHANES) from 2003 to 2018. We analyzed NHANES serum COT results from 8 continuous NHANES 2 year cycles from 2003 to 2018 using a liquid chromatography−tandem mass spectrometry assay that has been maintained continuously at the Centers for Disease Control and Prevention (CDC) since 1992. Serum COT concentrations (based on the geometric means) among nonsmokers in the U.S. decreased by an average of 11.0% (95% confidence interval (CI) [8.8%, 13.1%]; p < 0.0001) every 2 year cycle. From 2003 to 2018, serum COT concentrations in U.S. nonsmokers declined by 55.0%, from 0.065 ng/mL in 2003−2004 to 0.029 ng/mL in 2017−2018 (p < 0.0001). Significant decreases in serum COT concentrations were observed in all demographic groups. While disparities between these groups seems to be shrinking over time, several previously observed disparities in SHS exposure remain in 2017−2018. Serum COT concentrations of the non-Hispanic Black population remained higher than those of non-Hispanic Whites and Mexican Americans (p < 0.0001). Additionally, serum COT concentrations were significantly higher for children aged 3−5 years than other age groups (p ≤ 0.0002), and men continued to have significantly higher serum COT concentrations than women (p = 0.0384). While there is no safe level of exposure to SHS, the decrease in serum COT concentrations in the U.S. population as well as across demographic groupings represents a positive public health outcome and supports the importance of comprehensive smoke-free laws and policies for workplaces, public places, homes, and vehicles to protect nonsmokers from SHS exposure.
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Affiliation(s)
- Kevin T. Caron
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; (W.Z.); (J.T.B.); (L.W.); (B.C.B.); (K.D.); (R.E.H.); (T.H.); (J.R.A.); (J.L.P.); (C.S.S.)
- Correspondence: ; Tel.: +1-(770)-488-7648
| | - Wanzhe Zhu
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; (W.Z.); (J.T.B.); (L.W.); (B.C.B.); (K.D.); (R.E.H.); (T.H.); (J.R.A.); (J.L.P.); (C.S.S.)
| | - John T. Bernert
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; (W.Z.); (J.T.B.); (L.W.); (B.C.B.); (K.D.); (R.E.H.); (T.H.); (J.R.A.); (J.L.P.); (C.S.S.)
| | - Lanqing Wang
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; (W.Z.); (J.T.B.); (L.W.); (B.C.B.); (K.D.); (R.E.H.); (T.H.); (J.R.A.); (J.L.P.); (C.S.S.)
| | - Benjamin C. Blount
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; (W.Z.); (J.T.B.); (L.W.); (B.C.B.); (K.D.); (R.E.H.); (T.H.); (J.R.A.); (J.L.P.); (C.S.S.)
| | - Kristin Dortch
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; (W.Z.); (J.T.B.); (L.W.); (B.C.B.); (K.D.); (R.E.H.); (T.H.); (J.R.A.); (J.L.P.); (C.S.S.)
| | - Ronald E. Hunter
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; (W.Z.); (J.T.B.); (L.W.); (B.C.B.); (K.D.); (R.E.H.); (T.H.); (J.R.A.); (J.L.P.); (C.S.S.)
| | - Tia Harmon
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; (W.Z.); (J.T.B.); (L.W.); (B.C.B.); (K.D.); (R.E.H.); (T.H.); (J.R.A.); (J.L.P.); (C.S.S.)
| | - J. Ricky Akins
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; (W.Z.); (J.T.B.); (L.W.); (B.C.B.); (K.D.); (R.E.H.); (T.H.); (J.R.A.); (J.L.P.); (C.S.S.)
| | - James Tsai
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; (J.T.); (D.M.H.)
| | - David M. Homa
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; (J.T.); (D.M.H.)
| | - James L. Pirkle
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; (W.Z.); (J.T.B.); (L.W.); (B.C.B.); (K.D.); (R.E.H.); (T.H.); (J.R.A.); (J.L.P.); (C.S.S.)
| | - Connie S. Sosnoff
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; (W.Z.); (J.T.B.); (L.W.); (B.C.B.); (K.D.); (R.E.H.); (T.H.); (J.R.A.); (J.L.P.); (C.S.S.)
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210
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Triyana M, White JS. Non-monetary incentives for tobacco prevention among youth in Indonesia. JOURNAL OF HEALTH ECONOMICS 2022; 83:102620. [PMID: 35487104 DOI: 10.1016/j.jhealeco.2022.102620] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 02/25/2022] [Accepted: 03/31/2022] [Indexed: 06/14/2023]
Abstract
We provide evidence on the effectiveness of a school-based program that uses a non-monetary penalty and regular monitoring to prevent risky behavior among adolescents in Indonesia. The field experiment invited students to sign a pledge to abstain from tobacco use and a similar pledge for parents to monitor their children. To test group incentives, a subset of treated schools also competed against each other for the highest tobacco abstinence rates. We find that the individual pledge increases biochemically verified tobacco abstinence by 5 percentage points. This effect is sustained 3 months after the program ended. School competition has no additional impact on tobacco abstinence. Our findings highlight the effectiveness of non-monetary incentives to curb risky behaviors among adolescents who face limited self-control and peer pressure.
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Affiliation(s)
| | - Justin S White
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, United States.
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211
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Hajek P, Przulj D, Pesola F, Griffiths C, Walton R, McRobbie H, Coleman T, Lewis S, Whitemore R, Clark M, Ussher M, Sinclair L, Seager E, Cooper S, Bauld L, Naughton F, Sasieni P, Manyonda I, Myers Smith K. Electronic cigarettes versus nicotine patches for smoking cessation in pregnancy: a randomized controlled trial. Nat Med 2022; 28:958-964. [PMID: 35577966 PMCID: PMC9117131 DOI: 10.1038/s41591-022-01808-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 03/31/2022] [Indexed: 01/26/2023]
Abstract
Nicotine replacement therapy, in the form of nicotine patches, is commonly offered to pregnant women who smoke to help them to stop smoking, but this approach has limited efficacy in this population. Electronic cigarettes (e-cigarettes) are also used by pregnant women who smoke but their safety and efficacy in pregnancy are unknown. Here, we report the results of a randomized controlled trial in 1,140 participants comparing refillable e-cigarettes with nicotine patches. Pregnant women who smoked were randomized to e-cigarettes (n = 569) or nicotine patches (n = 571). In the unadjusted analysis of the primary outcome, validated prolonged quit rates at the end of pregnancy in the two study arms were not significantly different (6.8% versus 4.4% in the e-cigarette and patch arms, respectively; relative risk (RR) = 1.55, 95%CI: 0.95-2.53, P = 0.08). However, some participants in the nicotine patch group also used e-cigarettes during the study. In a pre-specified sensitivity analysis excluding abstinent participants who used non-allocated products, e-cigarettes were more effective than patches (6.8% versus 3.6%; RR = 1.93, 95%CI: 1.14-3.26, P = 0.02). Safety outcomes included adverse events and maternal and birth outcomes. The safety profile was found to be similar for both study products, however, low birthweight (<2,500 g) was less frequent in the e-cigarette arm (14.8% versus 9.6%; RR = 0.65, 95%CI: 0.47-0.90, P = 0.01). Other adverse events and birth outcomes were similar in the two study arms. E-cigarettes might help women who are pregnant to stop smoking, and their safety for use in pregnancy is similar to that of nicotine patches. ISRCTN62025374.
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Affiliation(s)
- Peter Hajek
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Dunja Przulj
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Francesca Pesola
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
| | - Chris Griffiths
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Robert Walton
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Hayden McRobbie
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Tim Coleman
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Sarah Lewis
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Rachel Whitemore
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Miranda Clark
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Michael Ussher
- Division of Population Heath Sciences and Education, St Georges, University of London, London, UK
- Institute of Social Marketing and Health, University of Stirling, Stirling, UK
| | - Lesley Sinclair
- Usher Institute and SPECTRUM Consortium, University of Edinburgh, Edinburgh, UK
| | - Emily Seager
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Sue Cooper
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Linda Bauld
- Usher Institute and SPECTRUM Consortium, University of Edinburgh, Edinburgh, UK
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Peter Sasieni
- The Cancer Research UK and King's College London Cancer Prevention Trials Unit, King's College, London, UK
| | | | - Katie Myers Smith
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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212
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Objective measure of smoking status highlights disparities by sex. AMERICAN HEART JOURNAL PLUS: CARDIOLOGY RESEARCH AND PRACTICE 2022; 17. [PMID: 35937642 PMCID: PMC9351394 DOI: 10.1016/j.ahjo.2022.100171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Current smoking is the strongest predictor of future morbidity and mortality in those with cardiovascular disease, yet clinically, smoking status is usually ascertained through self-report. We objectively measured smoking status, using exhaled carbon monoxide (CO), for 1122 consecutive patients entering cardiac rehabilitation. Within those with elevated CO levels (≥4 ppm), females had CO levels almost twice that of males (20.4 vs. 11.6), suggesting higher amounts of smoking.
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213
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Chaffee BW, Halpern-Felsher B, Jacob P, St Helen G. Biomarkers of nicotine exposure correlate with the Hooked on Nicotine Checklist among adolescents in California, United States. Addict Behav 2022; 128:107235. [PMID: 35033980 PMCID: PMC8897155 DOI: 10.1016/j.addbeh.2022.107235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 12/15/2021] [Accepted: 01/06/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Hooked on Nicotine Checklist (HONC) has been used to assess nicotine dependence (loss of autonomy over tobacco) among adolescents. Existing HONC validation studies for non-cigarette products, such as electronic cigarettes (e-cigarettes), have generally not considered biomarkers of nicotine exposure. METHODS Within a cross-sectional sample of California (USA) high school students (total N = 1396; mean age 15.2 years; 56% female; 54% Hispanic/Latinx), self-reported past 30-day users of any tobacco (including e-cigarettes) completed a modified 10-item HONC questionnaire and provided saliva samples (N = 318 samples, including N = 234 exclusive past 30-day e-cigarette users). Samples were analyzed for cotinine using liquid chromatography-tandem mass spectrometry (lower limit of quantification: 1.0 ng/mL). RESULTS Across four categories of HONC score corresponding to an increasing number of reported dependence symptoms (scores: 0, 1, 2-4, 5-10), the prevalence of quantifiable salivary cotinine increased among past 30-day tobacco users (20%, 21%, 38%, 55%, respectively, P-for-trend < 0.001) and among past 30-day exclusive e-cigarette users (15%, 22%, 31%, 42%, respectively, P-for-trend = 0.001). Among participants with quantifiable cotinine levels, HONC total score and cotinine were positively correlated among past 30-day tobacco users (n = 89; Spearman rho = 0.449; P < 0.001) and past 30-day exclusive e-cigarette users (n = 49; Spearman rho = 0.520; P < 0.001). HONC score was also associated with past 30-day frequency of tobacco product use and reported use of tobacco within 30 min of waking. CONCLUSIONS These results support the validity of HONC to assess nicotine dependence among adolescents. Dependence symptoms may be experienced at low levels of nicotine exposure.
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214
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Heffner JL, McClure JB. Commentary on Graham et al.: Biochemical verification of abstinence in remotely conducted smoking cessation trials should not be a universal design requirement for rigor. Addiction 2022; 117:1047-1048. [PMID: 35083798 DOI: 10.1111/add.15803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Jaimee L Heffner
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Jennifer B McClure
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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215
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Graham AL, Papandonatos GD, Cha S, Amato MS, Jacobs MA, Cohn AM, Abroms LC, Whittaker R. Effectiveness of an optimized text message and Internet intervention for smoking cessation: A randomized controlled trial. Addiction 2022; 117:1035-1046. [PMID: 34472676 PMCID: PMC9293135 DOI: 10.1111/add.15677] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 08/11/2021] [Indexed: 01/08/2023]
Abstract
AIMS To evaluate the effectiveness of a combined internet and text message intervention for smoking cessation compared with an internet intervention alone. The text message intervention was optimized for engagement in an earlier multiphase optimization (MOST) screening phase. DESIGN A parallel, two-group, individually randomized clinical trial (RCT) was conducted in a MOST confirming phase. Recruitment spanned December 2018 to March 2019. Follow-up was conducted at 3 and 9 months, beginning March 2019 and ending January 2020. SETTING United States: a digital study conducted among new registrants on a free tobacco cessation website. PARTICIPANTS Eligible individuals were 618 adult current smokers in the United States, age 18 years or older who signed up for text messages during website registration (67.2% female, 70.4% white). INTERVENTIONS The treatment arm (WEB+TXT; n = 311) received access to the website and text messaging. The control arm (WEB; n = 307) received access to the website alone. MEASUREMENTS The primary outcome was self-reported 30-day point prevalence abstinence (ppa) at 9 months post-randomization analyzed under intent to treat (ITT), counting non-responders as smoking. Secondary outcomes included 3-month measures of 30-day ppa, intervention engagement and intervention satisfaction. FINDINGS Abstinence rates at 9 months were 23.1% among WEB+TXT and 23.2% among WEB (OR = 1.00, 95% CI = 0.69-1.45; P = 0.99). WEB+TXT increased engagement with 5 of 6 interactive features (standardized mean difference (SMD) = 0.26-0.47, all P < 0.001) and repeat website visits (48.7% vs 38.9%, SMD = 0.14, P = 0.02). Satisfaction metrics favored WEB+TXT (satisfied: 96.3% vs 90.5%, SMD = 0.17, P = 0.008; recommend to friend: 95.9% vs 90.1%, SMD = 0.16, P = 0.028). CONCLUSIONS A randomized controlled trial found no evidence that a combined internet and text message intervention for smoking cessation compared with an internet intervention alone increased 9-month abstinence rates among adult current smokers in the United States, despite evidence of higher levels of intervention engagement and satisfaction at 3 months.
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Affiliation(s)
- Amanda L. Graham
- Innovations Center, Truth InitiativeWashingtonDCUSA,Department of MedicineMayo Clinic College of Medicine and ScienceRochesterMNUSA
| | | | - Sarah Cha
- Innovations Center, Truth InitiativeWashingtonDCUSA
| | - Michael S. Amato
- Innovations Center, Truth InitiativeWashingtonDCUSA,Department of MedicineMayo Clinic College of Medicine and ScienceRochesterMNUSA
| | | | - Amy M. Cohn
- Health Promotion Research CenterUniversity of Oklahoma Health Sciences CenterOklahoma CityOKUSA,Department of Pediatrics, Children's HospitalUniversity of Oklahoma Health Sciences CenterOklahoma CityOKUSA
| | - Lorien C. Abroms
- Department of Prevention and Community Health, Milken Institute School of Public HealthThe George Washington UniversityWashingtonDCUSA
| | - Robyn Whittaker
- National Institute for Health InnovationUniversity of AucklandAucklandNew Zealand
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216
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Thomas KH, Dalili MN, López‐López JA, Keeney E, Phillippo DM, Munafò MR, Stevenson M, Caldwell DM, Welton NJ. Comparative clinical effectiveness and safety of tobacco cessation pharmacotherapies and electronic cigarettes: a systematic review and network meta-analysis of randomized controlled trials. Addiction 2022; 117:861-876. [PMID: 34636108 PMCID: PMC9293179 DOI: 10.1111/add.15675] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 08/11/2021] [Indexed: 12/27/2022]
Abstract
AIM To determine how varenicline, bupropion, nicotine replacement therapy (NRT) and electronic cigarettes compare with respect to their clinical effectiveness and safety. METHOD Systematic reviews and Bayesian network meta-analyses of randomized controlled trials, in any setting, of varenicline, bupropion, NRT and e-cigarettes (in high, standard and low doses, alone or in combination) in adult smokers and smokeless tobacco users with follow-up duration of 24 weeks or greater (effectiveness) or any duration (safety). Nine databases were searched until 19 February 2019. Primary outcomes were sustained tobacco abstinence and serious adverse events (SAEs). We estimated odds ratios (ORs) and treatment rankings and conducted meta-regression to explore covariates. RESULTS We identified 363 trials for effectiveness and 355 for safety. Most monotherapies and combination therapies were more effective than placebo at helping participants to achieve sustained abstinence; the most effective of these, estimated with some imprecision, were varenicline standard [OR = 2.83, 95% credible interval (CrI) = 2.34-3.39] and varenicline standard + NRT standard (OR = 5.75, 95% CrI = 2.27-14.88). Estimates were higher in smokers receiving counselling than in those without and in studies with higher baseline nicotine dependence scores than in those with lower scores. Varenicline standard + NRT standard showed a high probability of being ranked best or second-best. For safety, only bupropion at standard dose increased the odds of experiencing SAEs compared with placebo (OR = 1.27, 95% CrI = 1.04-1.58), and we found no evidence of effect modification. CONCLUSIONS Most tobacco cessation monotherapies and combination therapies are more effective than placebo at helping participants to achieve sustained abstinence, with varenicline appearing to be most effective based on current evidence. There does not appear to be strong evidence of associations between most tobacco cessation pharmacotherapies and adverse events; however, the data are limited and there is a need for improved reporting of safety data.
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Affiliation(s)
- Kyla H. Thomas
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolUK
| | - Michael N. Dalili
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolUK
| | - José A. López‐López
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolUK,Department of Basic Psychology and Methodology, Faculty of PsychologyUniversity of MurciaMurciaSpain
| | - Edna Keeney
- Statistical and Health Economic Modelling, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - David M. Phillippo
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolUK
| | - Marcus R. Munafò
- School of Psychological ScienceUniversity of BristolBristolUK,MRC Integrative Epidemiology Unit at the University of BristolBristolUK
| | - Matt Stevenson
- Health Economics and Decision Science, School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | | | - Nicky J. Welton
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolUK
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217
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Santiago-Torres M, Mull KE, Sullivan BM, Ferketich AK, Bricker JB. Efficacy of an acceptance and commitment therapy-based smartphone application for helping rural populations quit smoking: Results from the iCanQuit randomized trial. Prev Med 2022; 157:107008. [PMID: 35257698 PMCID: PMC9793445 DOI: 10.1016/j.ypmed.2022.107008] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 02/22/2022] [Accepted: 02/26/2022] [Indexed: 12/30/2022]
Abstract
Limited access to evidence-based smoking cessation interventions among rural populations contributes to high rates of cigarette smoking and poor cessation outcomes. Yet, accessible digital interventions for cessation focusing on rural populations are lacking. In a secondary analysis, we determined the acceptability and efficacy of an Acceptance and Commitment Therapy (ACT)-based smartphone application (iCanQuit) relative to a U.S. Clinical Practice Guidelines (USCPG)-based smartphone application (QuitGuide) for smoking cessation among rural participants enrolled in the two-arm randomized iCanQuit trial. Participants were enrolled between May 2017 and September 2018 and randomized to either receive iCanQuit or QuitGuide for 12-months. Rural residence was determined by sub-county level Rural-Urban Commuting Area codes. A total of 550 rural participants were recruited from 43 U.S. states. Self-reported complete-case 30-day point-prevalence abstinence was 15% (33/226) for iCanQuit vs. 9% (22/253) for QuitGuide at 3-months (OR = 1.83; 95% CI: 1.03, 3.25) and 29% (66/231) for iCanQuit vs. 25% (64/288) for QuitGuide at 12-months (OR = 1.19 95% CI: 0.80, 1.79). Retention rate was 89% at 12-months and did not differ by arm. iCanQuit vs. QuitGuide participants were significantly more engaged and satisfied with the iCanQuit application. Increased acceptance of internal cues to smoke mediated the effect of treatment on cessation. Findings suggest that iCanQuit had significantly higher short-term quit rates, descriptively higher long-term quit rates, and operated through its hypothesized mechanisms of action relative to QuitGuide. Future larger studies are needed to further evaluate the efficacy of and methods for disseminating the iCanQuit application for smoking cessation among U.S. rural adults nationwide. Trial registrationClinicalTrials.gov Identifier: NCT02724462.
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Affiliation(s)
- Margarita Santiago-Torres
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N., Seattle, WA 98109, USA.
| | - Kristin E Mull
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N., Seattle, WA 98109, USA
| | - Brianna M Sullivan
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N., Seattle, WA 98109, USA
| | - Amy K Ferketich
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Jonathan B Bricker
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N., Seattle, WA 98109, USA; University of Washington, Department of Psychology, Box 351525, Seattle, WA 98195, USA
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218
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Coleman T, Clark M, Welch C, Whitemore R, Leonardi-Bee J, Cooper S, Hewitt C, Jones M, Sutton S, Watson J, Daykin K, Ussher M, Parrott S, Naughton F. Effectiveness of offering tailored text message, self-help smoking cessation support to pregnant women who want information on stopping smoking: MiQuit3 randomised controlled trial and meta-analysis. Addiction 2022; 117:1079-1094. [PMID: 34636086 DOI: 10.1111/add.15715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 09/22/2021] [Indexed: 11/27/2022]
Abstract
AIMS To test the efficacy of 'MiQuit', a tailored, self-help, text message stop smoking programme for pregnancy, as an adjunct to usual care (UC) for smoking cessation in pregnancy. DESIGN Multicentre, open, two-arm, parallel-group, superiority randomised controlled trial (RCT) and a trial sequential analysis (TSA) meta-analysis combining trial findings with two previous ones. SETTING Twenty-four English hospital antenatal clinics. PARTICIPANTS A total of 1002 pregnant women who were ≥16 years old, were ≤25 weeks gestation and smoked ≥1 daily cigarette and accepted information on cessation with no requirement to set quit dates. INTERVENTIONS UC or UC plus 'MiQuit': 12 weeks of tailored, smoking cessation text messages focussed on inducing and aiding cessation. MEASUREMENTS Primary outcome: biochemically validated cessation between 4 weeks after randomisation and late pregnancy. SECONDARY OUTCOMES shorter and non-validated abstinence periods, pregnancy outcomes and incremental cost-effectiveness ratios. FINDINGS RCT: cessation was 5.19% (26/501) and 4.59% (23/501) in MiQuit and UC groups (adjusted odds ratio [adj OR] for quitting with MiQuit versus UC, 95% CI = 1.15 [0.65-2.04]); other abstinence findings were similar, with higher point estimates. Primary outcome ascertainment was 61.7% (309) and 67.3% (337) in MiQuit and UC groups with 71.1% (54/76) and 69.5% (41/59) abstinence validation rates, respectively. Pregnancy outcomes were similar and the incremental cost per quality-adjusted life year was -£1118 (95% CI = -£4806-£1911). More MiQuit group women reported making at least one quit attempt (adj OR [95% CI]) for making an attempt, 1.50 (1.07-2.09). TSA meta-analysis: this found no significant difference in prolonged abstinence between MiQuit and UC (pooled OR = 1.49, adjusted 95% CI = 0.62-3.60). CONCLUSIONS Irrespective of whether they want to try quitting, when offered a tailored, self-help, text message stop smoking programme for pregnancy (MiQuit) as an adjunct to usual care, pregnant women are not more likely to stop smoking until childbirth but they report more attempts at stopping smoking.
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Affiliation(s)
- Tim Coleman
- Centre for Academic Primary Care, Medical School, University of Nottingham, Nottingham, Nottinghamshire, England
| | - Miranda Clark
- Centre for Academic Primary Care, Medical School, University of Nottingham, Nottingham, Nottinghamshire, England
| | - Charlie Welch
- York Trials Unit, University of York, York, Yorkshire, England
| | - Rachel Whitemore
- Centre for Academic Primary Care, Medical School, University of Nottingham, Nottingham, Nottinghamshire, England
| | - Jo Leonardi-Bee
- Division of Epidemiology and Public Health, Clinical Sciences Building, University of Nottingham, Nottingham, Nottinghamshire, England
| | - Sue Cooper
- Centre for Academic Primary Care, Medical School, University of Nottingham, Nottingham, Nottinghamshire, England
| | | | - Matthew Jones
- Centre for Academic Primary Care, Medical School, University of Nottingham, Nottingham, Nottinghamshire, England
| | - Stephen Sutton
- Institute of Public Health, University of Cambridge, Cambridge, Cambridgeshire, England
| | - Judith Watson
- York Trials Unit, University of York, York, Yorkshire, England
| | - Karen Daykin
- Centre for Academic Primary Care, Medical School, University of Nottingham, Nottingham, Nottinghamshire, England
| | - Michael Ussher
- Population Health Research Institute, St. George's, University of London, London, England.,Institute for Social Marketing and Health, University of Stirling, Stirling, Stirlingshire, Scotland
| | - Steve Parrott
- York Trials Unit, University of York, York, Yorkshire, England
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, Norfolk, England
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219
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Saroj SK, Bhardwaj T. Non-pharmacological interventions for tobacco cessation: A systematic review of existing practices and their effectiveness. Monaldi Arch Chest Dis 2022; 92. [PMID: 35347975 DOI: 10.4081/monaldi.2022.2229] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/08/2022] [Indexed: 11/23/2022] Open
Abstract
Smoking tobacco is associated with lung cancer and other life-threatening diseases which requires serious action to curb it. Tobacco cessation interventions are available as pharmacological and non-pharmacological methods or a combination of both. The present review examines the effectiveness of the existing non-pharmacological tobacco cessation interventions and synthesizes the result for the future development of drug-free treatment in the community for tobacco cessation. The literature search was conducted in August 2020, using two electronic databases (PubMed and JSTOR), with search terms: ['tobacco cessation' OR 'smoking cessation'] AND ['intervention'] which included studies published during 2010 and 2020 (till 31st July 2020). All studies were limited to English language, human participants and excluded patients with comorbidities. A total of 2,114 publications were retrieved out of which 11 articles were reviewed. On the basis of intervention used in reviewed studies, we categorized them into seven categories: i. incentive-based intervention, ii. exercise based, iii. telephone-based proactive counselling, iv. mobile phone SMS (Short Message Service) based, v. smartphone app (application) based, vi. web-based intervention, vii. self-help material. Incentives were provided in most of the studies to maintain the retention rate and motivate the participants for completing follow-up. Non-pharmacological interventions for tobacco cessation include a combination of various elements. Our findings suggest that behavioural counselling is one of the most important elements of any non-pharmacological intervention. In addition to behaviour counselling, yoga and exercises along with self-help material, video and phone counselling may have higher efficacy. Thus, practicing non-pharmacological interventions may also increase the cessation rate and reduce the tobacco use burden.
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Affiliation(s)
| | - Tushti Bhardwaj
- Social Work Department, Dr. B. R. Ambedkar College, University of Delhi, New Delhi.
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Short-term smoking increases the risk of insulin resistance. Sci Rep 2022; 12:3550. [PMID: 35241770 PMCID: PMC8894492 DOI: 10.1038/s41598-022-07626-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/22/2022] [Indexed: 11/08/2022] Open
Abstract
Insulin resistance can be affected directly or indirectly by smoking. This cross-sectional study aimed at examining the association between smoking patterns and insulin resistance using objective biomarkers. Data from 4043 participants sourced from the Korea National Health and Nutrition Examination Survey, conducted from 2016 to 2018, were examined. Short-term smoking patterns were used to classify participants according to urine levels of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol and cotinine as continuous-smokers, past-smokers, current-smokers, and non-smokers. Insulin resistance was calculated using the triglyceride-glucose index from blood samples and was defined as either high or low. Multiple logistic regression analysis was performed to investigate the association between smoking behavior and insulin resistance. Men and women who were continuous-smokers (men: odds ratio [OR] = 1.74, p = 0.001; women: OR = 2.01, p = 0.001) and past-smokers (men: OR = 1.47, p = 0.033; women: OR = 1.37, p = 0.050) were more likely to have high insulin resistance than their non-smoking counterparts. Long-term smokers (≥ 40 days) are at an increased risk of insulin resistance in short-term smoking patterns. Smoking cessation may protect against insulin resistance. Therefore, first-time smokers should be educated about the health benefits of quitting smoking.
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221
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Ramos GG, Sussman S, Moerner L, Unger JB, Soto C. Project SUN: Pilot Study of a Culturally Adapted Smoking Cessation Curriculum for American Indian Youth. JOURNAL OF DRUG EDUCATION 2022; 51:10-31. [PMID: 35788160 DOI: 10.1177/00472379221111542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
American Indian Alaska Native (AIAN) youth have disproportionately higher rates of commercial tobacco product use compared to other racial and ethnic groups in the U.S. These rates underscore a need for commercial tobacco product cessation interventions that are culturally informed. This project studied the development, implementation, and some impact data of an adapted version of Project EX, an evidence-based intervention for teen smoking cessation. Implementation challenges resulted in a change from a three-arm to a single-arm trial with 37 AIAN youth who participated in an eight-week curriculum. Intent-to-treat analysis with biochemical validation results indicated that 32% (N = 12/37) of youth quit smoking at the three-month follow-up. Participants reported being satisfied with the program overall and enjoying the culturally adapted activities. This study detailed the program's adaptation and lessons learned during implementation.
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Affiliation(s)
| | - Steve Sussman
- 5116University of Southern California, Los Angeles, CA, USA
| | - Lou Moerner
- 5116University of Southern California, Los Angeles, CA, USA
| | | | - Claradina Soto
- 5116University of Southern California, Los Angeles, CA, USA
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De Aquino JP, MacLean RR, Gueorguieva R, DeVito EE, Eid T, Sofuoglu M. Impact of delivery rate on the acute response to intravenous nicotine: A human laboratory study with implications for regulatory science. Addict Biol 2022; 27:e13161. [PMID: 35229960 PMCID: PMC8903077 DOI: 10.1111/adb.13161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/29/2021] [Accepted: 02/03/2022] [Indexed: 12/19/2022]
Abstract
Faster delivery rate enhances the abuse potential of drugs of abuse, yet systematic studies on the impact of delivery rate on the acute effects of nicotine in humans are lacking. Using an intravenous (IV) nicotine infusion procedure that allows precise control of rate of delivery, we examined the impact of nicotine delivery rate on the positive subjective drug effects, smoking urges, withdrawal, heart rate, blood pressure and attention function in smokers. Twenty-four male and female (ages 21-35) dependent smokers attended five experimental sessions, following overnight abstinence from smoking. Using a crossover design, participants attended five sessions, where they were assigned to a random sequence of saline infusion or 1 mg nicotine delivered over 1, 2.5, 5 or 10 min at rates of 1, 0.4, 0.2 or 0.1 mg/min, respectively. The positive subjective effects of nicotine were most robust under the two faster delivery rate conditions, 1- and 0.4-mg nicotine/min. In contrast, all nicotine delivery rates were equally more effective than saline in alleviating urges to smoke. Likewise, nicotine-induced heart rate increases did not vary with the rate of nicotine delivery. Lastly, the cognitive enhancing effects of nicotine were observed only under the two slowest delivery rate conditions-0.1- and 0.2-mg nicotine/min. Collectively, these findings support the critical role of delivery rate in optimizing nicotine's abuse potential versus potential therapeutic effects and have timely implications for developing novel therapeutics for nicotine dependence, as well as for tobacco regulatory science.
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Affiliation(s)
- Joao P. De Aquino
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
- VA Connecticut Healthcare System, West Haven, CT
| | - R. Ross MacLean
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
- VA Connecticut Healthcare System, West Haven, CT
| | - Ralitza Gueorguieva
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT
| | - Elise E. DeVito
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Tore Eid
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT
| | - Mehmet Sofuoglu
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
- VA Connecticut Healthcare System, West Haven, CT
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Houston TK, Chen J, Amante DJ, Blok AC, Nagawa CS, Wijesundara JG, Kamberi A, Allison JJ, Person SD, Flahive J, Morley J, Conigliaro J, Mattocks KM, Garber L, Sadasivam RS. Effect of Technology-Assisted Brief Abstinence Game on Long-term Smoking Cessation in Individuals Not Yet Ready to Quit: A Randomized Clinical Trial. JAMA Intern Med 2022; 182:303-312. [PMID: 35072714 PMCID: PMC8787683 DOI: 10.1001/jamainternmed.2021.7866] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
IMPORTANCE Most trials of behavioral or pharmaceutical interventions for people who smoke are limited to individuals reporting they are ready to quit smoking. Engaging individuals who initially report they are not yet ready to quit in brief, precessation, skills-building interventions (eg, practice quit attempts or nicotine replacement therapy [NRT] sampling) is challenging. OBJECTIVE To test an integrated behavioral plus NRT-sampling intervention using a gamification approach supported by mobile health. DESIGN, SETTING, AND PARTICIPANTS A multisite randomized clinical trial with site-level 1-to-1 allocation into 2 conditions was conducted in 4 US health care systems. A total of 433 individuals who were currently smoking and reported at enrollment that they were not ready to quit smoking were enrolled. The study was conducted from November 7, 2016, to July 31, 2020. INTERVENTIONS Take a Break (TAB) was a 3-week game experience and included 5 behavioral components (motivational messaging, challenge quizzes, brief abstinence goal setting, mobile health apps for cravings management, and reward points for participation) integrated with NRT sampling. TAB draws on social cognitive theory and game mechanics concepts to engage participants in health behavior change. The comparison included NRT sampling only. MAIN OUTCOMES AND MEASURES Time to first quit attempt (duration from TAB experience to primary outcome) and carbon monoxide level-verified smoking cessation at 6-month follow-up. All analyses used an intention-to-treat approach. RESULTS Of the 433 individuals included in the trial, 223 were women (52%); mean (SD) age was 54 (13) years. More than half (53% [112 of 213]) of the TAB participants completed 100% of the daily challenge quizzes in the first week, 73% (145 of 199) of participants who completed the goal-setting call set a brief abstinence goal (most frequently 1-2 days of abstinence from cigarettes), and 75% (159 of 213) of participants used the mobile health apps to manage nicotine cravings. Time to the first quit attempt was lower for the TAB vs comparison group (hazard ratio, 1.68; 95% CI, 1.09-2.60; P = .02). At the 6-month follow-up, 18% (28 of 160) of TAB participants and 10% (17 of 171) of the comparison (χ2 test, P = .045) participants obtained carbon monoxide level-verified smoking cessation (accounting for clustering of outcomes by site; odds ratio, 1.92; 95% CI, 1.01-3.68; P = .048). CONCLUSIONS AND RELEVANCE The findings of this randomized clinical trial demonstrate that individuals not yet ready to quit smoking could be engaged in a brief abstinence game. Six months later, the TAB group had nearly double the rate of smoking cessation vs the NRT sampling comparison group. Integrating a skills-building game experience with brief NRT sampling can enhance long-term cessation among those not yet ready to quit smoking. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02973425.
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Affiliation(s)
- Thomas K Houston
- General Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jinying Chen
- Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
| | - Daniel J Amante
- Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
| | - Amanda C Blok
- Veterans Affairs (VA) Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Catherine S Nagawa
- Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
| | - Jessica G Wijesundara
- Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
| | - Ariana Kamberi
- Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
| | - Jeroan J Allison
- Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
| | - Sharina D Person
- Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
| | - Julie Flahive
- Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
| | - Jeanne Morley
- General Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Joseph Conigliaro
- General Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Kristin M Mattocks
- Research and Education, VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts
| | | | - Rajani S Sadasivam
- Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
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Mobile contingency management for smoking cessation among socioeconomically disadvantaged adults: Protocol for a randomized trial. Contemp Clin Trials 2022; 114:106701. [PMID: 35114409 PMCID: PMC9514803 DOI: 10.1016/j.cct.2022.106701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Smoking rates remain high among socioeconomically disadvantaged adults. Offering small escalating financial incentives for abstinence (i.e., contingency management [CM]), alongside clinic-based treatment dramatically increases cessation rates in this vulnerable population. However, innovative approaches are needed for those who are less able to attend office visits. The current study will evaluate an automated mobile phone-based CM approach that will allow socioeconomically disadvantaged individuals to remotely earn financial incentives for smoking cessation. METHODS The investigators have previously combined technologies, including 1) carbon monoxide monitors that connect with mobile phones to remotely verify abstinence, 2) facial recognition software to confirm identity during breath sample submissions, and 3) automated delivery of incentives triggered by biochemical abstinence confirmation. This automated CM approach will be evaluated in a randomized controlled trial of 532 low-income adults seeking cessation treatment. Participants will be randomly assigned to telephone counseling and nicotine replacement therapy (standard care [SC]) or SC plus mobile financial incentives (CM) for abstinence. RESULTS Biochemically-verified 7-day point prevalence abstinence at 26 weeks post-quit is the primary outcome. The cost-effectiveness of the interventions will be evaluated. Potential treatment mechanisms, including self-efficacy, motivation, and treatment engagement, will be explored to optimize future interventions. DISCUSSION Automated mobile CM may offer a low-cost approach to smoking cessation that can be combined with telephone counseling and pharmacological interventions. This approach represents a critical step toward the widespread dissemination of CM treatment to real-world settings, to reduce tobacco-related disease and disparities.
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225
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Palmer AM, Tomko RL, Squeglia LM, Gray KM, Carpenter MJ, Smith TT, Dahne J, Toll BA, McClure EA. A pilot feasibility study of a behavioral intervention for nicotine vaping cessation among young adults delivered via telehealth. Drug Alcohol Depend 2022; 232:109311. [PMID: 35123362 PMCID: PMC8885867 DOI: 10.1016/j.drugalcdep.2022.109311] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/14/2022] [Accepted: 01/15/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Nicotine vaping among youth has increased, warranting concern from tobacco control proponents. Many youth who vape indicate interest in quitting; however, few empirically supported vaping cessation interventions exist. This pilot feasibility study adapted an established behavioral intervention, contingency management (CM), delivered via telehealth to promote vaping cessation among young adults. METHODS Participants (N = 27; ages 17-21) vaping nicotine regularly were recruited via social media and digital advertisements from across the US (June 2020-January 2021). Participants were randomized at approximately 4:1 to CM or Monitoring control (22:5). CM was delivered through DynamiCare Health's smartphone app for 4 weeks, in which financial incentives were delivered contingent on abstinent cotinine samples after the quit day until the end of treatment (EOT; Days 7-28; 10 expected submissions). Control participants earned incentives for submitting cotinine, regardless of abstinence. Feasibility, acceptability, and abstinence was collected throughout treatment, at EOT, and at 1-month follow-up. RESULTS The majority of enrolled participants completed treatment (Monitoring: 5/5; CM: 20/22), and intervention components were rated favorably overall (> 80%). CM participants submitted 112/220 (55%) abstinent cotinine samples throughout the quit attempt, while the Monitoring group submitted 4/50 (8%) negative samples. There were no differences in abstinence between groups at EOT or follow-up. CONCLUSION This pilot study of a telehealth-based youth vaping cessation intervention demonstrated preliminary feasibility and acceptability. These results suggest that CM for young adult vaping cessation, delivered remotely, is a promising direction for future work and fully powered trials are warranted to assess intervention efficacy.
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Affiliation(s)
- Amanda M Palmer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA; Department of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Rachel L Tomko
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Lindsay M Squeglia
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Kevin M Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Matthew J Carpenter
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Tracy T Smith
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Jennifer Dahne
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Benjamin A Toll
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Erin A McClure
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.
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Aquilina NJ, Jacob P, Benowitz NL, Fsadni P, Montefort S. Secondhand smoke exposure in school children in Malta assessed through urinary biomarkers. ENVIRONMENTAL RESEARCH 2022; 204:112405. [PMID: 34822856 PMCID: PMC9119146 DOI: 10.1016/j.envres.2021.112405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/20/2021] [Accepted: 11/15/2021] [Indexed: 06/13/2023]
Abstract
School children may be exposed to secondhand smoke (SHS) either at home, in transit or in social gatherings permitting smoking in their presence. Questionnaires about SHS often underestimate prevalence and extent of exposure. A more accurate tool is the use of biomarkers such as cotinine (COT) and trans-3'-hydrocycotinine (3HC) as biomarkers of SHS exposure, alongside 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), a reduction product in the body of the tobacco-specific nitrosamine, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), both potent carcinogens. We measured urinary COT, 3HC and total NNAL using sensitive and specific high-performance LC-MS/MS methods. The limit of quantification (LOQ) for each assay were 0.05 ng/mL, 0.1 ng/mL and 0.25 pg/mL respectively. The aim of this study was to evaluate the exposure to SHS of school children (9-11 years), from five public schools in the island of Malta, from questionnaire information about smoking at home and verify it by urinary biomarker data of COT, 3HC and NNAL. These biomarkers were measurable in 99.4%, 95.4% and 98.3% of the participating children respectively. From the children reporting smoking at home, 11% had a history of asthma and had COT, 3HC and NNAL geometric mean concentrations double compared to the non-asthmatic group. In has been confirmed that non-smokers exposed to SHS and THS have a higher NNAL/COT ratio than the group identified as smokers according to specific and defined COT threshold levels (despite the fact that a priori, the entire study group was composed of non-smokers). The implication of high measured levels of urinary NNAL in children should be of concern given its potency. A main effects multifactor ANOVA model was developed and the children's house and school locations and the smoking frequency were statistically significant to predict the levels of the three metabolites. For 3HC only, the status of the employment of the mother was also an important predictor.
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Affiliation(s)
- Noel J Aquilina
- Department of Chemistry, Faculty of Science, University of Malta, Msida MSD, 2080, Malta; Division of Cardiology, Clinical Pharmacology Program, Department of Medicine, University of California, San Francisco, CA, 94143, USA.
| | - Peyton Jacob
- Division of Cardiology, Clinical Pharmacology Program, Department of Medicine, University of California, San Francisco, CA, 94143, USA
| | - Neal L Benowitz
- Division of Cardiology, Clinical Pharmacology Program, Department of Medicine, University of California, San Francisco, CA, 94143, USA
| | - P Fsadni
- Department of Medicine, Faculty of Medicine and Surgery, University of Malta, Msida MSD, 2080, Malta
| | - S Montefort
- Department of Medicine, Faculty of Medicine and Surgery, University of Malta, Msida MSD, 2080, Malta
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Santiago-Torres M, Mull KE, Sullivan BM, Kwon DM, Nez Henderson P, Nelson LA, Patten CA, Bricker JB. Efficacy and Utilization of Smartphone Applications for Smoking Cessation Among American Indians and Alaska Natives: Results From the iCanQuit Trial. Nicotine Tob Res 2022; 24:544-554. [PMID: 34644389 PMCID: PMC8887580 DOI: 10.1093/ntr/ntab213] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION There is tremendous need for efficacious and accessible interventions for smoking cessation among American Indians and Alaska Natives. We tested the efficacy of an Acceptance and Commitment Therapy (ACT)-based smartphone application (iCanQuit) versus US Clinical Practice Guidelines-based smartphone application (QuitGuide) for smoking cessation among American Indians and Alaska Natives. AIMS AND METHODS We compared cessation, changes in ACT-based processes, engagement and satisfaction between American Indian and Alaska Native iCanQuit (n = 89) and QuitGuide (n = 80) participants enrolled in the iCanQuit trial. The primary outcome was self-reported, complete-case, 30-day point-prevalence abstinence. Follow-up timepoints were 12, 6, and 3 months. RESULTS Randomized American Indians and Alaska Natives from 31 US states (70% urban, 30% rural, with 25% of participants residing on tribal land). The outcome data retention rates were 93%, 92%, and 90% at the 12-, 6-, and 3-month follow-ups, respectively, with no differential retention between arms. The 30-day point-prevalence abstinence for iCanQuit versus QuitGuide was 30% versus 18% at 12 months (odds ratio [OR] = 1.96; 95% confidence interval [CI]: 0.90 to 4.26) 25% versus 11% at 6 months (OR = 2.62; 95% CI: 1.06 to 6.45), and 15% versus 6% at 3 months (OR = 2.93; 95% CI: 0.90 to 9.59). Increases in acceptance of internal cues to smoke mediated the effect of treatment on smoking cessation at 12 months. iCanQuit arm participants were also significantly more engaged and satisfied with their assigned application. CONCLUSIONS In a nationwide sample with high data retention and participant engagement, this is the first study to show that a digital intervention may be efficacious for helping American Indians and Alaska Natives quit smoking. IMPLICATIONS This is the first study to provide evidence of an efficacious, accessible, and engaging treatment for helping American Indians and Alaska Natives quit smoking. Compared to a US Clinical Practice Guidelines-based smartphone application (QuitGuide), an ACT-based smartphone application (iCanQuit) was more efficacious, engaging, and satisfactory among American Indians and Alaska Natives nationwide. Our results will inform the tailoring of the iCanQuit smartphone application for American Indian and Alaska Native tribal communities and organizations with potential for broad dissemination and high impact.
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Affiliation(s)
| | - Kristin E Mull
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Brianna M Sullivan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Diana M Kwon
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Psychology, University of Washington, Seattle, WA,USA
| | | | - Lonnie A Nelson
- Initiative for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA
- Washington State University College of Nursing, Spokane, WA, USA
| | - Christi A Patten
- Department of Psychiatry and Psychology and Behavioral Health Research Program, Mayo Clinic, Rochester, MN, USA
| | - Jonathan B Bricker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Psychology, University of Washington, Seattle, WA,USA
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228
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Tucker CJ, Bello MS, Weinberger AH, D'Orazio LM, Kirkpatrick MG, Pang RD. Association of depression symptom level with smoking urges, cigarette withdrawal, and smoking reinstatement: A preliminary laboratory study. Drug Alcohol Depend 2022; 232:109267. [PMID: 35042097 DOI: 10.1016/j.drugalcdep.2022.109267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/16/2021] [Accepted: 01/06/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cigarette smoking urges, withdrawal, and smoking reinstatement may be especially relevant to people with elevated depression symptoms who smoke. This laboratory study aimed to assess relations between depression symptom level and smoking urges for reward and relief, cigarette withdrawal, and smoking reinstatement in people who smoke cigarettes daily during acute abstinence and while smoking as usual. METHODS Participants with low (n = 51) or elevated (n = 29) baseline depression symptoms underwent two counterbalanced laboratory sessions (i.e., abstinent, non-abstinent). At each session, they completed subjective measures of smoking urges for reward and relief, and withdrawal. They also completed a laboratory smoking reinstatement task measuring whether they would delay smoking and the number of cigarettes smoked. RESULTS The elevated depression symptom group reported significantly higher withdrawal (p = .01) and smoked more cigarettes than the low depression symptoms group during the smoking reinstatement task self-administration period at the abstinent session (p = .04). Smoking urges for reward and relief were not significantly different by depression symptom group. There were no significant interactions of depression and abstinence with any outcomes. CONCLUSIONS As outcomes were measured at both an abstinent and non-abstinent session, findings identify factors for people with elevated depression symptoms who smoke which may drive smoking behavior and impede smoking cessation efforts. This study provides evidence that people with elevated depression symptoms who smoke may need additional/more pharmacological or behavioral smoking cessation aids targeted at reducing withdrawal and number of cigarettes smoked.
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Affiliation(s)
- Chyna J Tucker
- Department of Preventive Medicine, University of Southern California, 2001 N. Soto St., Los Angeles, CA 90032, USA; Department of Social Welfare, University of California, Los Angeles, 3250 Public Affairs Building, Los Angeles, CA 90095, USA.
| | - Mariel S Bello
- Department of Psychology, University of Southern California, 3620 McClintock Ave., Los Angeles, CA 90089, USA; Department of Psychiatry & Human Behavior, Warren Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903 USA.
| | - Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University and Department of Epidemiology, and Population Health, Albert Einstein College of Medicine, 1165 Morris Park Ave. Rousso Building, Bronx, NY 10461, USA.
| | - Lina M D'Orazio
- Department of Neurology, University of Southern California, 1520 San Pablo St. Los Angeles, CA 90033, USA.
| | - Matthew G Kirkpatrick
- Department of Preventive Medicine, University of Southern California, 2001 N. Soto St., Los Angeles, CA 90032, USA; Department of Psychology, University of Southern California, 3620 McClintock Ave., Los Angeles, CA 90089, USA.
| | - Raina D Pang
- Department of Preventive Medicine, University of Southern California, 2001 N. Soto St., Los Angeles, CA 90032, USA; Department of Psychology, University of Southern California, 3620 McClintock Ave., Los Angeles, CA 90089, USA.
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229
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Okuyemi KS, Ojo-Fati O, Aremu TO, Friedrichsen SC, Grude L, Oyenuga M, Shyne M, Murphy SE, Hatsukami D, Joseph AM. A Randomized Trial of Nicotine versus No-nicotine E-cigarettes Among African American Smokers: Changes in Smoking and Tobacco Biomarkers. Nicotine Tob Res 2022; 24:555-563. [PMID: 34669956 DOI: 10.1093/ntr/ntab212] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 10/18/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The objective of this clinical trial was to compare the effects of e-cigarettes with and without nicotine on patterns of combustible cigarette use and biomarkers of exposure to tobacco toxicants among African American smokers. METHODS African American smokers (n = 234) were enrolled in a 12-week, single blind, randomized controlled trial and assigned to ad lib use of nicotine e-cigarettes with or without menthol (2.4% nicotine [equivalent to combustible cigarettes], n = 118), or no-nicotine e-cigarettes (n = 116) for 6 weeks. Surveys were administered at baseline, 2, 6, and 12 weeks, and urinary biomarkers 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and total nicotine equivalents (TNE) were assessed at baseline and 6 weeks. RESULTS Participants smoked an average of 11.4 cigarettes per day (CPD) and 88% used menthol cigarettes at baseline. At Week 6, the nicotine group reported using e-cigarettes 9.1 times per day compared to 11.4 times in the no-nicotine group (p = 0.42). Combustible cigarette smoking decreased 3.0 CPD in the nicotine group compared to 2.7 CPD in the no-nicotine group (p = 0.74). Neither TNE nor NNAL changed significantly between baseline and Week 6. There were no differences in nicotine withdrawal symptoms between treatment groups. Smoking reduction persisted in both groups at Week 12. CONCLUSIONS Contrary to our hypotheses, nicotine e-cigarettes did not significantly reduce the use of combustible cigarettes compared to no-nicotine e-cigarettes in this cohort of African American smokers. Findings suggest e-cigarettes are modestly associated with the decreased use of combustible cigarettes among non-treatment seeking smokers, regardless of nicotine content, but without a reduction in tobacco toxicants. IMPLICATIONS Although e-cigarettes have the potential to reduce harm if substituted for combusted cigarettes (or if they promoted cessation) because of lower levels of tobacco toxicants, this study suggests ad lib use of e-cigarettes among African American smokers, with or without nicotine, results in modest smoking reduction but does not change toxicant exposure in a cohort where smoking cessation or reduction is not the goal. These data suggest that testing future harm reduction interventions using e-cigarettes should include more specific behavioral change coaching, including substituting for or completely stopping combusted cigarettes. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov - NCT03084315.
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Affiliation(s)
- Kolawole S Okuyemi
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - Olamide Ojo-Fati
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Taiwo O Aremu
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Samantha C Friedrichsen
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Lindsay Grude
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Mosunmoluwa Oyenuga
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Michael Shyne
- Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis, MN, USA
| | - Sharon E Murphy
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Minneapolis, MN, USA
| | - Dorothy Hatsukami
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Anne M Joseph
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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Hecht SS, Hatsukami DK. Smokeless tobacco and cigarette smoking: chemical mechanisms and cancer prevention. Nat Rev Cancer 2022; 22:143-155. [PMID: 34980891 PMCID: PMC9308447 DOI: 10.1038/s41568-021-00423-4] [Citation(s) in RCA: 77] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2021] [Indexed: 12/19/2022]
Abstract
Tobacco products present a deadly combination of nicotine addiction and carcinogen exposure resulting in millions of cancer deaths per year worldwide. A plethora of smokeless tobacco products lead to unacceptable exposure to multiple carcinogens, including the tobacco-specific nitrosamine N'-nitrosonornicotine, a likely cause of the commonly occurring oral cavity cancers observed particularly in South-East Asian countries. Cigarettes continue to deliver a large number of carcinogens, including tobacco-specific nitrosamines, polycyclic aromatic hydrocarbons and volatile organic compounds. The multiple carcinogens in cigarette smoke are responsible for the complex mutations observed in critical cancer genes. The exposure of smokeless tobacco users and smokers to carcinogens and toxicants can now be monitored by urinary and DNA adduct biomarkers that may be able to identify those individuals at highest risk of cancer so that effective cancer prevention interventions can be initiated. Regulation of the levels of carcinogens, toxicants and nicotine in tobacco products and evidence-based tobacco control efforts are now recognized as established pathways to preventing tobacco related cancer.
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Affiliation(s)
- Stephen S Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
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Patterson JG, Borger TN, Burris JL, Conaway M, Klesges R, Ashcraft A, Hauser L, Clark C, Wright L, Cooper S, Smith MC, Dignan M, Kennedy-Rea S, Paskett ED, Anderson R, Ferketich AK. A cluster randomized controlled trial for a multi-level, clinic-based smoking cessation program with women in Appalachian communities: study protocol for the "Break Free" program. Addict Sci Clin Pract 2022; 17:11. [PMID: 35164857 PMCID: PMC8842942 DOI: 10.1186/s13722-022-00295-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 01/31/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The cervical cancer burden is high among women living in Appalachia. Cigarette smoking, a cervical cancer risk factor, is also highly prevalent in this population. This project aims to increase smoking cessation among women living in Appalachia by embedding a smoking cessation program within a larger, integrated cervical cancer prevention program. METHODS The broader program, the Take CARE study, is a multi-site research collaborative designed to address three risk factors for cervical cancer incidence and mortality: tobacco use, human papillomavirus (HPV) infection, and cervical cancer screening. Break Free is a primary care clinic-based implementation program that aims to promote smoking cessation among female smokers in Appalachia by standardizing clinical practice protocols. Break Free includes: (1) implementation of a tobacco user identification system in the Electronic Health Record, (2) clinic staff and provider training on the Ask, Advise and Refer (AAR) model, (3) provider implementation of AAR to identify and treat women who want to quit smoking within the next 6 months, (4) facilitated access to cessation phone counseling plus pharmacotherapy, and (5) the bundling of Break Free tobacco cessation with HPV vaccination and cervical cancer screening interventions in an integrated approach to cervical cancer prevention. The study spans 35 Appalachian health clinics across 10 healthcare systems. We aim to enroll 51 adult female smokers per health system (total N = 510). Baseline and follow-up data will be obtained from participant (provider and patient) surveys. The primary outcome is self-reported 12-month point prevalence abstinence among enrolled patients. All randomized patients are asked to complete follow-up surveys, regardless of whether they participated in tobacco treatment. Data analysis of the primary aims will follow intent-to-treat methodology. Secondary outcomes will assess program implementation and cost effectiveness. DISCUSSION Addressing high tobacco use rates is critical for reducing cervical cancer morbidity and mortality among women living in Appalachia. This study evaluates the implementation and effectiveness of a smoking cessation program in increasing smoking cessation among female smokers. If results demonstrate effectiveness and sustainability, implementation of this program into other health care clinics could reduce both rates of smoking and cervical cancer. Trial registration NCT04340531 (April 9, 2020).
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Affiliation(s)
- Joanne G Patterson
- Division of Epidemiology, College of Public Health, The Ohio State University, 354 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA.
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
| | - Tia N Borger
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Jessica L Burris
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Mark Conaway
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Robert Klesges
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | | | - Lindsay Hauser
- UVA Cancer Center, University of Virginia, Charlottesville, VA, USA
| | - Connie Clark
- UVA Cancer Center, University of Virginia, Charlottesville, VA, USA
| | | | - Sarah Cooper
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Merry C Smith
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Mark Dignan
- Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Stephenie Kennedy-Rea
- West Virginia University Cancer Institute, Morgantown, WV, USA
- Department of Medicine, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Electra D Paskett
- Division of Epidemiology, College of Public Health, The Ohio State University, 354 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Roger Anderson
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Amy K Ferketich
- Division of Epidemiology, College of Public Health, The Ohio State University, 354 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43210, USA
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
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Feasibility and acceptability of testing a menstrual-cycle timed smoking cessation intervention for women of reproductive age (Project Phase): Results of a pilot randomized control trial. Addict Behav 2022; 125:107153. [PMID: 34739974 PMCID: PMC8629968 DOI: 10.1016/j.addbeh.2021.107153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Menstrual phase influences cigarette smoking-related outcomes. Telephone-based cessation programs (e.g., quitlines) may incorporate the role of the menstrual cycle in an effort to tailor interventions for women. PURPOSE The goal of this preliminary randomized clinical trial was to examine the feasibility and acceptability of timing quit date to menstrual phase in women in a quitline setting. METHODS We recruited treatment-seeking women with regular menstrual cycles between the ages of 18-40 years. Participants were randomized to the follicular phase (FP; quit date set 6-8 days post onset of menses) or standard of care (SC; no menstrual timing of quit date). All participants received four weeks of nicotine replacement therapy transdermal patch concurrent with six weeks of telephone-based counseling. We explored self-reported and biochemically-verified seven-day point prevalence abstinence at end-of-treatment and three-month follow-up. RESULTS Participants (n = 119; FP: n = 58, SC: n = 61) were, on average, 33.4 years old and smoked 13.6 cigarettes/day. The median number of counseling sessions completed was 6 out of 6 available, and 66% of participants completed the intervention. Over 90% of participants reported they would recommend this study to friends/family. Cessation rates did not significantly vary by randomization. CONCLUSIONS Results of this preliminary trial indicate that timing quit date to FP is an acceptable and feasible approach to address smoking cessation in women of reproductive age. While we observed similar smoking cessation rates between groups, this preliminary study was not fully powered to determine efficacy. Therefore, the feasibility and acceptability results indicate that a fully-powered efficacy trial is warranted.
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Go MD, Al-Delaimy WK, Schilling D, Vuylsteke B, Mehess S, Spindel ER, McEvoy CT. Hair and nail nicotine levels of mothers and their infants as valid biomarkers of exposure to intrauterine tobacco smoke. Tob Induc Dis 2022; 19:100. [PMID: 35035343 PMCID: PMC8693083 DOI: 10.18332/tid/143209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/21/2021] [Accepted: 10/19/2021] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Tobacco use remains the single most modifiable cause of adverse pregnancy outcomes. It is crucial to be able to accurately quantify the burden of tobacco exposure on both the mother and fetus to have better measures of efficacy with interventions being studied. METHODS This is a descriptive and exploratory study conducted within a randomized controlled trial. Pregnant smoking and non-smoking women were followed from ≤22 weeks' gestation through delivery with monthly maternal smoking questionnaires, urine cotinine levels, and collection of maternal and infant hair and nail samples, at delivery. Nicotine was extracted and measured (ng/mg) using high-performance liquid chromatography with electrochemical detection. RESULTS Forty-six mother-infant dyads (34 pregnant smokers and 12 pregnant non-smokers) had successful completion of maternal and infant hair and nails samples. The median hair nicotine levels of the smoking mothers and their infants was significantly higher than those of the non-smokers (1.015 vs 0.037 ng/ mg, p<0.05 for the mothers; 0.445 vs 0.080 ng/mg, p<0.01 for the infants). Similarly, the median nail nicotine levels for smoking mothers and their infants were significantly higher than the non-smokers (2.130 vs 0.056 ng/mg, p<0.01 for the mothers; 0.594 vs 0.132 ng/mg, p<0.05 for the infants). We found a moderate but significant correlation between maternal hair and nail nicotine (r=0.64, p<0.001), infant hair and nail nicotine (r=0.64; p<0.001), maternal and infant hair nicotine (r=0.61, p<0.001), and maternal and infant nail nicotine levels (r=0.58, p<0.001). CONCLUSIONS Our study shows that both infant hair and nail nicotine levels are valid biomarkers of intrauterine tobacco smoke exposure, and can be used to identify prenatal smoke exposure, correlating well with the level of maternal nicotine exposure.
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Affiliation(s)
- Mitzi D Go
- Division of Neonatology, Department of Pediatrics, Oregon Health and Science University, Portland, United States
| | - Wael K Al-Delaimy
- Department of Family and Preventive Medicine, University of California-San Diego, California, United States
| | - Diane Schilling
- Division of Neonatology, Department of Pediatrics, Oregon Health and Science University, Portland, United States
| | - Brittany Vuylsteke
- Division of Neonatology, Department of Pediatrics, Oregon Health and Science University, Portland, United States
| | - Shawn Mehess
- Division of Neonatology, Department of Pediatrics, Oregon Health and Science University, Portland, United States
| | - Eliot R Spindel
- Division of Neuroscience, Oregon National Primate Research Center, Beaverton, United States
| | - Cindy T McEvoy
- Division of Neonatology, Department of Pediatrics, Oregon Health and Science University, Portland, United States
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Bhatt G, Goel S, Gupta R, Grover S, Medhi B. Evaluating the impact of culturally specific patient-centric behavioral intervention package versus usual care for tobacco cessation among patients attending noncommunicable disease clinics in North India: A single-blind trial pilot study protocol. Tob Use Insights 2022; 14:1179173X211056622. [PMID: 34987297 PMCID: PMC8721367 DOI: 10.1177/1179173x211056622] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 10/08/2020] [Indexed: 11/30/2022] Open
Abstract
Background In a low and middle-income country (LMIC) like India, non—communicable diseases (NCDs) contribute a major proportion (61.8%) of all causes of death. Out of this, 48% of cardiovascular diseases , 23% of Chronic Respiratory Diseases , and 10% of Cancer deaths are attributable to tobacco use. Tobacco use is a major risk factor for NCDs and thus, the tobacco cessation approach is a high priority intervention to combat complications and death among NCD patients. While several interventions are available for tobacco cessation, in resource constraint countries like India, the effectiveness of low-cost, culturally specific patient-centric tobacco cessation behavioral intervention holds a potential that needs to be evaluated. A newly developed evidence-based tobacco cessation intervention package will be compared with the existing/usual care provided under the National Programme for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS) at NCD clinics. Methods and design 2 arm, parallel-group randomized controlled trial. Participants Patients aged ≥30 years suffering from NCD, currently using tobacco, and attending NCD clinics in 2 districts of Punjab, India. Sample size A total of 200 participants meeting the selection criteria will be recruited. They will be allocated either to the intervention arm or control (usual care) arm (100 each) using block randomization. Intervention For the participants, there will be 4 face-to-face disease-specific cessation counseling sessions, disease-specific pamphlets, short text messages in vernacular language, that is, Punjabi. Follow-ups will be done at the third, sixth, ninth, and 12th months. Primary outcome Seven-day abstinence, biochemically verified by plasma cotinine levels. Secondary outcome Quit attempts, number of sticks/number of times of smokeless tobacco usage in a day, and stage of behavior change in tobacco users. Discussion This multicomponent culturally specific-patient-centric behavioral intervention package for tobacco cessation at NCD clinic settings focusing on the individual, family, and social environment could increase the outreach of cessation services using existing resources, thereby strengthening health systems and enhancing the quality of life of NCD patients. Trial registration The protocol for the study has been registered with the Clinical Trials Registry in India under the registration number CTRI/2018/01/011643.
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Affiliation(s)
- Garima Bhatt
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sonu Goel
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rakesh Gupta
- Honorary Consultant, Tobacco Cessation, Department of Deaddiction, Santokba Durlabhji Memorial Hospital and Medical Research Institution, Jaipur, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Bikash Medhi
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Kale D, Perski O, Herbec A, Beard E, Shahab L. Changes in Cigarette Smoking and Vaping in Response to the COVID-19 Pandemic in the UK: Findings from Baseline and 12-Month Follow up of HEBECO Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020630. [PMID: 35055451 PMCID: PMC8775930 DOI: 10.3390/ijerph19020630] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/21/2021] [Accepted: 12/24/2021] [Indexed: 02/04/2023]
Abstract
This study investigated UK adults' changes in cigarette smoking and vaping during the COVID-19 pandemic and factors associated with any changes. Data were from an online longitudinal study. A self-selected sample (n = 332) of 228 smokers and 155 vapers (51 participants were both smokers and vapers) completed 5 surveys between April 2020 and June 2021. Participants self-reported data on sociodemographics, COVID-19-related, and smoking/vaping characteristics. During the 12 months of observations, among smokers, 45% self-reported a quit attempt (27.5% due to COVID-19-related reasons) since the onset of COVID-19 pandemic and the quit rate was 17.5%. At 12 months, 35.1% of continuing smokers (n = 174) reported smoking less and 37.9% the same, while 27.0% reported an increase in the number of cigarettes smoked/day. Among vapers, 25.0% self-reported a quit attempt (16.1% due to COVID-19-related reasons) and the quit rate was 18.1%. At 12 months, 47.7% of continuing vapers (n = 109) reported no change in the frequency of vaping/hour, while a similar proportion reported vaping less (27.5%) and more (24.8%). Motivation to quit smoking and being younger were associated with making a smoking quit attempt and smoking cessation. Being a cigarette smoker was associated with vaping cessation. Among a self-selected sample, COVID-19 stimulated more interest in reducing or quitting cigarette smoking than vaping.
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Affiliation(s)
- Dimitra Kale
- Department of Behavioural Science and Health, University College London, London WC1E 7HB, UK; (O.P.); (A.H.); (E.B.); (L.S.)
- SPECTRUM Research Consortium, Edinburgh EH8 9YL, UK
- Correspondence:
| | - Olga Perski
- Department of Behavioural Science and Health, University College London, London WC1E 7HB, UK; (O.P.); (A.H.); (E.B.); (L.S.)
- SPECTRUM Research Consortium, Edinburgh EH8 9YL, UK
| | - Aleksandra Herbec
- Department of Behavioural Science and Health, University College London, London WC1E 7HB, UK; (O.P.); (A.H.); (E.B.); (L.S.)
- Department of Clinical, Educational and Health Psychology, University College London, London WC1E 6BT, UK
| | - Emma Beard
- Department of Behavioural Science and Health, University College London, London WC1E 7HB, UK; (O.P.); (A.H.); (E.B.); (L.S.)
- SPECTRUM Research Consortium, Edinburgh EH8 9YL, UK
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, London WC1E 7HB, UK; (O.P.); (A.H.); (E.B.); (L.S.)
- SPECTRUM Research Consortium, Edinburgh EH8 9YL, UK
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Danilov M, Issany A, Mercado P, Haghdel A, Muzayad JK, Wen X. Sleep quality and health among pregnant smokers. J Clin Sleep Med 2022; 18:1343-1353. [PMID: 34978278 PMCID: PMC9059582 DOI: 10.5664/jcsm.9868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES We aimed to examine 1) sleep quality trends of pregnant smokers and 2) their associations with health outcomes. METHODS A secondary analysis of 88 participants from the University at Buffalo Pregnancy and Smoking Cessation Study (non-randomized clinical study) was performed. Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI) (higher scores, worse quality) and sleep duration was self-reported repeatedly during pregnancy at pre-intervention, post-intervention, and end-of-pregnancy visits. Participants were divided into 3 groups (until pre-intervention, until post-intervention, until end-of-pregnancy). Maternal outcomes included gestational weight gain (GWG) and smoking cessation. Infant outcomes included birth weight, gestational age, and APGAR score. RESULTS There was a significant increase (P= 0.046) in PSQI score from post-intervention (mean, 5.5 [SD, 2.6]) to end-of-pregnancy (6.6 [SD, 2.8]). Mean GWG was significantly lower for participants with poor sleep quality than those with good sleep quality (19.0 kg [SD, 21.3] vs. 36.1 kg [SD, 22.8]; P=0.008). Newborns with poor maternal sleep quality had a significantly lower mean 5-minute APGAR score (8.1 [SD, 1.3] vs. 9.0 [SD, 0.0]; P=0.021) than newborns with good maternal sleep quality. Pre-intervention sleep quality was not associated with smoking cessation, birth weight, or gestational age. Smoking cessation was almost half as prevalent in participants with insufficient sleep (<7 hours/night) vs. sufficient sleep duration (47.4% vs. 92.3%, P=0.011). CONCLUSIONS Sleep quality worsened towards the end-of-pregnancy among smokers. Poor sleep might negatively influence GWG and APGAR score. Insufficient pre-intervention sleep might negatively influence smoking cessation.
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Affiliation(s)
- Michael Danilov
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
| | - Arsh Issany
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
| | - Paul Mercado
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
| | - Arsalan Haghdel
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
| | - Jamila Khlid Muzayad
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
| | - Xiaozhong Wen
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
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Pizzi A, Calabrese M, Daolio A, Ursini M, Frontera A, Resnati G. Expanding the toolbox of coinage bond: Adducts involving new gold(III) derivatives and bioactive molecules. CrystEngComm 2022. [DOI: 10.1039/d2ce00446a] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
X-ray analyses of a small library of adducts between AuX3 (X=Cl, Br) and several pyridine derivatives indicate the systematic presence of quite short π -holes coinage bonds; computational studies reveal...
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Disparities in dental health issues and oral health care visits in US children with tobacco smoke exposure. J Am Dent Assoc 2022; 153:319-329. [PMID: 35078590 PMCID: PMC8969190 DOI: 10.1016/j.adaj.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/07/2021] [Accepted: 09/13/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The objective of the authors was to assess the relationships between tobacco smoke exposure (TSE) and dental health and dental care visits among US children. METHODS The authors examined 2018-2019 National Survey of Children's Health data on TSE, dental health, and oral health care visits. Children aged 1 through 11 years (N = 32,214) were categorized into TSE groups: no home TSE (did not live with a smoker), thirdhand smoke (THS) exposure (lived with a smoker who did not smoke inside the home), or secondhand smoke (SHS) and THS exposure (lived with a smoker who smoked inside the home). The authors conducted multivariable logistic regression analyses, adjusting for child age, sex, race or ethnicity, prematurity, caregiver education level, family structure, and federal poverty threshold. RESULTS Children with home SHS and THS exposure were at increased odds of having frequent or chronic difficulty with 1 or more oral health problem (adjusted odds ratio [AOR], 1.59; 95% CI, 1.07 to 2.35; P = .022) and carious teeth or caries (AOR, 1.74; 95% CI 1.14 to 2.65; P = .010) than those with no TSE. Compared with children aged 1 through 11 years with no TSE, children with SHS and THS exposure were 2.22 times (95% CI, 1.01 to 4.87; P = .048) more likely to have not received needed oral health care but at decreased odds of having had any kind of oral health care visit (AOR, 0.55; 95% CI, 0.32 to 0.95; P = .032), including a preventive oral health care visit (AOR, 0.60; 95% CI, 0.36 to 0.99; P = .047). CONCLUSIONS TSE in children is associated with caries and inadequate oral health care visits. PRACTICAL IMPLICATIONS The pediatric dental visit is an opportune time to educate caregivers who smoke about dental health to improve their children's teeth condition and increase oral health care visits.
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Bohadana A, Rokach A, Wild P, Peker B, Dror YF, Babai P, Arish N, Izbicki G. Varenicline for Gradual Versus Abrupt Smoking Cessation in Poorly Motivated Smokers With COPD: A Prematurely Terminated Randomized Controlled Trial. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2022; 9:486-499. [PMID: 35877930 PMCID: PMC9718580 DOI: 10.15326/jcopdf.2022.0305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Although smoking is the leading cause of chronic obstructive pulmonary disease (COPD), many patients with COPD smoke, highlighting the need for effective smoking cessation interventions in this population. This study examined the efficacy and safety of varenicline in increasing smoking cessation rates through "gradual" versus "abrupt" cessation in COPD patients with low motivation to quit smoking. Methods A randomized, open label, 30-week, controlled trial (ClinicalTrials.gov identifier: NCT02894957) was conducted between January 2019 and October 2020 at a center in Israel. Smokers with COPD, poorly motivated to quit, were randomized to 6 weeks of varenicline for smoking reduction and a target quit day (TQD) at the end of week 6 (gradual cessation group) or ad libitum smoking for 5 weeks, 1 week of varenicline, and a TQD at the end of week 6 (abrupt cessation group). After the pre-quit phase, both groups received 12-week regular varenicline treatment and 12-week follow-up. Primary outcome was biochemically-validated continuous abstinence for weeks 6-30. Secondary outcomes were: (1) biochemically-confirmed7-day point prevalence abstinence for weeks 4-30, (2) efficient smoking reduction (≥50% in number of cigarettes/day) in the pre-quit phase; and (3) number of cigarettes/day, motivation to quit, and changes in respiratory symptoms and spirometry from baseline through week 30. Results A drug recall issued by the study sponsor stopped the study after 70/242 (28.9%) patients had been enrolled. The gradual cessation group (n=29) had significantly higher continuous abstinence rates from TQD through week 30 versus the abrupt cessation group (n=41): 20.7% versus 4.9% (odds ratio [OR]=5.09; 95% confidence interval [CI] 0.89-29.17; p=0.048) and higher 7-day point prevalence abstinence levels at all time points but week 18 (p=0.027 at week 6, 0.056 at week 7, and 0.096 at week 9). Motivation to quit increased (p=0.002) and the number of cigarettes/day decreased (p=0.002) over time in both groups. Respiratory symptoms, but not spirometry, improved in both groups at week 30. Treatment was safe and well tolerated. Conclusion In poorly motivated smokers with COPD, using varenicline for a 6-week gradual smoking cessation before TQD, compared with abrupt cessation, significantly increased quit rates up to 6 months. Results were not affected by the smaller-than-expected sample size. Further studies are needed to confirm these data.
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Affiliation(s)
- Abraham Bohadana
- Respiratory Research Unit, Pulmonary Institute, Department of Medicine, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ariel Rokach
- Respiratory Research Unit, Pulmonary Institute, Department of Medicine, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Bela Peker
- Respiratory Research Unit, Pulmonary Institute, Department of Medicine, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | | | - Nissim Arish
- Respiratory Research Unit, Pulmonary Institute, Department of Medicine, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gabriel Izbicki
- Respiratory Research Unit, Pulmonary Institute, Department of Medicine, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Leavens ELS, Nollen N, Ahluwalia JS, Mayo MS, Rice M, Brett EI, Pulvers K. Changes in dependence, withdrawal, and craving among adult smokers who switch to nicotine salt pod-based e-cigarettes. Addiction 2022; 117:207-215. [PMID: 34105208 PMCID: PMC8655025 DOI: 10.1111/add.15597] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/01/2021] [Accepted: 05/26/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS For electronic cigarettes (e-cigarettes) to be a viable substitute for combustible cigarettes, it is likely that they must be rewarding enough for regular use, indicated by factors such as craving and dependence, important aspects of reinforcement. This study aimed to understand short-term changes in measures of nicotine dependence between groups differing by use trajectory in a switching trial, and within group changes of these measures. DESIGN Secondary data analysis of one arm of an e-cigarette randomized clinical trial. SETTING San Diego, California and Kansas City, Missouri, United States. PARTICIPANTS 114 African American (n = 60) and Latinx (n = 54) smokers (58.8% male) attempting to switch to nicotine salt pod system (NSPS) e-cigarettes in a 6-week trial. MEASUREMENTS At week 6, participants were classified by use trajectory: exclusive smokers (n = 16), exclusive e-cigarette (n = 32), or dual users (n = 66). E-cigarette, cigarette, and total nicotine dependence (cigarette + e-cigarette), use patterns, cigarette craving and nicotine withdrawal, and cotinine were assessed at baseline and week 6 using standard measures. FINDINGS In between group comparisons, exclusive e-cigarette and dual users showed greater reductions in cigarette dependence (e-cigarette: -32.38, 95% CI = -37.7,-27.1; dual: -18.48, 95% CI = -22.2,-14.7), withdrawal (e-cigarette: -6.25, 95% CI = -8.52,-3.98; dual: -3.18, 95% CI = -5.02,-1.34), craving (e-cigarette: -11.44, 95% CI = -14.2,8.7; dual: -9.59, 95% CI = -11.6,-7.59), and cigarettes per day (CPD; e-cigarette: -11.19, 95% CI = -13.1,-9.27; dual: -9.39, 95% CI = -11.3, -7.52) compared with exclusive smokers. In within group analyses, e-cigarette and dual users showed reductions in craving and withdrawal from baseline to week 6. Exclusive e-cigarette and dual users, maintained cotinine levels (all Ps > 0.05) and showed reductions in CPD and cigarette dependence (all Ps < 0.01). Findings were inconclusive regarding changes in total nicotine dependence from baseline to week 6 among exclusive e-cigarette users (P = 0.123). Dual users showed increased total nicotine dependence (P < 0.001) and smokers showed decreased total dependence (P = 0.004). CONCLUSIONS Smokers who switch to nicotine salt pod system e-cigarettes maintain their nicotine levels and transfer their dependence, suggesting that nicotine salt pod system e-cigarettes have a similar reinforcement potential to cigarettes and facilitate switching.
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Affiliation(s)
| | - Nicole Nollen
- University of Kansas School of Medicine, Department of Population Health
| | | | - Matthew S. Mayo
- University of Kansas Medical Center, Department of Biostatistics & Data Science
| | - Myra Rice
- California State University San Marcos, Department of Psychology
| | - Emma I. Brett
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience
| | - Kim Pulvers
- California State University San Marcos, Department of Psychology
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Noonan D, Lyna P, Kennedy DL, Gao X, Bejarano Hernandez S, Fish LJ, Pollak KI. Trajectories of Situational Temptations in Pregnant Smokers participating in a Scheduled Gradual Reduction Cessation Trial. Matern Child Health J 2022; 26:24-30. [PMID: 34860350 PMCID: PMC8770600 DOI: 10.1007/s10995-021-03321-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The purpose of this paper was to examine changes in situational temptations to smoke among women in early to late pregnancy enrolled in a texting trial to help them quit smoking. We compared changes between (1) intervention arms, (2) those who quit, (3) those who reduced by 50% or more, and (4) those who reduced by less than 50%. We also examined cravings overtime in the intervention arm and the relationship between real-time cravings assessed via text message and situational temptations. METHODS This was a secondary analysis of the Baby Steps trial, a randomized controlled trial testing the efficacy of a text-based scheduled gradual reduction (SGR) intervention on cessation. We used t-tests to examine changes across intervention arms and repeated measured proc mixed to explore changes in situational temptations and cravings. RESULTS Among all women, situational temptations decreased from early to late pregnancy for the positive, negative, and habitual subscales, (ps < 0.001). We found no difference in situational temptations across arms. We found a positive relationship between negative situational temptation and average craving during the Weeks 2 and Weeks 3 of the intervention. Negative ST increased by 0.11 for each unit increase of craving at Week 2. CONCLUSIONS As women progress through pregnancy their temptation to smoke reduces. A different relationship might exist, however with negative affect situations in which women reported higher craving but not in response to other temptations. Future work might have a particular focus on the intersection of negative affect with cravings and temptations to promote cessation during pregnancy. CLINICAL TRIAL NCT01995097.
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Affiliation(s)
- Devon Noonan
- School of Nursing, Duke University, 307 Trent Drive, Durham, NC, 27710, USA.
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, 27705, USA.
| | - Pauline Lyna
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, 27705, USA
| | - Danielle L Kennedy
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, 27705, USA
| | - Xiaomei Gao
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, 27705, USA
| | | | - Laura J Fish
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, 27705, USA
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Kathryn I Pollak
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, 27710, USA
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242
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Behavioral and Genetic Factors Associated with Successful Long-Term Cessation in Persons with HIV Who Smoke Cigarettes. J Smok Cessat 2021; 2021:1894160. [PMID: 34956404 PMCID: PMC8683200 DOI: 10.1155/2021/1894160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/10/2021] [Accepted: 11/24/2021] [Indexed: 11/30/2022] Open
Abstract
Background Persons with HIV (PWH) smoke cigarettes at much higher rates than the general population in the US, and smoking is now the leading cause of death in US PWH. Efforts to control the tobacco use epidemic in PWH have met with limited success, and the factors associated with successful cessation are not well delineated. There is a particular dearth of knowledge regarding PWH ex-smokers who have successfully quit smoking cigarettes for the long term. Methods We pooled data from three separate sources of PWH smokers and ex-smokers (reporting complete abstinence for ≥ one year with biochemical verification at the time of data collection) from New York City, collected sociodemographic and behavioral information from them in structured interviews, and obtained their DNA samples. Univariate and rigorous multivariate analytic strategies were employed to determine the sociobehavioral and genetic factors that distinguished PWH smokers from ex-smokers. Results We compared 142 current/recent smokers to 52 biochemically confirmed ex-smokers. The mean age of the participants was 53.3 ± 9.9 years, 49.5% were female, and 76.3% were Black/African American. Successful quitters had significantly lower anxiety scores and were less likely to report hazardous alcohol use or to use marijuana or cocaine. On multivariate analysis utilizing a conservative analytic approach, of 156 single nucleotide variants (SNV) within 12 a priori candidate genes, only the 37148248 T->C variant of gene SLC25A21 on chromosome 14 was associated with long-term cessation. Conclusions In this study, we report behavioral variables associated with long-term abstinence in PWH ex-smokers, and we also report the first genetic correlation of successful cessation in a PWH population yet described.
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243
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Quigley JM, Walsh C, Lee C, Long J, Kennelly H, McCarthy A, Kavanagh P. Efficacy and safety of electronic cigarettes as a smoking cessation intervention: A systematic review and network meta-analysis. Tob Prev Cessat 2021; 7:69. [PMID: 34877438 PMCID: PMC8607936 DOI: 10.18332/tpc/143077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/31/2021] [Accepted: 10/14/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This systematic review of randomized controlled trials (RCTs) evaluated the efficacy and safety of electronic cigarettes (e-cigarettes, ENDS) in helping people who smoke to achieve abstinence compared with electronic non-nicotine delivery systems (ENNDS, no nicotine) or any smoking cessation comparator treatment or combination of treatments at 24–26 weeks and at 52 weeks. METHODS Systematic review techniques involved searches of three databases in February 2020 with update searches run on 14 May 2021, two-person independent screening, two-person independent assessment of bias, formal extraction of data with verification by a second person, a feasibility assessment to decide if meta-analysis was appropriate, and network meta-analysis (NMA) of data at 24–26 weeks. Data at 52 weeks were narratively summarized. RESULTS Ten RCTs met the inclusion criteria, eight for efficacy and ten for safety. Eight of the nine RCTs were assessed as at high risk of bias. The sample sizes of the RCTs were 30–2012. Using nicotine replacement therapy (NRT) as the reference treatment, the incidences of smoking cessation at 24–26 weeks were comparable between ENDS and NRT groups (RR=1.17; 95% CrI: 0.66–1.86). Three sensitivity analyses were carried out indicating the main findings for 24–26 weeks were robust to assumptions. The findings at 52 weeks were inconclusive. CONCLUSIONS This systematic review and NMA indicates that there is no clear evidence of a difference in effect between nicotine containing e-cigarettes and NRT on incidences of smoking cessation at 24–26 weeks, and substantial uncertainty remains.
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Affiliation(s)
- Joan M Quigley
- Health Research Board, Dublin, Ireland.,Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, United Kingdom
| | - Cathal Walsh
- Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
| | | | - Jean Long
- Health Research Board, Dublin, Ireland
| | | | | | - Paul Kavanagh
- Department of Epidemiology and Public Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland.,Health Intelligence Unit, Strategic Planning and Transformation, Health Service Executive, Dublin, Ireland
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Shuter J, Hosgood HD, Nardin S, Weinberger AH. Persons living with HIV who do not smoke cigarettes: A comparison of ex-smokers and never smokers. Tob Use Insights 2021; 14:1179173X211053349. [PMID: 34866952 PMCID: PMC8637706 DOI: 10.1177/1179173x211053349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 09/28/2021] [Indexed: 12/04/2022] Open
Abstract
Background and Aims Approximately half of persons living with HIV (PLWH) in the US smoke
cigarettes. Large surveys show that 16.9%–37.3% of PLWH are never smokers
compared to 57.5% of US adults. Similar proportions of PLWH and general
population adults describe themselves as ex-smokers (20.3% vs 21.9%
respectively). Little research has been done to characterize PLWH
non-smokers. In this study, we compared a group of well characterized PLWH
ex-smokers (i.e., no cigarettes for at least 5 years) to PLWH never smokers
with the aim of developing a clearer understanding of the characteristics of
these groups and the differences between them. Design Cross-sectional interview study employing audio computer-assisted
self-interview (ACASI). Setting Comprehensive HIV care center in New York City. Participants In 2018–2019, we recruited a sample of PLWH never smokers (N = 54) and
long-term ex-smokers (no cigarettes for at least 5 years, N = 36).
Non-smoking status of participants was verified by exhaled carbon
monoxide. Measurements We collected a range of sociodemographic, historical, clinical, and
psychobehavioral data pertaining to tobacco use. Results Compared to never smokers, ex-smokers were older, more likely to have
heterosexually acquired HIV and less likely to have same-sex-acquired
infection, more likely to have parents and/or siblings who smoked, more
likely to have current smoker/s in their households, and more likely to have
ever used marijuana, cocaine, and/or heroin. Conclusions We describe important demographic and sociobehavioral differences between
PLWH never smokers and ex-smokers that may be useful in crafting an
effective response to the cigarette smoking epidemic in US PLWH.
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Affiliation(s)
- Jonathan Shuter
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - H Dean Hosgood
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Shaundell Nardin
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andrea H Weinberger
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.,Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
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245
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Merianos AL, Jandarov RA, Cataletto M, Mahabee-Gittens EM. Tobacco smoke exposure and fractional exhaled nitric oxide levels among U.S. adolescents. Nitric Oxide 2021; 117:53-59. [PMID: 34688860 DOI: 10.1016/j.niox.2021.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/14/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Fractional exhaled nitric oxide (FeNO) can objectively guide clinical practice in the assessment, diagnosis, and treatment of eosinophilic airway inflammation. FeNO values may be affected by current smoking, but the role of tobacco smoke exposure (TSE) is understudied. OBJECTIVE This study investigated the associations between biochemically validated and self-reported TSE and FeNO levels among U.S. nonsmoking adolescents without asthma. METHODS National Health and Nutrition Examination Survey 2007-2012 data were used. TSE was assessed via serum cotinine and self-reported measures. We assessed FeNO continuously and using cutpoints of >35 ppb and >50 ppb to indicate likely eosinophilic inflammation in children and adults, respectively. We conducted linear and logistic regression adjusting for potential covariates. RESULTS Overall, 34.0% of adolescents had low cotinine (0.05-2.99 ng/ml), 6.2% had high cotinine (≥3.00 ng/ml), and 11.9% had home TSE. Compared to adolescents with no/minimal cotinine, adolescents with high cotinine were at reduced odds to have FeNO >35 ppb (adjusted odds ratio [aOR] = 0.54, 95%CI = 0.43,0.69). Adolescents with low cotinine had lower FeNO values (β = -2.05, 95%CI = -3.61,-0.49), and were also at decreased odds to have FeNO >35 ppb (aOR = 0.74, 95%CI = 0.66,0.83) and FeNO >50 ppb (aOR = 0.62, 95%CI = 0.53,0.72). Adolescents with home TSE were at reduced odds to have FeNO >50 ppb (aOR = 0.72, 95%CI = 0.57,0.91) than adolescents without home TSE. Adolescents with a higher number of cigarettes/day smoked inside their home were at reduced odds to have FeNO >35 ppb (OR = 0.98, 95%CI = 0.97,0.99) and FeNO >50 ppb (OR = 0.98, 95%CI = 0.96,0.99). CONCLUSIONS TSE was associated with decreased FeNO levels. The addition of TSE may be clinically important when interpreting thresholds for FeNO.
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Affiliation(s)
- Ashley L Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH, USA.
| | - Roman A Jandarov
- Division of Biostatistics and Bioinformatics, Department of Environmental and Public Health Sciences, College of Medicine, University of Cincinnati, 162 Kettering Lab Building, 160 Panzeca Way, Cincinnati, OH, 45267-0056, USA.
| | - Mary Cataletto
- Department of Pediatrics, NYU Long Island School of Medicine, 222 Station Plaza North, Mineola, NY, 11501, USA.
| | - E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, 3333 Burnet Avenue, MLC 2008, Cincinnati, OH, 45229, USA.
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Laaksonen J, Mishra PP, Seppälä I, Raitoharju E, Marttila S, Mononen N, Lyytikäinen LP, Kleber ME, Delgado GE, Lepistö M, Almusa H, Ellonen P, Lorkowski S, März W, Hutri-Kähönen N, Raitakari O, Kähönen M, Salonen JT, Lehtimäki T. Mitochondrial genome-wide analysis of nuclear DNA methylation quantitative trait loci. Hum Mol Genet 2021; 31:1720-1732. [PMID: 35077545 PMCID: PMC9122653 DOI: 10.1093/hmg/ddab339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022] Open
Abstract
Abstract
Mitochondria have a complex communication network with the surrounding cell and can alter nuclear DNA methylation (DNAm). Variation in the mitochondrial DNA (mtDNA) has also been linked to differential DNAm. Genome-wide association studies have identified numerous DNAm quantitative trait loci, but these studies have not examined the mitochondrial genome. Herein, we quantified nuclear DNAm from blood and conducted a mitochondrial genome-wide association study of DNAm, with an additional emphasis on sex- and prediabetes-specific heterogeneity. We used the Young Finns Study (n = 926) with sequenced mtDNA genotypes as a discovery sample and sought replication in the Ludwigshafen Risk and Cardiovascular Health study (n = 2317). We identified numerous significant associations in the discovery phase (P < 10−9), but they were not replicated when accounting for multiple testing. In total, 27 associations were nominally replicated with a P < 0.05. The replication analysis presented no evidence of sex- or prediabetes-specific heterogeneity. The 27 associations were included in a joint meta-analysis of the two cohorts, and 19 DNAm sites associated with mtDNA variants, while four other sites showed haplogroup associations. An expression quantitative trait methylation analysis was performed for the identified DNAm sites, pinpointing two statistically significant associations. This study provides evidence of a mitochondrial genetic control of nuclear DNAm with little evidence found for sex- and prediabetes-specific effects. The lack of a comparable mtDNA data set for replication is a limitation in our study and further studies are needed to validate our results.
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Affiliation(s)
- Jaakko Laaksonen
- To whom correspondence should be addressed at: Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, PO Box 100, Tampere FI-33014, Finland. Tel: +358 504080774; E-mail:
| | - Pashupati P Mishra
- Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere 33520, Finland
| | - Ilkka Seppälä
- Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere 33520, Finland
| | - Emma Raitoharju
- Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere 33520, Finland
- Molecular Epidemiology, Faculty of Medicine and Health Technology, Tampere University, Tampere 33520, Finland
| | - Saara Marttila
- Molecular Epidemiology, Faculty of Medicine and Health Technology, Tampere University, Tampere 33520, Finland
- Gerontology Research Center, Tampere University, Tampere 33520, Finland
| | - Nina Mononen
- Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere 33520, Finland
| | - Leo-Pekka Lyytikäinen
- Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere 33520, Finland
| | - Marcus E Kleber
- Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim 68167, Germany
| | - Graciela E Delgado
- Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim 68167, Germany
| | - Maija Lepistö
- Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki 00290, Finland
| | - Henrikki Almusa
- Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki 00290, Finland
| | - Pekka Ellonen
- Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki 00290, Finland
| | - Stefan Lorkowski
- Institute of Nutritional Sciences, Friedrich Schiller University Jena, Jena 07743, Germany
- Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, Jena 07743, Germany
| | - Winfried März
- Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim 68167, Germany
- Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, Jena 07743, Germany
- SYNLAB Academy, SYNLAB Holding Deutschland GmbH, Augsburg 86156, Germany
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz 8010, Austria
| | - Nina Hutri-Kähönen
- Tampere Centre for Skills Training and Simulation, Tampere University, Tampere 33520, Finland
| | - Olli Raitakari
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku 20520, Finland
- Research Centre for Applied and Preventive Cardiovascular Medicine, University of Turku, Turku 20520, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku 20520, Finland
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital, Tampere 33520, Finland
- Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere 33520, Finland
| | - Jukka T Salonen
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki 00014, Finland
- MAS-Metabolic Analytical Services Oy, Helsinki 00990, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere 33520, Finland
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Romero DR, Pulvers K, Carter E, Barber C, Satybaldiyeva N, Novotny TE, Oren E. Naturalistic Topography Assessment in a Randomized Clinical Trial of Smoking Unfiltered Cigarettes: Challenges, Opportunities, and Recommendations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11857. [PMID: 34831613 PMCID: PMC8622580 DOI: 10.3390/ijerph182211857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/06/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022]
Abstract
Smoking topography (ST) is a set of measures profiling the behavioral characteristics of smoking in various settings. The CReSS portable device can measure ST in the natural environment. No standard protocol exists for measuring ST longitudinally with the CReSS. This study examined the utilization of the CReSS to measure ST and highlights challenges and opportunities in a naturalistic setting. This study is part of a randomized cross-over clinical trial of smoking filtered or unfiltered cigarettes. Participants (n = 43) smoked in each study condition for two weeks using the CReSS device for five days in their naturalistic smoking setting. The devices were calibrated and cleaned during the washout period, and data were downloaded every visit. Five test puffs were administered to calibrate each device. Moderate compliance rates (74.1%) were found with device usage, and the issues encountered were overheating/clogging, incorrectly registered date/time-stamped data, and device repair/replacement. Routine inspection/cleaning and training in device usage were instrumental in mitigating device malfunctioning. The CReSS device proved to be a feasible tool to examine naturalistic smoking topography and the potential impact of changes in tobacco product design on smoking unfiltered cigarettes. This is the first study to examine ST variables longitudinally, measured at multiple time points, and using unfiltered cigarettes.
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Affiliation(s)
- Devan R. Romero
- Department of Kinesiology and Psychology, California State University San Marcos, San Marcos, CA 92096, USA; (K.P.); (E.C.)
| | - Kim Pulvers
- Department of Kinesiology and Psychology, California State University San Marcos, San Marcos, CA 92096, USA; (K.P.); (E.C.)
| | - Erika Carter
- Department of Kinesiology and Psychology, California State University San Marcos, San Marcos, CA 92096, USA; (K.P.); (E.C.)
| | - Casey Barber
- School of Public Health, University of Nevada, Las Vegas, NV 89154, USA;
| | - Nora Satybaldiyeva
- School of Public Health, San Diego State University, San Diego, CA 91282, USA; (N.S.); (T.E.N.); (E.O.)
| | - Thomas E. Novotny
- School of Public Health, San Diego State University, San Diego, CA 91282, USA; (N.S.); (T.E.N.); (E.O.)
| | - Eyal Oren
- School of Public Health, San Diego State University, San Diego, CA 91282, USA; (N.S.); (T.E.N.); (E.O.)
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248
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Mahabee-Gittens EM, Matt GE, Ding L, Merianos AL. Comparison of Levels of Three Tobacco Smoke Exposure Biomarkers in Children of Smokers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211803. [PMID: 34831559 PMCID: PMC8622785 DOI: 10.3390/ijerph182211803] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 12/13/2022]
Abstract
Objectives: Cotinine, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), and N-oxides are biomarkers of tobacco smoke exposure (TSE) used to assess short- and longer-term TSE. The objective of this study was to assess the associations between these TSE biomarkers, sociodemographics, parental smoking, and child TSE patterns among 0–17-year-olds. Methods: A convenience sample of 179 pediatric patients (mean (SD) age = 7.9 (4.3) years) who lived with ≥1 smoker and who had parental assessments completed and urine samples analyzed for the three TSE biomarkers of interest were included. Biomarker levels were log-transformed, univariate regression models were built and Pearson correlations were assessed. Results: In total, 100% of children had detectable levels of cotinine and >96% had detectable NNAL and N-oxide levels. The geometric means of cotinine, NNAL, and N-oxide levels were 10.1 ng/mL, 25.3 pg/mL, and 22.9 pg/mL, respectively. The mean (SD) number of daily cigarettes smoked by parents was 10.6 (6.0) cigarettes. Child age negatively correlated with urinary cotinine (r = −0.202, p = 0.007) and log NNAL levels (r = −0.275, p < 0.001). The highest log-cotinine levels were in children who were younger, of African American race, and whose parents had a lower education, an annual income ≤USD15,000, and no smoking bans. The highest log-NNAL and N-oxide levels were in children whose parents had a lower education, had no smoking bans, and were around higher numbers of cigarettes. Conclusion: Children of smokers who were younger, African American, and had no smoking bans had the highest TSE biomarker levels. Targeted interventions are needed to reduce TSE levels among high-risk children.
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Affiliation(s)
- E. Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
- Correspondence: ; Tel.: +1-513-636-7966; Fax: +1-513-636-7967
| | - Georg E. Matt
- Department of Psychology, San Diego State University, San Diego, CA 92123, USA;
| | - Lili Ding
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA;
| | - Ashley L. Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH 45221, USA;
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Hiler M, Weidner AS, Hull LC, Kurti AN, Mishina EV. Systemic biomarkers of exposure associated with ENDS use: a scoping review. Tob Control 2021:tobaccocontrol-2021-056896. [PMID: 34732539 DOI: 10.1136/tobaccocontrol-2021-056896] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/13/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This scoping review provides an overview of the existing literature on biomarkers of exposure from electronic nicotine delivery systems (ENDS) use and identifies gaps in existing knowledge. DATA SOURCES We searched two international databases (PubMed and Web of Science) to identify relevant studies published from August 2013 to February 2021. DATA SELECTION Studies were included if they assessed and compared biomarkers of exposure between exclusive ENDS users, non-users, exclusive cigarette smokers, dual users of ENDS and cigarettes or cigarette smokers who switch to ENDS. DATA EXTRACTION AND SYNTHESIS Of the 5074 studies identified, 188 studies met criteria and were selected for full-text screening. Of these, 27 studies were selected for inclusion and data extraction. CONCLUSIONS Consistent, although limited, evidence shows that exclusive ENDS users have elevated levels of biomarkers of certain volatile organic compounds (VOCs; eg, acrylamide and acrylonitrile), metals (eg, cadmium and selenium) and propylene glycol compared with non-users; however, evidence for biomarkers of other toxicants (eg, acrolein, benzene and chromium) is mixed. Biomarkers of most VOCs are lower in ENDS users compared with cigarette smokers, and cigarette smokers who switch to ENDS consistently show reductions in VOC biomarkers. Evidence comparing metal exposures from exclusive ENDS use, cigarette smoking and dual use is mixed and depends on the metal. ENDS and e-liquid characteristics as well as use patterns may be associated with elevated exposure to VOCs and metals. Additional rigorous, controlled studies can assess biomarker exposures from ENDS use and inform the overall risk-benefit of ENDS use for different user populations.
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Affiliation(s)
- Marzena Hiler
- Center for Tobacco Products, Office of Science, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Anna-Sophie Weidner
- Center for Tobacco Products, Office of Science, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Lynn C Hull
- Center for Tobacco Products, Office of Science, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Allison N Kurti
- Center for Tobacco Products, Office of Science, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Elena V Mishina
- Center for Tobacco Products, Office of Science, US Food and Drug Administration, Silver Spring, Maryland, USA
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Guydish JR, Straus ER, Le T, Gubner N, Delucchi KL. Menthol cigarette use in substance use disorder treatment before and after implementation of a county-wide flavoured tobacco ban. Tob Control 2021; 30:616-622. [PMID: 33177211 PMCID: PMC8110613 DOI: 10.1136/tobaccocontrol-2020-056000] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/08/2020] [Accepted: 09/23/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION This study examined the impact of a San Francisco City and County ban on all flavoured tobacco products, including menthol cigarettes, among clients in residential substance use disorder (SUD) treatment. METHODS We conducted cross-sectional surveys of clients at two residential SUD programmes before the County began enforcing the ban (n=160) and twice after enforcement began (n=102, n=120). The samples were compared on demographic characteristics, smoking status, smoking behaviours and the proportion reporting menthol as their usual cigarette. Menthol smokers were asked whether they smoked only menthol cigarettes, mostly menthol, both menthol and non-menthol or mostly non-menthol. Post-ban samples were asked about awareness of the ban and access to menthol cigarettes. RESULTS In multivariate analyses, we found no evidence that the ban was associated with decreased number of cigarettes per day or increased readiness to quit among current smokers. However, odds were lower post-ban for reporting menthol as the usual cigarette (OR=0.80, 95% CI 0.72 to 0.90), and for smoking only menthol cigarettes (OR=0.19, 95% CI 0.18 to 0.19). Perhaps most importantly, and with the ability to influence all other findings, 50% of self-identified menthol smokers reported purchasing menthol cigarettes in San Francisco nearly 1 year after the ban was implemented. CONCLUSION In subgroups where smoking has remained elevated, like those receiving SUD treatment, local menthol bans may have only modest impacts on smoking behaviour. Broader regional, state or national bans, that effectively restrict access to menthol products, may be needed to show stronger effects on smoking behaviour.
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Affiliation(s)
- Joseph R Guydish
- Phillip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Elana R Straus
- Phillip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Thao Le
- Phillip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Noah Gubner
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Kevin L Delucchi
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
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