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Borrelli B, Endrighi R, Dunsiger S, Busch AM, Bock BC, Risica PM, Hughes RB, Lasater T. Greater engagement in valued activities is associated with less barriers to quitting smoking among smokers with mobility impairments. Disabil Health J 2023; 16:101480. [PMID: 37236878 PMCID: PMC10524132 DOI: 10.1016/j.dhjo.2023.101480] [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] [Received: 12/15/2022] [Revised: 04/13/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Individuals with mobility impairments (MI; use equipment to ambulate) have a high prevalence of both smoking and depression. Behavioral activation (BA) purports that depressed mood is remediated through valued activity engagement and may facilitate smoking cessation in MI populations. OBJECTIVE We examined cross-sectional associations between activity engagement and variables important for smoking cessation among a high-risk group of smokers (people with MIs) and also describe a smoking cessation intervention based on BA, given the lack of studies on smokers with MIs. METHODS This study used data from a smoking cessation trial enrolling smokers with MIs (n = 263). We assessed valued activities, activity type, activity restriction due to MI, and replacement of restricted activities. Motivation and confidence to quit smoking, number of cigarettes per day, and mood were also assessed. Analysis was performed with generalized linear (or logistic) regression models adjusted for age and physical functioning using aggregated data at baseline. RESULTS Greater number and frequency of valued activities was associated with less smoking, depression, negative affect, and stress and higher positive affect and self-efficacy to quit. Activity restriction was associated with greater odds of major depression, and activity replacement with lower odds of major depression, lower stress, and higher positive affect and self-efficacy. Strength of associations varied by activity type. CONCLUSIONS Consistent with our theoretical model, BA activity constructs were associated with several mediators of smoking outcomes in the expected directions. Smokers engaging in valued activities have more favorable profiles for smoking cessation and mood management.
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Affiliation(s)
- Belinda Borrelli
- Center for Behavioral Science Research, Boston University, Henry M. Goldman School of Dental Medicine, USA.
| | - Romano Endrighi
- Center for Behavioral Science Research, Boston University, Henry M. Goldman School of Dental Medicine, USA
| | - Shira Dunsiger
- The Miriam Hospital and Brown University School of Public Health, USA
| | - Andrew M Busch
- Department of Psychiatry and Human Behavior, Brown University School of Medicine and The Miriam Hospital, USA; Department of Medicine, University of Minnesota Medical School and Hennepin Healthcare Research Institute, Minnesota, USA
| | - Beth C Bock
- Department of Psychiatry and Human Behavior, Brown University School of Medicine and The Miriam Hospital, USA
| | - Patricia Markham Risica
- Departments of Behavioral and Social Sciences and of Epidemiology, Center for Health Equity Research, Brown University School of Public Health, USA
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Vickery KD, Ford BR, Gelberg L, Bonilla Z, Strother E, Gust S, Adair E, Montori VM, Linzer M, Evans MD, Connett J, Heisler M, O'Connor PJ, Busch AM. The development and initial feasibility testing of D-HOMES: a behavioral activation-based intervention for diabetes medication adherence and psychological wellness among people experiencing homelessness. Front Psychol 2023; 14:1225777. [PMID: 37794913 PMCID: PMC10546874 DOI: 10.3389/fpsyg.2023.1225777] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/08/2023] [Indexed: 10/06/2023] Open
Abstract
Introduction Compared to stably housed peers, people experiencing homelessness (PEH) have lower rates of ideal glycemic control, and experience premature morbidity and mortality. High rates of behavioral health comorbidities and trauma add to access barriers driving poor outcomes. Limited evidence guides behavioral approaches to support the needs of PEH with diabetes. Lay coaching models can improve care for low-resource populations with diabetes, yet we found no evidence of programs specifically tailored to the needs of PEH. Methods We used a multistep, iterative process following the ORBIT model to develop the Diabetes Homeless Medication Support (D-HOMES) program, a new lifestyle intervention for PEH with type 2 diabetes. We built a community-engaged research team who participated in all of the following steps of treatment development: (1) initial treatment conceptualization drawing from evidence-based programs, (2) qualitative interviews with affected people and multi-disciplinary housing and healthcare providers, and (3) an open trial of D-HOMES to evaluate acceptability (Client Satisfaction Questionnaire, exit interview) and treatment engagement (completion rate of up to 10 offered coaching sessions). Results In step (1), the D-HOMES treatment manual drew from existing behavioral activation and lay health coach programs for diabetes as well as clinical resources from Health Care for the Homeless. Step (2) qualitative interviews (n = 26 patients, n = 21 providers) shaped counseling approaches, language and choices regarding interventionists, tools, and resources. PTSD symptoms were reported in 69% of patients. Step (3) trial participants (N = 10) overall found the program acceptable, however, we saw better program satisfaction and treatment engagement among more stably housed people. We developed adapted treatment materials for the target population and refined recruitment/retention strategies and trial procedures sensitive to prevalent discrimination and racism to better retain people of color and those with less stable housing. Discussion The research team has used these findings to inform an NIH-funded randomized control pilot trial. We found synergy between community-engaged research and the ORBIT model of behavioral treatment development to develop a new intervention designed for PEH with type 2 diabetes and address health equity gaps in people who have experienced trauma. We conclude that more work and different approaches are needed to address the needs of participants with the least stable housing.
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Affiliation(s)
- Katherine Diaz Vickery
- The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Becky R. Ford
- The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States
| | - Lillian Gelberg
- Department of Family Medicine, David Geffen School of Medicine at UCLA and UCLA Fielding School of Public Health, Los Angeles, CA, United States
| | - Zobeida Bonilla
- School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Ella Strother
- The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States
| | - Susan Gust
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Edward Adair
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Victor M. Montori
- Division of Endocrinology, Diabetes, Metabolism, Nutrition, Department of Internal Medicine and the Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, United States
| | - Mark Linzer
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States
| | - Michael D. Evans
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, United States
| | - John Connett
- School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Michele Heisler
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Patrick J. O'Connor
- Center for Chronic Care Innovation, HealthPartners Institute, Bloomington, MN, United States
| | - Andrew M. Busch
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States
- The Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
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Gathright EC, Vickery KD, Ayenew W, Whited MC, Adkins-Hempel M, Chrastek M, Carter JK, Rosen RK, Wu WC, Busch AM. The development and pilot testing of a behavioral activation-based treatment for depressed mood and multiple health behavior change in patients with recent acute coronary syndrome. PLoS One 2022; 17:e0261490. [PMID: 35113860 PMCID: PMC8812840 DOI: 10.1371/journal.pone.0261490] [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: 08/11/2021] [Accepted: 11/11/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients with acute coronary syndrome (ACS) with depressed mood demonstrate poor cardiovascular behavioral risk profiles and elevated risk for recurrent ACS and mortality. Behavioral Activation (BA) offers an intervention framework for an integrated treatment targeting both depression and critical health behaviors post-ACS. Behavioral Activation for Health and Depression (BA-HD) was developed and pilot tested in a multiphase iterative process. METHODS First, an initial treatment manual was conceptualized based on the team's prior work, as well as the extant literature. Second, qualitative interviews were conducted with target patients and target providers on the proposed BA-HD treatment rationale, content, and structure. Framework matrix analyses were used to summarize and aggregate responses. Third, an expert panel was convened to elicit additional manual refinements. Finally, patients with post-ACS depression and health behavior non-adherence were recruited to complete an open pilot trial to evaluate acceptability (Client Satisfaction Questionnaire [CSQ], exit interview) and treatment engagement (number of sessions attended; treatment completion was considered completion of 8 out of 10 possible sessions). RESULTS The initial BA-HD treatment manual expanded an existing treatment manual for post-ACS BA-based mood management and smoking cessation to target four health behaviors relevant to post-ACS patients (e.g., smoking cessation, medication adherence, physical activity, and diet). After the initial conceptualization, ten post-ACS patients and eight cardiac rehabilitation professionals completed qualitative interviews. Patients endorsed bi-directional interactions between mood and health behaviors post-ACS. Both patients and providers expressed general support of the proposed treatment rationale and values-guided, collaborative goal-setting approach. Patients, providers, and experts provided feedback that shaped the iterative manual development. After the BA-HD manual was finalized, eight participants were enrolled in a single-arm pilot trial. The mean CSQ score was 30.57 ± 2.23, indicating high satisfaction. Seven out of eight (88%) completed treatment. Pre- to post treatment improvements in depressed mood and health behaviors were promising. CONCLUSIONS BA-HD treatment is an acceptable approach to target both mood and health behaviors in post-ACS patients with depression. A future larger, controlled trial is needed to evaluate the efficacy of the BA-HD treatment. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04158219.
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Affiliation(s)
- Emily C. Gathright
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, United States of America
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Katherine Diaz Vickery
- Health, Homelessness and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States of America
- Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, United States of America
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Woubeshet Ayenew
- Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, United States of America
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Matthew C. Whited
- Department of Psychology, East Carolina University, Greenville, North Carolina, United States of America
| | - Melissa Adkins-Hempel
- Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States of America
| | - Michelle Chrastek
- Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States of America
| | - Jill K. Carter
- Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, United States of America
| | - Rochelle K. Rosen
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, United States of America
- Department of Behavioral and Social Sciences, Brown School of Public Health, Brown University, Providence, Rhode Island, United States of America
| | - Wen-Chih Wu
- Division of Cardiology, Providence Veterans Affairs Medical Center, Providence, Rhode Island, United States of America
- Lifespan Cardiovascular Institute, The Miriam Hospital, Providence, Rhode Island, United States of America
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Andrew M. Busch
- Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, United States of America
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
- Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States of America
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Busch AM, Tooley EM, Dunsiger S, Chattillion EA, Srour JF, Pagoto SL, Kahler CW, Borrelli B. Behavioral activation for smoking cessation and mood management following a cardiac event: results of a pilot randomized controlled trial. BMC Public Health 2017; 17:323. [PMID: 28415979 PMCID: PMC5392972 DOI: 10.1186/s12889-017-4250-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 04/08/2017] [Indexed: 11/16/2022] Open
Abstract
Background Smoking cessation following hospitalization for Acute Coronary Syndrome (ACS) significantly reduces subsequent mortality. Depressed mood is a major barrier to cessation post-ACS. Although existing counseling treatments address smoking and depression independently in ACS patients, no integrated treatment addresses both. We developed an integrated treatment combining gold standard cessation counseling with behavioral activation-based mood management; Behavioral Activation Treatment for Cardiac Smokers (BAT-CS). The purpose of this pilot randomized controlled trial was to test feasibility, acceptability, and preliminary efficacy of BAT-CS vs. Standard of Care (SC). Methods Participants were recruited during hospitalization for ACS and were randomly assigned to BAT-CS or SC. The nicotine patch was offered in both conditions. Smoking, mood, and stress outcomes were collected at end-of-treatment and 24-week follow-up. Results Fifty-nine participants (28 BAT-CS, 31 SC) were recruited over 42 weeks, and assessment completion was above 80% in both conditions. Treatment acceptability and fidelity were high. At 24 week follow-up adjusted odds ratios favoring BAT-CS were 1.27 (95% CI: 0.41–3.93) for 7-day point prevalence abstinence and 1.27 (95% CI: 0.42–3.82) for continuous abstinence. Time to first smoking lapse was significantly longer in BAT-CS (62.4 vs. 31.8 days, p = 0.03). At 24-weeks, effect sizes for mood and stress outcomes ranged from η2partial of.07–.11, with significant between treatment effects for positive affect, negative affect, and stress. Conclusions The design of this study proved feasible and acceptable. Results provide preliminary evidence that combining behavioral activation with standard smoking cessation counseling could be efficacious for this high risk population. A larger trial with longer follow-up is warranted. Trial registration NCT01964898. First received by clinicaltrials.gov October 15, 2013. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4250-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrew M Busch
- The Miriam Hospital, Providence, RI, USA. .,Warren Alpert Medical School of Brown University, Providence, RI, USA. .,Current correspondence address, Minneapolis Medical Research Foundation, 701 Park Avenue, S9-309, Minneapolis, MN, 55415-1623, USA.
| | | | - Shira Dunsiger
- The Miriam Hospital, Providence, RI, USA.,Brown University School of Public Health, Providence, RI, USA
| | - Elizabeth A Chattillion
- Warren Alpert Medical School of Brown University, Providence, RI, USA.,Providence VA Medical Center, Providence, RI, USA
| | - John Fani Srour
- Warren Alpert Medical School of Brown University, Providence, RI, USA.,Rhode Island Hospital, Providence, RI, USA
| | - Sherry L Pagoto
- University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Belinda Borrelli
- Boston University, Henry M. Goldman School of Dental Medicine, Boston, MA, USA
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Leventhal AM. The Sociopharmacology of Tobacco Addiction: Implications for Understanding Health Disparities. Nicotine Tob Res 2016; 18:110-21. [PMID: 25890832 PMCID: PMC5967296 DOI: 10.1093/ntr/ntv084] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 03/31/2015] [Indexed: 12/18/2022]
Abstract
Efforts to reduce the public health burden of tobacco use have not equally benefited all members of society, leading to disparities in tobacco use as a function of ethnicity/race, socioeconomic position, physical/behavioral comorbidity, and other factors. Although multilevel transdisciplinary models are needed to comprehensively understand sources of tobacco-related health disparities (TRHD), the incorporation of psychopharmacology into TRHD research is rare. Similarly, psychopharmacology researchers have often overlooked the societal context in which tobacco is consumed. In an effort to facilitate transdisciplinary research agendas for studying TRHD and the psychopharmacology of tobacco use, this article introduces a novel paradigm, called "sociopharmacology." Sociopharmacology is a platform for investigating how contextual factors amplify psychopharmacological determinants of smoking to disproportionately enhance vulnerability to smoking in populations subject to TRHD. The overall goal of sociopharmacology is to identify proximal person-level psychopharmacological mechanisms that channel distal societal-level influences on TRHD. In this article I describe: (1) sociopharmacology's overarching methodology and theoretical framework; (2) example models that apply sociopharmacology to understand mechanisms underlying TRHD; (3) how sociopharmacological approaches may enhance the public health impact of basic research on the psychopharmacology of tobacco use; and (4) how understanding sociopharmacological mechanisms of TRHD might ultimately translate into interventions that reduce TRHD.
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Affiliation(s)
- Adam M Leventhal
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA; Department of Psychology, University of Southern California, Los Angeles, CA
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