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Vander Weg MW, Howren MB, Grant KM, Prochazka AV, Duffy S, Burke R, Cretzmeyer M, Parker C, Thomas EBK, Rizk MT, Bayer J, Kinner EM, Clark JM, Katz DA. A smoking cessation intervention for rural veterans tailored to individual risk factors: A multicenter randomized clinical trial. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 156:209191. [PMID: 37866436 DOI: 10.1016/j.josat.2023.209191] [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: 01/18/2023] [Revised: 04/24/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Rates of cigarette use remain elevated among those living in rural areas. Depressive symptoms, risky alcohol use, and weight concerns frequently accompany cigarette smoking and may adversely affect quitting. Whether treatment for tobacco use that simultaneously addresses these issues affects cessation outcomes is uncertain. METHODS The study was a multicenter, two-group, randomized controlled trial involving mostly rural veterans who smoke (N = 358) receiving treatment at one of five Veterans Affairs Medical Centers. The study randomly assigned participants to a tailored telephone counseling intervention or referral to their state tobacco quitline. Both groups received guideline-recommended smoking cessation pharmacotherapy, selected using a shared decision-making approach. The primary outcome was self-reported seven-day point prevalence abstinence (PPA) at three and six months. The study used salivary cotinine to verify self-reported quitting at six months. RESULTS Self-reported PPA was significantly greater in participants assigned to Tailored Counseling at three (OR = 1.66; 95 % CI: 1.07-2.58) but not six (OR = 1.35; 95 % CI: 0.85-2.15) months. Post hoc subgroup analyses examining treatment group differences based on whether participants had a positive screen for elevated depressive symptoms, risky alcohol use, and/or concerns about weight gain indicated that the cessation benefit of Tailored Counseling at three months was limited to those with ≥1 accompanying concern (OR = 2.02, 95 % CI: 1.20-3.42). Biochemical verification suggested low rates of misreporting. CONCLUSIONS A tailored smoking cessation intervention addressing concomitant risk factors enhanced short-term abstinence but did not significantly improve long-term quitting. Extending the duration of treatment may be necessary to sustain treatment effects.
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Affiliation(s)
- Mark W Vander Weg
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, United States of America; Department of Community and Behavioral Health, University of Iowa College of Public Health, United States of America; Department of Internal Medicine, University of Iowa Carver College of Medicine, United States of America; Department of Psychological and Brain Sciences, University of Iowa, United States of America; VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, United States of America.
| | - M Bryant Howren
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, United States of America; Department of Behavioral Sciences and Social Medicine, Florida State University, United States of America; Florida Blue Center for Rural Health Research & Policy, United States of America
| | - Kathleen M Grant
- VA Nebraska-Western Iowa Health Care System, United States of America; University of Nebraska Medical Center Department of Medicine, United States of America
| | - Allan V Prochazka
- Primary Care, VA Eastern Colorado Health Care System, United States of America; Denver Seattle Center for Veteran-centric Value-based Research (DiSCoVVR), United States of America
| | - Sonia Duffy
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, United States of America; College of Nursing, Ohio State University, United States of America
| | - Randy Burke
- Mental Health Service, G.V. (Sonny) Montgomery VA Medical Center, United States of America; Department of Psychiatry, University of Mississippi School of Medicine, United States of America
| | | | - Christopher Parker
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, United States of America
| | - Emily B K Thomas
- Department of Psychological and Brain Sciences, University of Iowa, United States of America
| | | | - Jennifer Bayer
- Department of Psychological and Brain Sciences, University of Iowa, United States of America
| | - Ellen M Kinner
- Department of Psychological and Brain Sciences, University of Iowa, United States of America
| | - Jennifer M Clark
- Department of Neurology, University of Iowa, Carver College of Medicine, United States of America
| | - David A Katz
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, United States of America; Department of Internal Medicine, University of Iowa Carver College of Medicine, United States of America; Department of Epidemiology, University of Iowa College of Public Health, United States of America
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Smith MSR, Saberi S, Ajaykumar A, Zhu MMT, Gadawski I, Sattha B, Maan EJ, Van Shalkwyk J, Elwood C, Pick N, Murray MCM, Boucoiran I, Money DM, Côté HCF. Robust tobacco smoking self-report in two cohorts: pregnant women or men and women living with or without HIV. Sci Rep 2023; 13:7711. [PMID: 37173380 PMCID: PMC10182043 DOI: 10.1038/s41598-023-34249-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Understanding the true burden of tobacco smoking on adverse pregnancy outcomes is critical in generating appropriate interventions to improve outcomes. Self-reporting of human behaviour that is associated with stigma is associated with underreporting in general and may bias the impact of smoking in studies; however, self-reporting is frequently the most practical method of gleaning this information. The objective of this study was to evaluate concordance between self-reported smoking and concentrations of plasma cotinine, a biomarker of smoking, among participants enrolled in two related HIV cohorts. A total of 100 pregnant women (76 living with HIV [LWH] and 24 negative controls) in their third trimester, and 100 men and non-pregnant women (43 LWH and 57 negative controls) were included. Among all participants, 43 pregnant women (49% LWH and 25% negative controls) and 50 men and non-pregnant women (58% LWH and 44% negative controls) were self-reported smokers. The odds of discordance between self-reported smoking and cotinine levels were not significantly different between self-reported smokers and non-smokers, nor between pregnant women and others, but were significantly increased, regardless of self-reported status, among people LWH compared to negative controls. The overall concordance between plasma cotinine and self-reported data among all participants was 94% with a sensitivity and specificity of 90% and 96%, respectively. Taken together, these data demonstrate that participant surveying in a non-judgemental context can lead to accurate and robust self-report smoking data among both persons LWH and not, including in the context of pregnancy.
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Affiliation(s)
- Marie-Soleil R Smith
- Department of Pathology and Laboratory Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
- Centre for Blood Research, UBC, Vancouver, BC, Canada
| | - Sara Saberi
- Department of Pathology and Laboratory Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
- Centre for Blood Research, UBC, Vancouver, BC, Canada
| | - Abhinav Ajaykumar
- Department of Pathology and Laboratory Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
- Centre for Blood Research, UBC, Vancouver, BC, Canada
| | - Mayanne M T Zhu
- Department of Pathology and Laboratory Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
| | - Izabelle Gadawski
- Department of Pathology and Laboratory Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
- Centre for Blood Research, UBC, Vancouver, BC, Canada
| | - Beheroze Sattha
- Department of Pathology and Laboratory Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
| | - Evelyn J Maan
- Women's Health Research Institute, Vancouver, BC, Canada
- Oak Tree Clinic, Vancouver, BC, Canada
| | - Julie Van Shalkwyk
- Women's Health Research Institute, Vancouver, BC, Canada
- Oak Tree Clinic, Vancouver, BC, Canada
- Department of Obstetrics and Gynaecology, UBC, Vancouver, BC, Canada
| | - Chelsea Elwood
- Women's Health Research Institute, Vancouver, BC, Canada
- Oak Tree Clinic, Vancouver, BC, Canada
- Department of Obstetrics and Gynaecology, UBC, Vancouver, BC, Canada
| | - Neora Pick
- Women's Health Research Institute, Vancouver, BC, Canada
- Oak Tree Clinic, Vancouver, BC, Canada
- Department of Medicine, Division of Infectious Diseases, UBC, Vancouver, BC, Canada
| | - Melanie C M Murray
- Women's Health Research Institute, Vancouver, BC, Canada
- Oak Tree Clinic, Vancouver, BC, Canada
- Department of Medicine, Division of Infectious Diseases, UBC, Vancouver, BC, Canada
| | - Isabelle Boucoiran
- Department of Obstetrics and Gynaecology and School of Public Health, Université de Montréal, Montreal, QC, Canada
- Women and Children Infectious Diseases Center, CHU Sainte-Justine, Montreal, QC, Canada
| | - Deborah M Money
- Women's Health Research Institute, Vancouver, BC, Canada
- Oak Tree Clinic, Vancouver, BC, Canada
- Department of Obstetrics and Gynaecology, UBC, Vancouver, BC, Canada
| | - Hélène C F Côté
- Department of Pathology and Laboratory Medicine, University of British Columbia (UBC), Vancouver, BC, Canada.
- Centre for Blood Research, UBC, Vancouver, BC, Canada.
- Women's Health Research Institute, Vancouver, BC, Canada.
- Department of Pathology & Laboratory Medicine, University of British Columbia, G227-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
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Heiden BT, Eaton DB, Chang SH, Yan Y, Schoen MW, Chen LS, Smock N, Patel MR, Kreisel D, Nava RG, Meyers BF, Kozower BD, Puri V. Assessment of Duration of Smoking Cessation Prior to Surgical Treatment of Non-small Cell Lung Cancer. Ann Surg 2023; 277:e933-e940. [PMID: 34793352 PMCID: PMC9114169 DOI: 10.1097/sla.0000000000005312] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To define the relationship between the duration of smoking cessation and postoperative complications for patients with lung cancer undergoing surgical treatment. BACKGROUND Smoking increases the risk of postoperative morbidity and mortality in patients with lung cancer undergoing surgical treatment. Although smoking cessation before surgery can mitigate these risks, the ideal duration of preoperative smoking cessation remains unclear. METHODS Using a uniquely compiled Veterans Health Administration dataset, we performed a retrospective cohort study of patients with clinical stage I non-small cell lung cancer undergoing surgical treatment between 2006 and 2016. We characterized the relationship between duration of preoperative smoking cessation and risk of postoperative complications or mortality within 30-days using multivariable restricted cubic spline functions. RESULTS The study included a total of 9509 patients, of whom 6168 (64.9%) were smoking at the time of lung cancer diagnosis. Among them, only 662 (10.7%) patients stopped smoking prior to surgery. Longer duration between smoking cessation and surgery was associated with lower odds of major complication or mortality (adjusted odds ratio [aOR] for every additional week, 0.919; 95% confidence interval [CI], 0.850-0.993; P = 0.03). Compared to nonsmokers, patients who quit at least 3 weeks before surgery had similar odds of death or major complication (aOR, 1.005; 95% CI, 0.702-1.437; P = 0.98) whereas those who quit within 3 weeks of surgery had significantly higher odds of death or major complication (aOR, 1.698; 95% CI, 1.203-2.396; P = 0.003). CONCLUSION Smoking cessation at least 3 weeks prior to the surgical treatment of lung cancer is associated with reduced morbidity and mortality. Providers should aggressively encourage smoking cessation in the preoperative period, since it can disproportionately impact outcomes in early-stage lung cancer.
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Affiliation(s)
- Brendan T. Heiden
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | | | - Su-Hsin Chang
- VA St. Louis Health Care System, St. Louis, MO
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Yan Yan
- VA St. Louis Health Care System, St. Louis, MO
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Martin W. Schoen
- VA St. Louis Health Care System, St. Louis, MO
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO
| | - Li-Shiun Chen
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO
| | - Nina Smock
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | | | - Daniel Kreisel
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
- VA St. Louis Health Care System, St. Louis, MO
| | - Ruben G. Nava
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
- VA St. Louis Health Care System, St. Louis, MO
| | - Bryan F. Meyers
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Benjamin D. Kozower
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Varun Puri
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
- VA St. Louis Health Care System, St. Louis, MO
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Yehoshua I, Adler L, Hermoni SA, Mizrahi Reuveni M, Bilitzky A, Oren K, Zacay G. Smoking quit rates among patients receiving pharmacotherapy who received general practitioner counselling versus intensive counselling: a retrospective cohort study. BMC PRIMARY CARE 2022; 23:340. [PMID: 36575392 PMCID: PMC9793508 DOI: 10.1186/s12875-022-01953-y] [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: 11/20/2021] [Accepted: 12/21/2022] [Indexed: 05/30/2023]
Abstract
BACKGROUND Behavioral treatments can augment the success of pharmacotherapy in smoking cessation. The aim of this study was to compare smoking quit rates between patients receiving individual counseling with their general practitioner during office visits or intensive counselling with behavioral support, both augmented by varenicline. METHODS A nationwide retrospective cohort study conducted in a large Healthcare Maintenance Organization in Israel. We selected randomly patients who filled a prescription for varenicline and received either individual consulting by their general practitioner or intensive counselling with behavioural support, and asked them to answer a questionnaire. The outcome variables were smoking cessation 26-52 weeks following the beginning of treatment and satisfaction with the process. RESULTS 870 patients were contacted and 604 agreed to participate (a response rate of 69%); 301 patients in the general practitioner group, 300 in the intensive counselling group and 3 were excluded due to missing date. The quit rate was 36.5% in the general practitioner group and 42.3% in the intensive counselling group (P = 0.147). In a logistic regression analysis, controlling for age, gender, socioeconomic status, ischemic heart disease, chronic obstructive pulmonary disease, pack years and duration of varenicline consumption, the adjusted OR for quitting in the general practitioner group was 0.79 (95% CI 0.56,1.13). The adjusted OR was higher in the group with the highest socioeconomic status at 2.06 (1.39,3.07) and a longer period of varenicline consumption at 1.30 (1.15,1.47). Age, gender and cigarette pack-years were not associated with quit rate. In the general practitioner group 68% were satisfied with the process, while 19% were not. In the intensive counselling group 64% were satisfied and 14% were not (P = 0.007). CONCLUSION We did not detect a statistically significant difference in smoking quit rates, though there was a trend towards higher quit rates with intensive counselling.
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Affiliation(s)
- Ilan Yehoshua
- Health Division, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Family Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Limor Adler
- Health Division, Maccabi Healthcare Services, Tel Aviv, Israel.
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | | | | | - Avital Bilitzky
- Health Division, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Family Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | | | - Galia Zacay
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Wilson KM, Moss A, Lowary M, Gambino J, Klein JD, Kerby GS, Hovell M, Winickoff JP. Smoking Behaviors Among Tobacco-Using Parents of Hospitalized Children and Association With Child Cotinine Level. Hosp Pediatr 2021; 11:17-24. [PMID: 33272923 PMCID: PMC7769203 DOI: 10.1542/hpeds.2020-0122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Understanding patterns of parental tobacco use and their association with child exposure can help us target interventions more appropriately. We aimed to examine the association between parental smoking practices and cotinine levels of hospitalized children. METHODS This is a secondary analysis of data collected from parents of hospitalized children, recruited for a cessation intervention randomized controlled trial. Smoking parents were identified by using a medical record screening question. Parent-reported demographics and smoking habits were compared to child urine cotinine by using geometric means and log-transformed cotinine levels in multivariable linear regression analyses. RESULTS A total of 213 patients had complete baseline parent-interview and urine cotinine data. The median age was 4 (interquartile range: 1-9); 57% were boys; 56% were white, 12% were Black, and 23% were multiracial; 36% identified as Hispanic. Most families (54%) had 1 smoker in the home; 36% had 2, and 9% had ≥3. Many (77%) reported having a ban on smoking in the home, and 86% reported smoking only outside. The geometric mean cotinine level of the cohort was 0.98 ng/mL. Higher cotinine levels were associated with more smokers in the home (ratio of 2.99) and smoking inside the house (ratio of 4.11). CONCLUSIONS Having more smokers in the home and parents who smoke inside are associated with increased smoke exposure; however, even children whose families who smoke only outside the home have significant levels of cotinine, a marker for toxin exposure.
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Affiliation(s)
- Karen M Wilson
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, New York;
- Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, Illinois
| | - Angela Moss
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | | | - Jonathan D Klein
- Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, Illinois
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Gwendolyn S Kerby
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Melbourne Hovell
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, College of Health and Human Sciences, San Diego State University, San Diego, California
| | - Jonathan P Winickoff
- Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, Illinois
- Department of Pediatrics, Massachusetts General Hospital for Children, Harvard Medical School, Harvard Universty, Boston, Massachusetts
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Benowitz NL, Bernert JT, Foulds J, Hecht SS, Jacob P, Jarvis MJ, Joseph A, Oncken C, Piper ME. Biochemical Verification of Tobacco Use and Abstinence: 2019 Update. Nicotine Tob Res 2020; 22:1086-1097. [PMID: 31570931 DOI: 10.1093/ntr/ntz132] [Citation(s) in RCA: 320] [Impact Index Per Article: 80.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/31/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The changing prevalence and patterns of tobacco use, the advent of novel nicotine delivery devices, and the development of new biomarkers prompted an update of the 2002 Society for Research on Nicotine and Tobacco (SRNT) report on whether and how to apply biomarker verification for tobacco use and abstinence. METHODS The SRNT Treatment Research Network convened a group of investigators with expertise in tobacco biomarkers to update the recommendations of the 2002 SNRT Biochemical Verification Report. RESULTS Biochemical verification of tobacco use and abstinence increases scientific rigor and is recommended in clinical trials of smoking cessation, when feasible. Sources, appropriate biospecimens, cutpoints, time of detection windows and analytic methods for carbon monoxide, cotinine (including over the counter tests), total nicotine equivalents, minor tobacco alkaloids, and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol are reviewed, as well as biochemical approaches to distinguishing cigarette smoking from use of electronic nicotine delivery devices (ENDS). CONCLUSIONS Recommendations are provided for whether and how to use biochemical verification of tobacco use and abstinence. Guidelines are provided on which biomarkers to use, which biospecimens to use, optimal cutpoints, time windows to detection, and methodology for biochemical verifications. Use of combinations of biomarkers is recommended for assessment of ENDS use. IMPLICATIONS Biochemical verification increases scientific rigor, but there are drawbacks that need to be assessed to determine whether the benefits of biochemical verification outweigh the costs, including the cost of the assays, the feasibility of sample collection, the ability to draw clear conclusions based on the duration of abstinence, and the variability of the assay within the study population. This paper provides updated recommendations from the 2002 SRNT report on whether and how to use biochemical markers in determining tobacco use and abstinence.
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Affiliation(s)
- Neal L Benowitz
- Division of Clinical Pharmacology and Experimental Therapeutics, Departments of Medicine and Biopharmaceutical Sciences; Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA
| | - John T Bernert
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jonathan Foulds
- Departments of Public Health Sciences and Psychiatry, Penn State College of Medicine, Hershey, PA
| | - Stephen S Hecht
- Departments of Laboratory Medicine and Pathology, Pharmacology, and Medicinal Chemistry, University of Minnesota, Masonic Cancer Center, Minneapolis, MN
| | - Peyton Jacob
- Departments of Medicine and Psychiatry, University of California San Francisco, San Francisco, CA
| | - Martin J Jarvis
- Department of Behavioural Science and Health, University College London, London, UK
| | - Anne Joseph
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Cheryl Oncken
- Department of Medicine, University of Connecticut, Farmington, CT
| | - Megan E Piper
- Center for Tobacco Research and Intervention, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI
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Do Daily Compensatory Health Beliefs Predict Intention to Quit and Smoking Behavior? A Daily Diary Study during Smoking Cessation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176419. [PMID: 32899272 PMCID: PMC7504513 DOI: 10.3390/ijerph17176419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 01/08/2023]
Abstract
Compensatory health beliefs (CHBs) are a means to cope with motivational conflicts between intended health goals and the temptation for an unhealthy behavior. As CHBs can fluctuate on a daily basis, this study examined how daily CHBs are associated with daily intention to quit smoking and daily number of cigarettes smoked before and after a quit date at the between- and within-person level. The study comprised a prospective longitudinal design and investigated 83 women and 83 men for 32 consecutive days during an ongoing joint self-set quit attempt. Daily CHBs varied from day to day and between individuals. At the between-person level, higher women’s mean CHBs were associated with lower intention (b = −0.23, p = 0.04) and at the 10% level with more cigarettes smoked after the quit date (rate ratio (RR) = 1.92, p = 0.07). At the within-person level, women’s higher than usual CHBs were unrelated to intention to quit, but were related to less smoking before (RR = 0.96, p = 0.03) and at the 10% level after the quit date (RR = 0.91, p = 0.09). A marginally positive association between daily CHBs and smoking at the within-person level emerged for men. The negative effect of daily CHBs at the between-person level on smoking seems to unfold after the quit attempt and for women only.
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Lathen LS, Plears ML, Shartle EL, Conner KL, Fiore MC, Christiansen BA. The HUD smoke-free rule: Perceptions of residents post-implementation. Prev Med Rep 2020; 19:101159. [PMID: 32728524 PMCID: PMC7381686 DOI: 10.1016/j.pmedr.2020.101159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/27/2020] [Accepted: 07/04/2020] [Indexed: 11/03/2022] Open
Abstract
The new HUD no smoking policy has had a favorable impact on smokers. The new HUD no smoking policy has reduced second hand smoke exposure. There remain needs for education, policy enforcement and on-site cessation help.
In July 2018, the U.S. Department of Housing and Urban Development (HUD) implemented a new Public health Agency rule prohibiting the use of tobacco in and within 25 feet of HUD housing. A convenience sample of 574 residents living in Milwaukee, Wisconsin multi-unit HUD complexes completed a survey from May through July 2019, designed to assess their perceptions of the new policy and its impact. Knowledge of the policy was strong, although continued educational efforts are needed. Attitudes about the policy were generally positive, although smokers held more negative attitudes than non-smokers. Some residents desired more and fairer policy enforcement. Most residents reported that smoke incursions were reduced post policy compared to pre policy, although such incursions still occurred. The policy has had a favorable health impact on smokers; over 80% made at least one positive change in their smoking, including 6.4% who said the policy motivated them to quit. There was no evidence that residents with mobility challenges were differentially affected by the policy. Overall, the HUD smoke-free policy was well received, reduced self-reported exposure to smoke and led most smokers to make positive changes in their smoking. Additional education on the policy, improved enforcement, and cessation services are needed.
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Affiliation(s)
| | | | - Emile L Shartle
- Wisconsin Department of Health Service's Tobacco Prevention and Control Program, United States
| | - Karen L Conner
- Wisconsin Department of Health Service's Tobacco Prevention and Control Program, United States
| | - Michael C Fiore
- University of Wisconsin, Center for Tobacco Research and Intervention, United States
| | - Bruce A Christiansen
- University of Wisconsin, Center for Tobacco Research and Intervention, United States
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9
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O'Reilly E, Frederick E, Palmer E. Models for pharmacist-delivered tobacco cessation services: a systematic review. J Am Pharm Assoc (2003) 2019; 59:742-752. [PMID: 31307963 DOI: 10.1016/j.japh.2019.05.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/08/2019] [Accepted: 05/25/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To summarize delivery models of pharmacist-led tobacco cessation services. DATA SOURCES Studies published from July 1, 2003, to April 1, 2019, describing pharmacist-led tobacco cessation services in the United States were identified via PubMed/MEDLINE and EBSCO searches. STUDY SELECTION Studies were considered for inclusion if they met the following criteria: population, patients 18 years of age and older using tobacco products; intervention, pharmacist-led tobacco cessation services; comparator, not required; and outcome, tobacco cessation. We used a web-based tool, Rayyan QCRI, to assist with study selection. DATA EXTRACTION We used a data extraction tool to collect article reference, study design, primary and secondary objectives, brief description of intervention, pharmacologic interventions, service model, business model, method to measure tobacco cessation, tobacco cessation rates, and other comments. RESULTS A total of 16 articles were incorporated into this review. Most studies included were observational (87.5%). The pharmacy settings included ambulatory care (68.8%), community (25%), and managed care (6.3%). Service models described most frequently followed an appointment-based, individual, face-to-face session between the patient and pharmacist. Business models included grant funding (12.5%), fee-for-service (6.3%), value-based (6.3%), and free services (6.3%), but most studies (56.3%) did not address reimbursement. Cessation rates ranged from 3.98% to 77.14% and were predominantly measured through self-report (62.5%). The timing of follow-up varied from 1 to 6 months after program completion, but in some articles was not reported (37.5%). CONCLUSION Pharmacists currently manage tobacco cessation services via an assortment of methods and can successfully assist patients in achieving abstinence. Gaps in the literature necessitate further guidance on consistent outcomes reporting, impact of service model on tobacco cessation, and economic data of business models. The profession will benefit from such information to further expand the pharmacists' role within tobacco cessation services.
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Smoking Cessation among Female and Male Veterans before and after a Randomized Trial of Proactive Outreach. Womens Health Issues 2019; 29 Suppl 1:S15-S23. [PMID: 31253237 PMCID: PMC8269751 DOI: 10.1016/j.whi.2019.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 03/27/2019] [Accepted: 04/02/2019] [Indexed: 11/04/2022]
Abstract
Introduction: Female veterans smoke cigarettes at high rates compared with both male veterans and nonveteran women. Proactive outreach (PRO) to smokers may reduce gender disparities in cessation care. The objectives of this study were to compare baseline experiences with VA smoking cessation care for men and women and to assess for gender differences in response to a PRO intervention. Methods: We conducted a post hoc subgroup analysis of a pragmatic, multisite randomized, controlled trial comparing PRO with usual care (UC). Baseline experiences included physician advice to quit, satisfaction with care, and past-year treatment use. At the 1-year follow-up, treatment use, quit attempts, and 6-month prolonged abstinence for women and men randomized to PRO versus UC were compared using logistic regression. Results: Baseline and follow-up surveys were returned by 138 women and 2,516 men. At baseline, women were less likely than men to report being very or somewhat satisfied with the process of obtaining smoking cessation medications in the VA (47% of women vs. 62% of men), but no less likely to report having used cessation medications from the VA in the past year (39% of women vs. 34% of men). After the intervention, phone counseling and combined therapy increased among both women and men in PRO as compared with UC. At the 1-year follow-up, men in PRO were significantly more likely to report prolonged abstinence than those in UC (odds ratio, 1.65; 95% CI, 1.28–2.14); results for women were in the same direction but not statistically significant (odds ratio, 1.39; 95% CI, 0.48–3.99). Conclusions: Satisfaction with cessation care in VA remains low. PRO to smokers was associated with an increased use of cessation therapies, and increased odds of achieving prolonged abstinence. A subgroup analysis by gender did not reveal significant differences in the treatment effect.
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Vieira A, Reis AM, Matos LC, Machado J, Moreira A. Does auriculotherapy have therapeutic effectiveness? An overview of systematic reviews. Complement Ther Clin Pract 2018; 33:61-70. [DOI: 10.1016/j.ctcp.2018.08.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 07/11/2018] [Accepted: 08/21/2018] [Indexed: 02/06/2023]
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Danan ER, Fu SS, Clothier BA, Noorbaloochi S, Hammett PJ, Widome R, Burgess DJ. The Equity Impact of Proactive Outreach to Smokers: Analysis of a Randomized Trial. Am J Prev Med 2018; 55:506-516. [PMID: 30139707 DOI: 10.1016/j.amepre.2018.05.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 03/14/2018] [Accepted: 05/16/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Population-based smoking-cessation services tend to preferentially benefit high-SES smokers, potentially exacerbating disparities. Interventions that include proactive outreach, telephone counseling, and free or low-cost cessation medications may be more likely to help low-SES smokers quit. This analysis evaluated the role of SES in smokers' response to a population-based proactive smoking-cessation intervention. METHODS This study, conducted in 2016 and 2017, was a secondary analysis of the Veterans Victory Over Tobacco Study, a multicenter pragmatic RCT of a proactive smoking-cessation intervention conducted from 2009 to 2011. Logistic regression modeling was used to test the effect of income or education level on 6-month prolonged abstinence at 1-year follow-up. RESULTS Of the 5,123 eligible, randomized participants, 2,565 (50%) reported their education level and 2,430 (47%) reported their income level. The interactions between education (p=0.07) or income (p=0.74) X treatment arm were not statistically significant at the 0.05 level. The largest effect sizes for the intervention were found among smokers in the lowest education category (≤11th grade), with a quit rate of 17.3% as compared with 5.7% in usual care (OR=3.5, 95% CI=1.4, 8.6) and in the lowest income range (<$10,000), with a quit rate of 18.7% as compared with 9.4% in usual care (OR=2.2, 95% CI=1.2, 4.0). CONCLUSIONS In a large, multicenter smoking-cessation trial, proactive outreach was associated with higher rates of prolonged abstinence among smokers at all SES levels. Proactive outreach interventions that integrate telephone-based care and facilitated cessation medication access have the potential to reduce socioeconomic disparities in quitting. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT00608426.
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Affiliation(s)
- Elisheva R Danan
- Veterans Affairs Health Services Research & Development Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota; Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
| | - Steven S Fu
- Veterans Affairs Health Services Research & Development Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota; Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Barbara A Clothier
- Veterans Affairs Health Services Research & Development Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota
| | - Siamak Noorbaloochi
- Veterans Affairs Health Services Research & Development Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota; Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Patrick J Hammett
- Veterans Affairs Health Services Research & Development Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota; Division of Epidemiology, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Rachel Widome
- Division of Epidemiology, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Diana J Burgess
- Veterans Affairs Health Services Research & Development Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota; Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
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Thrul J, Meacham MC, Ramo DE. A novel and remote biochemical verification method of smoking abstinence: Predictors of participant compliance. Tob Prev Cessat 2018; 4. [PMID: 30417159 PMCID: PMC6221470 DOI: 10.18332/tpc/90649] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Biochemical verification of smoking abstinence remains an important validity check of cessation trial outcomes. Digital health trials rarely establish in-person contacts between participants and intervention providers, requiring novel strategies to biochemically verify outcomes. We describe remote verification of smoking abstinence via saliva cotinine and individual predictors of compliance in a digital intervention. METHODS Data came from a feasibility trial and randomized controlled trial of a Facebook smoking cessation intervention for young adults. In both trials, participants completed baseline and follow-up surveys at 3, 6 and 12 months. Participants indicating past 7-day point prevalence smoking abstinence were mailed a saliva cotinine kit. Participants were instructed to electronically send two photos - one of them giving a saliva sample and the other with the test results. We investigated predictors of compliance with these procedures, independent of verification results, among participants that were mailed a kit at any follow-up point (N=130; mean age = 21.3; 59.2% female) using logistic and multinomial regression. RESULTS A total of 189 kits were sent out, of which 97 were completed (51.3% compliance). We did not identify significant predictors of completing any vs no kits using logistic regression. We also found no significant predictors of extent of kit completion (none vs some; none vs all) using multinomial regression and controlling for number of kits sent. CONCLUSIONS Findings demonstrate the feasibility of this biochemical verification method and suggest low risk for bias of results. Future studies should replicate findings in larger samples and improve compliance with verification procedures.
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Affiliation(s)
- Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Meredith C Meacham
- Department of Psychiatry and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, USA
| | - Danielle E Ramo
- Department of Psychiatry and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, USA
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Salgado García FI, Derefinko KJ, Bursac Z, Hand S, Klesges RC. Planning a Change Easily (PACE): A randomized controlled trial for smokers who are not ready to quit. Contemp Clin Trials 2018; 68:14-22. [PMID: 29549007 PMCID: PMC5899672 DOI: 10.1016/j.cct.2018.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 02/28/2018] [Accepted: 03/12/2018] [Indexed: 11/20/2022]
Abstract
Smoking cessation programs are efficacious and have been validated to assist the 10% to 30% of smokers who are ready to quit in the next 30 days. While the majority of smokers want to quit smoking in the future, only 69% are planning to quit within the next year. Planning a Change Easily (PACE) is a nation-wide, telephone-based comparative effectiveness, randomized controlled trial for smokers not ready to quit (SNRTQ). This project, as well as its intervention components, outcomes, and hypotheses are discussed. This study will compare the effectiveness of four intervention conditions that could potentially help SNRTQ to quit smoking: Brief Advice, Motivational Interviewing, Rate Reduction, and Motivational Interviewing plus Rate Reduction combined. Rate Reduction conditions will include the provision of nicotine replacement therapy in the form of gum. Approximately 840 participants will be recruited and randomized to the four intervention conditions. The main outcomes for this study include self-report prolonged and point prevalence abstinence with biochemical verification of cessation. Secondary outcomes include quit attempts, cost-per-quit, and cost-effectiveness analyses. Informed by evidenced-based interventions, strong clinical guidelines, and economic analysis, PACE has the potential for significant public health impact. Results could readily be disseminated and translated to tobacco quitlines, which are present in all 50 states and are offered free to the public.
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Affiliation(s)
- Francisco I Salgado García
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline St., Memphis, TN 38163, USA.
| | - Karen J Derefinko
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline St., Memphis, TN 38163, USA
| | - Zoran Bursac
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline St., Memphis, TN 38163, USA
| | - Sarah Hand
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline St., Memphis, TN 38163, USA
| | - Robert C Klesges
- Department of Public Health Sciences, University of Virginia School of Medicine, 560 Ray Hunt Drive, Charlottesville, VA 22911, USA
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Blitchtein-Winicki D, Zevallos K, Samolski MR, Requena D, Velarde C, Briceño P, Piazza M, Ybarra ML. Feasibility and Acceptability of a Text Message-Based Smoking Cessation Program for Young Adults in Lima, Peru: Pilot Study. JMIR Mhealth Uhealth 2017; 5:e116. [PMID: 28778850 PMCID: PMC5562935 DOI: 10.2196/mhealth.7532] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 05/22/2017] [Accepted: 06/13/2017] [Indexed: 11/13/2022] Open
Abstract
Background In Peru’s urban communities, tobacco smoking generally starts during adolescence and smoking prevalence is highest among young adults. Each year, many attempt to quit, but access to smoking cessation programs is limited. Evidence-based text messaging smoking cessation programs are an alternative that has been successfully implemented in high-income countries, but not yet in middle- and low-income countries with limited tobacco control policies. Objective The objective was to assess the feasibility and acceptability of an short message service (SMS) text message-based cognitive behavioral smoking cessation program for young adults in Lima, Peru. Methods Recruitment included using flyers and social media ads to direct young adults interested in quitting smoking to a website where interested participants completed a Google Drive survey. Inclusion criteria were being between ages 18 and 25 years, smoking at least four cigarettes per day at least 6 days per week, willing to quit in the next 30 days, owning a mobile phone, using SMS text messaging at least once in past year, and residing in Lima. Participants joined one of three phases: (1) focus groups and in-depth interviews whose feedback was used to develop the SMS text messages, (2) validating the SMS text messages, and (3) a pilot of the SMS text message-based smoking cessation program to test its feasibility and acceptability among young adults in Lima. The outcome measures included adherence to the SMS text message-based program, acceptability of content, and smoking abstinence self-report on days 2, 7, and 30 after quitting. Results Of 639 participants who completed initial online surveys, 42 met the inclusion criteria and 35 agreed to participate (focus groups and interviews: n=12; validate SMS text messages: n=8; program pilot: n=15). Common quit practices and beliefs emerged from participants in the focus groups and interviews informed the content, tone, and delivery schedule of the messages used in the SMS text message smoking cessation program. A small randomized controlled pilot trial was performed to test the program’s feasibility and acceptability; nine smokers were assigned to the SMS text message smoking cessation program and six to a SMS text message nutrition program. Participant retention was high: 93% (14/15) remained until day 30 after quit day. In all, 56% of participants (5/9) in the SMS text message smoking cessation program reported remaining smoke-free until day 30 after quit day and 17% of participants (1/6) in the SMS text message nutrition program reported remaining smoke-free during the entire program. The 14 participants who completed the pilot reported that they received valuable health information and approved the delivery schedule of the SMS text messages. Conclusions This study provides initial evidence that a SMS text message smoking cessation program is feasible and acceptable for young adults residing in Lima.
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Affiliation(s)
- Dora Blitchtein-Winicki
- Mental Health, Alcohol and Drug Unit, Public Health Department, Universidad Peruana Cayetano Heredia, Lima, Peru.,Executive Office of Research, Peruvian National Institute of Health, Lima, Peru
| | - Karine Zevallos
- Mental Health, Alcohol and Drug Unit, Public Health Department, Universidad Peruana Cayetano Heredia, Lima, Peru.,Centro de Investigación en Enfermedades Tropicales "Maxime Kuczynski", Peruvian National Institute of Health, Loreto, Peru
| | - M Reuven Samolski
- Mental Health, Alcohol and Drug Unit, Public Health Department, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - David Requena
- Mental Health, Alcohol and Drug Unit, Public Health Department, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Chaska Velarde
- Mental Health, Alcohol and Drug Unit, Public Health Department, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Patricia Briceño
- Mental Health, Alcohol and Drug Unit, Public Health Department, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Marina Piazza
- Mental Health, Alcohol and Drug Unit, Public Health Department, Universidad Peruana Cayetano Heredia, Lima, Peru.,Peruvian National Institute of Health, Lima, Peru
| | - Michele L Ybarra
- Center for Innovative Public Health Research, San Clemente, CA, United States
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Barnett PG, Chow A, Flores NE, Sherman SE, Duffy SA. Changes in Veteran Tobacco Use Identified in Electronic Medical Records. Am J Prev Med 2017; 53:e9-e18. [PMID: 28190690 DOI: 10.1016/j.amepre.2017.01.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 11/30/2016] [Accepted: 01/05/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Electronic medical records represent a new source of longitudinal data on tobacco use. METHODS Electronic medical records of the U.S. Department of Veterans Affairs were extracted to find patients' tobacco use status in 2009 and at another assessment 12-24 months later. Records from the year prior to the first assessment were used to determine patient demographics and comorbidities. These data were analyzed in 2015. RESULTS An annual quit rate of 12.0% was observed in 754,504 current tobacco users. Adjusted tobacco use prevalence at follow-up was 3.2% greater with alcohol use disorders at baseline, 1.9% greater with drug use disorders, 3.3% greater with schizophrenia, and lower in patients with cancer, heart disease, and other medical conditions (all differences statistically significant with p<0.05). Annual relapse rates in 412,979 former tobacco users were 29.6% in those who had quit for <1 year, 9.7% in those who had quit for 1-7 years, and 1.9% of those who had quit for >7 years. Among those who had quit for <1 year, adjusted relapse rates were 4.3% greater with alcohol use disorders and 7.2% greater with drug use disorders (statistically significant with p<0.05). CONCLUSIONS High annual cessation rates may reflect the older age and greater comorbidities of the cohort or the intensive cessation efforts of the U.S. Department of Veterans Affairs. The lower cessation and higher relapse rates in psychiatric and substance use disorders suggest that these groups will need intensive and sustained cessation efforts.
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Affiliation(s)
- Paul G Barnett
- VA Health Economics Resource Center, Menlo Park, California; VA Center for Innovation to Implementation, Menlo Park, California; Department of Health Research Policy, Stanford University School of Medicine, Stanford, California.
| | - Adam Chow
- VA Health Economics Resource Center, Menlo Park, California; VA Center for Innovation to Implementation, Menlo Park, California
| | - Nicole E Flores
- VA Health Economics Resource Center, Menlo Park, California; VA Center for Innovation to Implementation, Menlo Park, California
| | - Scott E Sherman
- New York Harbor VA Health Care System, New York, New York; Department of Population Health, New York University School of Medicine, New York, New York
| | - Sonia A Duffy
- VA Center for Clinical Management Research, Ann Arbor, Michigan; College of Nursing, Ohio State University, Columbus, Ohio
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Kayser JW, Cossette S, Côté J, Bourbonnais A, Purden M, Juneau M, Tanguay JF, Simard MJ, Dupuis J, Diodati JG, Tremblay JF, Maheu-Cadotte MA, Cournoyer D. Evaluation of a Web-Based Tailored Nursing Intervention (TAVIE en m@rche) Aimed at Increasing Walking After an Acute Coronary Syndrome: A Multicenter Randomized Controlled Trial Protocol. JMIR Res Protoc 2017; 6:e64. [PMID: 28450272 PMCID: PMC5427251 DOI: 10.2196/resprot.6430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 02/01/2017] [Accepted: 02/22/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite the health benefits of increasing physical activity in the secondary prevention of acute coronary syndrome (ACS), up to 60% of ACS patients are insufficiently active. Evidence supporting the effect of Web-based interventions on increasing physical activity outcomes in ACS patients is growing. However, randomized controlled trials (RCTs) using Web-based technologies that measured objective physical activity outcomes are sparse. OBJECTIVE Our aim is to evaluate in insufficiently active ACS patients, the effect of a fully automated, Web-based tailored nursing intervention (TAVIE en m@rche) on increasing steps per day. METHODS A parallel two-group multicenter RCT (target N=148) is being conducted in four major teaching hospitals in Montréal, Canada. An experimental group receiving the 4-week TAVIE en m@rche intervention plus a brief "booster" at 8 weeks, is compared with the control group receiving hyperlinks to publicly available websites. TAVIE en m@rche is based on the Strengths-Based Nursing Care orientation to nursing practice and the Self-Determination Theory of human motivation. The intervention is centered on videos of a nurse who delivers the content tailored to baseline levels of self-reported autonomous motivation, perceived competence, and walking behavior. Participants are recruited in hospital and are eligible if they report access to a computer and report less than recommended physical activity levels 6 months before hospitalization. Most outcome data are collected online at baseline, and 5 and 12 weeks postrandomization. The primary outcome is change in accelerometer-measured steps per day between randomization and 12 weeks. The secondary outcomes include change in steps per day between randomization and 5 weeks, and change in self-reported energy expenditure for walking and moderate to vigorous physical activity between randomization, and 5 and 12 weeks. Theoretical outcomes are the mediating role of self-reported perceived autonomy support, autonomous and controlled motivations, perceived competence, and barrier self-efficacy on steps per day. Clinical outcomes are quality of life, smoking, medication adherence, secondary prevention program attendance, health care utilization, and angina frequency. The potential moderating role of sex will also be explored. Analysis of covariance models will be used with covariates such as sex, age, fatigue, and depression symptoms. Allocation sequence is concealed, and blinding will be implemented during data analysis. RESULTS Recruitment started March 30, 2016. Data analysis is planned for November 2017. CONCLUSIONS Finding alternative interventions aimed at increasing the adoption of health behavior changes such as physical activity in the secondary prevention of ACS is clearly needed. Our RCT is expected to help support the potential efficacy of a fully automated, Web-based tailored nursing intervention on the objective outcome of steps per day in an ACS population. If this RCT is successful, and after its implementation as part of usual care, TAVIE en m@rche could help improve the health of ACS patients at large. TRIAL REGISTRATION ClinicalTrials.gov NCT02617641; https://clinicaltrials.gov/ct2/show/NCT02617641 (Archived by WebCite at http://www.webcitation.org/6pNNGndRa).
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Affiliation(s)
- John William Kayser
- Université de Montréal, Faculty of Nursing, Montréal, QC, Canada.,Montreal Heart Institute Research Center and Université de Montréal, Montréal, QC, Canada
| | - Sylvie Cossette
- Université de Montréal, Faculty of Nursing, Montréal, QC, Canada.,Montreal Heart Institute Research Center and Université de Montréal, Montréal, QC, Canada
| | - José Côté
- Université de Montréal, Faculty of Nursing, Montréal, QC, Canada.,Research Center of the Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Anne Bourbonnais
- Université de Montréal, Faculty of Nursing, Montréal, QC, Canada.,Research Center of the Institut universitaire de gériatrie de Montréal, Montréal, QC, Canada
| | - Margaret Purden
- McGill University, Ingram School of Nursing, Montréal, QC, Canada.,Jewish General Hospital Centre for Nursing Research, Montréal, QC, Canada
| | - Martin Juneau
- Montreal Heart Institute Research Center and Université de Montréal, Montréal, QC, Canada
| | - Jean-Francois Tanguay
- Montreal Heart Institute Research Center and Université de Montréal, Montréal, QC, Canada
| | - Marie-Josée Simard
- Integrated Health and Social Services Centres, l'Est de l'Île de Montréal, Montréal, QC, Canada
| | - Jocelyn Dupuis
- Montreal Heart Institute Research Center and Université de Montréal, Montréal, QC, Canada
| | | | | | - Marc-André Maheu-Cadotte
- Université de Montréal, Faculty of Nursing, Montréal, QC, Canada.,Montreal Heart Institute Research Center and Université de Montréal, Montréal, QC, Canada
| | - Daniel Cournoyer
- Montreal Health Innovations Coordinating Center, Montréal, QC, Canada
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Vander Weg MW, Holman JE, Rahman H, Sarrazin MV, Hillis SL, Fu SS, Grant KM, Prochazka AV, Adams SL, Battaglia CT, Buchanan LM, Tinkelman D, Katz DA. Implementing smoking cessation guidelines for hospitalized Veterans: Cessation results from the VA-BEST trial. J Subst Abuse Treat 2017; 77:79-88. [PMID: 28476277 DOI: 10.1016/j.jsat.2017.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 03/29/2017] [Accepted: 03/31/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To examine the impact of a nurse-initiated tobacco cessation intervention focused on providing guideline-recommended care to hospitalized smokers. DESIGN Pre-post quasi-experimental trial. SETTING General medical units of four US Department of Veterans Affairs hospitals. SUBJECTS 898 adult Veteran smokers (503 and 395 were enrolled in the baseline and intervention periods, respectively). INTERVENTION The intervention included academic detailing, adaptation of the computerized medical record, patient self-management support, and organizational support and feedback. MEASURES The primary outcome was self-reported 7-day point prevalence abstinence at six months. ANALYSIS Tobacco use was compared for the pre-intervention and intervention periods with multivariable logistic regression using generalized estimating equations to account for clustering at the nurse level. Predictors of abstinence at six months were investigated with best subsets regression. RESULTS Seven-day point prevalence abstinence during the intervention period did not differ significantly from the pre-intervention period at either three (adjusted odds ratio (AOR) and 95% confidence interval (CI95)=0.78 [0.51-1.18]) or six months (AOR=0.92; CI95=0.62-1.37). Predictors of abstinence included baseline self-efficacy for refraining from smoking when experiencing negative affect (p=0.0004) and perceived likelihood of staying off cigarettes following discharge (p<0.0001). CONCLUSIONS Tobacco use interventions in the VA inpatient setting likely require more substantial changes in clinician behavior and enhanced post-discharge follow-up to improve cessation outcomes.
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Affiliation(s)
- Mark W Vander Weg
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, United States; University of Iowa Department of Medicine, United States; University of Iowa Department of Psychological and Brain Sciences, United States.
| | - John E Holman
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, United States
| | - Hafizur Rahman
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, United States
| | - Mary Vaughan Sarrazin
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, United States; University of Iowa Department of Medicine, United States
| | - Stephen L Hillis
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, United States; University of Iowa Department of Biostatistics, United States; University of Iowa Department of Radiology, United States
| | - Steven S Fu
- Center for Chronic Disease and Outcomes Research (CCDOR), Minneapolis VA Health Care System, United States
| | - Kathleen M Grant
- Mental Health and Behavioral Sciences Department, VA Nebraska-Western Iowa Health Care System, United States; The Department of Internal Medicine, University of Nebraska Medical Center, United States
| | - Allan V Prochazka
- Department of Medicine, VA Eastern Colorado Health Care System, United States; The Denver Seattle Center for Veteran-centric Value-based Research (DiSCoVVR), United States
| | - Susan L Adams
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, United States
| | - Catherine T Battaglia
- Department of Medicine, VA Eastern Colorado Health Care System, United States; The Denver Seattle Center for Veteran-centric Value-based Research (DiSCoVVR), United States
| | | | | | - David A Katz
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, United States; University of Iowa Department of Medicine, United States; University of Iowa Department of Epidemiology, United States
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Tischler EH, Matsen Ko L, Chen AF, Maltenfort MG, Schroeder J, Austin MS. Smoking Increases the Rate of Reoperation for Infection within 90 Days After Primary Total Joint Arthroplasty. J Bone Joint Surg Am 2017; 99:295-304. [PMID: 28196031 DOI: 10.2106/jbjs.16.00311] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The relationship between smoking and complications after total joint arthroplasty is unclear. Prior studies have been limited by relatively small sample sizes or investigation of select cohorts. The purpose of this study was to investigate the association between smoking and readmission and/or reoperation within 90 days of total joint arthroplasty in a large, non-select cohort of patients. METHODS Using our institutional database, we retrospectively identified patients who underwent primary total joint arthroplasty between 2000 and 2014. Patients were stratified into 1 of 3 groups: current smokers, former smokers, and nonsmokers. The association between smoking status and subsequent readmission and/or reoperation within 90 days was investigated using multivariate regression analysis. RESULTS We retrospectively identified 15,264 patients (6,749 male and 8,515 female) who underwent 17,394 total joint arthroplasties during the study period. Of these patients, 1,371 (9.0%) were current smokers, 5,195 (34.0%) were former smokers, and 8,698 (57.0%) were nonsmokers. Former smokers reported a median of 22.2 years (range, 0.2 to 60 years) of abstinence prior to the surgical procedure. Current smokers were significantly younger (p < 0.001) at a mean age (and standard deviation) of 57.7 ± 10.3 years than nonsmokers at 63.2 ± 11.8 years. Current smokers were significantly more likely than nonsmokers to undergo reoperation for infection (odds ratio [OR], 1.82 [95% confidence interval (CI), 1.03 to 3.23]; p = 0.04), and former smokers were at no increased risk (OR, 1.11 [95% CI, 0.73 to 1.69]; p = 0.61). Packs per decade were independently associated with an increased risk of 90-day nonoperative readmission regardless of smoking status (OR, 1.12 [95% CI, 1.03 to 1.20]). Lastly, neither smoking status nor packs per decade were associated with aseptic or total reoperations. CONCLUSIONS This study, after controlling for confounding factors, demonstrated not only that current smokers have a significantly increased risk of reoperation for infection within 90 days of a surgical procedure compared with nonsmokers, but also that the amount that one has smoked, regardless of current smoking status, significantly contributed to increased risk of nonoperative readmission. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Eric H Tischler
- 1Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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An individually-tailored smoking cessation intervention for rural Veterans: a pilot randomized trial. BMC Public Health 2016; 16:811. [PMID: 27535024 PMCID: PMC4989380 DOI: 10.1186/s12889-016-3493-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 08/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tobacco use remains prevalent among Veterans of military service and those residing in rural areas. Smokers frequently experience tobacco-related issues including risky alcohol use, post-cessation weight gain, and depressive symptoms that may adversely impact their likelihood of quitting and maintaining abstinence. Telephone-based interventions that simultaneously address these issues may help to increase treatment access and improve outcomes. METHODS This study was a two-group randomized controlled pilot trial. Participants were randomly assigned to an individually-tailored telephone tobacco intervention combining counseling for tobacco use and related issues including depressive symptoms, risky alcohol use, and weight concerns or to treatment provided through their state tobacco quitline. Selection of pharmacotherapy was based on medical history and a shared decision interview in both groups. Participants included 63 rural Veteran smokers (mean age = 56.8 years; 87 % male; mean number of cigarettes/day = 24.7). The primary outcome was self-reported 7-day point prevalence abstinence at 12 weeks and 6 months. RESULTS Twelve-week quit rates based on an intention-to-treat analysis did not differ significantly by group (Tailored = 39 %; Quitline Referral = 25 %; odds ratio [OR]; 95 % confidence interval [CI] = 1.90; 0.56, 5.57). Six-month quit rates for the Tailored and Quitline Referral conditions were 29 and 28 %, respectively (OR; 95 % CI = 1.05; 0.35, 3.12). Satisfaction with the Tailored tobacco intervention was high. CONCLUSIONS Telephone-based treatment that concomitantly addresses other health-related factors that may adversely affect quitting appears to be a promising strategy. Larger studies are needed to determine whether this approach improves cessation outcomes. TRIAL REGISTRATION ClinicalTrials.gov identifier number NCT01592695 registered 11 April 2012.
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Land SR, Toll BA, Moinpour CM, Mitchell SA, Ostroff JS, Hatsukami DK, Duffy SA, Gritz ER, Rigotti NA, Brandon TH, Prindiville SA, Sarna LP, Schnoll RA, Herbst RS, Cinciripini PM, Leischow SJ, Dresler CM, Fiore MC, Warren GW. Research Priorities, Measures, and Recommendations for Assessment of Tobacco Use in Clinical Cancer Research. Clin Cancer Res 2016; 22:1907-13. [PMID: 26888828 PMCID: PMC4861174 DOI: 10.1158/1078-0432.ccr-16-0104] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 01/28/2016] [Indexed: 01/12/2023]
Abstract
There is strong evidence that cigarette smoking causes adverse outcomes in people with cancer. However, more research is needed regarding those effects and the effects of alternative tobacco products and of secondhand smoke, the effects of cessation (before diagnosis, during treatment, or during survivorship), the biologic mechanisms, and optimal strategies for tobacco dependence treatment in oncology. Fundamentally, tobacco is an important source of variation in clinical treatment trials. Nevertheless, tobacco use assessment has not been uniform in clinical trials. Progress has been impeded by a lack of consensus regarding tobacco use assessment suitable for cancer patients. The NCI-AACR Cancer Patient Tobacco Use Assessment Task Force identified priority research areas and developed recommendations for assessment items and timing of assessment in cancer research. A cognitive interview study was conducted with 30 cancer patients at the NIH Clinical Center to evaluate and improve the measurement items. The resulting Cancer Patient Tobacco Use Questionnaire (C-TUQ) includes "Core" items for minimal assessment of tobacco use at initial and follow-up time points, and an "Extension" set. Domains include the following: cigarette and other tobacco use status, intensity, and past use; use relative to cancer diagnosis and treatment; cessation approaches and history; and secondhand smoke exposure. The Task Force recommends that assessment occur at study entry and, at a minimum, at the end of protocol therapy in clinical trials. Broad adoption of the recommended measures and timing protocol, and pursuit of the recommended research priorities, will help us to achieve a clearer understanding of the significance of tobacco use and cessation for cancer patients.
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Affiliation(s)
- Stephanie R Land
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland.
| | - Benjamin A Toll
- Hollings Cancer Center, Medical University of South Carolina (MUSC), Charleston, South Carolina
| | - Carol M Moinpour
- Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Sandra A Mitchell
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | | | - Dorothy K Hatsukami
- Masonic Cancer Center, University of Minnesota (DKH), Minneapolis, Minnesota
| | - Sonia A Duffy
- College of Nursing and VA Center for Clinical Management Research, HSR&D Center of Excellence, The Ohio State University, Columbus, Ohio
| | - Ellen R Gritz
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nancy A Rigotti
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Thomas H Brandon
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, University of South Florida, Tampa, Florida
| | - Sheila A Prindiville
- Coordinating Center for Clinical Trials, National Cancer Institute, Bethesda, Maryland
| | - Linda P Sarna
- School of Nursing, University of California, Los Angeles, California
| | | | - Roy S Herbst
- Yale School of Medicine, Yale Cancer Center, New Haven, Connecticut
| | - Paul M Cinciripini
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Scott J Leischow
- College of Medicine, Mayo Clinic Cancer Center, Mayo Clinic Phoenix, Phoenix, Arizona
| | | | - Michael C Fiore
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Graham W Warren
- Hollings Cancer Center, Medical University of South Carolina (MUSC), Charleston, South Carolina. Department of Radiation Oncology, Medical University of South Carolina (MUSC), Charleston, South Carolina. Department of Cell and Molecular Pharmacology, Medical University of South Carolina (MUSC), Charleston, South Carolina
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Côté J, Cossette S, Ramirez-Garcia P, De Pokomandy A, Worthington C, Gagnon MP, Auger P, Boudreau F, Miranda J, Guéhéneuc YG, Tremblay C. Evaluation of a Web-based tailored intervention (TAVIE en santé) to support people living with HIV in the adoption of health promoting behaviours: an online randomized controlled trial protocol. BMC Public Health 2015; 15:1042. [PMID: 26458508 PMCID: PMC4603806 DOI: 10.1186/s12889-015-2310-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 09/22/2015] [Indexed: 11/19/2022] Open
Abstract
Background Long-term use of antiretroviral therapy, normal aging, and presence of certain risk factors are associated with metabolic disorders that predispose persons living with HIV to diabetes and cardiovascular diseases. The emergence and progression of these disorders can be prevented by adopting healthy behaviours. Based on the theory of planned behaviour, the Web-based tailored intervention TAVIE en santé was developed. The aim of this study is to evaluate the effectiveness of TAVIE en santé in order to support people living with HIV in the adoption of health promoting behaviours. Methods/Design An online randomized controlled trial with parallel-groups will be conducted across Canada. To participate in this study, people living with HIV must be: ≥ 18 years, able to read/understand French or English, have access to the Internet. A convenience sample of 750 participants will be randomly assigned either to an experimental group (TAVIE en santé, n = 375) or to a control group (websites, n = 375) (1:1 allocation ratio). The TAVIE en santé intervention is composed of seven interactive computer sessions, lasting between 5 and 10 min. The sessions, hosted by a virtual nurse, aim to develop and strengthen skills required for behaviour change. The control group will receive a validated list of five predetermined conventional health-related Websites. The adoption of health behaviour (smoking cessation or physical activity or healthy eating) is the principal outcome. Cognitions (intention, attitude, perceived behavioral control) are the secondary outcomes. Health indicators will also be assessed. All outcomes will be measured with a self-administered online questionnaire and collected three times: at baseline, 3 and 6 months after. The principal analyses will focus on differences between the two trial groups using Intention-to-Treat analysis. Discussion This study will yield new results about the efficacy of Web-based tailored health behaviours change interventions in the context of chronic disease. The TAVIE en santé intervention could constitute an accessible complementary service in support of existing specialized services to support people living with HIV adopt health behaviors. Trial registration NCT02378766, assigned on March 3th 2015.
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Affiliation(s)
- José Côté
- Research Centre of the Centre Hospitalier de l'Université de Montréal, 900 Saint Denis Street, Montreal, H2X 0A9, QC, Canada. .,Research Chair in Innovative Nursing Practices, 900 Saint Denis Street, Montreal, H2X 0A9, QC, Canada. .,Faculty of Nursing, Université de Montréal, 2375, chemin de la Côte-Ste-Catherine, Montréal, H3T 1A8, QC, Canada.
| | - Sylvie Cossette
- Faculty of Nursing, Université de Montréal, 2375, chemin de la Côte-Ste-Catherine, Montréal, H3T 1A8, QC, Canada. .,Research Center of the Montreal Heart Institute, 5000, Bélanger Street, Montréal, H1T 1C8, QC, Canada.
| | - Pilar Ramirez-Garcia
- Faculty of Nursing, Université de Montréal, 2375, chemin de la Côte-Ste-Catherine, Montréal, H3T 1A8, QC, Canada.
| | - Alexandra De Pokomandy
- Faculty of Medecine, McGill University, 3655 Sir William Osler, Montreal, H3G 1Y6, QC, Canada.
| | - Catherine Worthington
- Faculty of Human and Social Development, University of Victoria, 3800 Finnerty Road, Victoria, V8P 5C2, BC, Canada.
| | - Marie-Pierre Gagnon
- Research Centre of the Centre Hospitalier Universitaire de Québec, 2705, boulevard Laurier, Québec, G1V 4G2, QC, Canada. .,Faculty of Nursing Sciences, Université Laval, 1050, avenue de la Médecine Local 3645, Québec, G1V 0A6, QC, Canada.
| | - Patricia Auger
- Research Centre of the Centre Hospitalier de l'Université de Montréal, 900 Saint Denis Street, Montreal, H2X 0A9, QC, Canada. .,Research Chair in Innovative Nursing Practices, 900 Saint Denis Street, Montreal, H2X 0A9, QC, Canada.
| | - François Boudreau
- Faculty of Nursing, Université du Québec à Trois-Rivièves, 3351, boul. des Forges, CP 500, Trois-Rivières, G9A 5H7, QC, Canada.
| | - Joyal Miranda
- Ryerson University, 350 Victoria Street, Toronto, M5B 2K3, ON, Canada.
| | - Yann-Gaël Guéhéneuc
- Canada Research Chair on Software Patterns and Patterns of Software, 2500, chemin de Polytechnique, Montréal, H3T 1J4, QC, Canada. .,Department of Computer Engineering, Polytechnique Montréal, 2500, chemin de Polytechnique, Montréal, H3T 1J4, QC, Canada.
| | - Cécile Tremblay
- Research Centre of the Centre Hospitalier de l'Université de Montréal, 900 Saint Denis Street, Montreal, H2X 0A9, QC, Canada. .,Quebec Public Health Laboratory, Sainte-Marie Rd, Sainte-Anne-de-Bellevue, H9X 3R5, QC, Canada. .,Faculty of Medecine, Université de Montréal, 2900, boulevard Édouard-Montpetit, Montréal, H3T 1J4, QC, Canada.
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Chen D, Wu LT. Smoking cessation interventions for adults aged 50 or older: A systematic review and meta-analysis. Drug Alcohol Depend 2015; 154:14-24. [PMID: 26094185 PMCID: PMC4536122 DOI: 10.1016/j.drugalcdep.2015.06.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 05/31/2015] [Accepted: 06/02/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND The older population size has increased substantially, and a considerable proportion of older adults are cigarette smokers. Quitting smoking is associated with reduced health risk. This review is among the first to quantitatively assess the relative efficacy of types of cessation interventions for smokers aged ≥50 years. METHODS We conducted searches of the Cochrane Library, Embase, MEDLINE, and PsycINFO to identify smoking cessation studies on adults aged ≥50 years. Twenty-nine randomized clinical trials met the inclusion criteria. Three main types of interventions were identified. We analyzed relative cessation rates or Risk Ratios (RRs) between the type of intervention groups and the control group by fixed- and random-effects meta-analyses at the study level. We conducted a weighted least squares meta-regression of cessation rates on trial and sample characteristics to determine sources of outcome heterogeneity. RESULTS Fixed-effects analysis showed significant treatment effects for pharmacological (RR=3.18, 95% CI: 1.89-5.36), non-pharmacological (RR=1.80, 95% CI: 1.67-1.94), and multimodal interventions (RR=1.61, 95% CI: 1.41-1.84) compared with control group. Estimations based on meta-regression suggested that pharmacological intervention (mean point prevalence abstinence rate (PPA)=26.10%, CI: 15.20-37.00) resembled non-pharmacological (27.97%, CI: 24.00-31.94), and multimodal interventions (36.64%, CI: 31.66-41.62); and non-pharmacological and multimodal interventions had higher PPAs than the control group (18.80%, CI: 14.48-23.12), after adjusting for a number of trial and sample characteristics. CONCLUSIONS A small number of smoking cessation studies examined smokers aged ≥50 years. Additional research is recommended to determine smoking cessation efficacy for diverse older population groups (e.g., ethnic minorities).
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Affiliation(s)
- Danhong Chen
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, BOX 3903, Durham, NC, 27710, USA.
| | - Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, BOX 3903, Durham, NC, 27710, USA; Center for Child and Family Policy, Duke University, Durham, NC, USA.
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Duchman KR, Gao Y, Pugely AJ, Martin CT, Noiseux NO, Callaghan JJ. The Effect of Smoking on Short-Term Complications Following Total Hip and Knee Arthroplasty. J Bone Joint Surg Am 2015; 97:1049-58. [PMID: 26135071 DOI: 10.2106/jbjs.n.01016] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total joint arthroplasty is the most frequently performed orthopaedic procedure in the United States. The purpose of the present study was to identify differences in thirty-day morbidity and mortality following primary total hip and total knee arthroplasty according to smoking status and pack-year history of smoking. METHODS We queried the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database to identify patients who had undergone primary total hip or total knee arthroplasty between 2006 and 2012. Patients were stratified by smoking status and pack-year history of smoking. Thirty-day rates of mortality, wound complications, and total complications were compared with use of univariate and multivariate analyses. RESULTS We identified 78,191 patients who had undergone primary total hip or total knee arthroplasty. Of these, 81.8% (63,971) were nonsmokers, 7.9% (6158) were former smokers, and 10.3% (8062) were current smokers. Current smokers had a higher rate of wound complications (1.8%) compared with former smokers and nonsmokers (1.3% and 1.1%, respectively; p < 0.001). Former smokers had a higher rate of total complications (6.9%) compared with current smokers and nonsmokers (5.9% and 5.4%, respectively; p < 0.001). Multivariate analysis identified current smokers as being at increased risk of wound complications (odds ratio [OR], 1.47; 95% confidence interval [CI], 1.21 to 1.78), particularly deep wound infection, while both current smokers (OR, 1.18; 95% CI, 1.06 to 1.31) and former smokers (OR, 1.20; 95% CI, 1.08 to 1.34) were at increased total complication risk. Increasing pack-year history of smoking resulted in increasing total complication risk. CONCLUSIONS On the basis of our findings, current smokers have an increased risk of wound complications and both current and former smokers have an increased total complication risk following total hip or total knee arthroplasty.
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Affiliation(s)
- Kyle R Duchman
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242. E-mail address for K.R. Duchman: . E-mail address for Y. Gao: . E-mail address for A.J. Pugely: . E-mail address for C.T. Martin: . E-mail address for N.O. Noiseux: . E-mail address for J.J. Callaghan:
| | - Yubo Gao
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242. E-mail address for K.R. Duchman: . E-mail address for Y. Gao: . E-mail address for A.J. Pugely: . E-mail address for C.T. Martin: . E-mail address for N.O. Noiseux: . E-mail address for J.J. Callaghan:
| | - Andrew J Pugely
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242. E-mail address for K.R. Duchman: . E-mail address for Y. Gao: . E-mail address for A.J. Pugely: . E-mail address for C.T. Martin: . E-mail address for N.O. Noiseux: . E-mail address for J.J. Callaghan:
| | - Christopher T Martin
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242. E-mail address for K.R. Duchman: . E-mail address for Y. Gao: . E-mail address for A.J. Pugely: . E-mail address for C.T. Martin: . E-mail address for N.O. Noiseux: . E-mail address for J.J. Callaghan:
| | - Nicolas O Noiseux
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242. E-mail address for K.R. Duchman: . E-mail address for Y. Gao: . E-mail address for A.J. Pugely: . E-mail address for C.T. Martin: . E-mail address for N.O. Noiseux: . E-mail address for J.J. Callaghan:
| | - John J Callaghan
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242. E-mail address for K.R. Duchman: . E-mail address for Y. Gao: . E-mail address for A.J. Pugely: . E-mail address for C.T. Martin: . E-mail address for N.O. Noiseux: . E-mail address for J.J. Callaghan:
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Courtney RJ, Naicker S, Shakeshaft A, Clare P, Martire KA, Mattick RP. Smoking Cessation among Low-Socioeconomic Status and Disadvantaged Population Groups: A Systematic Review of Research Output. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:6403-22. [PMID: 26062037 PMCID: PMC4483709 DOI: 10.3390/ijerph120606403] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/02/2015] [Accepted: 06/03/2015] [Indexed: 12/13/2022]
Abstract
Background: Smoking cessation research output should move beyond descriptive research of the health problem to testing interventions that can provide causal data and effective evidence-based solutions. This review examined the number and type of published smoking cessation studies conducted in low-socioeconomic status (low-SES) and disadvantaged population groups. Methods: A systematic database search was conducted for two time periods: 2000–2004 (TP1) and 2008–2012 (TP2). Publications that examined smoking cessation in a low-SES or disadvantaged population were coded by: population of interest; study type (reviews, non-data based publications, data-based publications (descriptive, measurement and intervention research)); and country. Intervention studies were coded in accordance with the Cochrane Effective Practice and Organisation of Care data collection checklist and use of biochemical verification of self-reported abstinence was assessed. Results: 278 citations were included. Research output (i.e., all study types) had increased from TP1 27% to TP2 73% (χ² = 73.13, p < 0.001), however, the proportion of data-based research had not significantly increased from TP1 and TP2: descriptive (TP1 = 23% vs. TP2 = 33%) or intervention (TP1 = 77% vs. TP2 = 67%). The proportion of intervention studies adopting biochemical verification of self-reported abstinence had significantly decreased from TP1 to TP2 with an increased reliance on self-reported abstinence (TP1 = 12% vs. TP2 = 36%). Conclusions: The current research output is not ideal or optimal to decrease smoking rates. Research institutions, scholars and funding organisations should take heed to review findings when developing future research and policy.
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Affiliation(s)
- Ryan J Courtney
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, NSW 2052, Australia.
| | - Sundresan Naicker
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, NSW 2052, Australia.
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, NSW 2052, Australia.
| | - Philip Clare
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, NSW 2052, Australia.
| | - Kristy A Martire
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, NSW 2052, Australia.
- School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Richard P Mattick
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, NSW 2052, Australia.
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Regan S, Reid ZZ, Kelley JHK, Reyen M, Korotkin M, Japuntich SJ, Viana JC, Levy DE, Rigotti NA. Smoking Status Confirmation by Proxy: Validation in a Smoking Cessation Trial. Nicotine Tob Res 2015; 18:34-40. [PMID: 25847290 DOI: 10.1093/ntr/ntv073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 03/20/2015] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Biochemical confirmation (BC) of self-report is the gold standard of evidence for abstinence in smoking cessation research, but difficulty in obtaining samples may bias estimates of quit rates. Proxy confirmation (PC) has not been validated in cessation trials. We assessed the feasibility and validity of PC in a cessation trial for hospitalized smokers. METHODS We enrolled 402 daily cigarette smokers during a hospital admission. At enrollment, participants provided demographics, smoking history, and named proxies to confirm their smoking status at follow-up. Participants provided self-reported (SR) 7-day tobacco abstinence by telephone at 6 months post-discharge. SR quitters were asked to mail a saliva sample for BC. Incentives were offered for survey completion ($20) and returned samples ($50). We called proxies for all those with SR to obtain PC. Quit rates were calculated with missing data indicating smoking. We assessed associations of nonresponse with baseline characteristics using chi-squared tests and logistic regression. We calculated the sensitivity and specificity of PC in detecting smokers as determined by BC. RESULTS All patients named at least one proxy. Response rates were 82% for SR, 84% for PC, and 69% for BC. Observed participant characteristics were unrelated to provision of sample for BC. Estimated quit rates were 35% for SR, 27% for SR + PC, 21% for SR + BC and 27% for SR + BC or PC. Sensitivity of PC was not higher than SR (73% vs. 77%); specificity was lower (84% vs. 100%). CONCLUSION PC was feasible but not superior to self-report in a cessation trial.
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Affiliation(s)
- Susan Regan
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA;
| | - Zachary Z Reid
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
| | - Jennifer H K Kelley
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA; Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA
| | - Michele Reyen
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
| | - Molly Korotkin
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA; Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA
| | - Sandra J Japuntich
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA; National Center for PTSD, VA Boston Healthcare System, Boston, MA
| | - Joseph C Viana
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA; Department of Health Policy and Management, University of California, Los Angeles, CA
| | - Douglas E Levy
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA; Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA; Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA
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Choi SH, Waltje AH, Ronis DL, Noonan D, Hong O, Richardson CR, Meeker JD, Duffy SA. Web-enhanced tobacco tactics with telephone support versus 1-800-QUIT-NOW telephone line intervention for operating engineers: randomized controlled trial. J Med Internet Res 2014; 16:e255. [PMID: 25447467 PMCID: PMC4260077 DOI: 10.2196/jmir.3375] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 08/14/2014] [Accepted: 08/16/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Novel interventions tailored to blue collar workers are needed to reduce the disparities in smoking rates among occupational groups. OBJECTIVE The main objective of this study was to evaluate the efficacy and usage of the Web-enhanced "Tobacco Tactics" intervention targeting operating engineers (heavy equipment operators) compared to the "1-800-QUIT-NOW" telephone line. METHODS Operating engineers (N=145) attending one of 25 safety training sessions from 2010 through 2012 were randomized to either the Tobacco Tactics website with nurse counseling by phone and access to nicotine replacement therapy (NRT) or to the 1-800-QUIT-NOW telephone line, which provided an equal number of phone calls and NRT. The primary outcome was self-reported 7-day abstinence at 30-day and 6-month follow-up. The outcomes were compared using chi-square tests, t tests, generalized mixed models, and logistic regression models. RESULTS The average age was 42 years and most were male (115/145, 79.3%) and white (125/145, 86.2%). Using an intent-to-treat analysis, the Tobacco Tactics website group showed significantly higher quit rates (18/67, 27%) than the 1-800-QUIT NOW group (6/78, 8%) at 30-day follow-up (P=.003), but this difference was no longer significant at 6-month follow-up. There were significantly more positive changes in harm reduction measures (quit attempts, number of cigarettes smoked per day, and nicotine dependence) at both 30-day and 6-month follow-up in the Tobacco Tactics group compared to the 1-800-QUIT-NOW group. Compared to participants in the 1-800-QUIT NOW group, significantly more of those in the Tobacco Tactics website group participated in the interventions, received phone calls and NRT, and found the intervention helpful. CONCLUSIONS The Web-enhanced Tobacco Tactics website with telephone support showed higher efficacy and reach than the 1-800-QUIT-NOW intervention. Longer counseling sessions may be needed to improve 6-month cessation rates. TRIAL REGISTRATION Clinicaltrials.gov NCT01124110; http://clinicaltrials.gov/ct2/show/NCT01124110 (Archived by WebCite at http://www.webcitation.org/6TfKN5iNL).
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Affiliation(s)
- Seung Hee Choi
- Michigan State University, College of Nursing, East Lansing, MI, United States
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Vest BH, Kane C, DeMarce J, Barbero E, Harmon R, Hawley J, Lehmann L. Outcomes following treatment of veterans for substance and tobacco addiction. Arch Psychiatr Nurs 2014; 28:333-8. [PMID: 25439975 DOI: 10.1016/j.apnu.2014.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 08/13/2014] [Indexed: 10/24/2022]
Abstract
Persons who use tobacco in addition to alcohol and other drugs have increased health risks and mortality rates. The purpose of this study was to evaluate the impact of participation in a tobacco cessation program on tobacco, alcohol, and other drug use in a population seeking treatment for substance use disorders (SUDs). Tobacco, alcohol, and other drug use were assessed by urine drug screens, breathalyzer readings, and self-report. Veterans (N=137) with a tobacco use disorder enrolled in inpatient program for the treatment of SUDs at the Salem Veterans Affairs Medical Center participated in tobacco cessation education as part of their treatment programming. Use of tobacco, drugs and/or alcohol was evaluated upon admission, 2 weeks following admission, at discharge and 1 month following graduation. The 1-month follow-up rate was 70.8%, with 97 veterans completing the follow-up assessment. Of those 97 veterans, 90.7% (n=88) reported abstinence from alcohol and 91.8% (n=89) reported abstinence from other drugs of abuse. Fourteen veterans (14.4%) reported abstinence from tobacco at the 1-month follow-up. The veterans reporting abstinence from tobacco use also reported abstinence from alcohol and other drugs at the 1-month follow-up.
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Affiliation(s)
| | - Catherine Kane
- University of Virginia - School of Nursing, Charlottesville, VA.
| | - Josephine DeMarce
- Veterans Affairs Administration Salem, VA Medical Center, Salem, VA.
| | - Edie Barbero
- University of Virginia - School of Nursing, Charlottesville, VA.
| | - Rebecca Harmon
- University of Virginia - School of Nursing, Charlottesville, VA.
| | - Joanne Hawley
- Veterans Affairs Administration Salem, VA Medical Center, Salem, VA.
| | - Lauren Lehmann
- Veterans Affairs Administration Salem, VA Medical Center, Salem, VA.
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Meredith SE, Robinson A, Erb P, Spieler CA, Klugman N, Dutta P, Dallery J. A mobile-phone-based breath carbon monoxide meter to detect cigarette smoking. Nicotine Tob Res 2014; 16:766-73. [PMID: 24470633 PMCID: PMC4031569 DOI: 10.1093/ntr/ntt275] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 12/11/2013] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Mobile phones hold considerable promise for delivering evidence-based smoking cessation interventions that require frequent and objective assessment of smoking status via breath carbon monoxide (Breath CO) measurement. However, there are currently no commercially available mobile-phone-based Breath CO meters. We developed a mobile-phone-based Breath CO meter prototype that attaches to and communicates with a smartphone through an audio port. We then evaluated the reliability and the validity of Breath CO measures collected with the mobile meter prototype and assessed the usability and acceptability of the meter. METHODS Participants included 20 regular smokers (≥10 cigarettes/day), 20 light smokers (<10 cigarettes/day), and 20 nonsmokers. Expired air samples were collected 4 times from each participant: twice with the mobile meter and twice with a commercially available Breath CO meter. RESULTS Measures calculated by the mobile meter correlated strongly with measures calculated by the commercial meter (r = .96, p < .001). Additionally, the mobile meter accurately distinguished between smokers and nonsmokers. The area under the receiver-operating characteristic curve for the mobile meter was 94.7%, and the meter had a combined sensitivity and specificity of 1.86 at an abstinence threshold of ≤6 ppm. Responses on an acceptability survey indicated that smokers liked the meter and would be interested in using it during a quit attempt. CONCLUSIONS The results of our study suggest that a mobile-phone-based Breath CO meter is a reliable, valid, and acceptable device for distinguishing between smokers and nonsmokers.
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Affiliation(s)
- Steven E. Meredith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Andrew Robinson
- University of Michigan College of Engineering, Electrical Engineering and Computer Science, Ann Arbor, MI
| | - Philip Erb
- Department of Psychology, University of Florida, Gainesville, FL
| | | | - Noah Klugman
- University of Michigan College of Engineering, Electrical Engineering and Computer Science, Ann Arbor, MI
| | - Prabal Dutta
- University of Michigan College of Engineering, Electrical Engineering and Computer Science, Ann Arbor, MI
| | - Jesse Dallery
- Department of Psychology, University of Florida, Gainesville, FL
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Duffy SA, Ronis DL, Karvonen-Gutierrez CA, Ewing LA, Dalack GW, Smith PM, Carmody TP, Hicks T, Hermann C, Reeves P, Flanagan P. Effectiveness of the Tobacco Tactics Program in the Department of Veterans Affairs. Ann Behav Med 2014; 48:265-74. [DOI: 10.1007/s12160-014-9605-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Slagter SN, van Vliet-Ostaptchouk JV, Vonk JM, Boezen HM, Dullaart RPF, Kobold ACM, Feskens EJ, van Beek AP, van der Klauw MM, Wolffenbuttel BHR. Associations between smoking, components of metabolic syndrome and lipoprotein particle size. BMC Med 2013; 11:195. [PMID: 24228807 PMCID: PMC3766075 DOI: 10.1186/1741-7015-11-195] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Accepted: 07/24/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The clustering of metabolic and cardiovascular risk factors is known as metabolic syndrome (MetS). The risk of having MetS is strongly associated with increased adiposity and can be further modified by smoking behavior. Apolipoproteins (apo) associated with low-density lipoprotein-cholesterol (LDL-C) and high-density lipoprotein-cholesterol (HDL-C) may be altered in MetS. This study aimed to examine the association between smoking and the following parameters: MetS and its components, levels of apolipoproteins and estimated lipoprotein particle size, separately for men and women, and in different body mass index (BMI) classes. METHODS We included 24,389 men and 35,078 women aged between 18 and 80 years who participated in the LifeLines Cohort Study between December 2006 and January 2012; 5,685 men and 6,989 women were current smokers. Participants were categorized into three different body mass index (BMI) classes (BMI <25; BMI 25 to 30; BMI ≥30 kg/m²). MetS was defined according to the National Cholesterol Education Program's Adult Treatment Panel III (NCEP:ATPIII) criteria. Blood pressure, anthropometric and lipid measurements were rigorously standardized, and the large sample size enabled a powerful estimate of quantitative changes. The association between smoking and the individual MetS components, and apoA1 and apoB, was tested with linear regression. Logistic regression was used to examine the effect of smoking and daily tobacco smoked on risk of having MetS. All models were age adjusted and stratified by sex and BMI class. RESULTS Prevalence of MetS increased with higher BMI levels. A total of 64% of obese men and 42% of obese women had MetS. Current smoking was associated with a higher risk of MetS in both sexes and all BMI classes (odds ratio 1.7 to 2.4 for men, 1.8 to 2.3 for women, all P values <0.001). Current smokers had lower levels of HDL cholesterol and apoA1, higher levels of triglycerides and apoB, and higher waist circumference than non-smokers (all P <0.001). Smoking had no consistent association with blood pressure or fasting blood glucose. In all BMI classes, we found a dose-dependent association of daily tobacco consumption with MetS prevalence as well as with lower levels of HDL cholesterol, higher triglyceride levels and lower ratios of HDL cholesterol/apoA1 and, only in those with BMI <30, LDL cholesterol/apoB (all P <0.001). CONCLUSIONS Smoking is associated with an increased prevalence of MetS, independent of sex and BMI class. This increased risk is mainly related to lower HDL cholesterol, and higher triglycerides and waist circumference. In addition, smoking was associated with unfavorable changes in apoA1 and apoB, and in lipoprotein particle size. Please see related commentary: http://www.biomedcentral.com/1741-7015/11/196.
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Affiliation(s)
- Sandra N Slagter
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, HPC AA31, PO Box 30001, Groningen 9700 RB, The Netherlands.
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Anand V, Downs SM. Racial, Ethnic, and Language Disparities in Children's Exposure to Secondhand Smoke. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2013; 26:144-151. [PMID: 24066263 DOI: 10.1089/ped.2013.0257] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 07/15/2013] [Indexed: 11/13/2022]
Abstract
Race and ethnicity affect children's risk of secondhand smoke exposure. However, little is known about how race and language preference impact parents' self-reported smoking and stopping smoking rates. We analyzed data for 16,523 children aged 0-11 years from a pediatric computer decision support system (Child Health Improvement through Computer Automation [CHICA]). CHICA asks families in the waiting room about household smokers. We examined associations between race, insurance, language preference, and household smoking and reported stopping smoking rates using logistic regression. Almost a quarter (23%) of the children's families reported a smoker at home. Hispanic children are least likely (odds ratio [OR]: 0.17, confidence interval [CI]: 0.12-0.24) to have secondhand smoke exposure when compared to African American and white children, as were those with private insurance (OR: 0.52, CI: 0.43-0.64) or no insurance (OR: 0.79, CI: 0.71-0.88) compared to publicly insured. Children from English speaking families were more likely (OR: 1.55, CI: 1.24-1.95) to have secondhand smoke exposure compared to Spanish speaking families. Among smoking families, 30% reported stopping smoking subsequently. Stopping rates were higher in Hispanic (OR: 3.25, CI: 2.06-5.13) and African American (OR: 1.39, CI: 1.01-1.91) families compared to white children's families. Uninsured families were less likely than publicly insured families to report stopping smoking (OR: 0.76, CI: 0.63-0.92). English speaking families were less likely (OR: 0.56, CI: 0.41-0.75) to report stopping smoking compared to Spanish speaking even in a subgroup analyses of Hispanic families (OR: 0.55, CI: 0.39-0.76). In our safety net practices serving children predominantly on public insurance, Spanish speaking families reported the lowest risk of secondhand smoke exposure in children and the highest rate of stopping smoking in the household. Hispanic families may have increasing secondhand exposure and decreasing rates of stopping smoking as they acculturate.
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Affiliation(s)
- Vibha Anand
- Children's Health Services Research, Indiana University School of Medicine , Indianapolis, Indiana. ; The Regenstrief Institute, Inc. , Indianapolis, Indiana
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Arthur AE, Peterson KE, Rozek LS, Taylor JMG, Light E, Chepeha DB, Hébert JR, Terrell JE, Wolf GT, Duffy SA. Pretreatment dietary patterns, weight status, and head and neck squamous cell carcinoma prognosis. Am J Clin Nutr 2013; 97:360-8. [PMID: 23269814 PMCID: PMC3545683 DOI: 10.3945/ajcn.112.044859] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Few studies have evaluated the association of diet and weight status with head and neck cancer outcomes. OBJECTIVE The purpose of this study was to determine whether pretreatment dietary patterns and weight status are associated with head and neck cancer prognosis. DESIGN This was a longitudinal study of 542 patients with newly diagnosed head and neck cancer who completed food-frequency questionnaires and health surveys before treatment. Clinical data were abstracted from medical records and the Social Security Death Index. Dietary patterns were identified by using principal component analysis. Cox proportional hazard models were used to examine the association of derived dietary patterns (fit by quintiles of exposure) and weight status with time to recurrence and survival, with control for covariates. RESULTS During the study period, there were 229 deaths and 184 recurrences. Two dietary patterns were identified: a whole-foods pattern (characterized by high intakes of vegetables, fruit, fish, poultry, and whole grains) and a Western pattern (characterized by high intakes of red and processed meats, refined grains, potatoes, and French fries). In multivariable analyses, significantly fewer deaths were observed in subjects most adherent to the whole-foods pattern (HR: 0.56; 95% CI: 0.34, 0.92; P-trend = 0.01). Subjects classified as overweight or obese had significantly fewer deaths (HR: 0.65; 95% CI: 0.49, 0.85; P = 0.001) and recurrences (HR: 0.70; 95% CI: 0.52, 0.95; P = 0.02) than did normal-weight or underweight subjects. CONCLUSION Consumption of a diet rich in vegetables, fruit, fish, poultry, and whole grains and being overweight before diagnosis with head and neck cancer are associated with a better prognosis.
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Affiliation(s)
- Anna E Arthur
- Department of Environmental Health Sciences, University of Michigan Medical School, Ann Arbor, MI 48109-0482, USA
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Figueiró LR, Bortolon CB, Benchaya MC, Bisch NK, Ferigolo M, Barros HMT, Dantas DCM. Assessment of changes in nicotine dependence, motivation, and symptoms of anxiety and depression among smokers in the initial process of smoking reduction or cessation: a short-term follow-up study. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2013; 35:212-20. [DOI: 10.1590/s2237-60892013000300008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 02/25/2013] [Indexed: 11/22/2022]
Abstract
Introduction: The first days of a quit attempt represent an important challenge to long-term abstinence, especially because of the changes that take place over this period. Objective: To examine whether smokers who have recently changed their smoking behavior show changes in the intensity of nicotine dependence, motivational stage, or symptoms of anxiety and depression relative to smokers without recent changes in smoking behavior. Methods: Smokers attending a support group for smoking cessation in Porto Alegre, southern Brazil, were invited to participate. The program consisted of four weekly sessions. Smokers answered questionnaires covering intensity of nicotine dependence, stage of motivation, and symptoms of anxiety and depression at baseline and in the fourth week. Urine was collected at both time points, tested for cotinine concentration, and used to determine the final status of smokers. Results: Of the 54 smokers included in the study, 20 (37%) stopped smoking or decreased tobacco use. Both smokers who stopped or reduced tobacco use and those who did not change their behavior presented a decrease in nicotine dependence scores (p = 0.001). Conversely, only the smokers who changed behavior presented an increase in scores in the maintenance stage (p < 0.001). Conclusion: When modifying tobacco use, smokers face a difficult process, marked by several changes. A better understanding of these changes and their implications for treatment are discussed.
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