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Non-Pharmacologic Approaches to Tobacco Cessation. Respir Med 2023. [DOI: 10.1007/978-3-031-24914-3_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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Darville A, Williams L, Edward J, Butler K, Rademacher K, Gray B, Tischner CM, Keeler H, Hahn EJ. Enhancing Tobacco Treatment for Medicaid Recipients. South Med J 2022; 115:603-610. [PMID: 35922046 DOI: 10.14423/smj.0000000000001431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Medicaid recipients are vulnerable to increased morbidity and mortality secondary to high tobacco use prevalence and barriers to accessing tobacco treatment. The purpose of the pilot study was to explore managed care administrators' perceptions of the facilitators and barriers to tobacco treatment for Medicaid recipients. METHODS Focus groups with key informants (n = 14) from managed care organizations were conducted in fall 2018. Participants included case, integrated care, quality and field care managers, and individuals working in provider and network relations. RESULTS Facilitators to tobacco treatment were universal quality reporting requirements, access to medications, and the role of case management in identifying and engaging tobacco users in treatment. Barriers included bias regarding smokers' ability to quit, communication challenges, and competing priorities. CONCLUSIONS The analysis provided data to support the development of a policy brief and recommendations to the Department for Medicaid Services for enhancing tobacco dependence treatment.
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Affiliation(s)
- Audrey Darville
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
| | - Lovoria Williams
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
| | - Jean Edward
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
| | - Karen Butler
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
| | - Kathy Rademacher
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
| | - Brittney Gray
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
| | - Clair M Tischner
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
| | - Hannah Keeler
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
| | - Ellen J Hahn
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
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Lee HS, Su SJ, Yen ST, Tan AK. Cigarette smoking and quitting by individuals in Malaysia. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2091490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Helen S.H. Lee
- School of Social Sciences, Universiti Sains Malaysia, Minden, Malaysia
| | - Shew-Jiuan Su
- Department of Geography, National Taiwan Normal University, Taipei, Taiwan
| | - Steven T. Yen
- Department of Agricultural Economics, National Taiwan University, Taipei, Taiwan
| | - Andrew K.G. Tan
- School of Social Sciences, Universiti Sains Malaysia, Minden, Malaysia
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Jackson SL, Tsipas S, Yang PK, Ritchey MD, Loustalot F, Wozniak G, Wang X. Prescription Smoking-Cessation Medication Fills and Spending, 2009-2019. Am J Prev Med 2022; 62:e351-e355. [PMID: 35597571 PMCID: PMC9186091 DOI: 10.1016/j.amepre.2021.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/19/2021] [Accepted: 11/29/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Smoking is the leading cause of preventable disease and death. However, effective medicines, including prescription medications often covered by health insurance, are available to aid cessation. METHODS Trends of 7 U.S. Food and Drug Administration-approved prescription medications for smoking cessation during 2009-2019 (before and during Affordable Care Act implementation), including fill counts and spending (total and patient, adjusted to 2019 U.S. dollars), were assessed among U.S. adults aged ≥18 years. Symphony Health's Integrated Dataverse combines data on >90% of outpatient prescription fills with market purchasing data to create national estimates. Analyses were conducted in 2021. RESULTS Annually, total fills (spending) decreased from 3.7 million ($577 million) in 2009 to 2.5 million ($465 million) in 2013 and increased to 4.5 million ($1.279 billion) in 2019; patient spending decreased from $174 million (30% of total annual spending) in 2009 to $54 million (4%) in 2019. Comparing 2009 with 2019, the total spending per fill increased by 80% (from $157 to $282), whereas patient spending per fill decreased by 75% (from $47 to $12). The total spending per fill for branded products increased by 175% (from $166 to $459) and decreased by 41% (from $75 to $44) for generic products. Branded product percentage decreased from 89% to 57%. CONCLUSIONS Total fills and spending decreased from 2009 to 2013 and then increased through 2019, whereas patient spending decreased. Earlier studies suggest possible reasons for these trends, such as gradual implementation of federal requirements for insurance coverage of cessation medications and reduced cost sharing and financial barriers.
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Affiliation(s)
- Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | | | - Peter K Yang
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Matthew D Ritchey
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Xu Wang
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Asif A, Dailey H, Sheth HS, Petroulakis M. Enhancing hospitalists smoking cessation counseling and billing compliance by education intervention: a quality improvement project. J Community Hosp Intern Med Perspect 2021; 11:612-618. [PMID: 34567450 PMCID: PMC8462856 DOI: 10.1080/20009666.2021.1961380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022] Open
Abstract
Smoking causes an estimated 480,000 deaths every year. At our institute, tobacco treatment services (TTS) provide inpatient counseling and hospitalists have an essential role in providing education and replacement medications at discharge. Our project focused on increasing knowledge among hospitalists to improve the frequency of smoking cessation consultation and utilization of pharmacotherapy, accompanied by appropriate documentation and billing. We used baseline data from March 2018 to February 2019. Educational intervention was implemented from March 2019 to June 2019. Post-intervention results are reported from July 2019 to February 2020. Pre- and post-intervention periods' results were compared. A significantly higher number of patients received TTS counseling during the post-intervention phase compared to pre-intervention (54 vs. 41%, p < 0.0001). A significantly higher number of patients were prescribed inpatient medications (42% to 48%, p = 0.004) and at the time of discharge (22% to 31%, p < 0.0001). However, there was a significant decrease in physician billing from pre-intervention to post-intervention, dropping from 19.5% to 16.2% (p = 0.012). Physicians' gender, experience level, and loss of incentives impacted their consultation and billing behaviors. Future studies should continue to address the importance of TTS and physician behavior on increasing inpatient smoking cessation counseling and treatment.
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Affiliation(s)
- Anum Asif
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, Allegheny
| | - Hannah Dailey
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, Allegheny
| | - Heena S Sheth
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, Allegheny
| | - Maria Petroulakis
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, Allegheny
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Wang X, Babb S, Xu X, Ku L, Glover-Kudon R, Armour BS. Receipt of Cessation Treatments Among Medicaid Enrollees Trying to Quit Smoking. Nicotine Tob Res 2021; 23:1074-1078. [PMID: 33524992 PMCID: PMC9944845 DOI: 10.1093/ntr/ntaa213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 10/14/2020] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Cigarette smoking prevalence is higher among adults enrolled in Medicaid than adults with private health insurance. State Medicaid coverage of cessation treatments has been gradually improving in recent years; however, the extent to which this has translated into increased use of these treatments by Medicaid enrollees remains unknown. AIMS AND METHODS Using Medicaid Analytic eXtract (MAX) files, we estimated state-level receipt of smoking cessation treatments and associated spending among Medicaid fee-for service (FFS) enrollees who try to quit. MAX data are the only national person-level data set available for the Medicaid program. We used the most recent MAX data available for each state and the District of Columbia (ranging from 2010 to 2014) for this analysis. RESULTS Among the 37 states with data, an average of 9.4% of FFS Medicaid smokers with a past-year quit attempt had claims for cessation medications, ranging from 0.2% (Arkansas) to 32.9% (Minnesota). Among the 20 states with data, an average of 2.7% of FFS Medicaid smokers with a past-year quit attempt received cessation counseling, ranging from 0.1% (Florida) to 5.6% (Missouri). Estimated Medicaid spending for cessation medications and counseling for these states totaled just over $13 million. If all Medicaid smokers who tried to quit were to have claims for cessation medications, projected annual Medicaid expenditures would total $0.8 billion, a small fraction of the amount ($45.9 billion) that Medicaid spends annually on treating smoking-related disease. CONCLUSIONS The receipt of cessation medications and counseling among FFS Medicaid enrollees was low and varied widely across states. IMPLICATIONS Few studies have examined use of cessation treatments among Medicaid enrollees. We found that many FFS Medicaid smokers made quit attempts, but few had claims for proven cessation treatments, especially counseling. The receipt of cessation treatments among FFS Medicaid enrollees varied widely across states, suggesting opportunities for additional promotion of the full range of Medicaid cessation benefits. Continued monitoring of Medicaid enrollees' use of cessation treatments could inform state and national efforts to help more Medicaid enrollees quit smoking.
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Affiliation(s)
- Xu Wang
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephen Babb
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Xin Xu
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Leighton Ku
- Center for Health Policy Research at the George Washington University, Washington, DC
| | - Rebecca Glover-Kudon
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brian S. Armour
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Kollath-Cattano C, Thrasher JF, Salloum RG, Albano AW, Jindal M, Durkin M, Strayer SM. Evaluation of a smoking cessation patient decision aid that integrates information about e-cigarettes. Nicotine Tob Res 2021; 23:1880-1888. [PMID: 33984145 DOI: 10.1093/ntr/ntab095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/10/2021] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Smokers increasingly use e-cigarettes to try to quit smoking, even more than recommended cessation methods. However, few smokers discuss the range of cessation options with their physicians. Decision aids can inform smokers about smoking cessation options, including evidence about e-cigarettes, and encourage smokers to engage in shared decision making with their physician. This study aimed to evaluate a smoking cessation decision aid that included e-cigarette risks and benefits. METHODS Adult smokers were recruited from primary care clinics for two research phases: 1. usability and acceptability testing of the decision aid (n=37); and 2. pre/post study that compared usual care (n=90) with implementation of the decision aid in clinics (n=90). For the latter, outcome measures included frequency of clinical discussions of readiness to quit, methods to quit in general, and of specific cessation methods, in addition to decisional conflict, communication satisfaction, and overall patient satisfaction. RESULTS Smokers indicated high usability and acceptability of the decision aid. In the pre/post evaluation, decision aid implementation was associated with higher rates of smokers: being asked if they were ready to quit smoking (89% vs. 67%, respectively; p<0.001); discussing methods for smoking cessation in general (81% vs. 48%; p<0.001); and discussing specific cessation methods (NRT 55% vs. 26%, p<0.001; prescription medications 26% vs. 12%, p=0.022). Decision aid use was also associated with higher overall patient satisfaction with the physician visit. CONCLUSIONS Smoking cessation decision aids that incorporate information about e-cigarettes are acceptable among smokers and can lead to evidence-based clinical discussions about smoking cessation. IMPLICATIONS Smokers use e-cigarettes more than recommended cessation methods when they are trying to quit smoking, yet few physicians discuss the risks and benefits of e-cigarettes with their patients who smoke. This study presents preliminary findings about the feasibility and usability of a clinically based iPad-delivered smoking cessation decision aid that integrates information about e-cigarettes. Although promising, further research with randomized designs, larger samples, and longer-term follow-up is needed to determine whether this type of intervention can effectively promote cessation of all tobacco products and, for those not ready to quit smoking, the use of e-cigarettes for harm reduction.
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Affiliation(s)
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville
| | | | - Meenu Jindal
- Department of Internal Medicine, Prisma Health, Greenville
| | - Martin Durkin
- Department of Family and Preventive Medicine, University of South Carolina School of Medicine, Columbia
| | - Scott M Strayer
- Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Richmond
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Carlos S, Rico-Campà A, de la Fuente-Arrillaga C, Echavarri M, Fernandez-Montero A, Gea A, Salazar C, Martínez-González MA. Do healthy doctors deliver better messages of health promotion to their patients?: Data from the SUN cohort study. Eur J Public Health 2020; 30:466-472. [DOI: 10.1093/eurpub/ckaa019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Abstract
Background
Healthy lifestyle adherence is associated with lower chronic disease morbidity/mortality. The role of doctors, as counselors and role models, is essential. Among physicians participating in a prospective cohort, we investigated the behavioral counseling on diet and lifestyle provided to their patients in association with their own personal behaviors.
Methods
We assessed 890 doctors aged ≤65 years participating in the ‘Seguimiento Universidad de Navarra’ (SUN) cohort, who replied to an online questionnaire regarding their practices on behavioral counseling and drug prescription to their patients. Data were combined with previous baseline information on their personal healthy habits.
Results
Among doctors, 31% reported <10 min per visit; 73% counseled 60–100% of their patients on smoking cessation, 58% on physical activity, 54% on weight control, 51% on healthy nutrition, 44% on alcohol avoidance/reduction and 28% recommended alcohol moderate consumption. The percentage of doctors that counseled 100% of their patients about lifestyle was 43% for smoking cessation, 15% for exercise and 13% for weight control and nutrition. Better doctor’s adherence to the Mediterranean dietary pattern was associated with more frequent and longer nutrition counseling. Higher practice of physical activity was associated with longer time on counseling about exercise to their patients. Among doctors both current and former smoking were inversely associated with the frequency and duration of their smoking cessation/avoidance counseling practices.
Conclusions
Personal behavioral changes among doctors and better training of medical doctors on a personal healthy diet and lifestyle are likely to contribute to improve the behavioral counseling given to patients.
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Affiliation(s)
- Silvia Carlos
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Navarra, Spain
| | - Anaïs Rico-Campà
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Navarra, Spain
- Centro de Investigación Biomédica en Red Área de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain
| | - Carmen de la Fuente-Arrillaga
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Navarra, Spain
- Centro de Investigación Biomédica en Red Área de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain
| | - María Echavarri
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
| | - Alejandro Fernandez-Montero
- IdiSNA, Navarra Institute for Health Research, Pamplona, Navarra, Spain
- Department of Occupational Medicine, University of Navarra, Pamplona, Spain
| | - Alfredo Gea
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Navarra, Spain
- Centro de Investigación Biomédica en Red Área de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain
| | - Camino Salazar
- Unidad Docente Multiprofesional de Atención Familiar y Comunitaria, Sanidad de Castilla y Leon (SACYL), Palencia, Spain
| | - Miguel Angel Martínez-González
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Navarra, Spain
- Centro de Investigación Biomédica en Red Área de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain
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Young-Wolff KC, Adams SR, Tan ASL, Adams AS, Klebaner D, Campbell CI, Satre DD, Salloum RG, Carter-Harris L, Prochaska JJ. Disparities in knowledge and use of tobacco treatment among smokers in California following healthcare reform. Prev Med Rep 2019; 14:100847. [PMID: 31024786 PMCID: PMC6476812 DOI: 10.1016/j.pmedr.2019.100847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/25/2019] [Accepted: 03/14/2019] [Indexed: 11/28/2022] Open
Abstract
The Affordable Care Act (ACA) promised to narrow smoking disparities by expanding access to healthcare and mandating comprehensive coverage for tobacco treatment starting in 2014. We examined whether two years after ACA implementation disparities in receiving clinician advice to quit and smokers' knowledge and use of treatment resources remained. We conducted telephone interviews in 2016 with a stratified random sample of self-reported smokers newly enrolled in the Kaiser Permanente Northern California's (KPNC) integrated healthcare delivery system in 2014 (N = 491; 50% female; 53% non-white; 6% Spanish language). We used Poisson regression with robust standard errors to test whether sociodemographics, insurance type, comorbidities, smoking status in 2016 (former, light/nondaily [<5 cigarettes per day], daily), and preferred language (English or Spanish) were associated with receiving clinician advice to quit and knowledge and use of tobacco treatment. We included an interaction between smoking status and language to test whether the relation between smoking status and key outcomes varied with preferred language. Overall, 80% of respondents received clinician advice to quit, 84% knew that KPNC offers cessation counseling, 54% knew that cessation pharmacotherapy is free, 54% used pharmacotherapy, and 6% used counseling. In multivariate models, Spanish-speaking light/nondaily smokers had significantly lower rates of all outcomes, while there was no association with other demographic and clinical characteristics. Following ACA implementation, most smokers newly enrolled in KPNC received clinician advice to quit and over half used pharmacotherapy, yet counseling utilization was low. Spanish-language outreach efforts and treatment services are recommended, particularly for adults who are light/nondaily smokers.
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Affiliation(s)
- Kelly C Young-Wolff
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.,Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Sara R Adams
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Andy S L Tan
- Department of Social and Behavioral Health, Harvard T.H. Chan School of Public Health, Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Alyce S Adams
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Daniella Klebaner
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Cynthia I Campbell
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.,Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
| | | | - Judith J Prochaska
- Stanford Prevention Research Center, Stanford University, Stanford, CA, USA
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