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Smits JAJ, Zvolensky MJ, Cheney MK, Rosenfield D, Brown RA, Manser SS, Otto MW, Freeman SZ, Sarmiento MI, Thureen SE. Efficacy and implementation of exercise-based smoking cessation treatment for adults with high anxiety sensitivity (STEP): Study protocol for a randomized controlled trial. Contemp Clin Trials 2024; 141:107521. [PMID: 38580103 PMCID: PMC11139226 DOI: 10.1016/j.cct.2024.107521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/14/2024] [Accepted: 04/02/2024] [Indexed: 04/07/2024]
Abstract
Anxiety sensitivity (AS), reflecting the fear of bodily sensations, is a transdiagnostic vulnerability factor that underpins both affective psychopathology and smoking. Phase II research supports the efficacy of a 15-week community-based intervention (STEP) that combines high-intensity exercise offered by the YMCA with standard smoking cessation treatment (tobacco quitline and nicotine replacement therapy) for sedentary smokers with elevated AS. This Phase III study aims to enroll 360 adults to evaluate whether STEP efficacy for achieving smoking abstinence generalizes to Black and Hispanic smokers with elevated AS.
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Affiliation(s)
- Jasper A J Smits
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, Austin, TX 78712, USA.
| | - Michael J Zvolensky
- Department of Psychology and Health Institute, The University of Houston, Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Marshall K Cheney
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK 73019, USA
| | - David Rosenfield
- Department of Psychology, Southern Methodist University, Dallas, TX 75205, USA
| | - Richard A Brown
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, Austin, TX 78712, USA; School of Nursing, The University of Texas at Austin, Austin, TX 78712, USA
| | | | - Michael W Otto
- Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, USA
| | - Slaton Z Freeman
- Department of Psychology, University of Colorado Denver, Denver, CO 80204, USA
| | - Marla I Sarmiento
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, Austin, TX 78712, USA
| | - Sydney E Thureen
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, Austin, TX 78712, USA
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Brown RA, Minami H, Hecht J, Kahler CW, Price LH, Kjome KL, Bloom EL, Levy DE, Carpenter KM, Smith A, Smits JAJ, Rigotti NA. Sustained Care Smoking Cessation Intervention for Individuals Hospitalized for Psychiatric Disorders: The Helping HAND 3 Randomized Clinical Trial. JAMA Psychiatry 2021; 78:839-847. [PMID: 33950156 PMCID: PMC8100915 DOI: 10.1001/jamapsychiatry.2021.0707] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
IMPORTANCE Smoking among individuals with serious mental illness (SMI) represents a major public health problem. Intervening during a psychiatric hospital stay may provide an opportunity to aid engagement in smoking cessation treatment and facilitate success in quitting. OBJECTIVE To examine the effectiveness of a multicomponent, sustained care (SusC) smoking cessation intervention in adults with SMI receiving inpatient psychiatric care. DESIGN, SETTING, AND PARTICIPANTS The Helping HAND 3 randomized clinical trial compared SusC with usual care (UC) among individuals with SMI who smoked daily and were receiving inpatient psychiatric care in Austin, Texas, in a single hospital. The study was conducted from July 2015 through August 2019. INTERVENTIONS The UC intervention involved brief smoking cessation information, self-help materials and advice from the admitting nurse, and an offer to provide nicotine replacement therapy during hospitalization. The SusC intervention included 4 main components designed to facilitate patient engagement with postdischarge smoking cessation resources: (1) inpatient motivational counseling; (2) free transdermal nicotine patches on discharge; (3) an offer of free postdischarge telephone quitline, text-based, and/or web-based smoking cessation counseling, and (4) postdischarge automated interactive voice response calls or text messages. MAIN OUTCOMES AND MEASURES The primary outcome was biochemically verified 7-day point-prevalence abstinence at 6-month follow-up. A secondary outcome was self-reported smoking cessation treatment use at 1, 3, and 6 months after discharge. RESULTS A total of 353 participants were randomized, of whom 342 were included in analyses (mean [SD] age, 35.8 [12.3] years; 268 White individuals [78.4%]; 280 non-Hispanic individuals [81.9%]; 169 women [49.4%]). They reported smoking a mean (SD) of 16.9 (10.4) cigarettes per day. Participants in the SusC group evidenced significantly higher 6-month follow-up point-prevalence abstinence rates than those in the UC group (8.9% vs 3.5%; adjusted odds ratio, 2.95 [95% CI, 1.24-6.99]; P = .01). The number needed to treat was 18.5 (95% CI, 9.6-306.4). A series of sensitivity analyses confirmed effectiveness. Finally, participants in the SusC group were significantly more likely to report using smoking cessation treatment over the 6 months postdischarge compared with participants in the UC group (74.6% vs 40.5%; relative risk, 1.8 [95% CI, 1.51-2.25]; P < .001). CONCLUSIONS AND RELEVANCE The findings of this randomized clinical trial provide evidence for the effectiveness of a scalable, multicomponent intervention in promoting smoking cessation treatment use and smoking abstinence in individuals with SMI following hospital discharge. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02204956.
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Affiliation(s)
| | - Haruka Minami
- Department of Psychology, Fordham University, Bronx, New York
| | - Jacki Hecht
- School of Nursing, University of Texas at Austin, Austin
| | - Christopher W. Kahler
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Lawrence H. Price
- Butler Hospital, Alpert Medical School of Brown University, Providence, Rhode Island,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Kimberly L. Kjome
- Seton Shoal Creek Hospital, Austin, Texas,Department of Psychiatry, Dell Medical School at the University of Texas at Austin, Austin
| | - Erika Litvin Bloom
- Rhode Island Hospital, Providence, Rhode Island,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island,Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Douglas E. Levy
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston,Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts Medical School, Harvard Medical School, Boston
| | | | - Ashleigh Smith
- Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin,Department of Health Social Work, Steve Hicks School of Social Work, University of Texas at Austin, Austin
| | | | - Nancy A. Rigotti
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston
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Garey L, Wirtz MR, Labbe AK, Zvolensky MJ, Smits JAJ, Giordano TP, Rosenfield D, Robbins GK, Levy DE, McKetchnie SM, Bell T, O'Cleirigh C. Evaluation of an integrated treatment to address smoking cessation and anxiety/depressive symptoms among people living with HIV: Study protocol for a randomized controlled trial. Contemp Clin Trials 2021; 106:106420. [PMID: 33933667 PMCID: PMC10080995 DOI: 10.1016/j.cct.2021.106420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/14/2021] [Accepted: 04/26/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Interventions that target anxiety/depressive symptoms in the context of smoking treatment have shown promise irrespective of psychiatric diagnosis. Yet, these tailored treatments are largely absent for persons who smoke and are living with HIV (SLWH). OBJECTIVE To evaluate a novel, smoking cessation intervention that addresses anxiety/depression and HIV-related health (QUIT) against a time-matched control (TMC) and a standard of care (SOC) condition. METHODS SLWH (N = 180) will be recruited and enrolled from 3 medical clinics in Boston, MA, and Houston, TX. The trial will consist of a baseline assessment, a 10-week intervention/assessment period, and follow-up assessments, accounting for a total study duration of approximately 8 months. All participants will complete a baseline visit and a pre-randomization standardized psychoeducation visit, and will then be randomized to one of three conditions: QUIT, TMC, or SOC. QUIT and TMC will consist of nine 60-min, cognitive behavioral therapy-based, individual weekly counseling sessions using standard smoking cessation counseling; additionally, QUIT will target anxiety and depressive symptoms by addressing underlying mechanisms related to mood and quit difficulty. SOC participants will complete weekly self-report surveys for nine weeks. All participants will be encouraged to quit at Session 7 and will be offered nicotine replacement therapy to help. CONCLUSIONS QUIT is designed to improve smoking cessation in SLWH by addressing anxiety and depression and HIV-related health issues. If successful, the QUIT intervention would be ready for implementation and dissemination into "real-world" behavioral health and social service settings consistent with the four objectives outlined in NIDA's Strategic Plan.
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Affiliation(s)
- Lorra Garey
- Department of Psychology, University of Houston, Houston, TX, United States of America
| | - Megan R Wirtz
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
| | - Allison K Labbe
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, United States of America
| | - Jasper A J Smits
- Department of Psychology, University of Texas at Austin, Austin, TX, United States of America
| | - Thomas P Giordano
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America
| | - David Rosenfield
- Department of Psychology, Southern Methodist University, Dallas, TX, United States of America
| | - Gregory K Robbins
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
| | - Douglas E Levy
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA, United States of America; Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Samantha M McKetchnie
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America; The Fenway Institute, Fenway Health, Boston, MA, United States of America
| | - Tanisha Bell
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Conall O'Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America; The Fenway Institute, Fenway Health, Boston, MA, United States of America.
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Rigotti NA, Schnitzer K, Davis EM, Regan S, Chang Y, Kelley JHK, Notier AE, Gilliam K, Douaihy A, Levy DE, Singer DE, Tindle HA. Comparative effectiveness of post-discharge strategies for hospitalized smokers: Study protocol for the Helping HAND 4 randomized controlled trial. Trials 2020; 21:336. [PMID: 32299470 PMCID: PMC7164139 DOI: 10.1186/s13063-020-04257-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 03/14/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Tobacco smoking remains the leading preventable cause of death in the US. A hospital admission provides smokers with a unique opportunity to stop smoking because it requires temporary tobacco abstinence while illness may enhance motivation to quit. Hospital interventions must continue post-discharge to increase tobacco abstinence long-term, but how best to accomplish this remains unclear. Building on two previous randomized controlled trials, each of which tested smoking cessation interventions that began in hospital and continued after discharge, this trial compares two interventions that provide sustained smoking cessation treatment after hospital discharge with the goal of improving long-term smoking cessation rates among hospitalized smokers. METHODS/DESIGN Helping HAND 4 is a three-site randomized controlled trial that compares the effectiveness of two active interventions for producing validated past 7-day tobacco abstinence 6 months after hospital discharge. Smokers who are admitted to three hospitals receive a standard in-hospital smoking intervention, and those who plan to quit smoking after discharge are recruited and randomly assigned to two interventions that begin at discharge, Personalized Tobacco Care Management (PTCM) or Quitline eReferral. Each lasts 3 months. At discharge, PTCM provides 8 weeks of free nicotine replacement (NRT; a participant's choice of patch, gum, lozenge, or a combination) and then proactive smoking cessation support using an automated communication platform and live contact with a tobacco treatment specialist who is based in the health care system. In the eReferral condition, a direct referral is made from the hospital electronic health record to a community-based resource, the state's telephone quitline. The quitline provides up to 8 weeks of free NRT and offers behavioral support via a series of phone calls from a trained coach. Outcomes are assessed at 1, 3, and 6 months after discharge. The study hypothesis is that PTCM will produce higher quit rates than eReferral. DISCUSSION Helping HAND 4 is a pragmatic trial that aims to evaluate interventions in real-world conditions. This project will give hospital systems critical evidence-based tools for meeting National Hospital Quality Measures for tobacco treatment and maximizing their ability to improve cessation rates and overall health for the millions of smokers hospitalized annually in the US. TRIAL REGISTRATION Prospectively registered prior to start of enrollment at Clinicaltrials.gov, NCT03603496 (July 27, 2018). https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S00084MJ&selectaction=Edit&uid=U00002G7&ts=2&cx=ff0oxn.
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Affiliation(s)
- Nancy A. Rigotti
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 100 Cambridge St., Suite 1600, Boston, MA 02114 USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA USA
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Kristina Schnitzer
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 100 Cambridge St., Suite 1600, Boston, MA 02114 USA
- Harvard Medical School, Boston, MA USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | - Esa M. Davis
- University of Pittsburgh School of Medicine, Pittsburgh, PA USA
- University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Susan Regan
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 100 Cambridge St., Suite 1600, Boston, MA 02114 USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Yuchiao Chang
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 100 Cambridge St., Suite 1600, Boston, MA 02114 USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Jennifer H. K. Kelley
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 100 Cambridge St., Suite 1600, Boston, MA 02114 USA
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA USA
| | - Anna E. Notier
- University of Pittsburgh School of Medicine, Pittsburgh, PA USA
- University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Karen Gilliam
- Vanderbilt University Medical Center, Nashville, TN USA
| | - Antoine Douaihy
- University of Pittsburgh School of Medicine, Pittsburgh, PA USA
- University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Douglas E. Levy
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 100 Cambridge St., Suite 1600, Boston, MA 02114 USA
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Daniel E. Singer
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Hilary A. Tindle
- Vanderbilt University Medical Center, Nashville, TN USA
- Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN USA
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