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Holt AG, Hussong A, Castro MG, Bossenbroek Fedoriw K, Schmidt AM, Prentice A, Ware OD. Smoking Policies of Outpatient and Residential Substance Use Disorder Treatment Facilities in the United States. Tob Use Insights 2024; 17:1179173X241254803. [PMID: 38752184 PMCID: PMC11095085 DOI: 10.1177/1179173x241254803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 04/28/2024] [Indexed: 05/18/2024] Open
Abstract
Tobacco use is associated with morbidity and mortality. Many individuals who present to treatment facilities with substance use disorders (SUDs) other than tobacco use disorder also smoke cigarettes or have a concomitant tobacco use disorder. Despite high rates of smoking among those with an SUD, and numerous demonstrated benefits of comprehensive SUD treatment for tobacco use in addition to co-occurring SUDs, not all facilities address the treatment of comorbid tobacco use disorder. In addition, facilities vary widely in terms of tobacco use policies on campus. This study examined SUD facility smoking policies in a national sample of N = 16,623 SUD treatment providers in the United States in 2021. Most facilities with outpatient treatment (52.1%) and facilities with residential treatment (67.8%) had a smoking policy that permitted smoking in designated outdoor area(s). A multinomial logistic regression model found that among facilities with outpatient treatment (n = 13,778), those located in a state with laws requiring tobacco free grounds at SUD facilities, those with tobacco screening/education/counseling services, and those with nicotine pharmacotherapy were less likely to have an unrestrictive tobacco smoking policy. Among facilities with residential treatment (n = 3449), those with tobacco screening/education/counseling services were less likely to have an unrestrictive tobacco smoking policy. There is variability in smoking policies and tobacco use treatment options in SUD treatment facilities across the United States. Since tobacco use is associated with negative biomedical outcomes, more should be done to ensure that SUD treatment also focuses on reducing the harms of tobacco use.
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Affiliation(s)
- Alison G. Holt
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Andrea Hussong
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M. Gabriela Castro
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Amy Prentice
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Orrin D. Ware
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Campbell BK, Le T, McCuistian C, Bonniot C, Delucchi K, Guydish J. Policy and Practice Changes Associated with a Tobacco-Free Initiative in Residential Substance Use Disorder Treatment. J Psychoactive Drugs 2024:1-10. [PMID: 38363096 DOI: 10.1080/02791072.2024.2316278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/25/2024] [Indexed: 02/17/2024]
Abstract
A California-sponsored, 18-month, tobacco-free intervention in residential substance use disorder (SUD) programs was associated with increases in tobacco-free grounds and tobacco-related client services. The current study examined whether positive results would be replicated in 11 programs participating subsequently. Program directors (N = 11) completed surveys of tobacco-related policies pre- and post-intervention. Pre- (n = 163) and post-intervention (n = 128) cross-sectional staff surveys examined tobacco-related training, beliefs, practices, smoking policy, and smoking status. Directors reported increases in tobacco-free grounds (from 3 to 8 programs), tobacco-related staff training (1 to 10 programs), tobacco cessation staff services (1 to 9 programs) and nicotine replacement therapy (NRT) provision (6 to 10 programs). At post-intervention, staff were more likely to report smoke-free workplaces (p = 0.008), positive beliefs about treating tobacco use (p = 0.017) and less likely to report current smoking (p = 0.003). Clinical staff were more likely to report tobacco-related training receipt (p = 0.001), program-level NRT provision (p = 0.009) and conducting tobacco-related client services (p < 0.0001) post-intervention. Findings of increases in tobacco-free grounds and tobacco cessation client services corroborated prior results. These and the additional finding of decreases in staff smoking strengthen evidence that initiatives supporting tobacco-free policies can be successfully implemented in SUD treatment.
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Affiliation(s)
- Barbara K Campbell
- Division of General Internal Medicine & Geriatrics, Oregon Health and Science University, Portland, OR, USA
| | - Thao Le
- Philip R. Lee Institute for Health Policy Studies, San Francisco, CA, USA
| | - Caravella McCuistian
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Catherine Bonniot
- Smoking Cessation Leadership Center, Division of General Internal Medicine, University of California, San Francisco, CA, USA
| | - Kevin Delucchi
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Joseph Guydish
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
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Iyahen EO, Omoruyi OO, Rowa-Dewar N, Dobbie F. Exploring the barriers and facilitators to the uptake of smoking cessation services for people in treatment or recovery from problematic drug or alcohol use: A qualitative systematic review. PLoS One 2023; 18:e0288409. [PMID: 37440505 DOI: 10.1371/journal.pone.0288409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Smoking prevalence and the associated poor health and mortality is significantly higher among people with/recovering from problematic drug or alcohol (PDA) use in comparison with the general population. Evidence from existing systematic reviews shows smoking cessation enhances rather than compromises long-term abstinence from alcohol or drug use. However, these systematic reviews lack important contextual detail around the reasons why uptake of, and successful engagement with existing stop smoking services remains low for people in treatment or recovery from PDA use. This systematic review explores qualitative data on the barriers and facilitators to the uptake of smoking cessation services for people in treatment or recovery from PDA use. This key objective addresses the limited inclusion of qualitative studies in previous systematic reviews on this issue. METHODS A qualitative systematic review was conducted with searches across four electronic databases (PubMed, Embase, PsycINFO and Cumulative Index to Nursing and Allied Health Literature [CINAHL]). All studies that had a qualitative component about free smoking cessation/reduction programmes for people in treatment or recovery from PDA use were included. Studies that examined electronic smoking or services that required a fee were excluded. Study quality was assessed using National Institute for Health and Care Excellence checklist. Qualitative synthesis involved inductive thematic analysis. (PROSPERO Registration number: CRD42022298521). RESULTS 8809 potentially eligible articles were identified, 72 full texts were screened and ten articles were included for full review. Barriers to uptake and engagement with existing stop smoking services centered on three key themes: perception of public health importance, programme structure, and intervention elements. Facilitators included supportive treatment environment and optimization of support/staff resources for smoking cessation service delivery. CONCLUSION Recommendations included influencing a change in the way people perceive the importance of smoking cessation activities during PDA use treatment or recovery. There was also some emphasis on the need to create the right environment for sustained adherence to treatment or recovery plans, and deliver the interventions within the health system as comprehensive care. The limited qualitative evidence on community-based and outpatient services highlights a research gap.
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Affiliation(s)
| | | | - Neneh Rowa-Dewar
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Fiona Dobbie
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
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Britton M, Chen TA, Martinez Leal I, Rogova A, Kyburz B, Williams T, Patel M, El-Zein R, Bernicker EH, Lowenstein LM, Reitzel LR. Lung Cancer Screening Eligibility and Referral Practices in Texas Organizations Serving People with Substance Use Disorders. Cancers (Basel) 2023; 15:cancers15072073. [PMID: 37046736 PMCID: PMC10093429 DOI: 10.3390/cancers15072073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/17/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
For people at elevated risk for lung cancer, lung cancer screening (LCS) reduces lung cancer mortality. People with non-nicotine substance use disorders (SUDs) have elevated rates of smoking compared with the general population, highlighting them as a priority population for LCS consideration. Although research has shown LCS is underutilized, there is little literature to inform whether organizations that serve individuals with SUDs have existing clinical protocols surrounding LCS. In the current study, we examine the LCS eligibility and referral practices among these organizations. We conducted a statewide needs assessment survey in 2021 to discern how tobacco use was being addressed at Texas organizations that provide treatment or services to individuals with SUDs. Respondents were asked to report on their center’s LCS eligibility and referral practices. The analytic sample consists of 125 respondents who represented 23 federally qualified health centers, 29 global local mental health authorities (LMHAs), 12 substance use treatment programs in LMHAs, and 61 standalone substance use treatment centers. Very few respondents indicated that healthcare providers at their center made referrals to LCS for patients (8.8%); a few respondents indicated that their healthcare providers assessed patients’ eligibility for LCS but did not make referrals (3.2%). Intervention and implementation efforts are needed in these and other SUD healthcare settings to bolster organizational capacity and ensure that patients are being navigated to lung cancer screening at multiple touch points across the care continuum.
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Affiliation(s)
- Maggie Britton
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA
- Department of Psychological, Health & Learning Sciences, University of Houston, 3657 Cullen Blvd. Stephen Power Farish Hall, Houston, TX 77204, USA
- HEALTH Research Institute, The University of Houston, 4349 Martin Luther King Blvd., Houston, TX 77204, USA
- Correspondence:
| | - Tzuan A. Chen
- Department of Psychological, Health & Learning Sciences, University of Houston, 3657 Cullen Blvd. Stephen Power Farish Hall, Houston, TX 77204, USA
- HEALTH Research Institute, The University of Houston, 4349 Martin Luther King Blvd., Houston, TX 77204, USA
| | - Isabel Martinez Leal
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA
- Department of Psychological, Health & Learning Sciences, University of Houston, 3657 Cullen Blvd. Stephen Power Farish Hall, Houston, TX 77204, USA
- HEALTH Research Institute, The University of Houston, 4349 Martin Luther King Blvd., Houston, TX 77204, USA
| | - Anastasia Rogova
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA
- Department of Psychological, Health & Learning Sciences, University of Houston, 3657 Cullen Blvd. Stephen Power Farish Hall, Houston, TX 77204, USA
| | - Bryce Kyburz
- Integral Care, 1430 Collier St., Austin, TX 78704, USA
| | | | - Mayuri Patel
- Department of State Health Services, Tobacco Prevention and Control Branch, Austin, TX 78714, USA
| | - Randa El-Zein
- Houston Methodist Neal Cancer Center, 6445 Main Street, Houston, TX 77030, USA
| | - Eric H. Bernicker
- Houston Methodist Neal Cancer Center, 6445 Main Street, Houston, TX 77030, USA
| | - Lisa M. Lowenstein
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA
| | - Lorraine R. Reitzel
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA
- Department of Psychological, Health & Learning Sciences, University of Houston, 3657 Cullen Blvd. Stephen Power Farish Hall, Houston, TX 77204, USA
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Britton M, Martinez Leal I, Jafry MZ, Chen TA, Rogova A, Kyburz B, Williams T, Reitzel LR. Influence of Provider and Leader Perspectives about Concurrent Tobacco-Use Care during Substance-Use Treatment on Their Tobacco Intervention Provision with Clients: A Mixed-Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5260. [PMID: 37047876 PMCID: PMC10094458 DOI: 10.3390/ijerph20075260] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 06/19/2023]
Abstract
People with substance-use disorders have elevated rates of tobacco use compared with the general population, yet rarely receive tobacco-dependence treatment within substance-use treatment settings (SUTS). One barrier to delivering evidence-based interventions in SUTS is providers' misconception that treating tobacco use and non-nicotine substance use concurrently jeopardizes clients' substance-use recovery, although research indicates that it enhances support for recovery and relapse prevention. A total of 86 treatment providers employed in SUTS (i.e., 9 Federally Qualified Health Centers, 16 Local Mental Health Authorities (LMHAs), 6 substance-use treatment programs in LMHAs, and 55 stand-alone substance-use treatment centers) in Texas, USA, answered survey questions about their (1) thoughts about treating tobacco during substance-use treatment, and (2) delivery of the 5A's tobacco-use intervention (Ask, Advise, Assess, Assist, Arrange). Twenty-six providers and leaders were interviewed about attitudes toward tobacco-free workplace policies and tobacco dependence and the relative importance of treating tobacco (vs. other substance-use disorders) at their center. Providers who did not believe tobacco use should be addressed as soon as clients begin treatment (i.e., endorsed responses of after 1 year, it depends on the client, or never) had lower odds of Asking clients about their tobacco use (OR = 0.195), Advising clients to quit smoking (OR = 0.176), and Assessing interest in quitting smoking (OR = 0.322). Qualitative results revealed barriers including beliefs that clients need to smoke to relieve the stress of substance-use recovery, are disinterested in quitting, fears that concurrent treatment would jeopardize substance use, and limited resources; additional training and education resources was the key facilitator theme. The results demonstrate a critical need to eliminate barriers to tobacco-treatment provision for clients in SUTS through education to correct misperceptions, specialized training to equip providers with knowledge and skills, and resources to build center capacity. Integrating evidence-based smoking interventions into routine care is key to support the recovery efforts of clients in SUTS.
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Affiliation(s)
- Maggie Britton
- Department of Health Disparities Research, The University of Texas at MD Anderson Cancer Center, 1400 Pressler Street, Unit 1440, Houston, TX 77030, USA
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Isabel Martinez Leal
- Department of Health Disparities Research, The University of Texas at MD Anderson Cancer Center, 1400 Pressler Street, Unit 1440, Houston, TX 77030, USA
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Midhat Z. Jafry
- Department of Health Disparities Research, The University of Texas at MD Anderson Cancer Center, 1400 Pressler Street, Unit 1440, Houston, TX 77030, USA
| | - Tzuan A. Chen
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Anastasia Rogova
- Department of Health Disparities Research, The University of Texas at MD Anderson Cancer Center, 1400 Pressler Street, Unit 1440, Houston, TX 77030, USA
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
| | - Bryce Kyburz
- Integral Care, 1430 Collier Street, Austin, TX 78704, USA
| | | | - Lorraine R. Reitzel
- Department of Health Disparities Research, The University of Texas at MD Anderson Cancer Center, 1400 Pressler Street, Unit 1440, Houston, TX 77030, USA
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
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Vinci C, Sutton SK, Yang MJ, Baban S, Sauls R, Witkiewitz K, Brandon KO, Unrod M, Brandon TH, Wetter DW. Pilot randomized controlled trial of mindfulness-based relapse prevention vs cognitive behavioral therapy for smoking and alcohol use. Drug Alcohol Depend 2023; 244:109768. [PMID: 36645978 PMCID: PMC9975045 DOI: 10.1016/j.drugalcdep.2023.109768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/28/2022] [Accepted: 01/06/2023] [Indexed: 01/12/2023]
Abstract
BACKGROUND The combined use of cigarettes and alcohol is associated with a synergistic increase in the risk of morbidity and mortality. Continued alcohol use during a smoking quit attempt is a considerable risk factor for smoking relapse. As such, there is a need for interventions that address both behaviors concurrently. Mindfulness-based interventions hold much promise for simultaneously addressing tobacco and alcohol use. METHOD This pilot study evaluated the feasibility and acceptability of a mindfulness-based intervention using a two-arm randomized controlled trial of Mindfulness-Based Relapse Prevention for Smoking and Alcohol (MBRP-SA) vs Cognitive Behavioral Therapy (CBT). Interventions were delivered via telehealth in a group setting; all participants received a 6-week supply of the nicotine patch. Participants (N = 69) were adults who smoked cigarettes who reported binge drinking and were motivated to both quit smoking and change their alcohol use. Primary outcomes were feasibility and acceptability of MBRP-SA compared to CBT. Changes in tobacco and alcohol use are also presented. RESULTS Participants in MBRP-SA and CBT indicated that the treatments were highly acceptable, meeting a priori benchmarks. Feasibility was mixed with some outcomes meeting benchmarks (e.g., recruitment) and others falling below (e.g., retention). Participants in both conditions demonstrated significant reductions in tobacco and alcohol use at the end of treatment. CONCLUSIONS In sum, MBRP-SA had comparable outcomes to CBT on all metrics measured. Future research should evaluate the efficacy of MBRP-SA on smoking abstinence and drinking reductions in a large-scale, fully powered trial. This study was registered on clinicaltrials.gov (NCT03734666).
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Affiliation(s)
- Christine Vinci
- Moffitt Cancer Center, 12902 USF Magnolia Dr., Tampa, FL 33612, United States; University of South Florida, 4202 E Fowler Ave, Tampa, FL 33620, United States.
| | - Steven K Sutton
- Moffitt Cancer Center, 12902 USF Magnolia Dr., Tampa, FL 33612, United States; University of South Florida, 4202 E Fowler Ave, Tampa, FL 33620, United States
| | - Min-Jeong Yang
- Moffitt Cancer Center, 12902 USF Magnolia Dr., Tampa, FL 33612, United States
| | - Sana Baban
- Moffitt Cancer Center, 12902 USF Magnolia Dr., Tampa, FL 33612, United States
| | - Rachel Sauls
- Moffitt Cancer Center, 12902 USF Magnolia Dr., Tampa, FL 33612, United States
| | - Katie Witkiewitz
- University of New Mexico, Logan Hall, Room 118, MSC 03-2220, Albuquerque, NM 87131, United States
| | - Karen O Brandon
- Moffitt Cancer Center, 12902 USF Magnolia Dr., Tampa, FL 33612, United States
| | - Marina Unrod
- Moffitt Cancer Center, 12902 USF Magnolia Dr., Tampa, FL 33612, United States
| | - Thomas H Brandon
- Moffitt Cancer Center, 12902 USF Magnolia Dr., Tampa, FL 33612, United States; University of South Florida, 4202 E Fowler Ave, Tampa, FL 33620, United States
| | - David W Wetter
- University of Utah and Huntsman Cancer Institute, 2000 Circle of Hope Dr., Salt Lake City, UT 84112, United States
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Patel SY, Wayne GF, Progovac AM, Flores M, Moyer M, Mullin B, Levy D, Saloner B, Cook BL. Effects of Medicaid coverage on receipt of tobacco dependence treatment among Medicaid beneficiaries with substance use disorder. Health Serv Res 2022; 57:1303-1311. [PMID: 35584242 PMCID: PMC9643088 DOI: 10.1111/1475-6773.14007] [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] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Individuals with substance use disorder (SUD) smoke cigarettes at a rate that is more than double the rate of the general population. Tobacco dependence treatment (TDT) is effective at reducing smoking, yet it is unclear whether expanding insurance coverage of these services increases TDT use among Medicaid beneficiaries with SUD. DATA SOURCE 2009-2013 Medicaid data in all 50 states and Washington DC. STUDY DESIGN We conducted a retrospective analysis of the 2009-2013 de-identified Medicaid Analytic Extract (MAX) claims for a 100% national sample of fee-for-service (FFS) Medicaid adult beneficiaries. Using a difference-in-difference-in-differences analysis, we assessed the association of full TDT coverage on TDT medication use and tobacco cessation counseling services between beneficiaries with and without SUD. We adjusted for age, sex, race/ethnicity, diagnosis of co-occurring chronic illness, state tobacco taxes, and state and year fixed effects. DATA COLLECTION/EXTRACTION METHODS We excluded patients not continuously enrolled in Medicaid for 12 months during the calendar year, adults aged 65 and older (given their dual enrollment in Medicaid and Medicare), minors aged 12-17, and pregnant women (for whom different TDT coverage policies apply). PRINCIPAL FINDINGS We separately modeled the association between full coverage of (1) counseling, (2) over-the-counter nicotine replacement therapy, and (3) prescription cessation medications on TDT medication treatment and counseling services. We found that each coverage led to increases in any TDT medication treatment and counseling services for beneficiaries with SUD. The effects of each coverage on medication treatment were greater for beneficiaries with SUD compared to beneficiaries without SUD (ranging from 4.9 to 6.1 percentage point difference). CONCLUSION Coverage of tobacco cessation counseling, over-the-counter nicotine replacement therapy, and prescription cessation medications holds promise for reducing the wide disparities in rates of smoking between those with and without SUD.
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Affiliation(s)
- Sadiq Y. Patel
- Department of Health Care PolicyHarvard Medical SchoolBostonMassachusettsUSA
| | - Geoffrey F. Wayne
- Department of PsychiatryCambridge Health AllianceCambridgeMassachusettsUSA
| | - Ana M. Progovac
- Department of PsychiatryCambridge Health AllianceCambridgeMassachusettsUSA
- Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA
| | - Michael Flores
- Department of PsychiatryCambridge Health AllianceCambridgeMassachusettsUSA
- Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA
| | - Margo Moyer
- Department of PsychiatryCambridge Health AllianceCambridgeMassachusettsUSA
| | - Brian Mullin
- Department of PsychiatryCambridge Health AllianceCambridgeMassachusettsUSA
| | - Douglas Levy
- Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
- Mongan Institute Health Policy Research Center and Tobacco Research and Treatment CenterMassachusetts General HospitalBostonMassachusettsUSA
| | - Brendan Saloner
- Department of Health Policy and ManagementJohns Hopkins School of Public HealthBaltimoreMarylandUSA
| | - Benjamin Lê Cook
- Department of PsychiatryCambridge Health AllianceCambridgeMassachusettsUSA
- Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA
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Gaalema DE, Snell LM, Tidey JW, Sigmon SC, Heil SH, Lee DC, Bunn JY, Park C, Hughes JR, Higgins ST. Potential effects of nicotine content in cigarettes on use of other substances. Prev Med 2022; 165:107290. [PMID: 36208817 PMCID: PMC10275576 DOI: 10.1016/j.ypmed.2022.107290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 09/26/2022] [Accepted: 10/02/2022] [Indexed: 11/07/2022]
Abstract
A national nicotine reduction policy has the potential to reduce cigarette smoking and associated adverse health impacts among vulnerable populations. However, possible unanticipated adverse effects of reducing nicotine content in cigarettes, such as increasing the use of alcohol or other abused substances, must be examined. The purpose of this study was to evaluate the effects of exposure to varying doses of nicotine in cigarettes on use of other substances. This was a secondary analysis (n = 753) of three simultaneous, multisite, double-blind, randomized-controlled trials examining 12 weeks of exposure to study cigarettes varying in nicotine content (0.4, 2.4, 15.8 mg nicotine/g tobacco) among daily smokers from three vulnerable populations: individuals with affective disorders (n = 251), individuals with opioid use disorder (n = 256), and socioeconomically-disadvantaged women of reproductive age (n = 246). Effect of study cigarette assignment on urine toxicology screens (performed weekly) and responses to drug and alcohol use questionnaires (completed at study weeks 6 and 12) were examined using negative binomial regression, logistic regression, or repeated measures analysis of variance, controlling for sex, age, and menthol status. The most common substances identified using urine toxicology included tetrahydrocannabinol (THC; 44.8%), cocaine (9.2%), benzodiazepine (8.6%), and amphetamines (8.0%), with 57.2% of participants testing positive at least once for substance use (27.3% if excluding THC). No significant main effects of nicotine dose were found on any of the examined outcomes. These results suggest that reducing nicotine content does not systematically increase use of other substances, even among individuals at increased risk of substance use. ClinicalTrials.gov Identifiers: NCT02232737, NCT2250664, NCT2250534.
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Affiliation(s)
- Diann E Gaalema
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington, VT, United States of America.
| | - L Morgan Snell
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States of America
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States of America
| | - Stacey C Sigmon
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington, VT, United States of America
| | - Sarah H Heil
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington, VT, United States of America
| | - Dustin C Lee
- Behavioral Pharmacology Research Unit, Johns Hopkins University, Baltimore, MD, United States of America
| | - Janice Y Bunn
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington, VT, United States of America
| | - Claire Park
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington, VT, United States of America
| | - John R Hughes
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington, VT, United States of America
| | - Stephen T Higgins
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington, VT, United States of America
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9
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LoParco CR, Chen TA, Martinez Leal I, Britton M, Carter BJ, Correa-Fernández V, Kyburz B, Williams T, Casey K, Rogova A, Lin HC, Reitzel LR. Organization-Level Factors Associated with Changes in the Delivery of the Five A's for Smoking Cessation following the Implementation of a Comprehensive Tobacco-Free Workplace Program within Substance Use Treatment Centers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11850. [PMID: 36231153 PMCID: PMC9565836 DOI: 10.3390/ijerph191911850] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/14/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
Many adults with a substance use disorder smoke cigarettes. However, tobacco use is not commonly addressed in substance use treatment centers. This study examined how provider beliefs about addressing tobacco use during non-nicotine substance use treatment, provider self-efficacy in delivering tobacco use assessments, and perceived barriers to the routine provision of tobacco care were associated with changes in the delivery of the evidence-based five A's for smoking intervention (asking, advising, assessing, assisting, and arranging) at the organizational level. The data were from 15 substance use treatment centers that implemented a tobacco-free workplace program; data were collected before and after the program's implementation. Linear regression examined how center-level averages of provider factors (1) at pre-implementation and (2) post- minus pre-implementation were associated with changes in the use of the five A's for smoking in substance use treatment patients. The results indicated that centers with providers endorsing less agreement that tobacco use should be addressed in non-nicotine substance use treatment and reporting lower self-efficacy for providing tobacco use assessments at pre-implementation were associated with significant increases in asking patients about smoking, assessing interest in quitting and assisting with a quit attempt by post-implementation. Centers reporting more barriers at pre-implementation and centers that had greater reductions in reported barriers to treatment over time had greater increases in assessing patients' interest in quitting smoking and assisting with a quit attempt by post-implementation. Overall, the centers that had the most to learn regarding addressing patients' tobacco use had greater changes in their use of the five A's compared to centers whose personnel were already better informed and trained. Findings from this study advance implementation science and contribute information relevant to reducing the research-to-practice translational gap in tobacco control for a patient group that suffers tobacco-related health disparities.
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Affiliation(s)
- Cassidy R. LoParco
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX 76107, USA
| | - Tzuan A. Chen
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- HEALTH Research Institute, University of Houston, 4849 Martin Luther King Blvd., Houston, TX 77204, USA
| | - Isabel Martinez Leal
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- HEALTH Research Institute, University of Houston, 4849 Martin Luther King Blvd., Houston, TX 77204, USA
| | - Maggie Britton
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- HEALTH Research Institute, University of Houston, 4849 Martin Luther King Blvd., Houston, TX 77204, USA
| | - Brian J. Carter
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
| | - Virmarie Correa-Fernández
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- HEALTH Research Institute, University of Houston, 4849 Martin Luther King Blvd., Houston, TX 77204, USA
| | - Bryce Kyburz
- Integral Care, 1430 Collier Street, Austin, TX 78704, USA
| | | | - Kathleen Casey
- Integral Care, 1430 Collier Street, Austin, TX 78704, USA
| | - Anastasia Rogova
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- HEALTH Research Institute, University of Houston, 4849 Martin Luther King Blvd., Houston, TX 77204, USA
| | - Hsien-Chang Lin
- Department of Applied Health Science, School of Public Health, Indiana University-Bloomington, 1025 E. 7th St., Bloomington, IN 47405, USA
| | - Lorraine R. Reitzel
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- HEALTH Research Institute, University of Houston, 4849 Martin Luther King Blvd., Houston, TX 77204, USA
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10
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Secades-Villa R, Aonso-Diego G, González-Roz A. A randomized controlled trial of contingency management for smoking cessation in substance use treatment patients. Int J Clin Health Psychol 2022; 22:100314. [PMID: 35662791 PMCID: PMC9157212 DOI: 10.1016/j.ijchp.2022.100314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/03/2022] [Indexed: 12/04/2022] Open
Abstract
Background/Objective Contingency management (CM) is one of the most effective interventions for smokers with substance use disorder (SUD), and no empirical assessment of its long-term efficacy has been conducted so far in a real-world context. The objectives were: (1) examine the additive effectiveness of CM on cognitive-behavioral treatment (CBT) for smoking cessation, and (2) examine the relationship between smoking cessation and substance use abstinence. Method A total of 80 participants (75.8% males; Mage = 45.31; SD = 9.64) were assigned to two smoking cessation treatments: CBT or CBT+CM. A set of generalized estimating equations were conducted to examine the effect of treatment condition on smoking outcomes, as well as the effect of smoking status on substance abstinence. Results Adding CM to CBT for smoking cessation improved tobacco abstinence rates at the end-of-treatment (p = .049). Tobacco abstinence rates declined over time (p = .012), but no significant effects of treatment condition were observed across follow-ups (p = .260). Smoking cessation was not significantly related to substance abstinence (p ≥ .488). Conclusions CM facilitates early abstinence in smokers with SUD, although effects subside after treatment termination. The lack of association between smoking abstinence and substance use suggests no jeopardizing effects as a result of quitting smoking.
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Affiliation(s)
- Roberto Secades-Villa
- Addictive Behaviors Research Group, Faculty of Psychology, University of Oviedo, Plaza Feijoo s/n, 33003 Oviedo, Spain
| | - Gema Aonso-Diego
- Addictive Behaviors Research Group, Faculty of Psychology, University of Oviedo, Plaza Feijoo s/n, 33003 Oviedo, Spain
- Corresponding author.
| | - Alba González-Roz
- Addictive Behaviors Research Group, Faculty of Psychology, University of Oviedo, Plaza Feijoo s/n, 33003 Oviedo, Spain
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11
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Swithenbank Z, Harrison R, Porcellato L. Service user perceptions of smoking cessation in residential substance use treatment. PLoS One 2022; 17:e0270045. [PMID: 35731791 PMCID: PMC9216544 DOI: 10.1371/journal.pone.0270045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 06/02/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Prevalence of tobacco smoking among adults in substance misuse treatment is much higher than the wider population, yet limited research is available, and residential treatment services have been overlooked as a potential setting for cessation interventions. Exploring the perceptions of service users about smoking cessation in residential rehabilitation is important to gain better understanding of this issue and identify ways to inform future intervention development. METHODS Ten semi-structured interviews were conducted in the Northwest of England in 2017 with adults (7 male, 3 female) who were currently or had previously been in residential treatment for substance misuse. Five participants were current smokers, three had never smoked, and two were former smokers. Participants were asked about their smoking behaviours, factors relating to smoking and smoking cessation and the relationship between smoking and substance use. All interviews were transcribed and data was analysed thematically. RESULTS Study findings highlighted a general consensus amongst participants that residential treatment services offered an ideal opportunity for cessation but there were concerns that doing so might jeopardise recovery. Smoking in substance use treatment services is still the norm and factors such as perceived social and psychological benefits, normative behaviours and lack of perceived risk or prioritisation pose challenges for implementing smoking cessation within this setting, although facilitators such as motivation to change and appropriateness of the setting were also identified. CONCLUSIONS This study suggests that service users perceive residential treatment services as suitable environments to introduce smoking cessation. To address the needs of adults who smoke and are in recovery from substance use, further research and cooperation from treatment organisations is needed to integrate substance misuse and smoking cessation services. More conclusive evidence on the effectiveness of tackling both issues at the same time is also required.
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Affiliation(s)
- Zoe Swithenbank
- Public Health Institute, Liverpool John Moores University, Liverpool, United Kingdom
| | - Rebecca Harrison
- Public Health Institute, Liverpool John Moores University, Liverpool, United Kingdom
| | - Lorna Porcellato
- Public Health Institute, Liverpool John Moores University, Liverpool, United Kingdom
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12
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Patterson MS, Spadine MN, Graves Boswell T, Prochnow T, Amo C, Francis AN, Russell AM, Heinrich KM. Exercise in the Treatment of Addiction: A Systematic Literature Review. HEALTH EDUCATION & BEHAVIOR 2022; 49:10901981221090155. [PMID: 35484950 DOI: 10.1177/10901981221090155] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Exercise has been recognized as a promising and emerging treatment for individuals recovering from addiction. The purpose of this article was to systematically review scientific studies using exercise as a means to improve, sustain, or treat addictions, and to provide suggestions for the future use of exercise as a treatment method for addiction. METHODS Using PRISMA guidelines, a database search was conducted for articles that tested the impact of exercise interventions on addiction-related outcomes. To be included, peer-reviewed experimental design studies had to use human subjects to investigate the relationship between exercise and the treatment of or recovery from addiction. Garrard's Matrix Method was used to extract data from reviewed articles (n = 53). RESULTS Nearly three quarters of the studies reviewed documented a significant change in addiction-related outcomes (e.g., more days abstinent, reduced cravings) in response to exercise exposure, particularly while someone was receiving treatment at an in or outpatient clinic. Many studies investigated the effect of acute bouts of exercise on nicotine dependence, and many studies had small sample sizes, leaving room for future research on how exercise might benefit people recovering from substance and process addictions. CONCLUSION Results affirm that exercise can be a helpful aspect of addiction treatment. Future researchers should investigate different exercise settings (e.g., group-based exercise vs individual) and explore exercise maintenance and the long-term outcomes following discharge from treatment facilities.
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13
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McCuistian C, Kapiteni K, Le T, Safier J, Delucchi K, Guydish J. Reducing tobacco use in substance use treatment: An intervention to promote tobacco-free grounds. J Subst Abuse Treat 2022; 135:108640. [PMID: 34743925 PMCID: PMC8903046 DOI: 10.1016/j.jsat.2021.108640] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/10/2021] [Accepted: 10/13/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND People in substance use disorder (SUD) treatment experience disproportionate rates of tobacco use. California has prioritized smoking cessation among these individuals through the Tobacco-Free for Recovery Initiative, which includes an intervention aimed at supporting programs in implementing tobacco-free grounds. The current study examined changes in client smoking prevalence, tobacco use behaviors, and receipt of cessation services among the first seven programs participating in the initiative. METHODS Residential treatment program clients completed cross-sectional surveys at the start of the intervention (baseline: n = 249), at an interim timepoint post-baseline (interim: n = 275), and at the end of the intervention 15 months later (post-intervention: n = 219). All participants reported smoking status. Current smokers reported tobacco use behaviors, and both current smokers and those who quit in treatment reported receipt of cessation services. Univariate analyses explored differences across the three timepoints and multivariate logistic regression assessed change from baseline to interim and baseline to post-intervention. RESULTS Client smoking prevalence decreased from 54.2% at pre- to 26.6% at post-intervention (Adjusted Odds Ratio [AOR] = 0.25, 95% CI = 0.13, 0.45). Current smokers and those who quit while in treatment reported an increase in NRT/pharmacotherapy (11.9% vs. 25.2%; AOR = 3.02, CI = 1.24, 7.35). When comparing baseline to the interim timepoint (a timepoint before the COVID-19 pandemic), data analyses also demonstrated a significant decrease in smoking prevalence (54.2% vs. 41.8%; AOR = 0.62, CI = 0.42, 0.92) and increase in NRT/pharmacotherapy (11.9% vs. 24.5%; AOR = 3.68, CI = 1.11, 12.19). CONCLUSION An intervention to promote tobacco-free grounds implemented in residential SUD treatment programs was associated with a significant reduction in client smoking and an increase in NRT/pharmacotherapy. These associations were observed both before the COVID-19 pandemic and in the early stages of the pandemic, suggesting that they may be due to the intervention rather than to the pandemic.
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Affiliation(s)
- Caravella McCuistian
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St., Floor 7 San Francisco, CA 94158, United States of America.
| | - Kwinoja Kapiteni
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St., Floor 7 San Francisco, CA 94158, United States of America
| | - Thao Le
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St., Floor 7 San Francisco, CA 94158, United States of America.
| | - Jessica Safier
- Smoking Cessation Leadership Center, University of California San Francisco, 3333 California Street, Ste. 430, San Francisco, CA 94143, United States of America.
| | - Kevin Delucchi
- Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, United States of America.
| | - Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St., Floor 7 San Francisco, CA 94158, United States of America.
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14
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Fokuo JK, McCuistian CL, Masson CL, Gruber VA, Straus E, Wong J, Guydish JR. Pre-implementation Assessment of Tobacco Cessation Interventions in Substance Use Disorder Residential Programs in California. Subst Use Misuse 2022; 57:1345-1355. [PMID: 35621319 PMCID: PMC10083040 DOI: 10.1080/10826084.2022.2079139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Across the United States, substance use disorder (SUD) treatment programs vary in terms of tobacco-related policies and cessation services offered. Implementation of tobacco-related policies within this setting can face several barriers. Little is known about how program leadership anticipate such barriers at the pre-implementation phase. This study used the Consolidated Framework for Implementation Research (CFIR) during the pre-implementation stage to identify factors that may influence the implementation stage of tobacco-related cessation policies and services in residential SUD programs. METHODS We conducted semi-structured qualitative interviews with sixteen residential treatment program directors in California. The analysis was guided by a deductive approach using CFIR domains and constructs to develop codes and identify themes. ATLAS.ti software was used to facilitate thematic analysis of interview transcripts. FINDINGS Themes that arose as anticipated facilitators for implementation included the relative advantage of the intervention vs. current practice, external policies/incentives to support tobacco-related policy, program directors' strong commitment and high self-efficacy to incorporate cessation into SUD treatment, and recognizing the importance of planning and engaging opinion leaders. Potential barriers included the SUD recovery culture, low stakeholder engagement, organizational culture, lack of workforce expertise, and lack of reimbursement for smoking cessation services. CONCLUSION To support successful implementation of tobacco-related organizational change interventions, staff and clients of residential SUD programs require extensive education about the effectiveness of evidence-based medications and behavioral therapies for treating tobacco dependence. Publicly funded SUD treatment programs should receive support to address tobacco dependence among their clients through expanded reimbursement for tobacco cessation services.
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Affiliation(s)
- J Konadu Fokuo
- Mood and Anxiety Disorders Program, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Caravella L McCuistian
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Carmen L Masson
- UCSF Department of Psychiatry, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA
| | - Valerie A Gruber
- UCSF Department of Psychiatry, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA
| | - Elana Straus
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Jessie Wong
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Joseph R Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
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15
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Guydish J, Le T, Hosakote S, Straus E, Wong J, Martínez C, Delucchi K. Tobacco use among substance use disorder (SUD) treatment staff is associated with tobacco-related services received by clients. J Subst Abuse Treat 2022; 132:108496. [PMID: 34111773 DOI: 10.1016/j.jsat.2021.108496] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/10/2021] [Accepted: 05/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite disproportionately high rates of smoking among people in residential substance use disorder (SUD) treatment, few receive tobacco cessation services. Little is known about how smoking among treatment staff may impact this disparity. We explored the relationship between staff tobacco use and client tobacco use. Additionally, we examined the relationship between staff tobacco use and tobacco-related services reported by staff and clients. METHODS Staff (n = 363) and clients (n = 639) in 24 California publicly-funded residential SUD treatment programs were surveyed in 2019-20. Staff self-reported current tobacco use, as well as their beliefs, self-efficacy, and practices regarding smoking cessation. Clients reported their tobacco use and they services received while in treatment. Regression analyses examined the adjusted and unadjusted associations between staff and client tobacco use and other outcomes. RESULTS Use of any tobacco product by staff ranged from 0% to 100% by program, with an average of 32% across programs. Adjusted analyses found that higher rates of staff tobacco use were associated with higher rates of client tobacco use, and with fewer clients receiving tobacco-related counseling. In programs that had higher rates of staff tobacco use, staff were less likely to believe that clients should quit smoking in treatment and had lower self-efficacy to address smoking. CONCLUSION Higher rates of tobacco use among staff are associated with higher rates of client tobacco use and fewer clients receiving cessation counseling. Efforts to reduce tobacco use among SUD clients should be supported by efforts to reduce tobacco use among staff. SUD treatment programs, and agencies that fund and regulate those programs, should aim to reduce the use of tobacco products among staff.
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Affiliation(s)
- Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA 94118, United States of America.
| | - Thao Le
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA 94118, United States of America.
| | - Sindhushree Hosakote
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA 94118, United States of America.
| | - Elana Straus
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA 94118, United States of America.
| | - Jessie Wong
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA 94118, United States of America
| | - Cristina Martínez
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Kevin Delucchi
- Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave., San Francisco, CA 94143, United States of America.
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16
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Ballestar-Tarín ML, Ibáñez-del-Valle V, Cauli O, Navarro-Martínez R. Personal and Social Consequences of Psychotropic Substance Use: A Population-Based Internet Survey. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:65. [PMID: 35056373 PMCID: PMC8777796 DOI: 10.3390/medicina58010065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/24/2021] [Accepted: 12/28/2021] [Indexed: 11/17/2022]
Abstract
Background and objectives: Drug abuse has become a major worldwide health concern among all age groups. The present study analyses substance misuse and its social and personal consequences using a population-based internet survey in Spain. Materials and Methods: Screening for drug abuse (of alcohol, marijuana/hashish and psychostimulants) and its related risks and problems was performed using the Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) score. Socio-demographic factors, depressive, anxiety and stress symptoms as well as health habits were also evaluated. We used Linear regression methods to compare each variable's individual contribution so as to determine which one best explains the results. Results: In this population-based study, 1224 people completed and returned the online survey. Of all participants, 57% reported consuming at least one substance based on the CRAFFT scale. While increasing age reduces the probability of personal and social consequences of consumption, people who smoke receive up to three times more (OR = 3.370) recommendations from family and friends to reduce their consumption. As for the type of substance, the consumption of marijuana increases the risk of forgetting (OR = 2.33) and the consumption of other psychostimulant substances almost triples the risk of consuming alone (OR = 2.965). Combining substances can increase the rate of driving a vehicle after consumption by 3.4 times. Conclusions: Although age, smoking and the type of substances used increase the risk of suffering from social and personal consequences of the use or abuse of substances, future studies are needed to determine the influence of new variables as a potential tool for treating and minimizing the adverse consequences of drug abuse.
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Affiliation(s)
- María Luisa Ballestar-Tarín
- Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, Avda Menéndez Pidal 19, 46010 Valencia, Spain; (M.L.B.-T.); (V.I.-d.-V.); (R.N.-M.)
| | - Vanessa Ibáñez-del-Valle
- Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, Avda Menéndez Pidal 19, 46010 Valencia, Spain; (M.L.B.-T.); (V.I.-d.-V.); (R.N.-M.)
- Frailty and Cognitive Impairment Organized Group (FROG), Department of Nursing, University of Valencia, Avda Menéndez Pidal 19, 46010 Valencia, Spain
| | - Omar Cauli
- Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, Avda Menéndez Pidal 19, 46010 Valencia, Spain; (M.L.B.-T.); (V.I.-d.-V.); (R.N.-M.)
- Frailty and Cognitive Impairment Organized Group (FROG), Department of Nursing, University of Valencia, Avda Menéndez Pidal 19, 46010 Valencia, Spain
| | - Rut Navarro-Martínez
- Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, Avda Menéndez Pidal 19, 46010 Valencia, Spain; (M.L.B.-T.); (V.I.-d.-V.); (R.N.-M.)
- Frailty and Cognitive Impairment Organized Group (FROG), Department of Nursing, University of Valencia, Avda Menéndez Pidal 19, 46010 Valencia, Spain
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17
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Vinci C, Hemenway M, Baban SS, Yang MJ, Brandon KO, Witkiewitz K, Unrod M, Brandon TH, Wetter DW, Sutton SK. Transition to telehealth: Challenges and benefits of conducting group-based smoking and alcohol treatment virtually. Contemp Clin Trials 2022; 114:106689. [PMID: 35085833 PMCID: PMC8785408 DOI: 10.1016/j.cct.2022.106689] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/13/2022] [Accepted: 01/20/2022] [Indexed: 11/30/2022]
Abstract
In the midst of the COVID-19 pandemic, many research and clinical teams have transitioned their projects to a remote-based format, weighing the pros and cons of making such a potentially disruptive decision. One key aspect of this decision is related to the patient population, with underserved populations possibly benefiting from the increased reach of telehealth, while also encountering technology barriers that may limit accessibility. Early in the pandemic, our team shifted a group-based, smoking cessation and alcohol modification treatment trial to a remote-based format. Our population included individuals who concurrently wanted to quit smoking and modify their alcohol use. This paper describes technical and logistical considerations of transitioning from in-person to remote-based delivery for group-based treatment, including the impact upon study staff, group facilitators, participants, and the institution. Remotely-delivered group treatment may be valuable not only in response to pandemic-related restrictions, but it may also offer an alternative treatment-delivery modality with independent benefits in terms of population reach, costs, and pragmatics for clients, staff, and institutions.
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Affiliation(s)
- Christine Vinci
- Moffitt Cancer Center, Tampa, FL, United States of America; University of South Florida, Tampa, FL, United States of America.
| | | | - Sana S Baban
- Moffitt Cancer Center, Tampa, FL, United States of America
| | - Min-Jeong Yang
- Moffitt Cancer Center, Tampa, FL, United States of America
| | - Karen O Brandon
- Moffitt Cancer Center, Tampa, FL, United States of America; University of South Florida, Tampa, FL, United States of America
| | - Katie Witkiewitz
- University of New Mexico, Albuquerque, NM, United States of America
| | - Marina Unrod
- Moffitt Cancer Center, Tampa, FL, United States of America
| | - Thomas H Brandon
- Moffitt Cancer Center, Tampa, FL, United States of America; University of South Florida, Tampa, FL, United States of America
| | - David W Wetter
- University of Utah and Huntsman Cancer Institute, Salt Lake City, UT, United States of America
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18
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Felicione NJ, Ozga JE, Dino G, Berry JH, Sullivan CR, Blank MD. Timing of smoking cessation treatment integrated into outpatient treatment with medications for opioid use disorder: Feasibility trial. J Subst Abuse Treat 2022; 132:108579. [PMID: 34452780 PMCID: PMC8671242 DOI: 10.1016/j.jsat.2021.108579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/30/2021] [Accepted: 07/25/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Cigarette smoking rates among individuals with opioid use disorder (OUD) are notoriously high and may be improved by considering the timing of treatment integration for these two substances. The current study examined the feasibility of a method for assessing the timing of integrating smoking cessation pharmacotherapy within three different phases of outpatient treatment with medication for OUD (MOUD). METHODS Seventy-four buprenorphine-maintained smokers were enrolled in a quasi-experimental study across three MOUD treatment phases: 0-90 (Phase 1), 91-365 (Phase 2), and > 365 days of MOUD treatment (Phase 3). During a 12-week varenicline-based intervention, the study assessed outcomes daily via text messages (cigarette smoking, varenicline adherence, side effects) or monthly at in-person visits (quit motivation and carbon monoxide levels). RESULTS Thirty-five participants completed the study, with a lower retention rate in Phase 1 (37.5%) relative to Phases 2 (53.5%) or 3 (57.1%). A trend occurred for Phase 1 participants to report aversive side effects (e.g., abnormal dreams, gastrointestinal distress) on more study days. Among completers, adherence to text messaging and varenicline use was high and independent of MOUD treatment phase. Participants in all phases reported declines in cigarette smoking and increases in quit motivation over time; the study observed biochemically verified tobacco abstinence among only a few participants from Phases 2 or 3. CONCLUSIONS This feasibility study demonstrates a method to evaluate the timing of treatment integration for cigarette smoking and MOUD. Method strengths include a study schedule that coincided with the MOUD clinic schedule and use of text messaging to encourage varenicline adherence and evaluate outcomes regularly.
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Affiliation(s)
- Nicholas J. Felicione
- Psychology, West Virginia University, Morgantown, WV,Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Jenny E. Ozga
- Psychology, West Virginia University, Morgantown, WV,Behavioral Medicine & Psychiatry, West Virginia University School of Medicine, Morgantown, WV
| | - Geri Dino
- Social and Behavioral Sciences, West Virginia University School of Public Health, Morgantown, WV,West Virginia Prevention Research Center, West Virginia University School of Public Health, Morgantown, WV
| | - James H. Berry
- Behavioral Medicine & Psychiatry, West Virginia University School of Medicine, Morgantown, WV
| | - C. Rolly Sullivan
- Behavioral Medicine & Psychiatry, West Virginia University School of Medicine, Morgantown, WV
| | - Melissa D. Blank
- Psychology, West Virginia University, Morgantown, WV,West Virginia Prevention Research Center, West Virginia University School of Public Health, Morgantown, WV
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19
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Xie S, Minami H, Kumar DS, Hecht J, Bloom EL, Kahler C, Abrantes A, Price LH, Ondersma S, Brown RA. Readiness to Quit Smoking among Smokers in Substance Use Treatment: Associations with Stress, Substance Use Severity, Relapse Concerns and Gender. JOURNAL OF SUBSTANCE USE 2021; 26:669-676. [PMID: 34899051 DOI: 10.1080/14659891.2021.1879295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Smoking prevalence among individuals in substance use treatment remains higher than in the general population. Given that many smokers in substance use treatment are reluctant to quit smoking, it is important to understand the factors that impede smokers' readiness to quit. The current study used baseline data from a randomized controlled trial involving 60 adult smokers receiving substance use treatment to investigate relations between the severity of substance use problems (SSUP), perceived stress (PS), concerns about relapse (i.e., concerns that quitting smoking would hurt one's recovery process (CR)), and readiness to quit smoking. This study also investigated moderating roles of concerns about relapse and gender. Regression analyses showed a significant main effect of concerns about relapse on readiness to quit in the next 30 days, but no effect for either severity of substance use problems, perceived stress, or the SSUPxCR interaction. There were significant interaction effects between PS and both gender and CR. Among men and those with lower concerns about relapse, higher perceived stress was significantly associated with lower readiness to quit. Findings suggest that psychoeducation to alleviate concerns that quitting smoking could limit substance use recovery could be beneficial. Stress management interventions may be especially beneficial to men.
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Affiliation(s)
- Siwen Xie
- Fordham University, 441 East Fordham Road, Dealy Hall, Bronx, NY 10458
| | - Haruka Minami
- Fordham University, 441 East Fordham Road, Dealy Hall, Bronx, NY 10458
| | | | - Jacki Hecht
- University of Texas at Austin, 110 Inner Campus Drive, Austin, TX 78705
| | | | - Christopher Kahler
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-4, Providence, RI 02912
| | - Ana Abrantes
- Butler Hospital and Alpert Medical School of Brown University, 345 Blackstone Blvd., Providence, RI 02906
| | - Lawrence H Price
- Butler Hospital and Alpert Medical School of Brown University, 345 Blackstone Blvd., Providence, RI 02906
| | - Steven Ondersma
- Wayne State University, 71 E. Ferry Avenue, Detroit, MI 48202
| | - Richard A Brown
- University of Texas at Austin, 110 Inner Campus Drive, Austin, TX 78705
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Substitute Behaviors following Residential Substance Use Treatment in the Western Cape, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312815. [PMID: 34886541 PMCID: PMC8657596 DOI: 10.3390/ijerph182312815] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/27/2021] [Accepted: 12/01/2021] [Indexed: 11/21/2022]
Abstract
The dynamics of substitute behaviors and associated factors remain poorly understood globally, and particularly in low- and middle-income contexts. This prospective study describes the prevalence and types of substitute behaviors as well as predictors, correlates, and motivations associated with substitution in persons (n = 137) admitted to residential substance use treatment in the Western Cape province of South Africa. The brief assessment of recovery capital, overall life satisfaction scale, and an adapted version of the addiction matrix self-report measure were completed during and post-treatment. Results indicate that substitutes were employed consciously for anticipated appetitive effects, for time-spending, (re)connecting with others, and enjoyment. At follow-up, 36% of service users had substituted their primary substance(s) with another substance or behavior; 23% had relapsed and 40% had maintained abstinence. While some service users may be especially vulnerable to developing substitute behaviors, targeted prevention and intervention efforts can reduce this risk.
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McCuistian C, Le T, Delucchi K, Pagano A, Hosakote S, Guydish J. Racial/Ethnic Differences in Tobacco Use and Cessation Services among Individuals in Substance Use Treatment. J Psychoactive Drugs 2021; 53:483-490. [PMID: 34672862 DOI: 10.1080/02791072.2021.1977874] [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] [Indexed: 10/20/2022]
Abstract
Few studies explore racial/ethnic disparities in tobacco use and access to cessation services among people with substance use disorders (SUD). We collected data from Hispanics (n = 255), non-Hispanic Whites (n = 195), and non-Hispanic Blacks (n = 126) across 24 Californian residential SUD treatment programs. Data were analyzed via regression models adjusting for demographics, cigarettes per day, past quit attempts, intent to quit in the next 30 days, and physical health status. Non-Hispanic Whites smoked at a higher rate (68.7%) than both Hispanics (54.9%) and non-Hispanic Blacks (55.6%) and smoked more cigarettes per day (M = 11.2, SD = 6.5). Hispanics were more likely than non-Hispanic Whites to receive a referral to a cessation specialist (adjusted odds ratio; AOR = 2.34, 95% CI = 1.15, 4.78) and tobacco-cessation counseling (AOR = 2.68, 95% CI = 1.28, 5.62). Non-Hispanic Blacks were also more likely than non-Hispanic Whites to receive cessation counseling (AOR = 3.61, 95% CI = 1.01, 12.87) and NRT/pharmacotherapy (AOR = 2.65, 95% CI = 1.57, 4.47). Despite their decreased smoking prevalence and severity, REMs were accessing smoking cessation services while in treatment, suggesting that SUD treatment could serve as a place to address tobacco-related racial inequities.
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Affiliation(s)
- Caravella McCuistian
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Thao Le
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Kevin Delucchi
- Department of Psychiatry & Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
| | - Anna Pagano
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Sindhushree Hosakote
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
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Affiliation(s)
- Renee D Goodwin
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Melody Wu
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Larry Davidson
- Department of Psychiatry, School of Medicine at Yale University, New Haven, CT, USA
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Jeon CY, Feldman R, Althouse A, AlKaade S, Brand RE, Guda N, Sandhu BS, Singh VK, Wilcox CM, Slivka A, Gelrud A, Whitcomb DC, Yadav D. Lifetime smoking history and cohort-based smoking prevalence in chronic pancreatitis. Pancreatology 2021; 21:S1424-3903(21)00473-7. [PMID: 34116939 PMCID: PMC8628024 DOI: 10.1016/j.pan.2021.05.302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/21/2021] [Accepted: 05/22/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVE Smoking prevalence in patients with chronic pancreatitis [CP] is high. We aimed to understand lifetime history of smoking and cohort trends in CP patients to inform effective strategies for smoking cessation. METHOD Data on 317 CP patients from the North American Pancreatitis Study 2 [NAPS2] Continuation and Validation Study and the NAPS2 Ancillary Study were analyzed. Smoking history was assessed for each phase of life from the onset of smoking to study enrollment. Data on second-hand smoke and drinking history were also collected. We compared demographic factors, drinking history, pain level and pancreas morphology by smoking status at age 25 (non-smoking, <1 pack per day [PPD], ≥1 PPD). We compared smoking prevalence by birth cohorts: 1930-1949, 1950-1969, 1970-1989. RESULT Fifty-one percent of CP patients reported smoking at the time of enrollment. Those who smoked ≥1 PPD at age 25 smoked a cumulative total of 30.3 pack-years of cigarettes over a lifetime. Smoking at age 25 was associated with greater lifetime drinking and greater exposure to second-hand smoke at home and at workplace. Pancreatic atrophy and pseudocysts were more common among smokers. Pancreatic pain was more severe among smokers, and 12-13% of smokers reported smoking to alleviate pain. Male CP patients born in 1950-1969 reported the highest peak prevalence of smoking, and female CP patients born in 1970-1989 reported highest peak prevalence of smoking. CONCLUSION CP patients exhibit intense and sustained smoking behavior once established in the 20s. Regardless, cohort analyses demonstrate that the behaviors could potentially be altered by policy changes.
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Affiliation(s)
- Christie Y Jeon
- Cedars Sinai Cancer, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
| | - Robert Feldman
- Center for Research on Healthcare Data Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrew Althouse
- Center for Research on Healthcare Data Center, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Randall E Brand
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nalini Guda
- Aurora St. Luke's Medical Center, Milwaukee, WI, USA
| | | | - Vikesh K Singh
- Pancreatitis Center, Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - C Mel Wilcox
- Division of Gastroenterology and Hepatology, University of Alabama Birmingham, AL, USA
| | - Adam Slivka
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - David C Whitcomb
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Dhiraj Yadav
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Trapl ES, VanFrank B, Kava CM, Trinh V, Land SR, Williams RS, Frost E, Babb S. Smoking and cessation behaviors in patients at federally funded health centers - United States, 2014. Drug Alcohol Depend 2021; 221:108615. [PMID: 33652378 PMCID: PMC11001259 DOI: 10.1016/j.drugalcdep.2021.108615] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/12/2021] [Accepted: 01/29/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Federally funded health centers (HCs) provide care to the most vulnerable populations in the U.S., including populations with disproportionately higher smoking prevalence such as those with lower incomes. METHODS This study compared characteristics of adult HC patients, by cigarette smoking status, and assessed smoking cessation-related behaviors using 2014 Health Center Patient Survey data; analysis was restricted to adults with data on cigarette smoking status (n = 5583). Chi-square and logistic regression analyses were conducted. RESULTS Overall, 28.1 % were current smokers and 19.2 % were former smokers. Current smokers were more likely to report fair/poor health (48.2 %) and a high burden of behavioral health conditions (e.g., severe psychological distress 23.9 %) versus former and never smokers. Most current smokers reported wanting to quit in the past 12 months (79.0 %) and receiving advice to quit from a healthcare professional (78.7 %). In a multivariable model, age <45, non-white race, COPD diagnosis, and past 3-month marijuana use were significantly associated with desire to quit. Few former smokers (15.2 %) reported using cessation treatment, though use was higher among those who quit within the previous year (30.6 %). CONCLUSIONS Although most current smokers reported a desire to quit, low uptake of evidence-based treatment may reduce the number who attempt to quit and succeed. Given the burden of tobacco use, future efforts could focus on identifying and overcoming unique personal, healthcare professional, or health system barriers to connecting them with cessation treatments. Increasing access to cessation treatments within HCs could reduce smoking-related disparities and improve population health.
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Affiliation(s)
- Erika S Trapl
- Prevention Research Center for Healthy Neighborhoods, Dept. of Population and Quantitative Health Sciences, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106-7069, USA.
| | - Brenna VanFrank
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy. NE, MS: S107-7, Atlanta, GA, 30341, USA
| | - Christine M Kava
- Health Promotion Research Center, Department of Health Services, University of Washington School of Public Health, 3980 15th Avenue NE, Seattle, WA, 98105, USA
| | - Vinh Trinh
- Prevention Research Center for Healthy Neighborhoods, Dept. of Population and Quantitative Health Sciences, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106-7069, USA
| | - Stephanie R Land
- Tobacco Control Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | - Rebecca S Williams
- Center for Health Promotion and Disease Prevention, Campus Box 7424, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA; Lineberger Comprehensive Cancer Center, Campus Box 7424, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Elizabeth Frost
- Prevention Research Center for Healthy Neighborhoods, Dept. of Population and Quantitative Health Sciences, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106-7069, USA
| | - Stephen Babb
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy. NE, MS: S107-7, Atlanta, GA, 30341, USA
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Minian N, Noormohamed A, Lingam M, Zawertailo L, Le Foll B, Rehm J, Giesbrecht N, Samokhvalov AV, Baliunas D, Selby P. Integrating a brief alcohol intervention with tobacco addiction treatment in primary care: qualitative study of health care practitioner perceptions. Addict Sci Clin Pract 2021; 16:17. [PMID: 33726843 PMCID: PMC7968293 DOI: 10.1186/s13722-021-00225-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 03/03/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Randomized trials of complex interventions are increasingly including qualitative components to further understand factors that contribute to their success. In this paper, we explore the experiences of health care practitioners in a province wide smoking cessation program (the Smoking Treatment for Ontario Patients program) who participated in the COMBAT trial. This trial examined if the addition of an electronic prompt embedded in a Clinical Decision Support System (CDSS)-designed to prompt practitioners to Screen, provide a Brief intervention and Referral to Treatment (SBIRT) to patients who drank alcohol above the amounts recommended by the Canadian Cancer Society guidelines-influenced the proportion of practitioners delivering a brief intervention to their eligible patients. We wanted to understand the factors influencing implementation and acceptability of delivering a brief alcohol intervention for treatment-seeking smokers for health care providers who had access to the CDSS (intervention arm) and those who did not (control arm). METHODS Twenty-three health care practitioners were selected for a qualitative interview using stratified purposeful sampling (12 from the control arm and 11 from the intervention arm). Interviews were 45 to 90 min in length and conducted by phone using an interview guide that was informed by the National Implementation Research Network's Hexagon tool. Interview recordings were transcribed and coded iteratively between three researchers to achieve consensus on emerging themes. The preliminary coding structure was developed using the National Implementation Research Network's Hexagon Tool framework and data was analyzed using the framework analysis approach. RESULTS Seventy eight percent (18/23) of the health care practitioners interviewed recognized the need to simultaneously address alcohol and tobacco use. Seventy four percent (17/23), were knowledgeable about the evidence of health risks associated with dual alcohol and tobacco use but 57% (13/23) expressed concerns with using the Canadian Cancer Society guidelines to screen for alcohol use. Practitioners acknowledged the value of adding a validated screening tool to the STOP program's baseline questionnaire (19/23); however, following through with a brief intervention and referral to treatment proved challenging due to lack of training, limited time, and fear of stigmatizing patients. Practitioners in the intervention arm (5/11; 45%) might not follow the recommendations from CDSS if these recommendations are not perceived as beneficial to the patients. CONCLUSIONS The results of the study show that practitioners' beliefs were reflective of the current social norms around alcohol use and this influenced their decision to offer a brief alcohol intervention. Future interventions need to emphasize both organizational and sociocultural factors as part of the design. The results of this study point to the need to change social norms regarding alcohol in order to effectively implement interventions that target both alcohol and tobacco use in primary care clinics. Trial registration ClinicalTrials.gov NCT03108144. Retrospectively registered 11 April 2017, https://www.clinicaltrials.gov/ct2/show/NCT03108144.
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Affiliation(s)
- Nadia Minian
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen Street W, Toronto, ON, M6J 1H4, Canada
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St, 1st floor Toronto, ON, M6J 1H4, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Aliya Noormohamed
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen Street W, Toronto, ON, M6J 1H4, Canada
| | - Mathangee Lingam
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen Street W, Toronto, ON, M6J 1H4, Canada
| | - Laurie Zawertailo
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen Street W, Toronto, ON, M6J 1H4, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St, 1st floor Toronto, ON, M6J 1H4, Canada
- Department of Pharmacology and Toxicology, Faculty of Medicine, Medical Sciences Building, University of Toronto, Room 4207, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Bernard Le Foll
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St, 1st floor Toronto, ON, M6J 1H4, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
- Department of Pharmacology and Toxicology, Faculty of Medicine, Medical Sciences Building, University of Toronto, Room 4207, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, 250 College St., Toronto, ON, M5T 1R8, Canada
| | - Jürgen Rehm
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St, 1st floor Toronto, ON, M6J 1H4, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada
- Technische Universität Dresden, Klinische Psychologie & Psychotherapie, Chemnitzer Str. 46B, 01187, Dresden, Germany
| | - Norman Giesbrecht
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | - Andriy V Samokhvalov
- Department of Psychiatry, University of Toronto, 250 College St., Toronto, ON, M5T 1R8, Canada
- Addiction Division, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada
- Homewood Health Centre, 150 Delhi St., Guelph, ON, N1E 6K9, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada
| | - Dolly Baliunas
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen Street W, Toronto, ON, M6J 1H4, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
- School of Public Health, The University of Queensland, Herston, QLD, Australia
| | - Peter Selby
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen Street W, Toronto, ON, M6J 1H4, Canada.
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St, 1st floor Toronto, ON, M6J 1H4, Canada.
- Department of Psychiatry, University of Toronto, 250 College St., Toronto, ON, M5T 1R8, Canada.
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.
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Goh MCW, Kelly PJ, Deane FP, Raftery DK, Ingram I. Communication of health risk in substance-dependent populations: A systematic review of randomised controlled trials. Drug Alcohol Rev 2021; 40:920-936. [PMID: 33565172 DOI: 10.1111/dar.13249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/29/2020] [Accepted: 12/15/2020] [Indexed: 11/28/2022]
Abstract
ISSUES Individuals with substance use problems are at greater risk of chronic diseases due to their unhealthy lifestyle behaviours (e.g. alcohol use, smoking, physical inactivity, poor nutrition). There is increasing evidence that health risk communication is crucial in improving risk perception and knowledge of chronic diseases, and both factors are associated with health behaviour change. The aim of this systematic review is to provide a comprehensive overview of the current state of evidence on health risk communication on people with substance use problems. APPROACH A systematic search identified peer reviewed studies from the databases MEDLINE, PsycINFO, CINAHL and Scopus. Data were extracted from the included studies and a narrative synthesis of the results was conducted. KEY FINDINGS Eight articles, representing five unique studies, were included in the review. The overall risk of bias of the included studies was considered to be low. The studies evaluated the use of message framing and personalised/customised recommendations across smoking cessation and patient engagement with methadone maintenance treatment. Results revealed that message framing, specifically gain-framed messages, had a positive impact on smoking cessation. Risk perception, sex and level of nicotine dependence were also found to be associated with smoking cessation. IMPLICATIONS AND CONCLUSIONS The limited number of studies provides preliminary evidence that health risk communication promotes smoking cessation. However, studies included in the review were characterised by heterogeneous methods and measures. Further investigation of health risk communication using adequately powered randomised controlled trial is warranted.
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Affiliation(s)
- Melvin C W Goh
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Peter J Kelly
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Frank P Deane
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Dayle K Raftery
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Isabella Ingram
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
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El-Shahawy O, Schatz D, Sherman S, Shelley D, Lee JD, Tofighi B. E-cigarette use and beliefs among adult smokers with substance use disorders. Addict Behav Rep 2021; 13:100329. [PMID: 33385062 PMCID: PMC7772361 DOI: 10.1016/j.abrep.2020.100329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 12/14/2020] [Accepted: 12/14/2020] [Indexed: 11/21/2022] Open
Abstract
We estimated prevalence of e-cigarette dual use among smokers with substance use disorders. Dual e-cigarette users were more likely to have tried to quit in the past year. Overall, participants preferred to use e-cigarettes in comparison to nicotine patches/gum. E-cigarettes seem appealing to patients with substance use disorders. E-cigarette use may be effective for harm reduction among patients in addiction treatment.
Background We explored characteristics and beliefs associated with e-cigarette use patterns among cigarette smokers requiring inpatient detoxification for opioid and/or alcohol use disorder(s). Methods Adult cigarette smokers (≥18 years), admitted to inpatient detoxification for alcohol and/or opioid use disorder(s) in a safety-net tertiary referral center in New York City were surveyed in 2015 (n = 158). Descriptive statistics (proportions) were used to assess for demographic, clinical diagnosis, cigarette smoking patterns (exclusive and dual use of e-cigarettes). Chi-square, t-test statistics, and logistic regression models were used. Results Among our sample of combustible cigarette users, 13.9% (n = 22) reported dual use with electronic cigarettes. Dual use did not differ by demographic or clinical variables. Compared to exclusive smokers, dual users were more likely to have tried to quit in the past year (Adjusted Odds ratio = 8.59; CI: 2.58, 28.35; p < 0.001). Dual smokers had significantly higher mean ratings perceiving that e-cigarettes can help people quit smoking compared to exclusive smokers (M = 3.7, SD= ±1.4 vs. M = 2.7, SD= ±1.5, p = 0.002) respectively. Dual users also preferred e-cigarettes over nicotine patches /gum for quitting (M = 3.7, SD= ±1.7 vs. M = 2.6, SD= ±1.6, p = 0.005). Conclusions E-cigarette use seems to be appealing to a small proportion of cigarette smokers with SUD. Although, dual smokers seem to use e-cigarettes for its cessation premise, they don’t appear to be actively seeking to quit. E-cigarettes may offer a more effective method for harm reduction, further evaluation of incorporating it within smoking cessation protocols among patients in addiction treatment is needed.
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Affiliation(s)
- Omar El-Shahawy
- Department of Population Health, New York University School of Medicine, United States.,School of Global Public Health, New York University, United States.,NYU/Abu Dhabi Public Health Research Center, Abu Dhabi, United Arab Emirates
| | - Daniel Schatz
- Department of Population Health, New York University School of Medicine, United States.,Division of General Internal Medicine, New York University School of Medicine, United States
| | - Scott Sherman
- Department of Population Health, New York University School of Medicine, United States.,School of Global Public Health, New York University, United States.,NYU/Abu Dhabi Public Health Research Center, Abu Dhabi, United Arab Emirates.,Division of General Internal Medicine, New York University School of Medicine, United States.,VA New York Harbor Healthcare System, New York, NY, United States.,Department of Psychiatry, New York University School of Medicine, United States
| | - Donna Shelley
- Department of Population Health, New York University School of Medicine, United States.,School of Global Public Health, New York University, United States.,Division of General Internal Medicine, New York University School of Medicine, United States
| | - Joshua D Lee
- Department of Population Health, New York University School of Medicine, United States.,Division of General Internal Medicine, New York University School of Medicine, United States
| | - Babak Tofighi
- Department of Population Health, New York University School of Medicine, United States.,Division of General Internal Medicine, New York University School of Medicine, United States
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28
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Hemenway M, Witkiewitz K, Unrod M, Brandon KO, Brandon TH, Wetter DW, Sutton SK, Vinci C. Development of a mindfulness-based treatment for smoking cessation and the modification of alcohol use: A protocol for a randomized controlled trial and pilot study findings. Contemp Clin Trials 2021; 100:106218. [PMID: 33197610 PMCID: PMC7887009 DOI: 10.1016/j.cct.2020.106218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/05/2020] [Accepted: 11/11/2020] [Indexed: 02/06/2023]
Abstract
The combined use of cigarettes and alcohol is associated with an increased risk of morbidity and mortality. Yet, efficacious interventions that address both behaviors concurrently are lacking. Smoking cessation and alcohol modification not only garner health benefits, but there is also value in addressing alcohol use in the context of smoking cessation to reduce the risk for smoking relapse. In this paper we describe the development of mindfulness-based relapse prevention for smoking cessation and alcohol modification (MBRP-SA) and pilot study findings (Phase 1). Next, details regarding the methods and design of an ongoing, randomized controlled trial, Project RISE (Phase 2), are described. MBRP-SA is a group-based intervention that consists of eight weekly treatment sessions. Results from the Phase 1 pilot study (N = 21 enrolled) indicated that participants planned to use the skills learned in their everyday activities and to address their smoking and alcohol goals. Based on the progression of Phase 1 cohorts, modifications were made to the inclusion/exclusion criteria and recruitment methods that will be implemented in Phase 2. Phase 2 will assess the feasibility and acceptability of MBRP-SA, delivered via live online groups, as a primary treatment option for smoking cessation and alcohol use modification.
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Affiliation(s)
| | | | | | | | | | | | - Steven K Sutton
- Moffitt Cancer Center, USA; University of South Florida, USA
| | - Christine Vinci
- Moffitt Cancer Center, USA; University of South Florida, USA.
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29
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Hayhurst KP, Jones A, Cairns D, Jahr S, Williams E, Eastwood B, Millar T. Tobacco Smoking Rates in a National Cohort of People with Substance Use Disorder Receiving Treatment. Eur Addict Res 2021; 27:151-155. [PMID: 32720918 DOI: 10.1159/000508869] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 05/16/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIM The prevalence of tobacco smoking among individuals receiving treatment for substance use disorder (SUD) remains high. Respiratory disease and other harms are of prime concern to health policy-makers, given the contributory role played by tobacco smoking in the excess rates of premature mortality seen in individuals with SUD. The aim was to use SUD treatment data to investigate tobacco smoking prevalence among subgroups of adults over the course of treatment. METHODS We used the English National Drug Treatment Monitoring System (NDTMS) to examine number of days tobacco had been smoked in the previous month in adults receiving SUD treatment (N = 106,472, median length of treatment 157 days). RESULTS At baseline (treatment start), 48.7% reported smoking tobacco; the highest rate was observed in opiate users (61%). Overall, the level of smoking at the latest assessment was 48.5%. Reductions (of between 5 and 7%) were observed among those who finished treatment but only within the final stages of treatment. A 5% increase in smoking was observed in those still in treatment within the study timeframe. CONCLUSIONS This study identifies the potential for a greater emphasis on reducing tobacco consumption within SUD treatment, for example, by offering all smokers within SUD treatment smoking cessation support as part of their SUD treatment programme.
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Affiliation(s)
- Karen P Hayhurst
- Centre for Mental Health and Safety, Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom,
| | - Andrew Jones
- I3HS Hub, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Donal Cairns
- Centre for Epidemiology, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom
| | - Stefan Jahr
- Centre for Epidemiology, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom
| | - Elin Williams
- Division of Neuroscience & Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Brian Eastwood
- Alcohol, Drugs, Tobacco and Justice, Public Health England, London, United Kingdom
| | - Tim Millar
- Centre for Mental Health and Safety, Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
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30
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Serier KN, Venner KL, Hernandez-Vallant A. The Condom Use Self-Efficacy Scale in Substance Use Disorder Treatment-Seeking American Indian Adults. Subst Use Misuse 2021; 56:2066-2073. [PMID: 34590538 DOI: 10.1080/10826084.2021.1963988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
American Indians (AIs) experience substance use disorder and sexual risk related inequities with elevated rates of sexually transmitted infections, unintended pregnancy, and fetal alcohol spectrum disorders. Substance misuse is associated with risky sexual behaviors including condomless sex. Objectives: The current study aimed to test the validity of the Condom Use Self-Efficacy Scale (CUSES) and the relationship between self-efficacy and condom use behaviors in AI individuals with substance use disorders (SUDs). Exploratory analyses also examined changes in condom use self-efficacy across SUD treatment. Methods: As part of a larger randomized controlled trial, AI individuals (N = 79) seeking SUD treatment completed baseline measures of condom use self-efficacy and sexual risk behaviors. Results: Confirmatory factor analysis (CFA) indicated that a 3-factor, 10-item version of the CUSES was a reliable and valid measure in this population. Condom use self-efficacy was associated with condom use behavior and increased during SUD treatment. Conclusions: Overall, it appears that the CUSES is a valid measure in AI individuals, is related to condom use behavior, and increases with SUD treatment. There is a need for future research to integrate these findings into AI cultural values. Addressing sexual risk behaviors in SUD treatment may be an important target and future research is needed to understand predictors of condom use self-efficacy and determine potential intervention targets to reduce sexual risk behaviors and related health inequities.
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Affiliation(s)
- Kelsey N Serier
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Kamilla L Venner
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA.,Center on Alcohol, Substance use, & Addiction, University of New Mexico, Albuquerque, New Mexico, USA
| | - Alexandra Hernandez-Vallant
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA.,Center on Alcohol, Substance use, & Addiction, University of New Mexico, Albuquerque, New Mexico, USA
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31
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Daws C, Egan SJ, Allsop S. Brief Intervention Training for Smoking Cessation in Substance Use Treatment. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Carol Daws
- School of Psychology and Speech Pathology, Curtin University,
- Curtin Health Innovation Research Institute, Curtin University,
- Cyrenian House Drug and Alcohol Treatment Service,
| | - Sarah J Egan
- School of Psychology and Speech Pathology, Curtin University,
- Curtin Health Innovation Research Institute, Curtin University,
| | - Steve Allsop
- National Drug Research Institute, Curtin University,
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32
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Jo M, Rim SJ, Lee MG, Park S. Illuminating the treatment gap of mental disorders: A comparison of community survey-based and national registry-based prevalence rates in Korea. J Psychiatr Res 2020; 130:381-386. [PMID: 32882580 DOI: 10.1016/j.jpsychires.2020.07.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/22/2020] [Accepted: 07/24/2020] [Indexed: 10/23/2022]
Abstract
Estimating the prevalence rates of mental disorders is important for developing prevention, treatment, and research plans. Given that survey-based and registry-based prevalence rates of mental disorders each have pros and cons yet complement one another, it is important to consider both assessments when investigating the prevalence rates of mental disorders. However, no study has utilized actual treatment data of patients with mental disorders when investigating the treatment gap. The results of the Survey of Mental Disorders in Korea from 2006, 2011, and 2016 and data from the National Health Insurance Database were used to compare survey-based and registry-based prevalence rates for 17 disorders, as well the prevalence rates for each sex. The survey-based prevalence rate was higher for 10 years in Korea. However, the registry-based prevalence rate continuously increased. By 2016 the two rates were comparable. For alcohol use and nicotine use disorders, the survey-based prevalence rate was consistently higher than the registry-based prevalence rate, while the registry-based prevalence rate was higher for schizophrenia. Mood disorder rates were similar between the two types. Most anxiety disorders had a higher survey-based prevalence rate, except for panic disorder. Men had a higher survey-based prevalence rate, whereas women had a higher registry-based prevalence rate of mental disorders. Korea's registry-based prevalence rate of mental disorders has consistently increased due to various efforts in the field. However, there is still room for improvement, especially in mental health literacy. Therefore, each disorder and patient sex needs to be considered separately when planning education and campaigns.
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Affiliation(s)
- MinKyung Jo
- Department of Research Planning, Mental Health Research Institute, National Center for Mental Health, Seoul, South Korea; Graduate School of Public Health, Korea University, Seoul, South Korea.
| | - Soo Jung Rim
- Department of Research Planning, Mental Health Research Institute, National Center for Mental Health, Seoul, South Korea; Graduate School of Psychology, Seoul National University, Seoul, South Korea.
| | - Min-Geu Lee
- Department of Research Planning, Mental Health Research Institute, National Center for Mental Health, Seoul, South Korea.
| | - Subin Park
- Department of Research Planning, Mental Health Research Institute, National Center for Mental Health, Seoul, South Korea.
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33
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Abstract
The U.S. is in the midst of an opioid epidemic. At the same time, tobacco use remains the leading cause of preventable death and disability. While the shared biological underpinnings of nicotine and opioid addiction are well established, clinical implications for co-treatment of these two substance use disorders has not been emphasized in the literature, nor have researchers, clinicians, and policy makers adequately outlined pathways for incorporating co-treatment into existing clinical workflows. The current brief review characterizes the metabolic and neural mechanisms which mediate co-use of nicotine and opioids, and then outlines clinical and policy implications for concurrently addressing these two deadly epidemics. Screening, assessment, medication-assisted treatment (MAT), and tobacco-free policy are discussed. The evidence suggests that clinical care and policies that facilitate co-treatment are an expedient means of delivering healthcare to individuals that result in better health for the population while also meeting patients' substance abuse disorder recovery goals.
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Affiliation(s)
- Chad D Morris
- University of Colorado, Anschutz Medical Campus, 1784 Racine Street, Campus Box F478, Building 401, Aurora, CO, 80045, USA.
| | - Christine E Garver-Apgar
- University of Colorado, Anschutz Medical Campus, 1784 Racine Street, Campus Box F478, Building 401, Aurora, CO, 80045, USA
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34
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Smith PM, Seamark LD, Beck K. Integration of an evidence-based tobacco cessation program into a substance use disorders program to enhance equity of treatment access for northern, rural, and remote communities. Transl Behav Med 2020; 10:555-564. [PMID: 32766869 DOI: 10.1093/tbm/ibz162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Integrating tobacco cessation interventions into substance use disorder (SUD) programs is recommended, yet few are implemented into practice. This translational research implementation study was designed to integrate an evidence-based tobacco cessation intervention into a 2-week hospital outpatient SUD program that served a rural municipality and 33 remote Indigenous communities. Objectives included determining tobacco use prevalence, intervention uptake, and staffing resources required for intervention delivery. A series of 1-hr tobacco and health/well-being interactive education and behavior-change groups were developed for the SUD program to create a central access point to offer an evidence-based, intensive tobacco cessation intervention that included an initial counseling/planning session and nine post-SUD treatment follow-ups (weekly month 1; biweekly month 2; and 3, 6, and 12 months). Group sign-in data included age, gender, community, tobacco use, and interest in receiving tobacco cessation help. Thirty-two groups (April 2018 to February 2019) were attended by 105 people from 22 communities-56% were female, mean age = 30.9 (±7.3; 93% <45 years), 86% smoked, and 38% enrolled in the intensive tobacco cessation intervention. The age-standardized tobacco use ratio was two times higher than would be expected in the general rural population in the region. Average staff time to provide the intervention was 1.5-2.5 hr/week. Results showed that a Healthy Living group integrated into SUD programming provided a forum for tobacco education, behavior-change skills development, and access to an intensive tobacco cessation intervention for which enrollment was high yet the intervention could be delivered with only a few staff hours a week.
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Affiliation(s)
- Patricia M Smith
- Human Sciences Division, Faculty of Medicine/Northern Ontario School of Medicine, Lakehead University, Thunder Bay, Ontario, Canada
| | - Lisa D Seamark
- Mental Health and Addictions Program, Meno Ya Win Health Centre, Sioux Lookout, Ontario, Canada
| | - Katie Beck
- Sioux Lookout Diabetes Program, Meno Ya Win Health Centre, Sioux Lookout, Ontario, Canada
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35
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Predicting relapse after alcohol use disorder treatment in a high-risk cohort: The roles of anhedonia and smoking. J Psychiatr Res 2020; 126:1-7. [PMID: 32403028 PMCID: PMC8476113 DOI: 10.1016/j.jpsychires.2020.04.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/05/2020] [Accepted: 04/17/2020] [Indexed: 12/15/2022]
Abstract
On average, two-thirds of individuals treated for alcohol use disorder (AUD) relapse within six months. There is a critical need to identify modifiable risk factors associated with relapse that can be addressed during AUD treatment. Candidate factors include mood disorders and cigarette smoking, which frequently co-occur with AUD. We predicted that co-occurrence of mood disorders, cigarette smoking, and other modifiable conditions will predict relapse within six months of AUD treatment. Ninety-five Veterans, 23-91 years old, completed assessments of multiple characteristics including demographic information, co-occurring psychiatric disorders, and medical conditions during residential treatment for AUD. Participants' alcohol consumption was monitored over six months after participation. Logistic regression was used to determine if, mood disorders, cigarette smoking status, alcohol consumption, educational level, and comorbid general medical conditions are associated with relapse after AUD treatment. Sixty-nine percent of Veterans (n = 66) relapsed within six months of study while 31% remained abstinent (n = 29). While education, comorbid general medical conditions, and mood disorder diagnoses were not predictors of relapse, Veterans with greater symptoms of anhedonia, active smokers, and fewer days of abstinence prior to treatment showed significantly greater odds for relapse within six months. Anhedonia and cigarette smoking are modifiable risk factors, and effective treatment of underlying anhedonic symptoms and implementation of smoking cessation concurrent with AUD-focused interventions may decrease risk of relapse.
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36
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Rhodes BE, Gottfredson NC. Effects of tobacco on affect and craving during opioid addiction recovery: An ecological momentary assessment study. Addict Behav 2020; 106:106358. [PMID: 32151893 PMCID: PMC7303908 DOI: 10.1016/j.addbeh.2020.106358] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 01/07/2020] [Accepted: 02/15/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Blythe E Rhodes
- University of North Carolina Gillings School of Global Public Health, 135 Dauer Dr., Chapel Hill, NC 27599, USA.
| | - Nisha C Gottfredson
- University of North Carolina Gillings School of Global Public Health, 135 Dauer Dr., Chapel Hill, NC 27599, USA
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37
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Vinci C. Cognitive Behavioral and Mindfulness-Based Interventions for Smoking Cessation: a Review of the Recent Literature. Curr Oncol Rep 2020; 22:58. [PMID: 32415381 PMCID: PMC7874528 DOI: 10.1007/s11912-020-00915-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Cigarette smoking is the primary cause of cancer and is the leading preventable cause of morbidity and mortality. Cognitive behavioral therapy (CBT) is one of the most well-established and efficacious interventions for smoking cessation. The study of mindfulness-based interventions (MBIs) has increased exponentially in recent years, showing efficacy for smoking cessation as well. This review highlights research from the past 5 years examining CBT and MBIs for smoking cessation. RECENT FINDINGS Both CBT and MBIs are efficacious for special populations (e.g., low SES; pregnant smokers) and have shown initial efficacy when delivered via mhealth/ehealth. CBT has shown efficacy when combined with another behavioral treatment (e.g., ACT). Continued research is needed on CBT and MBIs that have high potential for scalability. Understanding whether they are beneficial for certain populations (e.g., cancer survivors), along with determining for whom CBT vs MBIs are most effective, is also needed.
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Affiliation(s)
- Christine Vinci
- Moffitt Cancer Center, Health Outcomes and Behavior, 4115 E Fowler Ave, Tampa, FL, 33617, USA.
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38
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Abstract
While prevalence of tobacco use in the US general population is declining, prevalence among those with opioid use disorder (OUD) remains high and results in excessive tobacco-related disease and premature mortality. Among smokers with OUD, tobacco cessation rates are negligible without treatment. However, both low-intensity behavioral interventions and more intensive motivational interventions yield negligible cessation rates. While contingency management has potent short-term cessation effects, effects are not maintained at post-intervention follow-up. Evidence-based smoking cessation pharmacotherapies, such as nicotine replacement therapy, bupropion, and varenicline, result in very modest cessation rates among smokers with OUD. Intensification of pharmacotherapy, such as high-dose and combination nicotine replacement therapy or extended medication treatment, has failed to improve cessation outcomes compared with standard treatment regimens. Targeting the unique challenges faced by smokers with OUD, including nicotine-opioid interactions and poor medication adherence, has potential to improve cessation outcomes, but further research is needed to optimize intervention efficacy among smokers with OUD.
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39
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Tremain D, Freund M, Bowman J, Wolfenden L, Wye P, Dunlop A, Bartlem K, McElwaine K, Gillham K, Wiggers J. Substance use treatment clinician attitudes to care for chronic disease health risk behaviours and associations of attitudes with care provision. Drug Alcohol Rev 2020; 39:232-237. [PMID: 32080938 DOI: 10.1111/dar.13044] [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: 05/05/2019] [Revised: 01/23/2020] [Accepted: 02/04/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS People who use substances have a high prevalence of modifiable chronic disease health risk behaviours. Preventive care to address such risks has not traditionally been provided during substance use treatment. This study aimed to assess clinicians' attitudes towards preventive care and their association with care provision. DESIGN AND METHODS A cross-sectional study utilising computer-assisted telephone interviews was undertaken with clinicians (n = 54) of community-based substance use treatment services in one health district, Australia. Clinicians indicated their agreement with 10 attitudinal statements regarding their perceived role and self-efficacy in providing preventive care and perceptions of client interest in modifying behaviours. Logistic regression analyses examined the association between clinician attitudinal items and self-reported care provision. RESULTS Fifty-four clinicians (74%) agreed to participate. The most positive attitudes were preventive care being part of their role (100%), and they have the knowledge and skills to provide preventive care (100%). The least favourable attitude was clients were interested in changing their health risk behaviours (60%). Clinicians who reported that preventive care left little time to undertake acute care were more likely to assess for smoking (OR 8.06 [95% CI 1.31, 49.46]) and less likely to provide brief advice for all risks combined (OR 0.11 [95% CI 0.02, 0.63]). DISCUSSION AND CONCLUSIONS Overall, clinicians reported positive attitudes regarding the preventive care provision for modifiable health risk behaviours in substance use treatment settings. Further research is required to investigate why, despite such positive attitudes, clinicians in substance use treatment settings do not routinely provide preventive care.
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Affiliation(s)
- Danika Tremain
- Population Health, Hunter New England Local Health District, Newcastle, Australia.,Faculty of Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Megan Freund
- Faculty of Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Jenny Bowman
- Hunter Medical Research Institute, Newcastle, Australia.,Faculty of Science and Information Technology, The University of Newcastle, Newcastle, Australia
| | - Luke Wolfenden
- Population Health, Hunter New England Local Health District, Newcastle, Australia.,Faculty of Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Paula Wye
- Hunter Medical Research Institute, Newcastle, Australia.,Faculty of Science and Information Technology, The University of Newcastle, Newcastle, Australia
| | - Adrian Dunlop
- Faculty of Health, The University of Newcastle, Newcastle, Australia.,Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia.,Centre for Translational Neuroscience and Mental Health, Newcastle, Australia
| | - Kate Bartlem
- Population Health, Hunter New England Local Health District, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia.,Faculty of Science and Information Technology, The University of Newcastle, Newcastle, Australia
| | - Kathleen McElwaine
- Faculty of Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Karen Gillham
- Population Health, Hunter New England Local Health District, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - John Wiggers
- Population Health, Hunter New England Local Health District, Newcastle, Australia.,Faculty of Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
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40
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Parnell A, Box E, Biagioni N, Bonevski B, Anwar-McHenry J, Slevin T, Pettigrew S. Factors influencing the willingness of community service organisation staff to provide smoking cessation support: a qualitative study. Aust N Z J Public Health 2020; 44:116-120. [PMID: 32050298 DOI: 10.1111/1753-6405.12967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/01/2019] [Accepted: 12/01/2019] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE This study aimed to explore factors influencing community service organisation (CSO) staff members' willingness to provide tobacco cessation support to clients experiencing disadvantage. METHODS Face-to-face semi-structured interviews were conducted with 29 staff members from seven services in the alcohol and other drugs, homelessness, and mental health sectors in Western Australia. RESULTS The primary barriers to providing cessation support were believing that addressing smoking was not a priority relative to other issues, being a current smoker, and the lack of a formal tobacco cessation program within the organisation. Factors that appeared to be most influential in enabling the delivery of cessation support were organisational processes requiring staff to routinely ask clients about tobacco use, confidence to provide support, and being a past smoker. CONCLUSIONS The introduction of organisational procedures that include routine cessation care should be of high priority in CSOs to help reduce smoking rates among clients. Staff may also benefit from receiving training in the provision of cessation support and education about the importance and feasibility of addressing smoking concurrently with other issues. Implications for public health: The results may inform future efforts to increase the delivery of cessation care to groups of people experiencing disadvantage and comorbidity.
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Affiliation(s)
| | - Emily Box
- Cancer Council WA, Western Australia
| | | | - Billie Bonevski
- School of Medicine and Public Health, University of Newcastle, New South Wales
| | | | - Terry Slevin
- School of Psychology, Curtin University, Western Australia.,Public Health Association of Australia, Australian Capital Territory
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41
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Bold KW, Rosen RL, Steinberg ML, Epstein EE, McCrady BS, Williams JM. Smoking characteristics and alcohol use among women in treatment for alcohol use disorder. Addict Behav 2020; 101:106137. [PMID: 31648138 PMCID: PMC7096210 DOI: 10.1016/j.addbeh.2019.106137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/16/2019] [Accepted: 09/16/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Understanding the association between smoking and alcohol use among women may help inform the delivery of targeted interventions to address both of these health behaviors. METHODS This study analyzed data from N = 138 women enrolled in a randomized clinical trial comparing female-specific individual versus group cognitive-behavior therapy for alcohol use disorder (AUD). We assessed cigarette use patterns, participants' interest in quitting smoking and motivation to quit smoking during treatment for AUD, and examined the relationship between smoking and alcohol use before and during alcohol treatment. RESULTS Over a third of the sample reported smoking cigarettes at baseline (N = 47, 34.1%), with the majority of smokers reporting daily cigarette use. At baseline, those who smoked reported a high interest in quitting smoking M = 7.8 out of 10 (SD = 2.7), although most believed they should quit smoking only after achieving some success in quitting drinking (50.0%). However, participants who smoked cigarettes (compared to non-smokers) reported more alcohol abuse and dependence symptoms (p = .001), lower rates of completing the alcohol treatment (p = .03), attended significantly fewer treatment sessions (p = .008), and consumed significantly more drinks per day on average both at baseline (p = .002) and during the treatment period (p = .04). CONCLUSIONS Findings suggest that women with AUD who also smoke cigarettes have greater difficulty engaging in or responding to treatment for their alcohol use. However, these participants reported high interest in quitting smoking but low perceived readiness during AUD treatment, suggesting that motivational interventions should be considered that could take advantage of the opportunity to treat women for both of these co-occurring behaviors while in treatment.
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Affiliation(s)
- Krysten W Bold
- Department of Psychiatry, Yale University School of Medicine, 34 Park Street CMHC, New Haven, CT 06519, United States.
| | - Rachel L Rosen
- Department of Psychology, Rutgers, The State University of New Jersey, 152 Frelinghuysen Rd, New Brunswick, NJ 08854, United States
| | - Marc L Steinberg
- Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, 317 George Street, New Brunswick, NJ 08901, United States
| | - Elizabeth E Epstein
- Center of Alcohol Studies, Rutgers, the State University of New Jersey, 607 Allison Rd, Piscataway, NJ 08854, United States; Department of Psychiatry, University of Massachusetts Medical School, 365 Plantation Street, Worcester, MA 01605, United States
| | - Barbara S McCrady
- Center of Alcohol Studies, Rutgers, the State University of New Jersey, 607 Allison Rd, Piscataway, NJ 08854, United States; Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, 2650 Yale Blvd. SE, Albuquerque, NM 87106, United States
| | - Jill M Williams
- Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, 317 George Street, New Brunswick, NJ 08901, United States
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42
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The provision of preventive care for modifiable health risk behaviours by clinicians within substance use treatment settings: A systematic review. Prev Med 2020; 130:105870. [PMID: 31678584 DOI: 10.1016/j.ypmed.2019.105870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/26/2019] [Accepted: 10/12/2019] [Indexed: 11/20/2022]
Abstract
People who use substances have a high prevalence of other modifiable health risk behaviours such as tobacco smoking which contribute to an increased mortality and morbidity. Preventive care can reduce the prevalence of such behaviours and is recommended by clinical practice guidelines. This review describes the prevalence of preventive care delivery by substance use treatment healthcare providers and examines differences by treatment setting. Five databases were searched for studies published between 2005 and 2017. Eligible studies reported levels of preventive care (assessment, brief advice and/or referral/follow-up) in substance use treatment services for tobacco smoking, nutrition or physical activity. Two reviewers independently conducted article screening, data extraction and methodological quality assessment. Sixteen studies were included and all except one investigated care provision for tobacco smoking only. Four studies reported care levels as a proportion and 12 studies reported care as a score-based mean. Client-reported receipt of smoking cessation care ranged from: 79-90% for assessment; 15-79% for brief advice; 0-30% for referral/follow-up. Meta-regression analyses of 12 studies found clinician-reported preventative care for tobacco smoking was more frequently reported in studies assessing care occurring across multiple substance use treatment settings, compared to studies reporting provision in inpatient only. This review indicated that, compared to smoking cessation care, little is known about the level of preventive care for nutrition or physical activity. Overall, the delivery of smoking cessation care reported was sub-optimal. High levels of assessment relative to brief advice and low levels of referral to ongoing assistance were indicated.
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43
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Sánchez-García NC, González RA, Ramos-Quiroga JA, van den Brink W, Luderer M, Blankers M, Grau-Lopez L, Levin FR, Kaye S, Demetrovics Z, van de Glind G, Schellekens A, Vélez-Pastrana MC. Attention Deficit Hyperactivity Disorder Increases Nicotine Addiction Severity in Adults Seeking Treatment for Substance Use Disorders: The Role of Personality Disorders. Eur Addict Res 2020; 26:191-200. [PMID: 32564016 DOI: 10.1159/000508545] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/07/2020] [Indexed: 11/19/2022]
Abstract
AIMS To examine the role of attention deficit/hyperactivity disorder (ADHD) and impulsive personality disorders in nicotine addiction severity among treatment-seeking substance use disorder (SUD) patients. METHODS In a cross-sectional study, we examined data from the second International ADHD in Substance Use Disorders Prevalence Study (IASP-2) on 402 adults in SUD treatment from Puerto Rico, Hungary, and Australia using diagnostic interviews for ADHD, antisocial (ASP) and borderline (BPD) personality disorders, and the self-report Fagerström Test of Nicotine Dependence (FTND). We compared SUD patients with and without ADHD on nicotine addiction severity. We tested direct and indirect pathways from ADHD to nicotine addiction and mediation through ASP and BPD. RESULTS Overall, 81.4% of SUD patients reported current cigarette smoking. SUD patients with ADHD had higher FTND scores and smoked more cigarettes than those without ADHD, with an earlier onset and more years of smoking. ASP mediated the effect of ADHD on all aspects of nicotine addiction severity, whereas BPD did so only on some aspects of nicotine addiction severity. CONCLUSIONS SUD patients with comorbid ADHD show more severe nicotine addiction than those without, which is largely explained by comorbid impulsive personality disorders. In SUD patients, it is important to screen for adult ADHD and other psychiatric disorders, especially those with impulse control deficits such as ASP and BPD.
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Affiliation(s)
| | - Rafael A González
- National Adoption and Fostering Service & National Conduct Problems Team, Michael Rutter Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Centre for Mental Health, Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom
| | - Josep A Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Barcelona, Spain.,Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute, Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Wim van den Brink
- Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Department of Psychiatry, Amsterdam, The Netherlands
| | - Mathias Luderer
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
| | - Matthijs Blankers
- Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands.,Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.,Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lara Grau-Lopez
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Frances R Levin
- Department of Psychiatry, Columbia University Medical Center, New York, New York, USA.,CUMC/Herbert Pardes Building, New York State Psychiatric Institute, New York, New York, USA
| | - Sharlene Kaye
- Research Unit, Justice Health and Forensic Mental Health Network, Sydney, New South Wales, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Zsolt Demetrovics
- Department of Clinical Psychology and Addictions, Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Geurt van de Glind
- Department of Psychiatry, Donders Centre for Medical Neuroscience, Radboudumc, Nijmegen, The Netherlands.,Department of Psychiatry, Nijmegen Institute for Scientist Practitioners in Addiction, Nijmegen, The Netherlands
| | - Arnt Schellekens
- Department of Psychiatry, Donders Centre for Medical Neuroscience, Radboudumc, Nijmegen, The Netherlands.,Department of Psychiatry, Nijmegen Institute for Scientist Practitioners in Addiction, Nijmegen, The Netherlands
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Parker MA, Sigmon SC, Villanti AC. Higher smoking prevalence among United States adults with co-occurring affective and drug use diagnoses. Addict Behav 2019; 99:106112. [PMID: 31476691 DOI: 10.1016/j.addbeh.2019.106112] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/30/2019] [Accepted: 08/25/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Individuals with drug use disorders or affective disorders have higher cigarette smoking prevalence and smoking intensity and are less likely to quit than the general population. We sought to estimate the prevalence of cigarette smoking by drug use and psychiatric diagnoses and to explore to what extent a co-occurring diagnosis was associated with current smoking. METHODS Data were derived from the most recent National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III, 2012-2013; n = 36,309). Cigarette smoking status was examined among those with any past-year or lifetime drug use disorders (i.e., alcohol, cannabis, opioid, cocaine) or affective disorders (i.e., mood, anxiety). Diagnoses were assessed using the Diagnostic and Statistical Manual of Mental Disorders criteria (DSM-5). RESULTS Adjusting for sociodemographic characteristics, those with drug use disorders (past-year AOR = 3.3, 95% CI: 3.0, 3.6; lifetime AOR = 3.2, 95% CI: 3.0, 3.5) and those with affective disorders (past-year AOR = 1.7; 95%CI: 1.5, 1.8, lifetime AOR = 1.3, 95% CI: 1.2; 1.4), had higher odds of current cigarette smoking compared to individuals with no diagnosis. The odds of current cigarette smoking was significantly higher in individuals with both drug use disorders and affective disorders compared to those with either a drug use or affective disorder or no disorder (past-year AOR = 5.1; 95% CI: 4.3, 5.9, lifetime AOR = 4.3; 95% CI: 3.8, 4.7). CONCLUSIONS Approximately 30% of the population had a past-year drug use or affective disorder, 17% of whom report both. The combination of both diagnoses produced a 1.5 to 3-fold higher correlation with smoking than either alone.
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Hemmy Asamsama O, Miller SC, Silvestri MM, Bonanno C, Krondilou K. Impact of implementing a tobacco and recreational nicotine-free policy and enhanced treatments on programmatic and patient-level outcomes within a residential substance use disorder treatment program. J Subst Abuse Treat 2019; 107:44-49. [PMID: 31757264 DOI: 10.1016/j.jsat.2019.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/18/2019] [Accepted: 09/09/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Recent estimates are that 30% of military veterans use tobacco or recreational nicotine products, and rates significantly increase for veterans with co-occurring substance use disorder (SUD). Despite emerging literature that indicate better outcomes when SUD and tobacco use disorder (TUD) are treated simultaneously (in parallel), most SUD programs fail to address tobacco use. This can prove catastrophic, as perhaps the most likely cause of death lifetime for patients admitted to a SUD treatment program is tobacco/nicotine-related. Studies suggest that residential SUD treatment programs can improve the screening, diagnosis, documentation, and treatment of TUD. Perceived barriers among staff include fear of causing patients to leave early. There are few studies evaluating the accuracy of these perceived barriers to programmatic and patient-level outcomes in the residential SUD treatment setting when TUD services are provided along with a nicotine/tobacco-free therapeutic milieu. OBJECTIVE In the fall of 2015, a SUD treatment program at a large midwestern Veteran. Affairs Medical Center fully implemented a tobacco-free residential unit. The current study investigates the programmatic and patient-level outcomes among cohorts treated before versus after the tobacco-free policy was implemented. PARTICIPANTS & PROCEDURES This study utilized archival data and all participants were enrolled in the residential program with 117 veterans enrolled pre and 92 post tobacco-free policy. The final sample consisted of 194 males (92.8%), 14 females (6.7%), and 1 transgendered (0.5%) with a mean age of 47.80 (SD = 12.65). Most of the participants were Caucasian (69.4%) and divorced (43.1%). The majority (167, 79.9%) reported current tobacco use, with cigarettes (118, 56.5%) being the most frequently reported type. In addition, 17.59 (SD = 6.51) years old is the average start age of tobacco use. RESULTS Veterans in the pre-policy cohort did not differ from post-policy cohort on age, gender, ethnicity, and marital status. Preliminary results related to programmatic outcomes indicate improved rates of TUD diagnosis during intake (28.4% to 75.0%). Similar rates were observed in veterans who reported tobacco quit goal during treatment planning (37.4% to 56.8%). However, while there were no significant differences in the total rates of infractions; tobacco-related infractions significantly increased from one to eight. Finally, there were no significant differences in the number of against medical advice discharges or irregular discharges. Examination of patient-level outcomes revealed similar rates of veterans enrolling in the program as it relates to rates of current tobacco use, admission expired breath carbon monoxide (CO) measured in parts per million (ppm), longest period of tobacco abstinence, and self-reported primary preferred substance/drug. Of note, there were also no differences in reported importance and confidence of quitting tobacco. Rates of veterans prescribed nicotine replacement therapy during residential stay more than doubled. CONCLUSIONS Our data suggest that implementing a tobacco-free policy within a residential SUD treatment program would not deter veterans from staying engaged in the program as evident by similar rates of irregular and AMA discharges. In addition, the prevalence of Veterans wishing to quit tobacco was higher in the post-policy cohort, as was NRT utilization, and without the addition of staff. Specific treatment recommendations will be discussed along with other implications.
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Affiliation(s)
| | - Shannon C Miller
- Veterans Affairs Medical Center, Dayton/Middletown, OH, United States of America; Center for Interventions, Treatment, and Addictions Research, Departments of Psychiatry & Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University, Dayton, OH, United States of America
| | - Mark M Silvestri
- University of Virginia, Charlottesville, VA, United States of America
| | - Christina Bonanno
- Veterans Affairs Medical Center, Indianapolis/Ft. Wayne, IN, United States of America
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Romano I, Costello MJ, Ropp C, Li Y, Sousa S, Bruce D, Roth D, MacKillop J, Rush B. Evaluating the short-term impact of a tobacco-free policy in an inpatient addiction treatment setting. J Subst Abuse Treat 2019; 107:50-59. [PMID: 31757265 DOI: 10.1016/j.jsat.2019.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 09/20/2019] [Accepted: 09/27/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Tobacco use is highly prevalent within addiction treatment settings, despite the potential benefits that cessation may provide to patients' psychosocial functioning and overall sobriety. Moreover, tobacco cessation is often insufficiently addressed in addiction treatment programs, although evidence suggests that tobacco control policies, such as access to evidence-based treatment or tobacco-free policies, may be effective. The objective of our study was to evaluate the impact of the implementation of these two tobacco control policies in an inpatient addiction treatment centre. METHODS Using a 3-group quasi-experimental design, we examined how the implementation of the Ottawa Model for Smoking Cessation (OMSC) and a subsequent campus-wide tobacco ban influenced patients' overall smoking status, frequency, amount used per day, and quit attempts during treatment, compared to usual care. Participants (N = 397) responded to a comprehensive questionnaire upon admission and discharge from an addiction treatment program. We used generalized linear mixed modelling to measure changes over time while accounting for relevant sociodemographic covariates. RESULTS Patients exposed to a more comprehensive tobacco control environment (i.e., the OMSC, plus complete tobacco ban) were over 80% less likely to report having used tobacco during treatment, compared to patients exposed to usual care (AOR = 0.17, 95% CI [0.05-0.63]). Receiving treatment in this setting also contributed to a 35% decrease in the average number of days patients used tobacco compared to usual care (AOR = 0.65, 95% CI [0.53-0.98]), and a 27% decrease in the average number of cigarettes used per day compared to usual care (AOR = 0.73, 95% CI [0.58-0.93]). CONCLUSION Comprehensive tobacco control policy interventions within inpatient addiction treatment hospitals promote tobacco cessation. Such interventions should include a combination of evidence-based treatment for patients and environmental restrictions to discourage tobacco use. The results of our study suggest that, within inpatient addiction treatment settings, use of the OMSC in combination with a campus-wide tobacco ban may be more effective than usual care or the OMSC alone.
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Affiliation(s)
- Isabella Romano
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada; Homewood Research Institute, Guelph, ON, Canada
| | - Mary Jean Costello
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada; Homewood Research Institute, Guelph, ON, Canada.
| | | | - Yao Li
- Homewood Research Institute, Guelph, ON, Canada
| | - Sarah Sousa
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada; Homewood Research Institute, Guelph, ON, Canada
| | | | - Don Roth
- Homewood Health Centre, Guelph, ON, Canada
| | - James MacKillop
- Homewood Research Institute, Guelph, ON, Canada; Peter Boris Centre for Addiction Research, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Brian Rush
- Homewood Research Institute, Guelph, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
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Gubner NR, Pagano A, Tajima B, Guydish J. A Comparison of Daily Versus Weekly Electronic Cigarette Users in Treatment for Substance Abuse. Nicotine Tob Res 2019; 20:636-642. [PMID: 28575519 DOI: 10.1093/ntr/ntx116] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 05/24/2017] [Indexed: 01/08/2023]
Abstract
Objective This research examined electronic cigarette (e-cigarette) use by individuals in treatment for substance abuse, a population with a high prevalence of tobacco use and poor smoking cessation outcomes. Methods We surveyed 1127 individuals from 24 substance abuse treatment centers across the United States. Bivariate analyses and logistic regression were used to examine factors associated with daily (N = 87) versus weekly (N = 81) e-cigarette use. Results Among the full sample, 59.8% reported any lifetime use of e-cigarettes, with 23.6% reporting past 30-day use. Daily e-cigarette users were more likely to have used second-generation, tank-type e-cigarettes, χ2(1,N = 165) = 11.54, p = .001, used more flavors overall, t(168) = 2.15, p = .03, and were more likely to report using their e-cigarette continuously throughout the day, χ2(4,N = 168) = 16.7, p = .002, compared to weekly e-cigarette users. Over half (57.7%) of the daily and weekly e-cigarette users reported having an e-cigarette device that broke. The logistic regression model adjusting for clinic type and days with poor mental health found that daily e-cigarette users were significantly more likely than weekly e-cigarette users to be from methadone clinics (adjusted odds ratio [AOR] = 2.40, p = .04), and former smokers (AOR = 6.37, p < .002). Conclusions Daily e-cigarette users in substance abuse treatment were more likely to be from methadone clinics and former cigarette smokers. However, the majority (73.6%) of daily e-cigarette users were current cigarette smokers. E-cigarette device type reliability (eg, breakage) may be an important factor to consider among drug treatment and other populations with lower socioeconomic status. Implications This study found several differences in the device type, flavors, and use characteristics of daily versus weekly e-cigarette users. While majority of e-cigarette users in substance abuse treatment were current cigarette smokers, daily e-cigarette users were more likely to be former cigarette smokers. Administrators of substance abuse treatment programs should evaluate potential benefits and harms of e-cigarettes when developing program policies.
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Affiliation(s)
- Noah R Gubner
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA.,Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, CA
| | - Anna Pagano
- Prevention Research Center, Pacific Institute for Research and Evaluation (PIRE), Oakland, CA
| | - Barbara Tajima
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA
| | - Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA.,Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, CA
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Hall SM, Humfleet GL, Gasper JJ, Delucchi KL, Hersh DF, Guydish JR. Cigarette Smoking Cessation Intervention for Buprenorphine Treatment Patients. Nicotine Tob Res 2019; 20:628-635. [PMID: 28549161 PMCID: PMC7207071 DOI: 10.1093/ntr/ntx113] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 05/22/2017] [Indexed: 12/03/2022]
Abstract
Introduction Patients receiving medication assisted therapy (MAT) for opioid use disorder have high cigarette smoking rates. Cigarette smoking interventions have had limited success. We evaluated an intervention to increase cigarette abstinence rates in patients receiving buprenorphine-assisted therapy. Methods Cigarette smokers (N = 175; 78% male; 69% Caucasian; 20% Hispanic), recruited from a buprenorphine clinic were randomly assigned to either an extended innovative system intervention (E-ISI) or to Standard Treatment Control (STC). The E-ISI combined motivational intervention with extended treatment (long-term nicotine replacement therapy , varenicline, and extended cognitive behavioral therapy). STC received written information about quit-lines, medication, and resources. Assessments were held at baseline and 3, 6, 12, and 18 months. Seven-day biochemically verified point-prevalence cigarette abstinence was the primary outcome measure. Results Fifty-four percent of E-ISI participants entered the extended treatment intervention; E-ISI and STC differed at 3 months on abstinence status but not at months 6, 12, and 18. E-ISI participants were more likely to attempt to quit, to have a goal of complete abstinence, and to be in a more advanced stage of change than STC participants. A higher number of cigarettes smoked and the use of cannabis in the previous 30 days predicted continued smoking Conclusions The E-ISI was successful in increasing motivation to quit smoking but did not result in long-term abstinence. The failure of treatments that have been efficacious in the general population to produce abstinence in patients receiving MAT of opioid use disorder suggests that harm reduction and other innovative interventions should be explored. Implications This study demonstrates that an intervention combining motivational interviewing with an extended treatment protocol can increase cigarette quit attempts, enhance cigarette abstinence goals, and further movement through stages of change about quitting smoking in patients receiving MAT for opioid use disorder who smoke cigarettes. The intervention did not increase abstinence rates over those observed in a standard treatment control, however. The latter finding supports those of earlier investigators who also failed to find efficacy for smoking cessation in this population and who also used interventions effective in the general population. This pattern of findings suggests that patients with opioid use disorder can be motivated to change smoking behavior, but alternative and innovative approaches to cigarette smoking treatment should be studied.
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Affiliation(s)
- Sharon M Hall
- Department of Psychiatry, University of California, San Francisco, CA
| | - Gary L Humfleet
- Department of Psychiatry, University of California, San Francisco, CA
| | - James J Gasper
- California Department of Health Care Services, Sacramento, CA
| | - Kevin L Delucchi
- Department of Psychiatry, University of California, San Francisco, CA
| | | | - Joseph R Guydish
- Philip R. Lee institute for Health Policy studies, University of California, San Francisco, CA
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Fallin-Bennett A, Parker KA, Miller A, Ashford K, Hahn EJ. Smoking and Tobacco-Free Policies in Women's Residential Substance Use Disorder Treatment Facilities: A Community-Engaged Approach. Nicotine Tob Res 2019; 20:1386-1392. [PMID: 29059449 DOI: 10.1093/ntr/ntx211] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 09/15/2017] [Indexed: 01/23/2023]
Abstract
Introduction The purpose of this study was to (1) describe the role of smoking in the lives of women in residential substance use disorder (SUD) treatment and (2) explore perceptions of the facilitators and barriers to tobacco-free policy among women in residential SUD treatment. Methods This was a community-engaged study using qualitative descriptive methods. We first recruited women in a residential SUD treatment facility to participate on a community research team. Interviews with staff (N = 10) and focus groups with clients (N = 42) were conducted using guides informed by the community research team. Interviews and focus groups were analyzed using content analysis. Results There were two themes related to the role of smoking in the women's lives: (1) smoking facilitates socialization and (2) smoking as a coping mechanism. There were three themes related to the benefits of tobacco-free policy: (1) improved health, (2) support for continued abstinence from a previous tobacco-free placement (eg, prison), and (3) less grounds up-keep. Barriers to tobacco-free policy included (1) lack of an alternative coping mechanism to smoking, (2) fear that a tobacco-free policy would drive clients away, and (3) anticipation of implementation challenges. Conclusions Many women in residential SUD treatment smoke, which they attribute to the fact that smoking is used to facilitate socialization and cope with stress. Future research is needed to develop and test messages to counter the misperception that smoking is an effective method to cope with stress. Ultimately, evidence-based tobacco-free policies are needed to reduce tobacco-related disease among women with SUDs. Implications To promote smoking cessation among women with substance use disorders through evidence-based tobacco policy, it is necessary to first understand the role of smoking in their lives as well as facilitators and barriers to tobacco-free policy in residential treatment facilities. Participants reported that smoking facilitated socialization and served as a coping mechanism. Tobacco-free policies have many benefits, including improved health, support for continued abstinence from a previous tobacco-free placement (eg, prison), and less grounds up-keep. Barriers include the lack of an alternative coping mechanism, fear that a tobacco-free policy would drive away clients and anticipation of implementation challenges. To reduce the burden of tobacco-related morbidity and mortality among women and their children, it is necessary to catalyze a culture change in behavioral health settings to prioritize the treatment of tobacco alongside treatment of other addictions.
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Affiliation(s)
| | - Kimberly A Parker
- College of Communication and Information, University of Kentucky, Lexington, KY
| | - Alana Miller
- BREATHE, College of Nursing, University of Kentucky, Lexington, KY
| | - Kristin Ashford
- BREATHE, College of Nursing, University of Kentucky, Lexington, KY
| | - Ellen J Hahn
- BREATHE, College of Nursing, University of Kentucky, Lexington, KY
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McCabe SE, West BT, McCabe VV. Associations Between Early Onset of E-cigarette Use and Cigarette Smoking and Other Substance Use Among US Adolescents: A National Study. Nicotine Tob Res 2019; 20:923-930. [PMID: 29986103 DOI: 10.1093/ntr/ntx231] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 09/29/2017] [Indexed: 12/23/2022]
Abstract
Introduction This study examines the associations between early onset of e-cigarette use and cigarette smoking and other substance use behaviors among US adolescents. Methods Data were collected via self-administered questionnaires from a nationally representative sample of 2299 US high school seniors attending public and private high schools during the spring of their senior year in 2015 as part of the Monitoring the Future study. Results A higher percentage of adolescents who began using e-cigarettes in ninth grade or earlier (early onset) were found to report current and lifetime cigarette smoking and other substance use relative to those individuals who never used e-cigarettes or those who began using e-cigarettes later in the 12th grade. Multivariate logistic regression analyses indicated that the adjusted odds of alcohol use, cigarette smoking, marijuana use, nonmedical prescription drug use, and other illicit drug use among early onset e-cigarette users were significantly greater than those for individuals never having used e-cigarettes (adjusted odds ratios [AORs] ranged 9.5-70.6, p < .001). While these associations were significant for both experimental and frequent e-cigarette users, the effects of early onset were stronger among frequent e-cigarette users. Similarly, the odds of these substance use behaviors (except alcohol) among early onset e-cigarette users were also significantly greater than the odds for later onset e-cigarette users (AORs ranged 2.8-4.1, p < .05). Conclusions Early onset of e-cigarette use was significantly associated with increased odds of cigarette smoking and other substance use behaviors. E-cigarette use is often preceded by alcohol use, cigarette smoking, and marijuana use, suggesting that more long-term prospective studies are warranted. Implications To date, no studies have examined the probability of cigarette smoking and other substance use behaviors as a function of age at onset of e-cigarette use. In the present study, early onset of e-cigarette use was significantly associated with increased odds of cigarette smoking and other substance use behaviors. The findings reinforce the importance of addressing a wide range of substances including alcohol, traditional cigarettes, and marijuana when developing early primary prevention efforts to reduce e-cigarette use among youth.
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Affiliation(s)
- Sean Esteban McCabe
- Institute for Research on Women and Gender, Substance Abuse Research Center, University of Michigan, Ann Arbor, MI
| | - Brady T West
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI
| | - Vita V McCabe
- Lung Care and Smoking Cessation Program, St. Joseph Mercy Ann Arbor, Ann Arbor, MI
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