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McCuistian C, Lisha NE, Campbell B, Cheng C, Le J, Guydish J. Reducing tobacco use in substance use treatment: The California tobacco free initiative. Addict Behav 2024; 155:108025. [PMID: 38593596 DOI: 10.1016/j.addbeh.2024.108025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/12/2024] [Accepted: 03/29/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND People in substance use disorder (SUD) treatment have a smoking prevalence that is five times higher than the national average. California funded the Tobacco Free for Recovery Initiative, designed to support programs in implementing tobacco-free grounds and increasing smoking cessation services. In the first cohort of the initiative (2018-2020) client smoking prevalence decreased from 54.2% to 26.6%. The current study examined whether similar findings would be replicated with a later cohort of programs (2020-2022). METHOD Cross-sectional survey data were collected from clients in 11 residential SUD treatment programs at baseline (n = 185) and at post intervention (n = 227). Multivariate logistic regression assessed change over time in smoking prevalence, tobacco use behaviors, and receipt of cessation services across the two timepoints. RESULTS Client smoking prevalence decreased from 60.3 % to 40.5 % (Adjusted Odds Ratio [AOR] = 0.46, 95 % CI = 0.27, 0.78; p = 0.004). Current smokers and those who quit while in treatment reported an increase in nicotine replacement therapy (NRT)/pharmacotherapy from baseline to post intervention (31.9 % vs 45.6 %; AOR = 2.22, 95 % CI = 1.08, 4.58; p = 0.031). CONCLUSIONS Like the first cohort, the Tobacco Free for Recovery initiative was associated with decreased client smoking prevalence and an increase in NRT/pharmacotherapy. These findings strengthen the evidence that similar initiatives may be effective in reducing smoking prevalence among people in SUD treatment.
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Affiliation(s)
- Caravella McCuistian
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco 1001 Potrero Ave, San Francisco, CA 94110, United States.
| | - Nadra E Lisha
- Division of General Internal Medicine, School of Medicine University of California, San Francisco 530 Parnassus Ave, San Francisco, CA 94143, United States
| | - Barbara Campbell
- Division of General Internal Medicine & Geriatrics, Oregon Health and Science University 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, United States
| | - Christine Cheng
- Smoking Cessation Leadership Center, University of California, San Francisco 490 Illinois Street, 9216, San Francisco, CA 94158, United States
| | - Jennifer Le
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco 1001 Potrero Ave, San Francisco, CA 94110, United States
| | - 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
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Distinct groups of smokers in primary care based on mental health diagnosis. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01357-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Blok AC, Ignacio RV, Geraci MC, Kim HM, Barnett PG, Duffy SA. Provider and clinical setting characteristics associated with tobacco pharmacotherapy dispensed in the Veterans Health Administration. Tob Induc Dis 2021; 19:65. [PMID: 34429727 PMCID: PMC8349177 DOI: 10.18332/tid/140091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/04/2021] [Accepted: 07/08/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION While initiation rates of tobacco cessation pharmacotherapy have improved both inside and outside the Department of Veteran Affairs (VA), prescribing rates remain low. The objective of this study was to examine correlation of the characteristics of providers, clinics, and facilities with initiation of tobacco cessation pharmacotherapy. METHODS This retrospective, observational study used VA outpatient electronic medical record data from federal fiscal year 2011. Logistic regression models estimated the adjusted odds ratio associated with provider characteristics for pharmacotherapy initiation. RESULTS For the 639507 veterans who used tobacco, there were 30388 providers caring for them. Younger (p<0.001) and female (p<0.001) providers were more likely to initiate tobacco cessation pharmacotherapy. Compared to physicians, pharmacists were 74% more likely to initiate pharmacotherapy, while all groups of nurses were 5-8% and physicians' assistants were 12% less likely (p<0.001). Compared to those seen in primary care clinics, patients assessed in substance use treatment clinics were 16% more likely to have pharmacotherapy initiated (p<0.001), while those in psychiatry were 10% less likely (p<0.001), and those in outpatient surgery were 39% less likely to initiate pharmacotherapy (p<0.001). Compared to almost all other classes of VA facilities, patients seen in primary care community-based outpatient clinics (CBOCs) were 7-28% more likely to initiate pharmacotherapy (p<0.0001). CONCLUSIONS While the VA is at the leading edge of providing tobacco cessation pharmacotherapy, targeting quality improvement efforts towards providers, clinics, and facilities with low prescribing rates will be essential to continue the declining rates of tobacco use among VA patients.
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Affiliation(s)
- Amanda C. Blok
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, United States
- Department of Systems, Populations and Leadership, School of Nursing, University of Michigan, Ann Arbor, United States
| | - Rosalinda V. Ignacio
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, United States
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, United States
| | - Mark C. Geraci
- Department of Veterans Affairs Pharmacy Benefits Management Services, United States Department of Veterans Affairs, Hines, United States
| | - Hyungjin Myra Kim
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, United States
- Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, United States
| | - Paul G. Barnett
- Health Economics Resource Center, United States Department of Veterans Affairs, Menlo Park, United States
| | - Sonia A. Duffy
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, United States
- College of Nursing, The Ohio State University, Columbus, United States
- Department of Psychiatry, University of Michigan, Ann Arbor, United States
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Aonso-Diego G, González-Roz A, Krotter A, García-Pérez A, Secades-Villa R. Contingency management for smoking cessation among individuals with substance use disorders: In-treatment and post-treatment effects. Addict Behav 2021; 119:106920. [PMID: 33798921 DOI: 10.1016/j.addbeh.2021.106920] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/18/2021] [Accepted: 03/18/2021] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Smokers with substance use disorders (SUDs) show elevated tobacco prevalence, and smoking abstinence rates are considerably low. This randomized controlled trial sought to compare the effect of a cognitive behavioral treatment (CBT) that includes an episodic future thinking (EFT) component with the same treatment protocol plus contingency management (CM). This study aims to examine the effect of CM on smoking outcomes and in-treatment behaviors (i.e., retention, session attendance and adherence to nicotine use reduction guidelines), and to analyze whether these in-treatment variables predicted days of continuous abstinence at end-of-treatment. METHOD A total of 54 treatment-seeking participants (75.9% males, M = 46.19 years old) were allocated to CBT + EFT (n = 30) or CBT + EFT + CM (n = 24). Intervention consisted of eight weeks of group-based sessions. Tobacco abstinence was verified biochemically by testing levels of carbon monoxide (≤4ppm) and urine cotinine (≤80 ng/ml). RESULTS CM intervention increased 24-hour tobacco abstinence (50% vs. 20%, χ2(1) = 5.4; p = .021) and days of continuous abstinence (M = 5.92 ± 7.67 vs. 5.53 ± 12.42; t(52) = -0.132; p = 0.89) at end-of-treatment in comparison with CBT + EFT intervention. Although not statistically significant, CBT + EFT + CM enhanced in-treatment behaviors, in terms of retention (83.3% vs. 70%; χ2(1) = 0.255; p = .208), sessions attended (12.29 ± 3.22 vs. 10.93 ± 3.26; t(52) = -1.527; p = .133) and adherence to weekly nicotine use reduction targets (41.07% ± 31.96 vs. 35% ±2 6.28; t(52) = -0.766; p = .447). A higher percentage of samples meeting reduction guidelines (β = 0.609; p<.001) predicted days of continuous abstinence at end-of-treatment. CONCLUSION Combining CM with CBT + EFT improves short-term quitting rates. Findings suggest the need to incorporate strategies for improving adherence to nicotine reduction guidelines.
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Aonso-Diego G, González-Roz A, Martínez-Loredo V, Krotter A, Secades-Villa R. Episodic future thinking for smoking cessation in individuals with substance use disorder: Treatment feasibility and acceptability. J Subst Abuse Treat 2021; 123:108259. [PMID: 33612193 DOI: 10.1016/j.jsat.2020.108259] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/09/2020] [Accepted: 12/10/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Smokers with substance use disorders (SUD) smoke approximately four times more than the general population. Current efforts are focused on improving smoking cessation treatments for this population. Episodic future thinking (EFT), a novel intervention aimed at decreasing impulsive choice, has shown promising results for reducing cigarette demand in experimental settings. This feasibility study sought to examine the feasibility and preliminary EFT effects on delay discounting (DD) and nicotine intake reductions throughout treatment. METHOD Smokers in substance use treatment (N = 29; 75.9% males) received an 8-week cognitive-behavioral treatment (CBT) + EFT for smoking cessation. The study assessed feasibility through successful recruitment rates, retention, and adherence to treatment. Participants' satisfaction acted as our acceptability measure. We computed nonparametric range tests to analyze changes in continuous variables. RESULTS Among interested individuals, 42 (43.75%) met the inclusion criteria, and 29 entered the treatment program. Rate of treatment completion was 65.5% (19/29). Mean (SD) sessions attended were 7(1.11), and mean patient satisfaction rating with treatment was 8.83/10. The study observed low compliance with EFT, with 15.8% (3/19) of patients practicing at least 50% of the requested times. CONCLUSIONS CBT + EFT is acceptable for the SUD population. However, future studies should implement some adjustments to improve the adherence and feasibility of EFT, such as reducing the number of practices and temporal intervals in EFT events. Given the small sample size, and the absence of a control group, future larger scale trials are needed to elucidate EFT effects on DD and smoking cessation.
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Affiliation(s)
- Gema Aonso-Diego
- Department of Psychology, University of Oviedo, Plaza Feijoo, s/n, 33003 Oviedo, Spain.
| | - Alba González-Roz
- Department of Psychology, University of Oviedo, Plaza Feijoo, s/n, 33003 Oviedo, Spain
| | | | - Andrea Krotter
- Department of Psychology, University of Oviedo, Plaza Feijoo, s/n, 33003 Oviedo, Spain
| | - Roberto Secades-Villa
- Department of Psychology, University of Oviedo, Plaza Feijoo, s/n, 33003 Oviedo, Spain
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Hess DE, Carstensen SE, Moore S, Dacus AR. Smoking Increases Postoperative Complications After Distal Radius Fracture Fixation: A Review of 417 Patients From a Level 1 Trauma Center. Hand (N Y) 2020; 15:686-691. [PMID: 30463450 PMCID: PMC7543206 DOI: 10.1177/1558944718810882] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background: Unstable distal radius fractures that undergo surgical stabilization have varying complication rates in the literature. Smoking is known to affect bone healing and implant fixation rates but has never been definitively shown to affect postoperative outcomes of surgically managed distal radius fractures. Methods: A retrospective review was performed of patients with surgically treated distal radius fractures at a Level 1 Trauma Center who had at least 6 weeks of follow-up over a 5-year period. Charts were reviewed for basic demographic information, comorbidities, details about the operative procedure, and early complications. Notable physical examination findings were noted, such as wrist stiffness and distal radius tenderness to palpation. Statistical analysis was performed to compare the smoking and nonsmoking groups. To control for confounding differences, a hierarchical multivariable regression analysis was performed. Results: Four hundred seventeen patients were included in the study, and 24.6% were current smokers at the time of surgery. The overall complication rate for smokers was 9.8% compared with 5.6% in nonsmokers. The smoking cohort showed significantly higher rates of hardware removal, nonunion, revision procedures, wrist stiffness, and distal radius tenderness. When controlling for the confounding variables of diabetes and obesity, smokers still had significantly higher rates of the same complications. Conclusion: Patients who smoke have a statistically significant higher rate of postoperative distal radius tenderness, wrist stiffness, nonunion, hardware removal, and revision procedures compared with those who do not smoke in a review of 417 total patients undergoing surgical fixation for distal radius fractures.
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Affiliation(s)
- Daniel E. Hess
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, USA
| | - S. Evan Carstensen
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, USA
| | - Spencer Moore
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, USA
| | - A. Rashard Dacus
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, USA,A. Rashard Dacus, Department of Orthopaedic Surgery, University of Virginia, 400 Ray C. Hunt Drive, Charlottesville, VA 22908, USA.
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Hess DE, Carstensen SE, Moore S, Dacus AR. Smoking Increases Postoperative Complications After Distal Radius Fracture Fixation: A Review of 417 Patients From a Level 1 Trauma Center. Hand (N Y) 2018. [PMID: 30463450 DOI: 10.1177/1558944718810882.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Unstable distal radius fractures that undergo surgical stabilization have varying complication rates in the literature. Smoking is known to affect bone healing and implant fixation rates but has never been definitively shown to affect postoperative outcomes of surgically managed distal radius fractures. Methods: A retrospective review was performed of patients with surgically treated distal radius fractures at a Level 1 Trauma Center who had at least 6 weeks of follow-up over a 5-year period. Charts were reviewed for basic demographic information, comorbidities, details about the operative procedure, and early complications. Notable physical examination findings were noted, such as wrist stiffness and distal radius tenderness to palpation. Statistical analysis was performed to compare the smoking and nonsmoking groups. To control for confounding differences, a hierarchical multivariable regression analysis was performed. Results: Four hundred seventeen patients were included in the study, and 24.6% were current smokers at the time of surgery. The overall complication rate for smokers was 9.8% compared with 5.6% in nonsmokers. The smoking cohort showed significantly higher rates of hardware removal, nonunion, revision procedures, wrist stiffness, and distal radius tenderness. When controlling for the confounding variables of diabetes and obesity, smokers still had significantly higher rates of the same complications. Conclusion: Patients who smoke have a statistically significant higher rate of postoperative distal radius tenderness, wrist stiffness, nonunion, hardware removal, and revision procedures compared with those who do not smoke in a review of 417 total patients undergoing surgical fixation for distal radius fractures.
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Affiliation(s)
- Daniel E Hess
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, USA
| | - S Evan Carstensen
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, USA
| | - Spencer Moore
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, USA
| | - A Rashard Dacus
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, USA
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