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Zhang M, Niu X, Tao Q, Sun J, Dang J, Wang W, Han S, Zhang Y, Cheng J. Altered intrinsic neural timescales and neurotransmitter activity in males with tobacco use disorder. J Psychiatr Res 2024; 175:446-454. [PMID: 38797041 DOI: 10.1016/j.jpsychires.2024.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/07/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024]
Abstract
Previous researches of tobacco use disorder (TUD) has overlooked the hierarchy of cortical functions and single modality design separated the relationship between macroscopic neuroimaging aberrance and microscopic molecular basis. At present, intrinsic timescale gradient of TUD and its molecular features are not fully understood. Our study recruited 146 male subjects, including 44 heavy smokers, 50 light smokers and 52 non-smokers, then obtained their rs-fMRI data and clinical scales related to smoking. Intrinsic neural timescale (INT) method was performed to describe how long neural information was stored in a brain region by calculating the autocorrelation function (ACF) of each voxel to examine the difference in the ability of information integration among the three groups. Then, correlation analyses were conducted to explore the relationship between INT abnormalities and clinical scales of smokers. Finally, cross-modal JuSpace toolbox was used to investigate the association between INT aberrance and the expression of specific receptor/transporters. Compared to healthy controls, TUD subjects displayed decreased INT in control network (CN), default mode network (DMN), sensorimotor areas and visual cortex, and such trend of decreasing INT was more pronounced in heavy smokers. Moreover, various neurotransmitters (including dopaminergic, acetylcholine and μ-opioid receptors) were involved in the molecular mechanism of timescale decreasing and differed in heavy and light smokers. These findings supplied novel insights into the brain functional aberrance in TUD from an intrinsic neural dynamic perspective and confirm INT was a potential neurobiological marker. And also established the connection between macroscopic imaging aberrance and microscopic molecular changes in TUD.
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Affiliation(s)
- Mengzhe Zhang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, China
| | - Xiaoyu Niu
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, China
| | - Qiuying Tao
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, China
| | - Jieping Sun
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, China
| | - Jinghan Dang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, China
| | - Weijian Wang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, China
| | - Shaoqiang Han
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, China
| | - Yong Zhang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, China.
| | - Jingliang Cheng
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, China.
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Bou-Hamad I, Hoteit J, Yehya N, Ghandour L. Personality traits and high cigarette dependence among university students: Insights from Lebanon. PLoS One 2024; 19:e0298193. [PMID: 38359081 PMCID: PMC10868771 DOI: 10.1371/journal.pone.0298193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 01/20/2024] [Indexed: 02/17/2024] Open
Abstract
PURPOSE The use of tobacco and cigarette products remains widespread globally, with varying patterns across countries. Understanding the factors influencing cigarette dependence among young adults is crucial for effective smoking prevention and control programs. Personality traits are one of the factors that influence smoking behaviour, yet the evidence on their role in high cigarette dependence among young adults remains inconclusive. This study aims to provide insights and initial evidence on the potential association between personality dimensions, sociodemographic factors, lifestyle habits, and high cigarette dependence among Lebanese university students. METHODS A convenient sample of 212 student smokers from one private and one public university in Lebanon participated in an online survey. The survey included measures of personality traits using the Big-Five framework, sociodemographic factors, lifestyle habits, and the Fagerström Test for Cigarette Dependence (FTCD). Logistic regression models and mediation analysis were used to analyze the data. RESULTS The results revealed significant associations between personality dimensions and high cigarette dependence among Lebanese university students. Smokers with higher levels of Openness to Experience were more likely to have high cigarette dependence (β = 0.408, p < = 0.015). Conversely, smokers with higher levels of Conscientiousness (β = -0.500, p < 0.001) and Agreeableness (β = -0.491, p < 0.01) were less likely to have high cigarette dependence. Additionally, attending a public university (β = 1.198, p = 0.018), having more close friends who smoke (β = 0.525, p < 0.01), and switching to a cheaper cigarette brand (β = 0.928, p < 0.05) were associated with a higher cigarette dependence. CONCLUSION These findings highlight the importance of considering personality dimensions, sociodemographic factors, and lifestyle habits in understanding high cigarette dependence among Lebanese university students. The results can inform the development of targeted interventions to address high cigarette dependence in this population.
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Affiliation(s)
- Imad Bou-Hamad
- Department of Business Information and Decision Systems, Suliman S. Olayan School of Business, American University of Beirut, Beirut, Lebanon
| | - Jaafar Hoteit
- Department of Business Information and Decision Systems, Suliman S. Olayan School of Business, American University of Beirut, Beirut, Lebanon
| | - Nadine Yehya
- Department of Public Affairs and Marketing, University of California, Davis, California, United States of America
| | - Lilian Ghandour
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Smiley SL, Shin H. Motivation to Quit Smoking Among Black Adults Residing in Los Angeles County Communities With Menthol Cigarette Sales Restrictions. Subst Use Misuse 2024; 59:727-731. [PMID: 38226661 DOI: 10.1080/10826084.2023.2294984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
Background: Research is needed to identify the determinants of motivation to quit smoking among non-Hispanic Black (NHB) adults who smoke menthol cigarettes and reside in communities covered by menthol cigarette bans. Objectives: This study examined the associations between motivation to quit smoking and a range of individual-level predictors, including measures of demographics, harm/risk perception of menthol cigarettes, and awareness of a ban on menthol cigarettes in Los Angeles County unincorporated communities. Self-identified NHB adults who currently smoke menthol cigarettes (N=50; M=47.2 years; SD=13.7; 46% female) were recruited in Los Angeles County unincorporated communities. Participants completed an interviewer-administered cross-sectional survey between January to September 2021. Results: Participants (74%) reported an annual household income of less than $25,000. Participants' mean age at cigarette initiation was 15.7 years old (SD=5.68). Most (88%) were aware of the ordinance banning menthol cigarette sales. Employing multivariable linear regression analysis, harm/risk perception of menthol cigarettes (B=14.69, p<0.01) and awareness of the local menthol ban (B=26.18, p<0.05) were found to be independently associated with motivation to quit smoking. Conclusions: Findings from this community-based sample suggest that among NHB adults who smoke menthol cigarettes, motivation to quit smoking is influenced by their perception of menthol cigarettes as harmful and awareness of local policy banning the sale of menthol cigarettes. Findings underscore the need for community-centered and culturally grounded interventions to facilitate quitting among NHB adults who smoke in order for communities covered by menthol bans to achieve health equity in reducing preventable racial inequities due to menthol cigarettes.
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Affiliation(s)
- Sabrina L Smiley
- Division of Health Promotion and Behavioral Science, School of Public Health, College of Health and Human Services, San Diego State University, San Diego, California, USA
| | - Heesung Shin
- Division of Health Promotion and Behavioral Science, School of Public Health, College of Health and Human Services, San Diego State University, San Diego, California, USA
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Geboers C, Candel MJJM, Nagelhout GE, de Vries H, van den Putte B, Fong GT, Willemsen MC. Smokers' strategies to reduce tobacco spending: self-reported use and differences across subgroups. Findings from the International Tobacco Control (ITC) Netherlands Survey. BMC Public Health 2023; 23:738. [PMID: 37085828 PMCID: PMC10119824 DOI: 10.1186/s12889-023-15678-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/14/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND The cost of tobacco is one of the most reported reasons for smoking cessation. Rather than quitting, smokers can use also strategies to reduce tobacco expenditure while continuing smoking, such as smoking less or using price-minimising strategies. The Netherlands announced to increase the price of a pack cigarettes from seven (2018) to ten euros (2023), to reduce tobacco prevalence and consumption. This study explores the self-reported strategies to reduce tobacco spending among Dutch smokers, and whether this differed per age, income, and education. Additionally, we analysed among quitters in these subgroups whether price played a role in their decision to quit. METHODS Cross-sectional survey data from the International Tobacco Control (ITC) Netherlands Wave 2 (September-November 2020, N = 1915) was used. Strategies to reduce spending among smokers (N = 1790) were: reducing consumption, bulk buying, switching to cheaper products or buying from low-taxed sources. These were collapsed into: reducing consumption (solely or in combination with other behaviours), solely price-minimising behaviours (such as buying cheaper brands), or no strategies to reduce spending. Associations between strategies and characteristics were analysed through multinomial and binary logistic regression models. Second, we explored which subgroups were more likely to report that price played a role in their decision to quit among quitters (N = 125). RESULTS The majority of smokers used strategies to reduce tobacco spending: 35.6% reduced consumption and 19.3% used solely price-minimising strategies. 82.1% of quitters reported that price played a role in their decision to quit. Low-income individuals were more likely to report price as a reason for quitting and reduce consumption, but also to buy cheaper products. Highly nicotine dependent smokers were more likely to use price-minimising behaviours, and less likely to reduce consumption. CONCLUSIONS The majority reported using strategies to reduce spending or that price played a role in their decision to quit. Reducing consumption was the most reported strategy. Low-income smokers were more likely to reportedly reduce consumption, buy cheaper products, or quit. Price policies have the potential to reduce socioeconomic inequalities in smoking. To discourage price-minimising behaviours, such as switching to cheaper products, reducing price differences between products should be prioritized.
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Grants
- #2.1.19.004 Longfonds (Lung Foundation Netherlands), Hartstichting (Netherlands Heart Foundation), KWF Kankerbestrijding (Dutch Cancer Society), Trombosestichting Nederland (Thrombosis Foundation), Diabetesfonds (Diabetes Funds)
- #2.1.19.004 Longfonds (Lung Foundation Netherlands), Hartstichting (Netherlands Heart Foundation), KWF Kankerbestrijding (Dutch Cancer Society), Trombosestichting Nederland (Thrombosis Foundation), Diabetesfonds (Diabetes Funds)
- #2.1.19.004 Longfonds (Lung Foundation Netherlands), Hartstichting (Netherlands Heart Foundation), KWF Kankerbestrijding (Dutch Cancer Society), Trombosestichting Nederland (Thrombosis Foundation), Diabetesfonds (Diabetes Funds)
- #2.1.19.004 Longfonds (Lung Foundation Netherlands), Hartstichting (Netherlands Heart Foundation), KWF Kankerbestrijding (Dutch Cancer Society), Trombosestichting Nederland (Thrombosis Foundation), Diabetesfonds (Diabetes Funds)
- #2.1.19.004 Longfonds (Lung Foundation Netherlands), Hartstichting (Netherlands Heart Foundation), KWF Kankerbestrijding (Dutch Cancer Society), Trombosestichting Nederland (Thrombosis Foundation), Diabetesfonds (Diabetes Funds)
- #2.1.19.004 Longfonds (Lung Foundation Netherlands), Hartstichting (Netherlands Heart Foundation), KWF Kankerbestrijding (Dutch Cancer Society), Trombosestichting Nederland (Thrombosis Foundation), Diabetesfonds (Diabetes Funds)
- FDN-148477 Canadian Institutes for Health Research
- Senior Investigator Grant Ontario Institute for Cancer Research
- O. Harold Warwick Prize Canadian Cancer Society
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Affiliation(s)
- Cloé Geboers
- Department of Health Promotion (CAPHRI), Maastricht University, P. Debyeplein 1, 6221 HA, Maastricht, The Netherlands.
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, the Netherlands.
| | - Math J J M Candel
- Department of Methodology and Statistics (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Gera E Nagelhout
- Department of Health Promotion (CAPHRI), Maastricht University, P. Debyeplein 1, 6221 HA, Maastricht, The Netherlands
- IVO Research Institute, The Hague, the Netherlands
| | - Hein de Vries
- Department of Health Promotion (CAPHRI), Maastricht University, P. Debyeplein 1, 6221 HA, Maastricht, The Netherlands
| | - Bas van den Putte
- Department of Communication (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Marc C Willemsen
- Department of Health Promotion (CAPHRI), Maastricht University, P. Debyeplein 1, 6221 HA, Maastricht, The Netherlands
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, the Netherlands
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Richter KP, Catley D, Gajewski BJ, Faseru B, Shireman TI, Zhang C, Scheuermann TS, Mussulman LM, Nazir N, Hutcheson T, Shergina E, Ellerbeck EF. The Effects of Opt-out vs Opt-in Tobacco Treatment on Engagement, Cessation, and Costs: A Randomized Clinical Trial. JAMA Intern Med 2023; 183:331-339. [PMID: 36848129 PMCID: PMC9972241 DOI: 10.1001/jamainternmed.2022.7170] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/29/2022] [Indexed: 03/01/2023]
Abstract
Importance Tobacco use causes 7 million deaths per year; most national guidelines require people who use tobacco to opt in to care by affirming they are willing to quit. Use of medications and counseling is low even in advanced economy countries. Objective To evaluate the efficacy of opt-out care vs opt-in care for people who use tobacco. Design, Setting, and Participants In Changing the Default (CTD), a Bayesian adaptive population-based randomization trial, eligible patients were randomized into study groups, treated according to group assignment, and debriefed and consented for participation at 1-month follow-up. A total of 1000 adult patients were treated at a tertiary care hospital in Kansas City. Patients were randomized from September 2016 to September 2020; final follow-up was in March 2021. Interventions At bedside, counselors screened for eligibility, conducted baseline assessment, randomized patients to study group, and provided opt-out care or opt-in care. Counselors and medical staff provided opt-out patients with inpatient nicotine replacement therapy, prescriptions for postdischarge medications, a 2-week medication starter kit, treatment planning, and 4 outpatient counseling calls. Patients could opt out of any or all elements of care. Opt-in patients willing to quit were offered each element of treatment described previously. Opt-in patients who were unwilling to quit received motivational counseling. Main Outcomes and Measures The main outcomes were biochemically verified abstinence and treatment uptake at 1 month after randomization. Results Of a total of 1000 eligible adult patients who were randomized, most consented and enrolled (270 [78%] of opt-in patients; 469 [73%] of opt-out patients). Adaptive randomization assigned 345 (64%) to the opt-out group and 645 (36%) to the opt-in group. The mean (SD) age at enrollment was 51.70 (14.56) for opt-out patients and 51.21 (14.80) for opt-out patients. Of 270 opt-in patients, 123 (45.56%) were female, and of 469 opt-out patients, 226 (48.19%) were female. Verified quit rates for the opt-out group vs the opt-in group were 22% vs 16% at month 1 and 19% vs 18% at 6 months. The Bayesian posterior probability that opt-out care was better than opt-in care was 0.97 at 1 month and 0.59 at 6 months. Treatment use for the opt-out group vs the opt-in group was 60% vs 34% for postdischarge cessation medication (bayesian posterior probability of 1.0), and 89% vs 37% for completing at least 1 postdischarge counseling call (bayesian posterior probability of 1.0). The incremental cost-effectiveness ratio was $678.60, representing the cost of each additional quit in the opt-out group. Conclusions and Relevance In this randomized clinical trial, opt-out care doubled treatment engagement and increased quit attempts, while enhancing patients' sense of agency and alliance with practitioners. Stronger and longer treatment could increase cessation. Trial Registration ClinicalTrials.gov Identifier: NCT02721082.
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Affiliation(s)
- Kimber P. Richter
- Department of Population Health, University of Kansas School of Medicine, Kansas City
| | - Delwyn Catley
- Children’s Mercy Hospitals and Clinics, Center for Children’s Healthy Lifestyles & Nutrition, Kansas City, Missouri
| | - Byron J. Gajewski
- Department of Biostatistics and Data Science, University of Kansas School of Medicine, Kansas City
| | - Babalola Faseru
- Department of Population Health, University of Kansas School of Medicine, Kansas City
| | - Theresa I. Shireman
- Department of Health Services, Policy, and Practice, Brown University, Providence, Rhode Island
| | | | | | - Laura M. Mussulman
- Department of Population Health, University of Kansas School of Medicine, Kansas City
| | - Niaman Nazir
- Department of Population Health, University of Kansas School of Medicine, Kansas City
| | - Tresza Hutcheson
- Department of Population Health, University of Kansas School of Medicine, Kansas City
| | - Elena Shergina
- Department of Biostatistics and Data Science, University of Kansas School of Medicine, Kansas City
| | - Edward F. Ellerbeck
- Department of Population Health, University of Kansas School of Medicine, Kansas City
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Lim KH, Cheong YL, Sulaiman N, Yah XY, Mahadzir ME, Lim JH, Kee CC, Mohd Ghazali S, Lim HL. Agreement between the Fagerström test for nicotine
dependence (FTND) and the heaviness of smoking index
(HSI) for assessing the intensity of nicotine dependence
among daily smokers. Tob Induc Dis 2022; 20:105. [DOI: 10.18332/tid/155376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/18/2022] [Accepted: 10/13/2022] [Indexed: 11/27/2022] Open
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Almeida R, Barbosa C, Pereira B, Diniz M, Baena A, Conde A. Tobacco Smoking during Pregnancy: Women's Perception about the Usefulness of Smoking Cessation Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6595. [PMID: 35682178 PMCID: PMC9180849 DOI: 10.3390/ijerph19116595] [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: 04/07/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 12/10/2022]
Abstract
Tobacco consumption during pregnancy is a serious public health problem due to its negative effects on fetal development and on pregnant women's health and well-being. Thus, it is of utmost importance to plan and implement smoking cessation interventions, to prevent the negative impact of this risk factor, namely on children's health and development. This cross-sectional study aimed at exploring the perceptions and beliefs about the usefulness of smoking cessation interventions during pregnancy, in a sample of pregnant Portuguese women. The smoking use by pregnant women, as well as the risk factors associated with tobacco smoking during pregnancy, were also analyzed. The sample included 247 pregnant Portuguese women aged between 18-43-years-old (M = 30.30, SD = 5.02): 42.5% never smoked, 18.3% quit smoking before pregnancy, 19.0% quit smoking after getting pregnant and 20.2% were current smokers. The pregnant Portuguese women who smoked during pregnancy (current smokers or who quit smoking after getting pregnant) were mostly single or divorced, with lower education levels, showed a higher prevalence of clinically significant anxiety symptoms, and perceived smoking cessation interventions during pregnancy as less useful when compared to women who never smoked or quit smoking prior pregnancy. Daily or weekly smoking cessation interventions, implemented by health professionals such as doctors, nurses, or psychologists are the ones perceived as the most useful for pregnant women. These findings provide important clues for the planning of smoking cessation interventions during pregnancy, highlighting the domains that should be carefully monitored by health professionals. Specific strategies should also be used by health professionals to promote smoking cessation considering the demands of pregnancy and postpartum.
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Affiliation(s)
- Rita Almeida
- Portucalense Institute for Human Development (INPP), Portucalense University, 4200-072 Porto, Portugal; (R.A.); (C.B.); (B.P.); (M.D.)
| | - Carolina Barbosa
- Portucalense Institute for Human Development (INPP), Portucalense University, 4200-072 Porto, Portugal; (R.A.); (C.B.); (B.P.); (M.D.)
| | - Bruno Pereira
- Portucalense Institute for Human Development (INPP), Portucalense University, 4200-072 Porto, Portugal; (R.A.); (C.B.); (B.P.); (M.D.)
| | - Mateus Diniz
- Portucalense Institute for Human Development (INPP), Portucalense University, 4200-072 Porto, Portugal; (R.A.); (C.B.); (B.P.); (M.D.)
| | - Antoni Baena
- eHealth Center, Faculty of Health Sciences, Universitat Oberta de Catalunya, 08018 Barcelona, Spain;
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Ana Conde
- Portucalense Institute for Human Development (INPP), Portucalense University, 4200-072 Porto, Portugal; (R.A.); (C.B.); (B.P.); (M.D.)
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Geboers C, Shang C, Nagelhout GE, de Vries H, van den Putte B, Fong GT, Candel MJJM, Willemsen MC. Demand for Factory-Made Cigarettes and Roll-Your-Own Tobacco and Differences Between Age and Socioeconomic Groups: Findings From the International Tobacco Control Netherlands Survey. Nicotine Tob Res 2022; 24:529-535. [PMID: 35231115 PMCID: PMC8887592 DOI: 10.1093/ntr/ntab220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 10/21/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Macroeconomic studies have shown that young individuals who smoke, and have a low socioeconomic status respond more strongly to price increases. Most of this evidence stems from research on factory-made (FM) cigarettes. With the rising popularity of roll-your-own (RYO) tobacco, there is a need for studies on cigarette demand that distinguish between both. AIMS AND METHODS This study examined whether individual demand differed for FM and RYO tobacco, and across age, and socioeconomic (income and education) groups. Purchase tasks for FM and RYO cigarettes were included in the 2020 International Tobacco Control (ITC) Netherlands Survey. Adults who smoke daily (n = 1620) stated how many cigarettes they would smoke in 24 hours across eight prices. Four demand indices were derived: intensity (consumption at zero costs), alpha (rate of change in elasticity), Pmax (turning point elasticity), and breakpoint (lowest price where consumption equals zero). The indices were tested for subgroup differences. RESULTS Individuals who smoke RYO tobacco indicated higher intensity, and greater alpha than individuals who smoke FM cigarettes. Participants aged 25-39 had lower Pmax, and 18-24 year olds displayed higher breakpoints. Participants with low income displayed higher intensity, and lower Pmax than other income groups. No associations were found with education. CONCLUSIONS Individuals who smoke RYO tobacco indicated higher price sensitivity than those smoking FM cigarettes, supporting the need to harmonize tobacco taxation. Taxation may be especially beneficial to reducing consumption among individuals with a low income or smoke RYO tobacco. Substantially higher prices are needed in the Netherlands to achieve the desired results. IMPLICATIONS Individuals who smoke daily were willing to pay substantially higher prices than the current market prices, indicating the room and need for much higher taxation levels. Demand for RYO tobacco was more sensitive to price changes than demand for FM cigarettes. Taxation should be raised at equivalent rates for FM and RYO cigarettes. Taxation appears to be especially effective in reducing consumption among people who smoke RYO tobacco and low-income individuals. It remains important to combine increased taxation with other tobacco control measures.
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Affiliation(s)
- Cloé Geboers
- Maastricht University, Department of Health Promotion (CAPHRI), Maastricht, The Netherlands
- Trimbos Institute, Netherlands Expertise Centre for Tobacco Control, Utrecht, The Netherlands
| | - Ce Shang
- Ohio State University, Department of Internal Medicine, Columbus, OH, USA
| | - Gera E Nagelhout
- Maastricht University, Department of Health Promotion (CAPHRI), Maastricht, The Netherlands
- IVO Research Institute, The Hague, The Netherlands
| | - Hein de Vries
- Maastricht University, Department of Health Promotion (CAPHRI), Maastricht, The Netherlands
| | - Bas van den Putte
- University of Amsterdam, Department of Communication (ASCoR), Amsterdam, The Netherlands
| | - Geoffrey T Fong
- University of Waterloo, Department of Psychology, Waterloo, ON, Canada
- University of Waterloo, School of Public Health Sciences, Waterloo, ON, Canada
- Ontario Institute of Cancer Research, Toronto, ON, Canada
| | - Math J J M Candel
- Maastricht University, Department of Methodology and Statistics (CAPHRI), Maastricht, The Netherlands
| | - Marc C Willemsen
- Maastricht University, Department of Health Promotion (CAPHRI), Maastricht, The Netherlands
- Trimbos Institute, Netherlands Expertise Centre for Tobacco Control, Utrecht, The Netherlands
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Faseru B, Mussulman LM, Nazir N, Ellerbeck EF, Shergina E, Scheuermann TS, Gajewski BJ, Catley D, Richter KP. Use of pre-enrollment randomization and delayed consent to maximize participation in a clinical trial of opt-in versus opt-out tobacco treatment. Subst Abus 2022; 43:1035-1042. [PMID: 35435813 PMCID: PMC9195495 DOI: 10.1080/08897077.2022.2060441] [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] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Enrollment in smoking cessation trials remain sub-optimal. The aim of this analysis was to determine the effectiveness of a modified Zelen's design in engaging hospitalized patients who smoke in a pragmatic OPT-IN versus OPT-OUT tobacco treatment trial. Methods: At bedside, clinical staff screened smokers for eligibility, randomized eligible into study arms, and delivered the appropriate treatment approach. Study staff called randomized patients at one-month post-discharge, debriefed patients on the study design, and collected consent to participate. We used frequencies and percentages for categorical variables and means and standard deviations for quantitative variables to describe the characteristics of those who consented and were enrolled versus those who did not enroll. We also compared the characteristics of participants who consented and those who were reached and explicitly refused consent at one-month follow-up. We used the Cohen's d measure of effect size to evaluate differences. Results: Of the 1,000 randomized, 741 (74.1%) consented to continue in the study at one-month follow-up. One hundred and twenty-seven (12.7%) refused consent and 132 (13.2%) were unreachable. Cohen's d effect size differences between those who consented/enrolled (n = 741) and those who were not enrolled (n = 259) were negligible (<0.2) for age, gender, race/ethnicity, and most forms of insurance. The effect size was small for Medicaid (0.36), and other public insurance (0.48). After excluding those unreached at 1 month (12.7%), there were medium Cohen's d effect size differences between those who consented to participate (n = 741) and those who explicitly refused (n = 127) with respect to age (0.55) and self-pay or no insurance (0.51). There were small to negligible effect size differences with respect to sex, race/ethnicity, and other forms of health insurance. Conclusions: The modified Zelen's design resulted in successful enrollment of most participants who were initially randomized into the trial, including those not motivated to quit.
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Affiliation(s)
- Babalola Faseru
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Laura M. Mussulman
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Niaman Nazir
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Edward F. Ellerbeck
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Elena Shergina
- Department of Biostatistics and Data Science, University of Kansas Cancer Center, Kansas City, Kansas, USA
| | - Taneisha S. Scheuermann
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Byron J. Gajewski
- Department of Biostatistics and Data Science, University of Kansas Cancer Center, Kansas City, Kansas, USA
| | - Delwyn Catley
- Children’s Mercy Hospitals and Clinics, Center for Children’s Healthy Lifestyles & Nutrition, Kansas City, Missouri, USA
| | - Kimber P. Richter
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
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Hong T, He C, Gu ZK, Xie JJ, Lu Q, Li YQ, Xu XJ, Shen Y, Wang YQ, Zheng H. Psychometric investigation of the Chinese version of the Habit, Reward and Fear Scale (HRFS). Brain Behav 2021; 11:e2364. [PMID: 34554655 PMCID: PMC8613424 DOI: 10.1002/brb3.2364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/14/2021] [Accepted: 08/31/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Tobacco use is one of the most important risk factors for health, and China is the largest producer and consumer of tobacco in the world. Monitoring and controlling the tobacco epidemic is an important issue. However, the motivation underlying smoking behavior is complex and specific to the individual. The Habit, Reward and Fear Scale (HRFS) is a feasible tool to evaluate this complex motivation. OBJECTIVES To validate the psychometric properties of the HRFS Chinese version (HRFS-C) and to assess the relationship between motivation and smoking behavior. METHOD We recruited 967 participants through social media and assessed their smoking behavior with three instruments: the Fagerstrom Test for Nicotine Dependence-Chinese version (FTND-C), the Questionnaire on Smoking Urges-Brief Scale-Chinese version (QSU-brief-C), and the HRFS-C. Ultimately, we retained 700 valid data points. Cronbach's α and split-half tests were used to evaluate the reliability. Confirmatory factor analysis, Pearson's r and an analysis of variance (ANOVA) were used to evaluate the validity. In addition, linear regression was used to explore the relationship among the three instruments. The HRFS-C showed good homogeneity (α = 0.965), concurrent validity, and discriminant validity. A significant linear relationship was observed among the FTND-C, QSU-brief-C, and HRFS-C (p < .001). CONCLUSION The motivation measured by the HRFS-C can significantly predict nicotine dependence and craving in the smoking population. The HRFS-C can be used to carry out targeted interventions for addicted patients (e.g., motivational enhancement therapy).
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Affiliation(s)
- Tu Hong
- Department of Rehabilitation Medicine, The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University, Suzhou, China.,College of Psychology, Nanjing Normal University, Nanjing, China
| | - Chuan He
- Department of Rehabilitation Medicine, The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University, Suzhou, China
| | - Zhong-Ke Gu
- Department of Sport and Health Sciences, Nanjing Sport Institute, Nanjing, China
| | - Jun-Jie Xie
- College of Psychology, Nanjing Normal University, Nanjing, China
| | - Qian Lu
- Department of Rehabilitation Medicine, The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University, Suzhou, China
| | - Yong-Qiang Li
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xing-Jun Xu
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ying Shen
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yun-Qiang Wang
- College of Psychology, Nanjing Normal University, Nanjing, China
| | - Hui Zheng
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Nikkholgh A, Ahmad Ebrahimi S, Bakhshi E, Zarrindast MR, Asgari Y, Torkaman-Boutorabi A. New Biomarkers Based on Smoking-Related Phenotypes for Smoking Cessation Outcomes of Nicotine Replacement Therapy: A Prospective Study. Basic Clin Neurosci 2021; 12:639-650. [PMID: 35173918 PMCID: PMC8818114 DOI: 10.32598/bcn.2021.1552.1] [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: 09/23/2020] [Revised: 06/02/2021] [Accepted: 08/28/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Identifying a potent biomarker for smoking cessation can play a key role in predicting prognosis and improving treatment outcomes. This study aimed to evaluate the contribution of new biomarkers based on the levels of Cotinine (Cot) and carbon monoxide (CO) to the short- and long-term quit rates of nicotine replacement therapies (Nicotine Patch [NP] and Nicotine Lozenge [NL]). METHODS In this prospective interventional study, 124 smokers under treatment with the 5A's method were selected from an outpatient smoking cessation center in district 18 of Tehran City, Iran. The study was conducted from April 2016 to December 2018. They were divided into NP (n=56) and NL (n=61) intervention groups. The levels of Cot and CO were measured using ELISA and breath analysis at the beginning of the study. Three markers were calculated: Cot/CO, Cot to cigarette per day ratio (Cot/CPD), and CO/CPD. Binary logistic regression models and generalized estimating equations models were analyzed by SPSS software, version 21 to determine the chances of quitting smoking. RESULTS Of the NP participants, 30.4% and 19.6% were abstinent after 2 and 6 months, respectively, while NL was found less effective with 19.7% for 2-month follow-up and 13.1% for 6-month follow-up. The 6-month success of quitting attempts was significantly different for the NP participants at the second half of Cot/CO (P=0.029). Of the NL participants, CO/CPD would be a superior predictor for smoking cessation success (P>0.05). CONCLUSION The findings of this study suggested two markers of Cot/CO and CO/CPD in this order for the optimum treatment outcomes of NP and NL.
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Affiliation(s)
- Arash Nikkholgh
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Soltan Ahmad Ebrahimi
- Department of Pharmacology, School of Medicine, Iran University of Medical Sciences, Tehran Iran
| | - Enayatollah Bakhshi
- Department of Biostatistics and Epidemiology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad-Reza Zarrindast
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Yazdan Asgari
- Department of Medical Biotechnology, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Anahita Torkaman-Boutorabi
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for Cognitive and Behavioral Studies, Tehran University of Medical Sciences, Tehran, Iran
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Johnston J, Xia J, Yau MTK, Wang JCC, Okoli CTC, Khara M. The Impact of Psychiatric Disorder Diagnosis on Motivation to Quit and Stage of Change Among Patients at a Hospital-Based Outpatient Smoking Cessation Clinic. J Dual Diagn 2021; 17:113-123. [PMID: 33600740 DOI: 10.1080/15504263.2021.1881684] [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: 10/22/2022]
Abstract
Smoking is among the greatest international public health concerns, causing excessive levels of preventable premature death, disability, and economic costs. The prevalence of tobacco use among people with psychiatric disorders (PDs) remains persistently high relative to the general population, highlighting the need to improve smoking cessation (SC) strategies in this group. We aimed to assess the associations between having a PD and baseline motivation to quit (MtQ) smoking and Prochaska's stage of change (SoC), two clinically important metrics linked to SC outcomes. Methods: This retrospective chart review included patients who completed a baseline visit at a hospital-based outpatient SC clinic (N = 896). Multivariate hierarchical logistic and linear regression models were developed to assess variables associated with MtQ (importance and confidence in quitting) and SoC, primarily PD category (externalizing, internalizing, externalizing/internalizing, psychotic or no PD) and secondarily, demographics, physical health history, and tobacco use/dependence metrics. Results: The variables negatively associated with MtQ were female sex (p = .011), older age (p = .038), deriving income from social assistance (p < .001), and age at smoking initiation (p = .005), whereas ≥ 1 quit attempt in the past year predicted higher MtQ (p < .0001). Being in the preparative/action SoC (versus the pre-contemplative/contemplative) was associated with income from social assistance (OR 0.39, p = .001), more daily cigarettes smoked (OR 0.98, p = .005) and ≥ 1 past-year quit attempt (OR 1.69, p = .013). Conclusions: Having a PD was not associated with either MtQ or SoC. Deriving income from social assistance predicted lower MtQ and SoC. Having made ≥ 1 quit attempt in the past year was associated with higher MtQ and SoC. Our study suggests that people with PDs are as motivated to quit smoking and ready for change as people without PDs, and smoking cessation efforts should be amplified in this group to address the disproportionately high level of tobacco use, especially because having at least one quit attempt may enhance MtQ and SoC.
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Affiliation(s)
- Jake Johnston
- Smoking Cessation Clinic, Centre for Cardiovascular Health, Vancouver General Hospital, Vancouver, Canada
| | - Joanna Xia
- Smoking Cessation Clinic, Centre for Cardiovascular Health, Vancouver General Hospital, Vancouver, Canada
| | - Man Ting Kristina Yau
- Smoking Cessation Clinic, Centre for Cardiovascular Health, Vancouver General Hospital, Vancouver, Canada
| | | | | | - Milan Khara
- Smoking Cessation Clinic, Centre for Cardiovascular Health, Vancouver General Hospital, Vancouver, Canada
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Sujal P, Anand P, Abhishek S. Heaviness of Smoking Index versus Fagerstrom Test for Nicotine Dependence among Current Smokers of Ahmedabad City, India. ADDICTION & HEALTH 2021; 13:29-35. [PMID: 33995957 PMCID: PMC8080173 DOI: 10.22122/ahj.v13i1.291] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The purpose of this research was to compare Heaviness of Smoking Index (HSI), high early smoking, and heavy smoking with the Fagerstrom Test for Nicotine Dependence (FTND) and further to evaluate the sensitivity of HSI, high early smoking, and heavy smoking among existing smokers. METHODS A cross sectional study was conducted by using FTND questionnaire among 200 existing smokers. The cut-off point for HSI was kept at 4; high early smokers and heavy smokers were classified as those individuals who smoked within 30 minutes after waking up and individuals who smoked 30 cigarettes or more daily, respectively. Receiver-operating characteristic (ROC) analysis and Cohen's Kappa statistics were evaluated. FINDINGS A significant agreement was observed between the HSI and the FTND, having Kappa value of 0.70, with good sensitivity of 78.16% and specificity as high as 91.15%. The ROC analysis confirmed that a cut-off score of 4 for HSI was suitable. Agreement between FTND and high early smoking was observed to be moderate (Kappa = 0.47, P < 0.001), while very low agreement (Kappa = 0.19, P < 0.001) was observed for FTND and heavy smoking. CONCLUSION Results show that HSI is an effective tool which can be substituted for the conventional FTND by the clinicians, psychotherapists, and investigators in health research.
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Affiliation(s)
- Parkar Sujal
- Department of Public Health Dentistry, Siddhpur Dental College and Hospital, Hemchandracharya North Gujarat University, Patan, Gujarat, India
- Correspondence to: Parkar Sujal; Department of Public Health Dentistry, Siddhpur Dental College and Hospital, Hemchandracharya North Gujarat University, Patan,Gujarat, India;
| | - Patel Anand
- Department of Oral Medicine and Radiology, Government Dental College and Hospital, Gujarat University, Ahmedabad, Gujarat, India
| | - Sharma Abhishek
- Department of Public Health Dentistry, Government Dental College and Hospital, Rajasthan University of Health Sciences College of Dental Sciences, Jaipur, India
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Round JT, Fozard TE, Harrison AA, Kolokotroni KZ. Disentangling the effects of cannabis and cigarette smoking on impulsivity. J Psychopharmacol 2020; 34:955-968. [PMID: 32519578 PMCID: PMC7436435 DOI: 10.1177/0269881120926674] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cannabis smoking and cigarette smoking often co-occur, yet limited research has investigated the potentially different role impulsivity may play when these behaviours occur in isolation, compared with in combination. AIMS This study examined trait and behavioural impulsivity as a function of both cigarette and cannabis smoking. METHODS Trait impulsivity (BIS-11) was compared between 44 non-smokers, 76 cigarette only, 47 cannabis only and 58 cannabis plus cigarette smokers. The effects of cigarette and cannabis smoking on behavioural impulsivity (stop-signal and information sampling tasks) were then assessed in 87 of these participants during a laboratory session. RESULTS Trait impulsivity was significantly higher in cigarette smokers than non-smokers, irrespective of cannabis use, except for motor impulsivity, where cigarette smoking was only associated with elevated trait impulsivity in non-smokers of cannabis. Dimensions of trait impulsivity were significantly positively related to cigarette smoking frequency and nicotine dependence, but not to cannabis smoking frequency or dependence. Smoking cigarettes or cannabis was associated with significantly impaired reflection impulsivity relative to not smoking either substance. However, no additional increases in reflection impulsivity were observed in those who smoked both cigarettes and cannabis. No group differences in response inhibition were detected. CONCLUSIONS Heightened trait impulsivity appears to be uniquely related to cigarette smoking, whilst the smoking of cigarettes or cannabis is associated with impairments in reflection impulsivity. Improved outcomes for treating cannabis dependence may result from encouraging concomitant cigarette smokers to cease using both drugs simultaneously in order to reduce heightened impulsivity and risk of relapse.
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Affiliation(s)
- Jason T Round
- Leeds School of Social Sciences, Leeds Beckett University, Leeds, UK,Jason T Round, Leeds School of Social Sciences, Leeds Beckett University, Leeds, LS1 3HE, UK.
| | - Therese E Fozard
- Leeds School of Social Sciences, Leeds Beckett University, Leeds, UK
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15
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Kotz D, Batra A, Kastaun S. Smoking Cessation Attempts and Common Strategies Employed. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:7-13. [PMID: 32008606 DOI: 10.3238/arztebl.2020.0007] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 06/11/2019] [Accepted: 10/10/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Clinical guidelines on smoking cessation contain recommendations for various evidence-based methods. The goal of this study was to provide a represen- tative analysis for Germany of the percentage of smokers who try to quit smoking at least once per year, the use of evidence-based methods and other methods of smoking cessation, and potential associations of the use of such methods with the degree of tobacco dependence and with socioeconomic features. METHODS Data from 19 waves of the German Smoking Behavior Questionnaire (Deutsche Befragung zum Rauchverhalten, DEBRA), from the time period June/July 2016 to June/July 2019, were analyzed. Current smokers and recent ex-smokers (<12 months without smoking) were asked about their smoking cessation attempts in the past year and the methods they used during the last attempt (naming more than one method was permitted). The degree of tobacco dependence in current smokers was assessed with the Heaviness of Smoking Index. RESULTS Out of 11 109 current smokers and 407 recent ex-smokers, 19.9% (95% confidence interval: [19.1; 20.6]) had tried to quit smoking at least once in the preceding year. 13.0% of them [11.6; 14.5] had used at least one evidence-based method during their last attempt. The stronger the tobacco dependence, the more likely the use of an evidence-based method (odds ratio [OR] = 1.27 [1.16; 1.40]). Pharmacotherapy (nicotine replacement therapy, medication) was used more com- monly by persons with higher incomes (OR = 1.44 per 1000 euro/month [1.28; 1.62]). Electronic cigarettes were the most commonly used single type of smoking cessation support (10.2 % [9.0; 11.6]). CONCLUSION In Germany, only one in five smokers tries to quit smoking at least once per year. Such attempts are only rarely supported by evidence-based methods and are thus likely to fail. The high cost of treatment must be borne by the individual and thus fall disproportionately on poorer smokers. It follows that there is an urgent need for vered by health insurance pro- viders, in order to give all smokers fair and equal access to the medical care they need.
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Affiliation(s)
- Daniel Kotz
- Institute of General Medicine, Addiction Research and Clinical Epidemiology Unit, Medical Faculty ofthe Heinrich-Heine University Düsseldorf; Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care,University College London, London, UK; Section for Addiction Medicine and Addiction Research, Department of Psychiatry and Psychotherapy, University Hospital and Faculty of Medicine, Tübingen
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16
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de Granda-Orive JI, Pascual-Lledó JF, Asensio-Sánchez S, Solano-Reina S, García-Rueda M, Martínez-Muñiz MÁ, Lázaro-Asegurado L, Bujulbasich D, Pendino R, Luhning S, Cienfuegos-Agustín I, Jiménez-Ruiz CA. Fagerström Test and Heaviness Smoking Index. Are they Interchangeable as a Dependence Test for Nicotine? Subst Use Misuse 2020; 55:200-208. [PMID: 31519135 DOI: 10.1080/10826084.2019.1660680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: The purpose of this study was to evaluate the degree of agreement between the Fagerström Test for Cigarette Dependence (FTCD) and the Heaviness of Smoking Index (HSI) in daily smokers admitted to smoking cessation clinics from National Healthcare System in Spain and Argentine Republic. Material and methods: An observational, longitudinal, multicenter study (prospective cohort) conducted in smoking clinics in daily clinical practice. The patients were consecutively included as they attended the consultations. The statistical analysis was descriptive, and correlation and concordance tests as well as analysis and regression models were used. Results: In total, 308 subjects were included [161 women (52.3%)], with a mean age of 51.4 (10.8) years. We found an absence of agreement and the existence of a proportional difference between both tests [Regression coefficient for global series: 0.55 (0.52-0.59) p < .001]. This difference increased as the value of the FTCD score increased; that is, the higher the value of the FTCD score was, the greater the difference in relation to the value of the HSI score. Likewise, Cohen's kappa concordance coefficient, according to various combinations of categorization of both tests, showed that the agreement between these variables was only good. Approximately 20% of the subjects were not classified with the same degree of dependence by the two tests. Thus, a classification mismatch existed. Conclusions: We found an absence of agreement between both tests. These data imply that we should not substitute one test for the other when we analyze nicotine dependence in a population of smokers.
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Affiliation(s)
| | | | | | | | | | | | | | - Daniel Bujulbasich
- Servicio de Neumología, Sanatorio Nuestra Señora Del Rosario, Centro Médico IPAM, Rosario, Santa Fe, República Argentina
| | - Rogelio Pendino
- Servicio de Neumología, Sanatorio Nuestra Señora Del Rosario, Centro Médico IPAM, Rosario, Santa Fe, República Argentina
| | - Susana Luhning
- Neumóloga Instituto Médico Humana, Centro Asistencial de Consulta Externa, Córdoba, República Argentina
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17
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Gomajee R, El-Khoury F, Goldberg M, Zins M, Lemogne C, Wiernik E, Lequy-Flahault E, Romanello L, Kousignian I, Melchior M. Association Between Electronic Cigarette Use and Smoking Reduction in France. JAMA Intern Med 2019; 179:1193-1200. [PMID: 31305860 PMCID: PMC6632120 DOI: 10.1001/jamainternmed.2019.1483] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE The electronic cigarette (EC) has become popular among smokers who wish to reduce their tobacco use levels or quit smoking, but its effectiveness as a cessation aid is uncertain. OBJECTIVE To examine the association of regular EC use with the number of cigarettes smoked per day, smoking cessation among current smokers, and smoking relapse among former smokers. DESIGN, SETTING, AND PARTICIPANTS The CONSTANCES (Consultants des Centres d'Examens de Santé) cohort study, based in France, began recruiting participants January 6, 2012, and is currently ongoing. Participants were enrolled in CONSTANCES through 2015, and included 5400 smokers (mean [SD] follow-up of 23.4 [9.3] months) and 2025 former smokers (mean [SD] follow-up of 22.1 [8.6] months) at baseline who quit smoking in 2010, the year in which ECs were introduced in France, or afterward. Analyses were performed from February 8, 2017, to October 15, 2018. MAIN OUTCOMES AND MEASURES The association between EC use and the number of cigarettes smoked during follow-up was studied using mixed regression models. The likelihood of smoking cessation was studied using Poisson regression models with robust sandwich variance estimators. The association between EC use and smoking relapse among former smokers was studied using Cox proportional hazards regression models. All statistical analyses were adjusted for sociodemographic characteristics, duration of follow-up, and smoking characteristics. RESULTS Among the 5400 daily smokers (2906 women and 2494 men; mean [SD] age, 44.9 [12.4] years), regular EC use was associated with a significantly higher decrease in the number of cigarettes smoked per day compared with daily smokers who did not use ECs (-4.4 [95% CI, -4.8 to -3.9] vs -2.7 [95% CI, -3.1 to -2.4]), as well as a higher adjusted relative risk of smoking cessation (1.67; 95% CI, 1.51-1.84]). At the same time, among the 2025 former smokers (1004 women and 1021 men; mean [SD] age, 43.6 [12.1] years), EC use was associated with an increase in the rate of smoking relapse among former smokers (adjusted hazard ratio, 1.70; 95% CI, 1.25-2.30). CONCLUSIONS AND RELEVANCE This study's findings suggest that, among adult smokers, EC use appears to be associated with a decrease in smoking level and an increase in smoking cessation attempts but also with an increase in the level of smoking relapse in the general population after approximately 2 years of follow-up.
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Affiliation(s)
- Ramchandar Gomajee
- Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - Fabienne El-Khoury
- Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - Marcel Goldberg
- Inserm, Unité Mixte de Service 011, Population-based Epidemiological Cohorts, Villejuif, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Marie Zins
- Inserm, Unité Mixte de Service 011, Population-based Epidemiological Cohorts, Villejuif, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France.,Inserm, Unité Mixte de Recherche 1168, VIeillissement et Maladies chroniques-Approches épidémiologiques et de santé publique, Villejuif, France
| | - Cédric Lemogne
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France.,Assistance publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Ouest, Service de Psychiatrie de l'adulte et du sujet âgé, Paris, France.,Inserm, U894, Centre Psychiatrie et Neurosciences, Paris, France
| | - Emmanuel Wiernik
- Inserm, Unité Mixte de Service 011, Population-based Epidemiological Cohorts, Villejuif, France
| | - Emeline Lequy-Flahault
- Inserm, Unité Mixte de Service 011, Population-based Epidemiological Cohorts, Villejuif, France
| | - Lucile Romanello
- Inserm, Unité Mixte de Service 011, Population-based Epidemiological Cohorts, Villejuif, France
| | - Isabelle Kousignian
- BioStatistique, Traitement et Modélisation des données biologiques-Équipe d'Accueil 7537, Faculté de Pharmacie de Paris, Université Paris Descartes, Paris 75006
| | - Maria Melchior
- Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
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Heckman BW, Cummings KM, Nahas GJ, Willemsen MC, O’Connor RJ, Borland R, Hirsch AA, Bickel WK, Carpenter MJ. Behavioral Economic Purchase Tasks to Estimate Demand for Novel Nicotine/tobacco Products and Prospectively Predict Future Use: Evidence From The Netherlands. Nicotine Tob Res 2019; 21:784-791. [PMID: 29547973 PMCID: PMC6528146 DOI: 10.1093/ntr/nty042] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 03/13/2018] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The demand for alternative nicotine/tobacco products is not well established. This paper uses a behavioral economic approach to test whether smokers have differential demand for conventional factory-made, electronic, and very low nicotine content cigarettes (FMCs/ECs/VLNCs) and uses the prospective cohort design to test the predictive validity of demand indices on subsequent use of commercially available FMCs and ECs. METHODS Daily smokers (≥16 years) from the Netherlands completed an online survey in April 2014 (N = 1215). Purchase tasks were completed for FMCs, ECs, and VLNCs. Participants indicated the number of cigarettes they would consume in 24 h, across a range of prices (0-30 euro). The relationship between consumption and price was quantified into four indices of demand (intensity, Pmax, breakpoint, and essential value). A follow-up survey in July 2015 measured FMC and EC use. RESULTS At baseline, greater demand was observed for FMCs relative to ECs and VLNCs across all demand indices, with no difference between ECs and VLNCs. At follow-up, greater baseline FMC demand (intensity, essential value) was associated with lower quit rates and higher relapse. EC demand (Pmax, breakpoint, essential value) was positively associated with any EC use between survey waves, past 30 day EC use, and EC purchase between waves. CONCLUSIONS Smokers valued FMCs more than ECs or VLNCs, and FMCs were less sensitive to price increases. Demand indices predicted use of commercially available products over a 15 month period. To serve as viable substitutes for FMCs, ECs and VLNCs will need to be priced lower than FMCs. IMPLICATIONS Purchase tasks can be adapted for novel nicotine/tobacco products as a means to efficiently quantify demand and predict use. Among current daily smokers, the demand for ECs and VLNCs is lower than FMCs.
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Affiliation(s)
- Bryan W Heckman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
- Cancer Control, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
- Cancer Control, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Georges J Nahas
- Cancer Control, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Marc C Willemsen
- Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, Netherlands
- Dutch Alliance for a Smokefree Society, The Hague, NL
| | - Richard J O’Connor
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY
| | - Ron Borland
- Nigel Gray Fellowship Group, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Alexander A Hirsch
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Warren K Bickel
- Virginia Tech Carilion Research Institute, Virginia Tech, Roanoke, VA
| | - Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
- Cancer Control, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
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Esen AD, Arıca S. The Evaluation of Nicotine Dependence Levels and Sociodemographic Characteristics Among Applicants Admitted for Smoking Cessation. ANKARA MEDICAL JOURNAL 2018. [DOI: 10.17098/amj.461371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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20
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Predictors of engagement in post-discharge quitline counseling among hospitalized smokers. J Behav Med 2018; 42:139-149. [PMID: 30027388 DOI: 10.1007/s10865-018-9951-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 07/13/2018] [Indexed: 01/02/2023]
Abstract
Quitlines provide evidence-based tobacco treatment and multiple calls yield higher quit rates. This study aimed to identify subgroups of smokers with greater quitline engagement following referral during hospitalization. Data were from a randomized clinical trial assessing the effectiveness of fax referral (referral faxed to proactive quitline) versus warm handoff (patient connected to quitline at bedside) (n = 1054). Classification and regression trees analyses evaluated individual and treatment/health system-related variables and their interactions. Among all participants, warm handoff, higher ratings of the tobacco treatment care transition, and being older predicted completing more quitline calls. Among patients enrolled in the quitline, higher transition of care ratings, being older, and use of cessation medication post-discharge predicted completing more calls. Three of the four factors influencing engagement were characteristics of treatment within the hospital (quality of tobacco treatment care transition and referral method) and therapy (use of cessation medications), suggesting potential targets to increase quitline engagement post-discharge.
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Svicher A, Cosci F, Giannini M, Pistelli F, Fagerström K. Item Response Theory analysis of Fagerström Test for Cigarette Dependence. Addict Behav 2018; 77:38-46. [PMID: 28950117 DOI: 10.1016/j.addbeh.2017.09.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 09/13/2017] [Accepted: 09/14/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The Fagerström Test for Cigarette Dependence (FTCD) and the Heaviness of Smoking Index (HSI) are the gold standard measures to assess cigarette dependence. However, FTCD reliability and factor structure have been questioned and HSI psychometric properties are in need of further investigations. The present study examined the psychometrics properties of the FTCD and the HSI via the Item Response Theory. METHODS The study was a secondary analysis of data collected in 862 Italian daily smokers. Confirmatory factor analysis was run to evaluate the dimensionality of FTCD. A Grade Response Model was applied to FTCD and HSI to verify the fit to the data. Both item and test functioning were analyzed and item statistics, Test Information Function, and scale reliabilities were calculated. Mokken Scale Analysis was applied to estimate homogeneity and Loevinger's coefficients were calculated. RESULTS The FTCD showed unidimensionality and homogeneity for most of the items and for the total score. It also showed high sensitivity and good reliability from medium to high levels of cigarette dependence, although problems related to some items (i.e., items 3 and 5) were evident. HSI had good homogeneity, adequate item functioning, and high reliability from medium to high levels of cigarette dependence. Significant Differential Item Functioning was found for items 1, 4, 5 of the FTCD and for both items of HSI. CONCLUSIONS HSI seems highly recommended in clinical settings addressed to heavy smokers while FTCD would be better used in smokers with a level of cigarette dependence ranging between low and high.
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Tooley EM, Borrelli B. Characteristics of Cigarette Smoking in Individuals in Smoking Concordant and Smoking Discordant Couples. ACTA ACUST UNITED AC 2018; 6:106-116. [PMID: 29375932 DOI: 10.1037/cfp0000078] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Introduction Partner smoking status may impact smoking cessation outcomes. The purpose of this study is to compare smokers in smoking concordant couples (both partners smoke) to smokers in smoking discordant couples (one partner smokes) on variables that have been shown to be important for quitting smoking. Methods Participants were 123 cigarette smokers with cohabitating romantic partners (smoking discordant: n=60, smoking concordant: n=63, 63.9% females). We used one-way MANCOVA, controlling for age and number of cigarettes smoked/day, to examine differences between groups on smoking outcome expectancies, motivation to quit smoking, and dyadic efficacy to quit smoking. We examined smoking behavior in a series of exploratory analyses. Results We found a significant multivariate difference between individuals in smoking concordant and discordant couples (p < .05) such that 20.3% of the variation in the linear combination of dependent variables was accounted for by group membership. Follow-up univariate ANCOVA analyses indicated that those in smoking discordant couples reported greater positive outcome expectancies for cigarettes with regard to facilitating social situations and reducing boredom than those in the smoking concordant group. Participants in smoking concordant couples smoked more cigarettes when their partners were present, fewer cigarettes without their partners present, and were more likely to prefer that their partner be involved in their smoking cessation treatment than those in smoking discordant couples. Discussion The results of this study may guide the development of smoking cessation interventions that attend to the unique needs of smoking concordant and discordant couples.
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Affiliation(s)
| | - Belinda Borrelli
- Boston University, Henry M. Goldman School of Dental Medicine, Boston, MA
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DeGutis J, Chiu C, Thai M, Esterman M, Milberg W, McGlinchey R. Trauma Sequelae are Uniquely Associated with Components of Self-Reported Sleep Dysfunction in OEF/OIF/OND Veterans. Behav Sleep Med 2018; 16:38-63. [PMID: 27183394 DOI: 10.1080/15402002.2016.1173550] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
While the associations between psychological distress (e.g., posttraumatic stress disorder [PTSD], depression) and sleep dysfunction have been demonstrated in trauma-exposed populations, studies have not fully explored the associations between sleep dysfunction and the wide range of common physical and physiological changes that can occur after trauma exposure (e.g., pain, cardiometabolic risk factors). We aimed to clarify the unique associations of psychological and physical trauma sequelae with different aspects of self-reported sleep dysfunction. A comprehensive psychological and physical examination was administered to 283 combat-deployed trauma-exposed Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) veterans. The Pittsburgh Sleep Quality Index (PSQI) and PSQI Addendum for PSTD (PSQI-A) were administered along with measures of PTSD, depression, anxiety, pain, traumatic brain injury, alcohol use, nicotine dependence, and cardiometabolic symptoms. We first performed a confirmatory factor analysis of the PSQI and then conducted regressions with the separate PSQI factors as well as the PSQI-A to identify unique associations between trauma-related measures and the separate aspects of sleep. We found that the PSQI global score was composed of three factors: Sleep Efficiency (sleep efficiency/sleep duration), Perceived Sleep Quality (sleep quality/sleep latency/sleep medication) and Daily Disturbances (sleep disturbances/daytime dysfunction). Linear regressions demonstrated that PTSD symptoms were uniquely associated with the PSQI global score and all three factors, as well as the PSQI-A. For the other psychological distress variables, anxiety was independently associated with PSQI global as well as Sleep Efficiency, Perceived Sleep Quality, and PSQI-A, whereas depression was uniquely associated with Daily Disturbances and PSQI-A. Notably, cardiometabolic symptoms explained independent variance in PSQI global and Sleep Efficiency. These findings help lay the groundwork for further investigations of the mechanisms of sleep dysfunction in trauma-exposed individuals and may help in the development of more effective, individualized treatments.
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Affiliation(s)
- Joseph DeGutis
- a Boston Attention and Learning Laboratory , Boston Division VA Healthcare System , Boston , Massachusetts , USA.,b Geriatric Research Education and Clinical Center , Boston Division VA Healthcare System , Boston , Massachusetts , USA.,c Department of Medicine , Harvard Medical School , Boston , Massachusetts , USA
| | - Christopher Chiu
- a Boston Attention and Learning Laboratory , Boston Division VA Healthcare System , Boston , Massachusetts , USA.,b Geriatric Research Education and Clinical Center , Boston Division VA Healthcare System , Boston , Massachusetts , USA
| | - Michelle Thai
- a Boston Attention and Learning Laboratory , Boston Division VA Healthcare System , Boston , Massachusetts , USA.,b Geriatric Research Education and Clinical Center , Boston Division VA Healthcare System , Boston , Massachusetts , USA
| | - Michael Esterman
- a Boston Attention and Learning Laboratory , Boston Division VA Healthcare System , Boston , Massachusetts , USA.,b Geriatric Research Education and Clinical Center , Boston Division VA Healthcare System , Boston , Massachusetts , USA.,d Department of Psychiatry , Boston University School of Medicine , Boston , Massachusetts , USA
| | - William Milberg
- b Geriatric Research Education and Clinical Center , Boston Division VA Healthcare System , Boston , Massachusetts , USA.,e Translational Research Center for TBI and Stress Disorders (TRACTS) , VA RR&D TBI Center of Excellence, VA Boston Healthcare System , Boston , Massachusetts , USA
| | - Regina McGlinchey
- b Geriatric Research Education and Clinical Center , Boston Division VA Healthcare System , Boston , Massachusetts , USA.,e Translational Research Center for TBI and Stress Disorders (TRACTS) , VA RR&D TBI Center of Excellence, VA Boston Healthcare System , Boston , Massachusetts , USA
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Mushtaq N, Beebe LA. Evaluating the role of smokeless tobacco use indices as brief measures of dependence. Addict Behav 2017; 69:87-92. [PMID: 28214708 DOI: 10.1016/j.addbeh.2017.02.019] [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: 10/29/2016] [Revised: 01/28/2017] [Accepted: 02/09/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION There is considerable interest in using brief measures of dependence for evaluation and treatment of tobacco dependence. The Heaviness of Smoking Index (HSI) is a validated measure of dependence among cigarette smokers. However, a similar index has not been studied among ST users. The aim of this study is to develop similar ST use indices and evaluate their utility as concise dependence measures. Time to first chew/dip of the day (TTFD), number of cans of ST used per week (CPW), and number of dips/chews per day (DPD) were used to create three ST use indices; heaviness of ST use index (HSTI), ST dependence index (STDI), and ST quantity frequency index (ST-QFI). METHODS The study was based on data collected from a community based sample of exclusive ST users living in Oklahoma. Participants completed the self-administered survey which included dependence scales and questionnaires to measure sociodemographic factors and tobacco use characteristics. Saliva samples were obtained to measure cotinine concentration. Method of scoring for TTFD and DPD was similar to the scoring scheme employed for HSI items. DPD was transformed by a series of statistical tests into a three category scoring variable. Concurrent validity and reliability of the ST use indices were evaluated and overall accuracy of ST use indices was assessed. Level of agreement between the ST use indices and Fagerström Test for Nicotine Dependence for ST users (FTND-ST) was calculated to find the extent these indices were equivalent to FTND-ST in measuring dependence. RESULTS ST use indices were significantly correlated with FTND-ST. ST users who had higher HSTI or STDI scores were more likely to have Tobacco Dependence Screener (TDS) based dependence diagnosis (OR: 1.50, 95%CI: 1.12, 2.02 and OR: 1.53, 95%CI: 1.16, 2.02, respectively). Study findings showed that all ST use indices were predictors of cotinine concentration. The internal consistency assessed by Cronbach's alpha indicated that STDI had acceptable reliability. At the optimal cutoff scores, both HSTI and STDI had good level of agreement with FTND-ST (k=0.81, p<0.0001 and k=0.71, p≤0.0001, respectively). CONCLUSIONS Components of physical dependence are interrelated and each ST use item, TTFD, CPW, and DPD, explains a different dependence feature. Significant association of HSTI and STDI with other tobacco dependence measures and FTND-ST suggests that these indices are valuable brief measures of dependence among ST users and can be used as a substitute for FTND-ST, similar to HSI in smoking dependence studies. A concise dependence measure like HSTI or STDI has reduced response burden and is an effective tool in clinical and research setting.
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Smoking-Related Attitudes and Knowledge Among Medical Students and Recent Graduates in Argentina: A Cross-Sectional Study. J Gen Intern Med 2017; 32:549-555. [PMID: 27730488 PMCID: PMC5400752 DOI: 10.1007/s11606-016-3890-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/22/2016] [Accepted: 09/14/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Physicians in Argentina smoke at rates similar to the general population, and do not have a clear role in tobacco control strategies. OBJECTIVE To describe the attitudes and knowledge of medical students and recent graduates towards smoking behavior in Argentina. DESIGN Cross-sectional self-administered online survey conducted in 2011. PARTICIPANTS Medical students and recent medical graduates from the University of Buenos Aires. MAIN MEASURES Attitudes and knowledge were evaluated by responses to 16 statements regarding the effects of smoking cigarettes and the role of physicians in tobacco control. Rates of agreement with a full ban on indoor smoking in different public settings were assessed. KEY RESULTS The sample included 1659 participants (response rate: 35.1 %), 453 of whom (27.3 %) were current smokers. Only 52 % of participants agreed that doctors should set an example for their patients by not smoking, 30.9 % thought that medical advice had little effect on patients' cessation behavior, and 19.4 % believed that physicians could decline to care for smoking patients who failed to quit. In adjusted logistic regression models, current smokers had less supportive attitudes about tobacco control and were less likely than non-smokers to agree with a full indoor smoking ban in hospitals (OR: 0.30; 95 % CI 0.16-0.58), universities (OR: 0.55; 95 % CI 0.41-0.73), workplaces (OR: 0.67; 95 % CI 0.50-0.88), restaurants (OR: 0.42; 95 % CI 0.33-0.53), cafes (OR: 0.41; 95 % CI 0.33-0.51), nightclubs (OR: 0.32; 95 % CI 0.25-0.40), and bars (0.35; 95 % CI 0.28-0.45). Recent medical graduates had more accurate knowledge about cessation and were more likely to agree with a full smoking ban in recreational venues. CONCLUSIONS Although most participants reported a strong anti-tobacco attitude, a proportion still failed to recognize the importance of their role as physicians in tobacco control strategies. Current smokers and current students were less likely to support indoor smoking bans. Specific educational curricula could address these factors.
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Jiang N, Ho SY, Wang MP, Leung LT, Lam TH. The relationship of waterpipe use with cigarette smoking susceptibility and nicotine dependence: A cross-sectional study among Hong Kong adolescents. Addict Behav 2017; 64:123-128. [PMID: 27608324 DOI: 10.1016/j.addbeh.2016.08.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 08/14/2016] [Accepted: 08/29/2016] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Waterpipe smoking has become increasingly popular in adolescents. We examined the association of waterpipe smoking with cigarette smoking susceptibility and nicotine dependence among adolescents in Hong Kong. METHODS We analyzed the data of School-based Survey on Smoking among Students 2012/13 from a representative sample of 45,857 secondary school students (US grades 7-12) in Hong Kong. Among never cigarette smokers (n=37,740), we conducted chi-square test to compare cigarette smoking susceptibility by current (past 30-day) waterpipe smoking status, and used multivariate logistic regression to examine the association between current waterpipe smoking and cigarette smoking susceptibility controlling for age, sex, peer cigarette smoking, and living with a cigarette smoker. Then we conducted chi-square test and multivariate logistic regression among current cigarette smokers (n=1694) to examine the relationship of current waterpipe smoking with two nicotine dependence outcomes, including heavier smoking (≥5 cigarettes/day) and first cigarette within 30min of waking, controlling for demographics and the number of smoking days in the past 30days. RESULTS Among never cigarette smokers, current waterpipe use was associated with cigarette smoking susceptibility (adjusted odds ratio [AOR]=3.58, 95% confidence interval [CI]: 1.61-7.97). Of current cigarette smokers, waterpipe use was associated with heavier smoking (AOR=1.56, 95% CI: 1.00-2.43) and first cigarette within 30min of waking (AOR=2.08, 95% CI: 1.35-3.19). CONCLUSIONS Surveillance, prevention, and intervention programs should address waterpipe use in addition to cigarette smoking. Educational programs need to inform youth about the harmful and addictive effects of waterpipe smoking. Public health campaigns deglamourizing waterpipe use may help reduce waterpipe smoking among youth.
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Affiliation(s)
- Nan Jiang
- School of Public Health, The University of Hong Kong, Hong Kong.
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong.
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong.
| | - Lok Tung Leung
- School of Public Health, The University of Hong Kong, Hong Kong.
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong.
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Baek JH, Kim JH, Kim BN, Park SJ, Fava M, Mischoulon D, Lee D, Jeon HJ. Comparisons of Subthreshold Versus Full Posttraumatic Stress Disorder Distinguished by Subjective Functional Impairment Among Train Drivers: A Population-Based Nationwide Study in South Korea. Psychiatry Investig 2017; 14:1-7. [PMID: 28096868 PMCID: PMC5240462 DOI: 10.4306/pi.2017.14.1.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/06/2016] [Accepted: 03/15/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Subthreshold posttraumatic stress disorder (SPTSD), a condition that meets the full symptomatic criteria of posttraumatic stress disorder (PTSD) without subjective functional impairment, has yet to be fully investigated. In this study, we aimed to determine the prevalence and characteristics of SPTSD. METHODS The web-based survey including psychiatric diagnosis and experience of human error was conducted in actively working train drivers in South Korea. RESULTS Of the 4,634 subjects, 103 (2.23%) were categorized as full PTSD and 322 (6.96%) were categorized as having SPTSD. Individuals with full PTSD showed higher impulsivity and anxiety compared to those with SPTSD and those without PTSD, while those with SPTSD had more frequent clinically meaningful depression, posttraumatic stress, and alcohol and nicotine dependence and significant human error. CONCLUSION Despite not qualifying as a subjective functional disability, SPTSD still had significant psychiatric symptoms. More clinical attentions need to be given to the diagnosis and treatment of SPTSD.
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Affiliation(s)
- Ji Hyun Baek
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji-Hae Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Bin-Na Kim
- Department of Psychology, Seoul National University, Seoul, Republic of Korea
| | - Seung Jin Park
- Department of Psychology, Seoul National University, Seoul, Republic of Korea
| | - Maurizio Fava
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David Mischoulon
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Dongsoo Lee
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Babaoğlu E, Karalezli A, Er M, Hasanoğlu HC, Öztuna D. Exhaled carbon monoxide is a marker of heavy nicotine dependence. Turk J Med Sci 2016; 46:1677-1681. [PMID: 28081308 DOI: 10.3906/sag-1601-140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 04/02/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM Exhaled CO level provides an objective measure of a patient's smoking status. The relationship between CO levels and nicotine dependence is controversial. The aim of this study is to evaluate the relationship between exhaled CO levels and nicotine dependence as well as to demonstrate that exhaled CO levels may be used as a marker of nicotine dependence. MATERIALS AND METHODS Two hundred eighty-nine patients (132 females, 157 males) were included in the study. Smoking duration, the age of smoking initiation, exhaled CO levels, and Fagerström Test for Nicotine Dependence (FTND) scores were recorded. The relationship between FTND scores and exhaled CO levels was investigated. RESULTS There was a statistically significant correlation between FTND score and exhaled CO levels (P < 0.001). We found that a cut-off score of 7.5 ppm for exhaled CO may be useful as a marker for heavy smoking. The sensitivity and specificity of this cut-off score for exhaled CO was 69.3% and 49.3%, respectively (P < 0.001). CONCLUSION We found that exhaled CO levels significantly correlated with FTND scores. For patients who are unable to provide reliable answers to questions in the FTND, exhaled CO measurements may be used as an alternative test for estimating the status of heavy smoking.
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Affiliation(s)
- Elif Babaoğlu
- Department of Chest Diseases, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Ayşegül Karalezli
- Department of Chest Diseases, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Mükremin Er
- Department of Chest Diseases, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Hatice Canan Hasanoğlu
- Department of Chest Diseases, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Derya Öztuna
- Department of Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey
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Using Internet to recruit immigrants with language and culture barriers for tobacco and alcohol use screening: a study among Brazilians. J Immigr Minor Health 2016; 17:553-60. [PMID: 24563138 DOI: 10.1007/s10903-013-9934-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Limited English proficient (LEP) individuals face disparities in accessing substance abuse treatment, but little is known on how to reach this population. This study aimed to test online recruitment methods for tobacco and alcohol screening among LEP Portuguese speakers. The study was advertised in Portuguese using Facebook, Google, online newsletters and E-mail. Participants clicked ads to consent and access a screening for tobacco and alcohol dependence. Ads yielded 690 screening responses in 90 days. Respondents had a mean age of 42.7 (SD 12), with a higher proportion of women than men, 95% born in Brazil with high levels of LEP and low levels of acculturation. Facebook ads yielded 41.4% of responses, and were the lowest cost recruitment channel ($8.9, $31.10 and $20.40 per respondent, hazardous drinker and smoker, respectively). Online recruitment of LEP populations is feasible. Future studies should test similar strategies in other LEP groups.
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Richter KP, Faseru B, Shireman TI, Mussulman LM, Nazir N, Bush T, Scheuermann TS, Preacher KJ, Carlini BH, Magnusson B, Ellerbeck EF, Cramer C, Cook DJ, Martell MJ. Warm Handoff Versus Fax Referral for Linking Hospitalized Smokers to Quitlines. Am J Prev Med 2016; 51:587-96. [PMID: 27647059 PMCID: PMC5031370 DOI: 10.1016/j.amepre.2016.04.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 03/29/2016] [Accepted: 04/04/2016] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Few hospitals treat patients' tobacco dependence. To be effective, hospital-initiated cessation interventions must provide at least 1 month of supportive contact post-discharge. STUDY DESIGN Individually randomized clinical trial. Recruitment commenced July 2011; analyses were conducted October 2014-June 2015. SETTING/PARTICIPANTS The study was conducted in two large Midwestern hospitals. Participants included smokers who were aged ≥18 years, planned to stay quit after discharge, and spoke English or Spanish. INTERVENTION Hospital-based cessation counselors delivered the intervention. For patients randomized to warm handoff, staff immediately called the quitline from the bedside and handed the phone to participants for enrollment and counseling. Participants randomized to fax were referred on the day of hospital discharge. MAIN OUTCOME MEASURES Outcomes at 6 months included quitline enrollment/adherence, medication use, biochemically verified cessation, and cost effectiveness. RESULTS Significantly more warm handoff than fax participants enrolled in quitline (99.6% vs 59.6%; relative risk, 1.67; 95% CI=1.65, 1.68). One in four (25.4% warm handoff, 25.3% fax) were verified to be abstinent at 6-month follow-up; this did not differ significantly between groups (relative risk, 1.02; 95% CI=0.82, 1.24). Cessation medication use in the hospital and receipt of a prescription for medication at discharge did not differ between groups; however, significantly more fax participants reported using cessation medication post-discharge (32% vs 25%, p=0.01). The average incremental cost-effectiveness ratio of enrolling participants into warm handoff was $0.14. Hospital-borne costs were significantly lower in warm handoff than in fax ($5.77 vs $9.41, p<0.001). CONCLUSIONS One in four inpatient smokers referred to quitline by either method were abstinent at 6 months post-discharge. Among motivated smokers, fax referral and warm handoff are efficient and comparatively effective ways to link smokers with evidence-based care. For hospitals, warm handoff is a less expensive and more effective method for enrolling smokers in quitline services.
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Affiliation(s)
- Kimber P Richter
- Department of Preventive Medicine and Public Health and The University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, Kansas.
| | - Babalola Faseru
- Department of Preventive Medicine and Public Health and The University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, Kansas
| | - Theresa I Shireman
- Department of Health Services, Policy, and Practice, Brown University, Providence, Rhode Island
| | - Laura M Mussulman
- Department of Preventive Medicine and Public Health and The University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, Kansas
| | - Niaman Nazir
- Department of Preventive Medicine and Public Health and The University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, Kansas
| | | | - Taneisha S Scheuermann
- Department of Preventive Medicine and Public Health and The University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, Kansas
| | - Kristopher J Preacher
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee
| | - Beatriz H Carlini
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, Washington
| | | | - Edward F Ellerbeck
- Department of Preventive Medicine and Public Health and The University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, Kansas
| | - Carol Cramer
- Tobacco Use Prevention, Kansas Department of Health and Environment, Topeka, Kansas
| | - David J Cook
- Department of Health Policy and Management, University of Kansas Medical Center, Kansas City, Kansas
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Risky use and misuse of alcohol and cigarettes in psychiatric inpatients: a screening questionnaire study. Compr Psychiatry 2016; 70:9-16. [PMID: 27624418 DOI: 10.1016/j.comppsych.2016.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 04/19/2016] [Accepted: 05/13/2016] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Mental disorders are associated with an increased prevalence of substance use disorders (SUDs). Despite this comorbidity being firmly established, alcohol and nicotine risky use and misuse are not routinely and systematically assessed in clinical practice. OBJECTIVE The aim of this study is to examine the prevalence of risky use of alcohol, alcohol use disorder (AUD), smoking, and nicotine use disorder in people with psychiatric diagnoses and their association with age, gender, and occupational functioning. METHOD Participants were 210 patients from an inpatient psychiatric ward. Three self-reporting questionnaires were used: the Alcohol Use Disorders Identification Test (AUDIT), the Lübeck Alcoholism Screening Test (LAST), and the Fagerström Test for Nicotine Dependence (FTND). RESULTS Risky alcohol use or AUD was found in more than one third of patients and was more common in males than in females (p<0.01) and in young people as compared to older adults (p=0.04). Current nicotine consumption concerned over a half participants and was significantly associated with risky alcohol use and AUD (p<0.01). Patients with current SUD had the highest prevalence of both smoking (80%) and alcohol misuse (80%). Low occupational functioning was associated with both alcohol use (p=0.02) and concurrent alcohol and SUDs (p=0.03). CONCLUSIONS Both alcohol and nicotine risky use and misuse are highly prevalent in people with psychiatric disorders and their concurrent abuse is common. The simultaneous use of different screening questionnaires allows the identification not only of people with frank use disorders, but also those with harmful use, facilitating early detection of people at risk.
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Ruiz-Veguilla M, Martín-Rodríguez JF, Palomar FJ, Porcacchia P, Álvarez de Toledo P, Perona-Garcelán S, Rodríguez-Testal JF, Huertas-Fernández I, Mir P. Trait- and state-dependent cortical inhibitory deficits in bipolar disorder. Bipolar Disord 2016; 18:261-71. [PMID: 27004755 DOI: 10.1111/bdi.12382] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 02/08/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Euthymic patients with bipolar disorder (BD) have deficits in cortical inhibition. However, whether cortical inhibitory deficits are trait- or state-dependent impairments is not yet known and their relationship with psychiatric symptoms is not yet understood. In the present study, we examined trait- and state-dependent cortical inhibitory deficits and evaluated the potential clinical significance of these deficits. METHODS Nineteen patients with bipolar I disorder were evaluated using the paired-pulse transcranial stimulation protocol, which assessed cortical inhibition during an acute manic episode. Cortical inhibition measures were compared with those obtained in 28 demographically matched healthy controls. A follow-up assessment was performed in 15 of these patients three months later, when there was remission from their mood and psychotic symptoms. The association between cortical inhibitory measures and severity of psychiatric symptoms was also studied. RESULTS During mania, patients showed decreased short-interval intracortical and transcallosal inhibition, as well as a normal cortical silent period and long-interval cortical inhibition. These findings were the same during euthymia. Symptoms associated with motor hyperactivity were correlated negatively with the degree of cortical inhibition. These correlations were not significant when a Bonferroni correction was applied. CONCLUSIONS The present longitudinal study showed cortical inhibitory deficits in patients with BD, and supports the hypothesis that cortical inhibitory deficits in BD are trait dependent. Further research is necessary to confirm the clinical significance of these deficits.
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Affiliation(s)
- Miguel Ruiz-Veguilla
- Grupo Neurodesarrollo y Psicosis, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocio/CSIC/Universidad de Sevilla/UGC Salud Mental HVR, Seville, Spain
| | - Juan Francisco Martín-Rodríguez
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Francisco J Palomar
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Paolo Porcacchia
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Paloma Álvarez de Toledo
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Salvador Perona-Garcelán
- Grupo Neurodesarrollo y Psicosis, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocio/CSIC/Universidad de Sevilla/UGC Salud Mental HVR, Seville, Spain
| | - Juan Francisco Rodríguez-Testal
- Grupo Neurodesarrollo y Psicosis, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocio/CSIC/Universidad de Sevilla/UGC Salud Mental HVR, Seville, Spain.,Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Facultad de Psicología, Universidad de Sevilla, Seville, Spain
| | - Ismael Huertas-Fernández
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Seville, Spain
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Kaleta D, Polańska K, Korytkowski P, Usidame B, Bąk-Romaniszyn L. Patterns of nicotine dependence in four Eastern European countries. BMC Public Health 2015; 15:1189. [PMID: 26613592 PMCID: PMC4662821 DOI: 10.1186/s12889-015-2537-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 11/22/2015] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Evidence of patterns of nicotine dependence, although crucial for developing and implementing effective tobacco control strategies, is limited in the Eastern European countries. The purpose of this study was to evaluate the correlates of high nicotine dependence among adults in Poland, Romania, the Russian Federation and Ukraine. METHODS The data used in the current analysis is available from the Global Adult Tobacco Survey (2009-2011). Nicotine dependence was assessed using the Heaviness of Smoking Index (HSI), which covers two measures: reported cigarettes smoked per day and time to the first cigarette upon waking. Based on a six-point scale of HSI, nicotine dependence was categorized into low to moderate (score 0-3), and high dependence (score 4-6). Out of 31,936 completed interviews, we used data from 8229 daily smokers. RESULTS The study results indicate that more than 25 % of daily smokers were highly dependent on nicotine. Higher odds of high nicotine dependence were identified for males (OR = 1.5 in Poland and Romania, OR = 2.7 in Russia; p ≤ 0.001), people between 50-59 years of age (the highest odds in Romania; OR = 4.8; p ≤ 0.001) and those who had started smoking at a young age (the highest odds in Romania, OR = 5.0; p ≤ 0.001). Having fewer restrictions on smoking at home was significantly associated with a high level of nicotine dependence (the highest odds in Romania, OR = 3.0; p ≤ 0.001). A high proportion of the participants had no interest in quitting smoking, with a statistically significantly higher percentage observed among smokers highly dependent on nicotine compared to the less addicted (p ≤ 0.01). CONCLUSIONS Smokers highly dependent on nicotine constitute a quarter of the Romanian group of daily smokers and even more in the remaining three analyzed countries. Similar patterns of nicotine dependence were observed in all of the investigated countries showing that male gender, younger age at the smoking onset, and fewer restrictions on smoking at home were significantly associated with higher nicotine dependence. The study highlighted the fact that a high proportion of the participants had no interest in quitting smoking. These results underscore importance of policy measures as well as prevention and cessation interventions for smokers who are highly dependent on nicotine, which need to take into account the social gradient in smoking patterns.
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Affiliation(s)
- Dorota Kaleta
- Department of Tobacco Control, Preventive Medicine Department, Medical University of Lodz, 90-752, Lodz, Poland.
| | - Kinga Polańska
- Department of Tobacco Control, Preventive Medicine Department, Medical University of Lodz, 90-752, Lodz, Poland.
| | - Przemysław Korytkowski
- Faculty of Computer Science and Information Technology, West Pomeranian University of Technology in Szczecin, 71-210, Szczecin, Poland.
| | - Bukola Usidame
- Department of Public Policy, University of Massachusetts, Boston, USA.
| | - Leokadia Bąk-Romaniszyn
- Department of Nutrition in Digestive Tract Diseases, Medical University of Lodz, 93-338, Lodz, Poland.
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Jackson JG, Diaz FJ, Lopez L, de Leon J. A combined analysis of worldwide studies demonstrates an association between bipolar disorder and tobacco smoking behaviors in adults. Bipolar Disord 2015; 17:575-97. [PMID: 26238269 DOI: 10.1111/bdi.12319] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 01/31/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Worldwide studies were combined to examine two hypotheses: (i) bipolar disorder is associated with smoking behaviors, compared with the general population; and (ii) smoking behavior prevalences in bipolar disorder are intermediate between those in major depressive disorder and those in schizophrenia. METHODS Combined analyses used 56 articles on adults obtained from a PubMed search or the senior author's article collection. Odds ratios (ORs) and their 95% confidence intervals (CIs) compared current smoking, heavy smoking among current smokers, smoking cessation in ever smokers, and ever smoking in bipolar disorder versus control groups. RESULTS The combined OR was 3.5 (CI: 3.39-3.54) in 51 current smoking studies of bipolar disorder versus the general population from 16 countries. More limited data provided an OR = 0.34 (CI: 0.31-0.37) for smoking cessation and an OR = 3.6 (CI: 3.30-3.80) for ever smoking. The combined OR was 0.76 (CI: 0.74-0.79) for current smoking in bipolar disorder versus schizophrenia in 20 studies from ten countries. Ever smoking may be lower in bipolar disorder than in schizophrenia (OR = 0.83, CI: 0.75-0.91). The OR was 2.05 (CI: 2.00-2.10) for current smoking in bipolar disorder versus major depression in 18 studies from seven countries. Ever smoking may be higher (OR = 1.5, CI: 1.40-1.70) and smoking cessation lower (OR = 0.51, CI: 0.45-0.59) in bipolar disorder than in major depression. CONCLUSIONS Increased current smoking in bipolar disorder versus the general population reflected increased ever smoking (initiation) and decreased smoking cessation. Smoking behavior frequencies in bipolar disorder may be between those in depressive disorder and schizophrenia, with schizophrenia showing the highest severity level.
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Affiliation(s)
| | - Francisco J Diaz
- Department of Biostatistics, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Lucelly Lopez
- School of Health Sciences, Universidad Pontificia Bolivariana, Medellin, Colombia
| | - Jose de Leon
- Mental Health Research Center at Eastern State Hospital, University of Kentucky, Lexington, KY, USA.,Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain.,Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apóstol Hospital, University of the Basque Country, Vitoria, Spain
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Liu J, Claus ED, Calhoun VD, Hutchison KE. Brain regions affected by impaired control modulate responses to alcohol and smoking cues. J Stud Alcohol Drugs 2015; 75:808-16. [PMID: 25208199 DOI: 10.15288/jsad.2014.75.808] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Despite the commonly observed comorbidity of alcohol and tobacco use disorders and years of research, the mechanism underlying concurrent use of alcohol and tobacco is not yet clear. In this study, we used functional magnetic resonance imaging (fMRI) to investigate the relationship between brain responses to alcohol and smoking cues in 45 subjects with episodic drinking and regular smoking. METHOD fMRI data were collected from two studies performing an alcohol-craving task and a smoking-craving task. First, we identified brain voxels significantly activated for both substance cues and then associated the activation of these voxels with various alcohol- and nicotine-dependence measures. Significant clusters (cluster-wise p < .05) correlated with behavioral assessments were extracted, and clusters identified from both cues were compared. RESULTS The association tests with various dependence scores showed that the loss of behavioral control subcategory in the Alcohol Dependence Scale was significantly correlated with brain activation of the posterior cingulate cortex (PCC) and right posterior insula regardless of cue types. CONCLUSIONS Our findings suggest that the PCC and right posterior insula, each playing a role in the salience network, are affected significantly by impaired control for alcohol and in turn influence brain responses to not only alcohol but also smoking cues, providing insight to neuronal mechanisms for concurrent use or comorbidity of alcohol and nicotine dependence.
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Affiliation(s)
- Jingyu Liu
- The Mind Research Network and Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, New Mexico
| | - Eric D Claus
- The Mind Research Network and Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico
| | - Vince D Calhoun
- The Mind Research Network and Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, New Mexico
| | - Kent E Hutchison
- The Mind Research Network and Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, Departments of Psychology and Neuroscience, University of Colorado, Boulder, Colorado
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Abstract
Smoking is highly prevalent among HIV+ individuals and studies indicate that it may be associated with poor ART adherence, though the relationship is poorly understood. In addition little is known about interest in quitting among HIV+ smokers who are having adherence difficulties. We examined smoking and ART adherence among 203 HIV+ individuals enrolled in a randomized trial of interventions to increase ART adherence. Prior analyses indicated there were no overall treatment group effects. Smoking status and motivation to quit was assessed at baseline and ART adherence was assessed at week 12, 24, 36, and 48. Longitudinal generalized estimating equation analysis that controlled for treatment group revealed that smoking status was not significantly related to adherence over time. Motivation to quit was high with 58 % intending to quit in the next 6 months and 25 % intending to quit in the next 30 days. Findings suggest that smoking is not associated with adherence among those with adherence difficulties. However it does not diminish importance of addressing both behaviors especially given HIV+ smokers substantial interest in changing smoking behavior.
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Predictors of tobacco smoking abstinence among tuberculosis patients in South Africa. J Behav Med 2015; 38:472-82. [PMID: 25655663 DOI: 10.1007/s10865-015-9620-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 01/22/2015] [Indexed: 10/24/2022]
Abstract
This study examines predictors of smoking cessation in tuberculosis patients with high HIV co-infection rates in a South African primary care setting. Current smokers were randomly allocated to brief motivational interviewing (n = 205) or receipt of a brief message (n = 204). Multi-level logistic regression was performed to identify predictors of sustained 3- and 6-month abstinence and 7-day point prevalence abstinence (PPA) at 1 month, with the facility as a random effect. The intervention was ineffective among smokers with high nicotine-dependence at 1 month, but was effective for all smokers over longer periods. Higher baseline self-efficacy predicted the 1-month 7-day PPA, but not sustained abstinence. HIV-positive participants' odds of sustained abstinence were about three times higher than those of their HIV-negative counterparts. Results support a more intensive motivational intervention and/or coping skills' training to increase self-efficacy and abstinence rates. Tobacco cessation services can be introduced in tuberculosis services where high HIV co-infection rates occur.
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Albrithen AA, Singleton EG. Brief Arabic tobacco craving questionnaire: An investigation into craving and heavy smoking in Saudi Arabian males. J Family Community Med 2015; 22:8-12. [PMID: 25657605 PMCID: PMC4317997 DOI: 10.4103/2230-8229.149573] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Research in the United States has shown that craving tobacco is associated with smoking, yet no investigation has been done into the relationship between craving and the use of tobacco in Saudi Arabian smokers. The aim of this cross-sectional study was to examine the craving of tobacco by Saudi males and its influence on daily smoking. Subjects were recruited under the auspices of the Tobacco Control Program in Jeddah City and Riyadh. METHODS The American English version of the tobacco craving questionnaire (TCQ-12) is a valid measure of four distinct aspects (factors) of tobacco craving. The TCQ-12 was translated into Arabic tobacco craving questionnaire (ATCQ-12) and administered to a sample of 322 male smokers. Predictive validity was determined by examining the relationship between the factors and the number of cigarettes smoked per day (CPD). RESULTS In a general linear multivariate analysis of variance model, CPD increased significantly as either ATCQ-12 Factor 1 (emotionality) or Factor 3 (compulsiveness) increased. A significant Factor 1 by Factor 3 interaction indicated that Factor 1 was a better predictor of heavy smoking, but only when Factor 3 was low. Factor 3 was a better predictor of heavy smoking, but only when Factor 1 was low. CONCLUSIONS The ATCQ-12 is a rapid measure of craving and valid predictor of CPD and heavy smoking. Craving in anticipation of smoking as relief from a negative mood (emotionality) is an indicator of psychological withdrawal symptoms, while craving in anticipation of the inability to control tobacco use (compulsiveness) is an indicator of physical dependence.
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Ohmoto M, Takahashi T, Kubota Y, Kobayashi S, Mitsumoto Y. Genetic influence of dopamine receptor, dopamine transporter, and nicotine metabolism on smoking cessation and nicotine dependence in a Japanese population. BMC Genet 2014; 15:151. [PMID: 25526961 PMCID: PMC4307219 DOI: 10.1186/s12863-014-0151-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 12/11/2014] [Indexed: 01/04/2023] Open
Abstract
Background This study investigated whether polymorphisms of the ankyrin repeat and kinase domain containing 1 gene (ANKK1), which is adjacent to the dopamine D2 receptor gene (DRD2), and the dopamine transporter (SLC6A3) and cytochrome P450 2A6 (CYP2A6) genes influence smoking cessation and nicotine dependence in a Japanese population. In 96 current and former smokers, genotyping frequencies for the ANKK1/DRD2 TaqIA, SLC6A3 VNTR, and CYP2A6 polymorphisms were subjected to chi-square analysis, and regression analyses were used to determine the association of the genotypes of current smokers with a Heavy Smoking Index, in addition to evaluating the effect of the subjects’ smoking history on the association. Results Genotyping results suggested that nicotine dependence among current smokers homozygous for the SLC6A3 10r allele was lower than that of smokers carrying the minor alleles, and that the CYP2A6 polymorphism might mediate this association. Furthermore, the age at which current smokers began smoking might moderate the association between their genetic polymorphisms and nicotine dependence. Conclusions This study provides preliminary findings on the influence of genetic variants on the smoking phenotypes in a Japanese population.
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Affiliation(s)
- Masanori Ohmoto
- Faculty of Pharmaceutical Sciences, Hokuriku University, Ho-3 Kanagawa-machi, Kanazawa, 920-1181, Japan.
| | - Tatsuo Takahashi
- Faculty of Pharmaceutical Sciences, Hokuriku University, Ho-3 Kanagawa-machi, Kanazawa, 920-1181, Japan.
| | - Yoko Kubota
- Faculty of Pharmaceutical Sciences, Hokuriku University, Ho-3 Kanagawa-machi, Kanazawa, 920-1181, Japan.
| | - Shinjiro Kobayashi
- Faculty of Pharmaceutical Sciences, Hokuriku University, Ho-3 Kanagawa-machi, Kanazawa, 920-1181, Japan.
| | - Yasuhide Mitsumoto
- Faculty of Pharmaceutical Sciences, Hokuriku University, Ho-3 Kanagawa-machi, Kanazawa, 920-1181, Japan.
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Bogenschutz MP, Donovan DM, Mandler RN, Perl HI, Forcehimes AA, Crandall C, Lindblad R, Oden NL, Sharma G, Metsch L, Lyons MS, McCormack R, Konstantopoulos WM, Douaihy A. Brief intervention for patients with problematic drug use presenting in emergency departments: a randomized clinical trial. JAMA Intern Med 2014; 174:1736-45. [PMID: 25179753 PMCID: PMC4238921 DOI: 10.1001/jamainternmed.2014.4052] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Medical treatment settings such as emergency departments (EDs) present important opportunities to address problematic substance use. Currently, EDs do not typically intervene beyond acute medical stabilization. OBJECTIVE To contrast the effects of a brief intervention with telephone boosters (BI-B) with those of screening, assessment, and referral to treatment (SAR) and minimal screening only (MSO) among drug-using ED patients. DESIGN, SETTING, AND PARTICIPANTS Between October 2010 and February 2012, 1285 adult ED patients from 6 US academic hospitals, who scored 3 or greater on the 10-item Drug Abuse Screening Test (indicating moderate to severe problems related to drug use) and who were currently using drugs, were randomized to MSO (n = 431), SAR (n = 427), or BI-B (n = 427). Follow-up assessments were conducted at 3, 6, and 12 months by blinded interviewers. INTERVENTIONS Following screening, MSO participants received only an informational pamphlet. The SAR participants received assessment plus referral to addiction treatment if indicated, and the BI-B participants received assessment and referral as in SAR, plus a manual-guided counseling session based on motivational interviewing principles and up to 2 "booster" sessions by telephone during the month following the ED visit. MAIN OUTCOMES AND MEASURES Outcomes evaluated at follow-up visits included self-reported days using the patient-defined primary problem drug, days using any drug, days of heavy drinking, and drug use based on analysis of hair samples. The primary outcome was self-reported days of use of the patient-defined primary problem drug during the 30-day period preceding the 3-month follow-up. RESULTS Follow-up rates were 89%, 86%, and 81% at 3, 6, and 12 months, respectively. For the primary outcome, estimated differences in number of days of use (95% CI) were as follows: MSO vs BI-B, 0.72 (-0.80 to 2.24), P (adjusted) = .57; SAR vs BI-B, 0.70 (-0.83 to 2.23), P (adjusted) = .57; SAR vs MSO, -0.02 (-1.53 to 1.50), P (adjusted) = .98. There were no significant differences between groups in self-reported days using the primary drug, days using any drug, or heavy drinking days at 3, 6, or 12 months. At the 3-month follow-up, participants in the SAR group had a higher rate of hair samples positive for their primary drug of abuse (265 of 280 [95%]) than did participants in the MSO group (253 of 287 [88%]) or the BI-B group (244 of 275 [89%]). Hair analysis differences between groups at other time points were not significant. CONCLUSIONS AND RELEVANCE In this sample of drug users seeking emergency medical treatment, a relatively robust brief intervention did not improve substance use outcomes. More work is needed to determine how drug use disorders may be addressed effectively in the ED. TRIAL REGISTRATION clinicaltrials.gov Identifier:NCT01207791.
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Affiliation(s)
- Michael P. Bogenschutz
- Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Dennis M. Donovan
- Alcohol & Drug Abuse Institute, University of Washington, Seattle, Washington
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, Washington
| | | | | | - Alyssa A. Forcehimes
- Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Cameron Crandall
- Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | | | | | | | - Lisa Metsch
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Michael S. Lyons
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ryan McCormack
- Department of Emergency Medicine, New York University School of Medicine, New York, New York
| | - Wendy Macias Konstantopoulos
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Antoine Douaihy
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Louwagie GMC, Okuyemi KS, Ayo-Yusuf OA. Efficacy of brief motivational interviewing on smoking cessation at tuberculosis clinics in Tshwane, South Africa: a randomized controlled trial. Addiction 2014; 109:1942-52. [PMID: 24962451 DOI: 10.1111/add.12671] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 03/10/2014] [Accepted: 06/16/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Tuberculosis (TB) patients who smoke risk adverse TB outcomes and other long-term health effects of smoking. This study aimed to determine the efficacy of brief motivational interviewing by lay health-care workers (LHCWs) in assisting TB patients to quit smoking. DESIGN Multi-centre two-group parallel individual randomized controlled trial. SETTING Six primary care tuberculosis clinics in a South African township. PARTICIPANTS Newly diagnosed adult TB patients identified as current smokers were randomized to brief motivational interviewing by a LHCW (intervention group, n = 205) or brief smoking cessation advice from a TB nurse (control group, n = 204). MEASUREMENTS The primary outcome was self-reported sustained 6-month smoking abstinence. Exhaled carbon monoxide (CO) testing was offered to about half the participants. Secondary outcomes were sustained abstinence at 3 months; 7-day point prevalence abstinence at 1, 3 and 6 months; and quit attempts. Allocation was concealed. Primary analysis relied on intention to treat. Multi-level analysis accounted for site heterogeneity of effect. FINDINGS Self-reported 6-month sustained abstinence was 21.5% for the intervention group versus 9.3% for the control group [relative risk (RR) = 2.29, 95% confidence interval (CI) = 1.34, 3.92]. Biochemically verified 6-month sustained abstinence was also higher in the intervention group (RR 2.21, 95% CI = 1.08, 4.51) for the 166 participants who were offered carbon monoxide testing. Self-reported 3-month sustained abstinence was 25.4% for the intervention group and 12.8% for the control group (RR = 1.98, 95% CI = 1.24, 3.18). CONCLUSIONS Motivational interviewing by lay counsellors to promote smoking cessation in tuberculosis patients in South Africa approximately doubled sustained smoking abstinence for at least 6 months compared with brief advice alone.
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Affiliation(s)
- Goedele M C Louwagie
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, South Africa
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Schnoll RA, Goren A, Annunziata K, Suaya JA. The prevalence, predictors and associated health outcomes of high nicotine dependence using three measures among US smokers. Addiction 2013; 108:1989-2000. [PMID: 23795712 DOI: 10.1111/add.12285] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 05/03/2013] [Accepted: 06/11/2013] [Indexed: 02/06/2023]
Abstract
AIMS Using the Fagerström Test of Nicotine Dependence (FTND), the Heaviness of Smoking Index (HSI) and the time-to-first-cigarette (TTFC), this study estimated prevalence, evaluated optimal scale cut-offs, identified predictors and assessed potential impact on health, productivity and health-care use of high nicotine dependence among US smokers. DESIGN, SETTING AND PARTICIPANTS This cross-sectional study used 2011 National Health and Wellness Survey data (n = 50 000). MEASUREMENTS Nicotine dependence, demographic data, measures of health, productivity and health-care use and health attitudes were assessed. FINDINGS The prevalence of high nicotine dependence ranged from 23% (TTFC < 5 minutes) to 63.6% (TTFC < 30 minutes). Based on diagnostic accuracy, the cut-offs for high nicotine dependence using HSI and TTFC varied according to FTND cut-off: if FTND > 4, then HSI > 3 and TTFC < 30 minutes represented optimal cut-offs; if FTND > 5, HSI > 4 and TTFC < 5 minutes represented optimal cut-offs. Across all measures, high nicotine dependence was related significantly to being male, single, age 45-64 years and Caucasian; lower education; lack of health insurance; under/unemployment; comorbid respiratory or cardiovascular disease, diabetes or psychiatric illness; and lower rates of exercise and concern for weight control. Controlling for demographic variables and comorbid physical and psychiatric illness, high nicotine dependence, measured by FTND, HSI or TTFC, was associated significantly with reduced mental and physical quality of life, reduced work-place productivity and more health-care use. CONCLUSIONS High nicotine dependence is associated with lower quality of life, lower work productivity and higher health-care use. The Heaviness of Smoking Index and the time-to-first-cigarette can provide useful screening measures of nicotine dependence in clinical and research settings.
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Affiliation(s)
- Robert A Schnoll
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
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Moran LV, Sampath H, Kochunov P, Hong LE. Brain circuits that link schizophrenia to high risk of cigarette smoking. Schizophr Bull 2013; 39:1373-81. [PMID: 23236076 PMCID: PMC3796082 DOI: 10.1093/schbul/sbs149] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Schizophrenia is associated with a high prevalence of smoking. Functional connectivity between the dorsal anterior cingulate (dACC) and limbic regions including the ventral striatum, extended amygdala and parahippocampal areas has been previously implicated in the genetics and clinical severity of smoking. In this study, we test the hypothesis that dACC functional circuits are key paths for the high risk of smoking comorbidity in schizophrenia. Resting state functional magnetic resonance imaging (fMRI) was performed using the dACC as a seed region in smoking and nonsmoking patients with schizophrenia (n = 54), matched controls (n = 65), and nonpsychotic first-degree relatives (n = 24). Multiple regions had decreased connectivity with the dACC in schizophrenia patients when compared with matched controls (n = 65). Several of these functional circuits were also associated with nicotine addiction severity; the largest cluster included limbic areas such as the parahippocampal, extended amygdala, ventral striatal, and posterior insula regions, indicating an overlap of schizophrenia and nicotine addiction on to this circuit. These same functional connectivity-defined circuits were also significantly impaired in schizophrenia nonsmokers compared with control nonsmokers and in nonpsychotic first-degree relatives. Functional connectivity between the dACC and limbic regions is inherently abnormal in schizophrenia, related to its genetic liability regardless of smoking, and overlaps with a nicotine addiction-related circuit. Our findings establish a biologically defined brain circuit mechanism that contributes to the high prevalence of smoking.
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Affiliation(s)
| | | | | | - L. Elliot Hong
- To whom correspondence should be addressed; Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, PO Box 21247, Baltimore, MD 21228, US; tel: 410-402-6828, fax: 410-402-6023, e-mail:
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Louwagie GMC, Ayo-Yusuf OA. Tobacco use patterns in tuberculosis patients with high rates of human immunodeficiency virus co-infection in South Africa. BMC Public Health 2013; 13:1031. [PMID: 24172187 PMCID: PMC4228453 DOI: 10.1186/1471-2458-13-1031] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 10/28/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) patients who smoke tobacco are at an increased risk for adverse TB treatment outcomes. This study describes tobacco use patterns among newly diagnosed TB patients, their readiness to quit, and their beliefs about tobacco-related health effects in a high HIV-burden setting in South Africa. Socio-economic and demographic factors associated with smoking were also determined. METHODS This was a cross-sectional analysis of baseline data collected for a smoking cessation study at six large tuberculosis clinics in a South African township (N = 1926). We collected information on current and past tobacco use, socio-economic and demographic status, beliefs regarding the harmful effects of smoking and quit behaviour, and motivation, using structured interviewer-administered questionnaires. TB- and HIV-related information was obtained from patient records. Data analysis entailed descriptive statistics, followed by multivariate logistic regression with backward elimination, adjusted for clustering by facility. RESULTS Just over one fifth of respondents (21.8%, 420/1924) reported currently smoking tobacco (males 37.6%, females 4.6%). By contrast, only 1.8% (35/1918) of all respondents reported being past smokers. Of the current smokers, about half (51.8%, 211/407) had previously attempted to quit, mainly for health reasons. The majority of respondents (89.3%, 1675/1875) believed tobacco smoking was harmful for their health and smokers were highly motivated to quit (median score 9, interquartile range 7-10). Smoking was less common among female respondents (Odds Ratio [OR] 0.10, 95% Confidence Interval [CI] 0.06-0.19) and respondents who had completed high school (OR 0.57, 95% CI 0.39-0.84), but was more common among respondents who do occasional work (OR 2.82, 95% CI 1.58-5.02), respondents who to bed hungry regularly (OR 4.19, 95% CI 2.42-7.25), those who have an alcohol problem (OR 5.79, 95% CI 3.24-10.34) and those who use illicit substances (OR 10.81, 95% CI 4.62-25.3). CONCLUSIONS Despite documented evidence of its harmful effects, smoking is prevalent among male TB patients in this high HIV-prevalence population. Few patients have managed to quit smoking on their own. However, patients are highly motivated to stop smoking. We recommend implementing and evaluating a smoking cessation programme in tandem with TB services.
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Affiliation(s)
- Goedele M C Louwagie
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Private Bag X 323, Pretoria 0001, South Africa.
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Yong HH, Borland R, Balmford J, Hyland A, O'Connor RJ, Thompson ME, Spittal MJ. Heaviness of smoking predicts smoking relapse only in the first weeks of a quit attempt: findings from the International Tobacco Control Four-Country Survey. Nicotine Tob Res 2013; 16:423-9. [PMID: 24158228 DOI: 10.1093/ntr/ntt165] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The Heaviness of Smoking Index (HSI) is the measure of dependence most strongly predictive of relapse. However, recent research suggests it may not be predictive of longer-term relapse. Our aim was to examine its predictive power over the first 2 years after quitting and explore whether use of stop-smoking medications is a moderator. METHODS Data (n = 7,093) came from the first 7 waves (2002-2009) of the International Tobacco Control Four-Country Survey, an annual cohort survey of smokers in Canada, the United States, the United Kingdom, and Australia. HSI and its 2 components (cigarettes per day [CPD] and time to first cigarette [TTFC]) were used to predict smoking relapse risk in the 2 years after the start of a quit attempt. RESULTS Scores on HSI and its components all strongly predicted relapse, but there was an interaction with time (p < .001). These measures were strong predictors of relapse within the first week of quitting (hazard ratios [HR] = 1.17, 1.24, and 1.30 for HSI, CPD, and TTFC, respectively; all p < .001), less predictive of relapse occurring between 1 week and 1 month, and not clearly predictive beyond 1 month. Among those using medication to quit, hazard ratio for HSI (HR = 1.11, p < .001) was significantly lower than for those not using (HR = 1.24, p < .001) in the first week but not beyond. CONCLUSIONS HSI and its 2 components are strong predictors of short-term smoking relapse, but they rapidly lose predictive power over the first weeks of an attempt, becoming marginally significant at around 1 month and not clearly predictive beyond then.
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Affiliation(s)
- Hua-Hie Yong
- VicHealth Centre for Tobacco Control, Cancer Council Victoria, Carlton, Australia
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Patterns of smoking prevalence among the elderly in Europe. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:4418-31. [PMID: 24048208 PMCID: PMC3799502 DOI: 10.3390/ijerph10094418] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 09/06/2013] [Accepted: 09/13/2013] [Indexed: 11/17/2022]
Abstract
Scant information is available on determinants of smoking prevalence in the vulnerable population of the elderly, particularly in Europe. Therefore, we analyzed smoking patterns among older adults (≥65 years old), using data from a representative survey based on 3,071 elderly, conducted in 17 European countries in 2010, within the Pricing Policies And Control of Tobacco in Europe (PPACTE) project. Overall smoking prevalence in 17 European countries was 11.5% (15.3% in men and 8.6% in women). An inverse relation with level of education was observed among men, while no specific pattern was evident among women. Smoking prevalence was highest in eastern/central Europe for men (20.3%) and northern Europe for women (13.1%). In both sexes combined, smokers were more frequent in countries with low implementation of tobacco control activities (14.9%). Anti-tobacco campaigns and smoking cessation interventions specifically targeted to the elderly are urgently needed in Europe.
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Association between tobacco industry denormalization beliefs, tobacco control community discontent and smokers' level of nicotine dependence. Addict Behav 2013; 38:2273-8. [PMID: 23583832 DOI: 10.1016/j.addbeh.2013.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 01/18/2013] [Accepted: 03/11/2013] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Tobacco industry denormalization (TID) informs the public about the tobacco industry's role in the tobacco epidemic and is an important component of a comprehensive tobacco control strategy. Although TID beliefs have been noted in adult smokers and associated with intent to quit, research has not evaluated whether they are affected by smokers' level of nicotine dependence. The present article sought to concurrently examine how attitudes towards the tobacco industry and tobacco control groups may differ among smokers of varying levels of nicotine dependence. In addition, it evaluated how these attitudes and beliefs may be associated with smokers' intentions to reduce or quit smoking. METHODS A random digit dialing telephone survey was conducted of 889 Canadian current daily smokers, 18 years and older. RESULTS Attitudes towards the tobacco industry were mixed among the entire cohort and differences in beliefs towards the tobacco industry were not found among smokers of varying levels of nicotine dependence. However, smokers that held strong TID beliefs were 5 times more intent to quit smoking than those without such beliefs. Compared to smokers with low level of nicotine dependence, heavy smokers were more likely to report strong overall displeasure with the tobacco control community (OR=1.98, 95% CI=1.23-3.19, p=0.005), however there were no differences with regards to future intent to quit. CONCLUSIONS The absence of strong negative sentiment toward the tobacco industry among smokers as a whole suggests that more targeted anti-industry messages are needed, raising greater awareness of tobacco industry practices within smokers and non-smokers alike. As heavier smokers' discontent with the tobacco control community highlights increasing social disapproval and pressure to quit smoking, future educational and media strategies used for smoking cessation purposes may benefit from emphasizing more of the positive attributes associated with quitting smoking, as opposed to the negative features of smoking itself.
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Bhang SY, Choi SW, Ahn JH. The efficacy and predictive value of the Heavy Smoking Index for smoking cessation among daily smokers in a public health center. JOURNAL OF SUBSTANCE USE 2013. [DOI: 10.3109/14659891.2012.709911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Spanish Adaptation of the NDSS (Nicotine Dependence Syndrome Scale) and Assessment of Nicotine-Dependent Individuals at Primary Care Health Centers in Spain. SPANISH JOURNAL OF PSYCHOLOGY 2013; 13:951-60. [DOI: 10.1017/s1138741600002596] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The availability of adequate instruments for the assessment of nicotine dependence is an important factor that is relevant in the area of tobacco addiction. In this study, we present a Spanish validation of the Nicotine Dependence Syndrome Scale (NDSS) (Shiffman, Waters, & Hickcox, 2004). The sample was composed of patients, all daily smokers, who visited their General Practitioner (GP) at five Primary Health Care Centers in different cities of Spain (N = 637). The results indicated adequate reliability for the general factor that assesses nicotine dependence (NDSS-Total) (Cronbach's α = .76). Factor analysis confirms the five factors of the original validation: Drive, Continuity, Stereotypy, Priority, and Tolerance. It must be noted that reliability is adequate for the first, and moderate or low for the rest. The NDSS-T and its scales correlate significantly with the Fagerström Test for Nicotine Dependence (FTND), with the nicotine dependence criteria of the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) as assessed through the Structured Clinical Interview for DSM-IV (SCID), with carbon monoxide levels in expired air (CO), and with the number of cigarettes smoked. The ROC curve indicates that the NDSS-T has a score of .79 which is under the curve (.69 for the FTND), thus the prediction of nicotine dependence is adequate. We conclude that this instrument is useful (in terms of its total score NDSS-T) for assessing nicotine dependence for Spanish smokers (in Spain), as has been found in other countries, language groups, and cultures.
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Osório FDL, de Carvalho ACF, Crippa JADS, Loureiro SR. Screening for smoking in a general hospital: scale validation, indicators of prevalence, and comorbidity. Perspect Psychiatr Care 2013; 49:5-12. [PMID: 23293992 DOI: 10.1111/j.1744-6163.2012.00330.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The study aims to conduct a psychometric study of the Fagerström Test for Nicotine Dependence (FTND) and to assess the prevalence, sociodemographic profile, and psychiatric comorbidities of smokers in a general hospital. DESIGN AND METHODS Two hundred sixty-four inpatients were elegible for inclusion in the study and assessed with Structured Clinical Interview for the DSM-IV (Module E), Patient Health Questionnaire, Fast Alcohol Screening Test, and FTND. FINDINGS The cut-off note two of the FTND is the most adequate to identify tobacco abuse/dependence (sensibility: 0.59-0.76). The reliability was estimated to be 0.68-0.96. A 44% rate of tobacco abuser/dependent patients was detected, with a 28% rate of psychiatric comorbidity. PRACTICE IMPLICATIONS Detection of the smoking habits at the time of hospitalization can be opportune, favoring the planning and the beginning of treatment.
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Affiliation(s)
- Flávia de Lima Osório
- Department of Neurosciences and Behavior, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto/São Paulo, Brazil.
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