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Little MA, Reid T, Moncrief M, Cohn W, Wiseman KP, Wood CH, You W, Anderson RT, Krukowski RA. Testing the feasibility of the QuitAid smoking cessation intervention in a randomized factorial design in an independent, rural community pharmacy. Pilot Feasibility Stud 2024; 10:41. [PMID: 38409089 PMCID: PMC10895740 DOI: 10.1186/s40814-024-01465-9] [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: 05/22/2023] [Accepted: 02/14/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Adult smoking rates in the USA are highest in economically depressed rural Appalachia. Pharmacist-delivered tobacco cessation support that incorporates medication therapy management (such as the QuitAid intervention) is a promising approach to address this need. METHODS Twenty-four adult smokers recruited between September and November 2021 through an independent pharmacy in rural Appalachia were randomized in a non-blinded 2 × 2 × 2 factorial design to (1) pharmacist delivered QuitAid intervention (yes vs. no); (2) combination nicotine replacement therapy (NRT) gum + NRT patch (vs. NRT patch); and/or (3) 8 weeks of NRT (vs. standard 4 weeks). Participants received 4 weeks of NRT patch in addition to the components to which they were assigned. Participants completed baseline and 3-month follow-up assessments. Primary outcomes were feasibility of recruitment and randomization, retention, treatment adherence, and fidelity. RESULTS Participants were recruited in 7 weeks primarily through a referral process, commonly referred to as ask-advise-connect (61%). Participants were on average 52.4 years old, 29.2% were male and the majority were white (91.6%) and Non-Hispanic (91.7%). There was a high level of adherence to the interventions, with 85% of QuitAid sessions completed, 83.3% of the patch used, and 54.5% of gum used. Participants reported a high level of satisfaction with the program, and there was a high level of retention (92%). CONCLUSIONS This demonstration pilot randomized controlled study indicates that an ask-advise-connect model for connecting rural smokers to smoking cessation support and providing QuitAid for smoking cessation is feasible and acceptable among rural Appalachian smokers and independent pharmacists. Further investigation into the efficacy of a pharmacist-delivered approach for smoking cessation is needed. TRIAL REGISTRATION The trial was retrospectively registered at ClinicalTrials.gov. Trial #: NCT05649241.
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Affiliation(s)
- Melissa A Little
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA.
- Cancer Control and Population Health, University of Virginia Cancer Center, Charlottesville, VA, USA.
| | - Taylor Reid
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA
- Cancer Control and Population Health, University of Virginia Cancer Center, Charlottesville, VA, USA
| | - Matthew Moncrief
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA
| | - Wendy Cohn
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA
- Cancer Control and Population Health, University of Virginia Cancer Center, Charlottesville, VA, USA
| | - Kara P Wiseman
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA
- Cancer Control and Population Health, University of Virginia Cancer Center, Charlottesville, VA, USA
| | | | - Wen You
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA
- Cancer Control and Population Health, University of Virginia Cancer Center, Charlottesville, VA, USA
| | - Roger T Anderson
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA
- Cancer Control and Population Health, University of Virginia Cancer Center, Charlottesville, VA, USA
| | - Rebecca A Krukowski
- Department of Public Health Sciences, University of Virginia, School of Medicine, PO Box 800765, Charlottesville, VA, 22908-0765, USA
- Cancer Control and Population Health, University of Virginia Cancer Center, Charlottesville, VA, USA
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Minian N, Mehra K, Earle M, Hafuth S, Ting-A-Kee R, Rose J, Veldhuizen S, Zawertailo L, Ratto M, Melamed OC, Selby P. AI Conversational Agent to Improve Varenicline Adherence: Protocol for a Mixed Methods Feasibility Study. JMIR Res Protoc 2023; 12:e53556. [PMID: 38079201 PMCID: PMC10750231 DOI: 10.2196/53556] [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: 10/10/2023] [Revised: 11/10/2023] [Accepted: 11/23/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Varenicline is a pharmacological intervention for tobacco dependence that is safe and effective in facilitating smoking cessation. Enhanced adherence to varenicline augments the probability of prolonged smoking abstinence. However, research has shown that one-third of people who use varenicline are nonadherent by the second week. There is evidence showing that behavioral support helps with medication adherence. We have designed an artificial intelligence (AI) conversational agent or health bot, called "ChatV," based on evidence of what works as well as what varenicline is, that can provide these supports. ChatV is an evidence-based, patient- and health care provider-informed health bot to improve adherence to varenicline. ChatV has been programmed to provide medication reminders, answer questions about varenicline and smoking cessation, and track medication intake and the number of cigarettes. OBJECTIVE This study aims to explore the feasibility of the ChatV health bot, to examine if it is used as intended, and to determine the appropriateness of proceeding with a randomized controlled trial. METHODS We will conduct a mixed methods feasibility study where we will pilot-test ChatV with 40 participants. Participants will be provided with a standard 12-week varenicline regimen and access to ChatV. Passive data collection will include adoption measures (how often participants use the chatbot, what features they used, when did they use it, etc). In addition, participants will complete questionnaires (at 1, 4, 8, and 12 weeks) assessing self-reported smoking status and varenicline adherence, as well as questions regarding the acceptability, appropriateness, and usability of the chatbot, and participate in an interview assessing acceptability, appropriateness, fidelity, and adoption. We will use "stop, amend, and go" progression criteria for pilot studies to decide if a randomized controlled trial is a reasonable next step and what modifications are required. A health equity lens will be adopted during participant recruitment and data analysis to understand and address the differences in uptake and use of this digital health solution among diverse sociodemographic groups. The taxonomy of implementation outcomes will be used to assess feasibility, that is, acceptability, appropriateness, fidelity, adoption, and usability. In addition, medication adherence and smoking cessation will be measured to assess the preliminary treatment effect. Interview data will be analyzed using the framework analysis method. RESULTS Participant enrollment for the study will begin in January 2024. CONCLUSIONS By using predetermined progression criteria, the results of this preliminary study will inform the determination of whether to advance toward a larger randomized controlled trial to test the effectiveness of the health bot. Additionally, this study will explore the acceptability, appropriateness, fidelity, adoption, and usability of the health bot. These insights will be instrumental in refining the intervention and the health bot. TRIAL REGISTRATION ClinicalTrials.gov NCT05997901; https://classic.clinicaltrials.gov/ct2/show/NCT05997901. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/53556.
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Affiliation(s)
- Nadia Minian
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Kamna Mehra
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Mackenzie Earle
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sowsan Hafuth
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Ryan Ting-A-Kee
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jonathan Rose
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Edward S Rogers Sr Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON, Canada
| | - Scott Veldhuizen
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Laurie Zawertailo
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Matt Ratto
- Faculty of Information, University of Toronto, Toronto, ON, Canada
- Schwartz Reisman Institute for Technology and Society, University of Toronto, Toronto, ON, Canada
| | - Osnat C Melamed
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Peter Selby
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Abouzeid M, Alam HB, Arif H, Ballman K, Bennion R, Bernardi K, Burris D, Carter D, Chee P, Chen F, Chung B, Clark S, Cooper R, Cuschieri J, Deeney K, Dhanani N, Diflo T, Drake FT, Fairfield C, Farjah F, Ferrigno L, Fischkoff K, Fleischman R, Foster C, Gerry T, Gibbons M, Guiden M, Haas N, Hayes LA, Hayward A, Hennessey L, Hernandez M, Horvath KF, Howell EC, Hsu C, Johnson J, Johnsson B, Kim D, Kim D, Ko TC, Lavallee DC, Lew D, Mack J, MacKenzie D, Maggi J, Marquez S, Martinez R, McGrane K, Melis M, Miller K, Mireles D, Moran GJ, Morgan D, Morris A, Moser KM, Mount L, O'Connor K, Odom SR, Olavarria O, Olbrich N, Osborn S, Owens O, Park P, Parr Z, Parsons CS, Pathmarajah K, Patki D, Patton JH, Peacock RK, Pierce K, Pullar K, Putnam B, Rushing A, Sabbatini A, Saltzman D, Salzberg M, Schaetzel S, Schmidt PJ, Shah P, Shapiro NI, Sinha P, Skeete D, Skopin E, Sohn V, Spence LH, Steinberg S, Tichter A, Tschirhart J, Tudor B, Uribe L, VanDusen H, Wallick J, Weiss M, Wells S, Wiebusch A, Williams EJ, Winchell RJ, Wisler J, Wolfe B, Wolff E, Yealy DM, Yu J, Zhang IY, Voldal EC, Davidson GH, Liao JM, Thompson CM, Self WH, Kao LS, Cherry-Bukowiec J, Raghavendran K, Kaji AH, DeUgarte DA, Gonzalez E, Mandell KA, Ohe K, Siparsky N, Price TP, Evans DC, Victory J, Chiang W, Jones A, Kutcher ME, Ciomperlik H, Liang MK, Evans HL, Faine BA, Neufeld M, Sanchez SE, Krishnadasan A, Comstock BA, Heagerty PJ, Lawrence SO, Monsell SE, Fannon EEC, Kessler LG, Talan DA, Flum DR. Association of Patient Belief About Success of Antibiotics for Appendicitis and Outcomes: A Secondary Analysis of the CODA Randomized Clinical Trial. JAMA Surg 2022; 157:1080-1087. [PMID: 36197656 PMCID: PMC9535504 DOI: 10.1001/jamasurg.2022.4765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Importance A patient's belief in the likely success of a treatment may influence outcomes, but this has been understudied in surgical trials. Objective To examine the association between patients' baseline beliefs about the likelihood of treatment success with outcomes of antibiotics for appendicitis in the Comparison of Outcomes of Antibiotic Drugs and Appendectomy (CODA) trial. Design, Setting, and Participants This was a secondary analysis of the CODA randomized clinical trial. Participants from 25 US medical centers were enrolled between May 3, 2016, and February 5, 2020. Included in the analysis were participants with appendicitis who were randomly assigned to receive antibiotics in the CODA trial. After informed consent but before randomization, participants who were assigned to receive antibiotics responded to a baseline survey including a question about how successful they believed antibiotics could be in treating their appendicitis. Interventions Participants were categorized based on baseline survey responses into 1 of 3 belief groups: unsuccessful/unsure, intermediate, and completely successful. Main Outcomes and Measures Three outcomes were assigned at 30 days: (1) appendectomy, (2) high decisional regret or dissatisfaction with treatment, and (3) persistent signs and symptoms (abdominal pain, tenderness, fever, or chills). Outcomes were compared across groups using adjusted risk differences (aRDs), with propensity score adjustment for sociodemographic and clinical factors. Results Of the 776 study participants who were assigned antibiotic treatment in CODA, a total of 425 (mean [SD] age, 38.5 [13.6] years; 277 male [65%]) completed the baseline belief survey before knowing their treatment assignment. Baseline beliefs were as follows: 22% of participants (92 of 415) had an unsuccessful/unsure response, 51% (212 of 415) had an intermediate response, and 27% (111 of 415) had a completely successful response. Compared with the unsuccessful/unsure group, those who believed antibiotics could be completely successful had a 13-percentage point lower risk of appendectomy (aRD, -13.49; 95% CI, -24.57 to -2.40). The aRD between those with intermediate vs unsuccessful/unsure beliefs was -5.68 (95% CI, -16.57 to 5.20). Compared with the unsuccessful/unsure group, those with intermediate beliefs had a lower risk of persistent signs and symptoms (aRD, -15.72; 95% CI, -29.71 to -1.72), with directionally similar results for the completely successful group (aRD, -15.14; 95% CI, -30.56 to 0.28). Conclusions and Relevance Positive patient beliefs about the likely success of antibiotics for appendicitis were associated with a lower risk of appendectomy and with resolution of signs and symptoms by 30 days. Pathways relating beliefs to outcomes and the potential modifiability of beliefs to improve outcomes merit further investigation. Trial Registration ClinicalTrials.gov Identifier: NCT02800785.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Cindy Hsu
- Writing Group for the CODA Collaborative
| | | | | | - Dennis Kim
- Writing Group for the CODA Collaborative
| | - Daniel Kim
- Writing Group for the CODA Collaborative
| | - Tien C. Ko
- Writing Group for the CODA Collaborative
| | | | - Debbie Lew
- Writing Group for the CODA Collaborative
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Olga Owens
- Writing Group for the CODA Collaborative
| | | | - Zoe Parr
- Writing Group for the CODA Collaborative
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Vance Sohn
- Writing Group for the CODA Collaborative
| | | | | | | | | | | | | | | | | | | | - Sean Wells
- Writing Group for the CODA Collaborative
| | | | | | | | - Jon Wisler
- Writing Group for the CODA Collaborative
| | | | | | | | | | - Irene Y. Zhang
- Department of Surgery, Surgical Outcomes Research Center, University of Washington, Seattle
| | - Emily C. Voldal
- Department of Surgery, Surgical Outcomes Research Center, University of Washington, Seattle
| | - Giana H. Davidson
- Department of Surgery, Surgical Outcomes Research Center, University of Washington, Seattle
| | - Joshua M. Liao
- Department of Surgery, Surgical Outcomes Research Center, University of Washington, Seattle
| | - Callie M. Thompson
- Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Surgery, University of Utah, Salt Lake City
| | - Wesley H. Self
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lillian S. Kao
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston
| | | | | | - Amy H. Kaji
- Harbor–UCLA Medical Center, West Carson, California
| | | | - Eva Gonzalez
- Harbor–UCLA Medical Center, West Carson, California
| | | | - Kristen Ohe
- The Swedish Medical Center, Seattle, Washington
| | | | | | - David C. Evans
- The Ohio State University Wexner Medical Center, Columbus
| | - Jesse Victory
- Bellevue Hospital Center, NYU School of Medicine, New York, New York
| | - William Chiang
- Tisch Hospital, NYU Langone Medical Center, New York, New York
| | - Alan Jones
- The University of Mississippi Medical Center, Jackson
| | | | | | - Mike K. Liang
- Lyndon B. Johnson General Hospital, University of Texas, Houston
- HCA Healthcare, University of Houston, Kingwood, Kingwood, Texas
| | - Heather L. Evans
- Harborview Medical Center, UW Medicine, Seattle, Washington
- The Medical University of South Carolina, Charleston
| | | | | | | | | | - Bryan A. Comstock
- Department of Surgery, Surgical Outcomes Research Center, University of Washington, Seattle
| | - Patrick J. Heagerty
- Department of Surgery, Surgical Outcomes Research Center, University of Washington, Seattle
| | - Sarah O. Lawrence
- Department of Surgery, Surgical Outcomes Research Center, University of Washington, Seattle
| | - Sarah E. Monsell
- Department of Surgery, Surgical Outcomes Research Center, University of Washington, Seattle
| | - Erin E. C. Fannon
- Department of Surgery, Surgical Outcomes Research Center, University of Washington, Seattle
| | - Larry G. Kessler
- Department of Surgery, Surgical Outcomes Research Center, University of Washington, Seattle
| | - David A. Talan
- Olive View–UCLA Medical Center, Los Angeles, California
- Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - David R. Flum
- Department of Surgery, Surgical Outcomes Research Center, University of Washington, Seattle
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da Silva Teixeira R, Nazareth IF, de Paula LC, do Nascimento Duque GP, Colugnati FAB. Adherence to Computational Technologies for the Treatment of Smoking Cessation: Systematic Review and Meta‐analysis. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00839-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Carpenter MJ, Gray KM, Wahlquist AE, Cropsey K, Saladin ME, Froeliger B, Smith TT, Toll BA, Dahne J. A Pilot Randomized Clinical Trial of Remote Varenicline Sampling to Promote Treatment Engagement and Smoking Cessation. Nicotine Tob Res 2021; 23:983-991. [PMID: 33249458 PMCID: PMC8150130 DOI: 10.1093/ntr/ntaa241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/24/2020] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Medication sampling is a clinically useful tool to engage smokers in the quitting process. Whether varenicline is suitable for sampling purposes is unclear. The purpose of this study was to examine the feasibility, uptake, and preliminary outcomes of varenicline sampling. METHODS Smokers (N = 99), both motivated to quit and not, were recruited and randomized to varenicline sampling versus not, with 12 week follow-up. The intervention consisted of mailing one-time samples of varenicline (lasting 2-4 wks), with minimally suggestive guidance on use. RESULTS Uptake of varenicline was strong, at 2 weeks (54% any use, 66% daily use) and 4 weeks (38%, 46%), with 58% of medication users seeking additional medication. Most users followed conventional titration patterns, self-titrating from 0.5 mg to 2 mg. Relative to control, varenicline sampling increased motivation (p = 0.006) and confidence to quit (p = 0.02), and decreased cigarette smoking (p = 0.02). Smokers receiving varenicline samples were significantly more likely to achieve 50% reduction in cigarettes per day (CPD), both immediately following the sampling exercise (Adjusted Odds Ratio [AOR] = 4.12; 95% CI: 1.39 to 12.17) and at final follow-up (AOR = 4.50; 95% CI: 1.56 to 13.01). Though cessation outcomes were not statistically significant, there was a 1.5 to 3-fold increase in quit attempts and abstinence from varenicline sampling throughout follow-up. These outcomes were comparable among smokers motivated to quit and not. CONCLUSIONS Unguided, user-driven sampling of varenicline sampling is a concrete behavioral exercise that is feasible to do and seems to suggest clinical utility. Sampling is a pragmatic clinical approach to engage more smokers in quitting. IMPLICATIONS Use of evidence-based pharmacotherapies for smoking cessation is low. Medication sampling is a pragmatic behavioral exercise that allows smokers to experience the benefits of using them, while promoting positive downstream effects towards quitting. While previous studies have shown that nicotine replacement therapy (NRT) sampling is viable and effective, whether this extends to varenicline is unclear. Results from this trial demonstrate that varenicline sampling is feasible, safe, and suggestive of clinically important steps toward quitting, deserving of a larger trial. CLINICAL TRIAL REGISTRATION NCT #03742154.
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Affiliation(s)
- Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC
- Department of Public Health Sciences, MUSC, Charleston, SC
- Hollings Cancer Center, MUSC, Charleston, SC
| | - Kevin M Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC
- Hollings Cancer Center, MUSC, Charleston, SC
| | - Amy E Wahlquist
- Department of Public Health Sciences, MUSC, Charleston, SC
- Hollings Cancer Center, MUSC, Charleston, SC
| | - Karen Cropsey
- Department of Psychiatry, University of Alabama, Birmingham, UK
| | | | - Brett Froeliger
- Department of Psychiatry, University of Missouri, Columbia, MI
- Department of Psychological Sciences, University of Missouri, Columbia, MI
| | - Tracy T Smith
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC
- Hollings Cancer Center, MUSC, Charleston, SC
| | - Benjamin A Toll
- Department of Public Health Sciences, MUSC, Charleston, SC
- Hollings Cancer Center, MUSC, Charleston, SC
| | - Jennifer Dahne
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC
- Hollings Cancer Center, MUSC, Charleston, SC
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Kelly BC, Pawson M, Vuolo M. Beliefs on COVID-19 Among Electronic Cigarette Users: Behavioral Responses and Implications for COVID Prevention and E-Cigarette Interventions. JOURNAL OF DRUG ISSUES 2020. [DOI: 10.1177/0022042620977828] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
E-cigarette users’ beliefs about COVID-19 may shape their responses to the pandemic and their e-cigarette consumption. A U.S. national cross-sectional survey of 562 e-cigarette users was conducted in April 2020. Participants self-reported nicotine consumption, COVID-19 beliefs, beliefs about e-cigarettes, social distancing, COVID-19 disruptions, cessation considerations, and individual characteristics. Ordinary least squares (OLS) regression provided unstandardized, and standardized coefficients. Frequency of e-cigarette use is inversely associated with beliefs COVID-19 is relevant (β = −0.215). Beliefs e-cigarettes are addictive, harmful, or pose a risk to future health were positively associated with beliefs COVID-19 is relevant (β = 0.171; β = 0.164; β = 0.203), beliefs the media are truthful on COVID-19 (β = 0.133; β = 0.136; β = 0.137), and beliefs e-cigarette users are at greater risk (β = 0.279; β = 0.411; β = 0.447). All three COVID-19 beliefs (COVID relevant; media truthful; and greater risk) were positively associated with social distancing (β = 0.307; β = 0.259; β = 0.115), work disruptions (β = 0.134; β = 0.135; β = 0.130), family disruptions (β = 0.232; β = 0.131; β = 0.164), friendship disruptions (β = 0.214; β = 0.139; β = 0.133), and considerations of quitting (β = 0.250; β = 0.222; β = 0.620). Strong associations between e-cigarette beliefs and COVID-19 beliefs exist. COVID-19 beliefs are associated with behavioral responses, such as social distancing and considerations of e-cigarette cessation. Interventions may be able to leverage COVID-19 beliefs to reduce e-cigarette consumption or promote cessation during the pandemic.
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Affiliation(s)
| | | | - Mike Vuolo
- The Ohio State University, Columbus, OH, USA
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Schlagintweit HE, Perry RN, Darredeau C, Barrett SP. Non-pharmacological Considerations in Human Research of Nicotine and Tobacco Effects: A Review. Nicotine Tob Res 2020; 22:1260-1266. [PMID: 31058286 DOI: 10.1093/ntr/ntz064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 04/24/2019] [Indexed: 12/17/2023]
Abstract
Human research of nicotine and tobacco effects demonstrates that non-pharmacological factors may systematically affect responses to administered substances and inert placebos. Failure to measure or manipulate these factors may compromise study reliability and validity. This is especially relevant for double-blind placebo-controlled research of nicotine, tobacco, and related substances. In this article, we review laboratory-based human research of the impact of non-pharmacological factors on responses to tobacco and nicotine administration. Results suggest that varying beliefs about drug content and effects, perceptions about drug use opportunities, and intentions to cease drug use systematically alter subjective, behavioral, and physiological responses to nicotine, tobacco, and placebo administration. These non-pharmacological factors should be considered when designing and interpreting the findings of human research of nicotine and tobacco effects, particularly when a double-blind placebo-controlled design is used. The clinical implications of these findings are discussed, and we propose methodological strategies to enhance the reliability and validity of future research. IMPLICATIONS Growing research demonstrates that non-pharmacological factors systematically alter responses to acute nicotine, tobacco, and placebo administration. Indeed, varying beliefs about nicotine and/or tobacco administration and effects, differing perceptions about nicotine and/or tobacco use opportunities, and inconsistent motivation to quit smoking have been found to exert important influences on subjective, physiological, and behavioral responses. These variables are infrequently measured or manipulated in nicotine and tobacco research, which compromises the validity of study findings. Incorporating methodological strategies to better account for these non-pharmacological factors has the potential to improve the quality of addiction research and treatment.
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Affiliation(s)
- Hera E Schlagintweit
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Robin N Perry
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Christine Darredeau
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sean P Barrett
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
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Amante DJ, Blok AC, Nagawa CS, Wijesundara JG, Allison JJ, Person SD, Morley J, Conigliaro J, Mattocks KM, Garber L, Houston TK, Sadasivam RS. The 'Take a Break' game: Randomized trial protocol for a technology-assisted brief abstinence experience designed to engage lower-motivated smokers. Contemp Clin Trials 2020; 93:106002. [PMID: 32335288 PMCID: PMC7298726 DOI: 10.1016/j.cct.2020.106002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND While smoking continues to be the most preventable cause of mortality in the United States, most current smokers remain not ready to quit at any given time. Engaging these 'motivation phase' smokers with brief experiences to build confidence and practice skills related to cessation could lead to sooner and more successful quit attempts. Increasingly available mobile technology and gamification can be used to provide smokers with accessible and engaging support. METHODS We describe our protocol for conducting a randomized controlled trial evaluating Take a Break, an mHealth-based smoking pre-cessation challenge designed for smokers not ready to quit. Participants in the intervention receive 1) Motivational Messages, 2) text message Challenge Quizzes, 3) Goal-setting with tobacco treatment specialist, 4) Coping Mini-Games apps, and 5) Recognition and Rewards for participation during a 3-week challenge. Access to coping mini-games and motivational messaging continues for 6-months. Both intervention and comparison group participants receive brief Nicotine Replacement Therapy (NRT) sampling and daily smoking assessment text messages for three weeks. Primary outcomes include number of days abstinent during the challenge, change in patient-reported self-efficacy after the challenge, time to first quit attempt following the challenge, and 7-day point prevalent smoking cessation at six months. CONCLUSION Take a Break is an innovative approach to engage those not prepared for a quit attempt. Take a Break provides motivation phase smokers with tools and a brief experience to prepare them for a quit attempt, filling a gap in tobacco cessation support and current research.
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Affiliation(s)
- Daniel J Amante
- Department of Population and Quantitative Health Science, University of Massachusetts Medical School, Worcester, MA, United States of America.
| | - Amanda C Blok
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, United States Department of Veterans Affairs, Ann Arbor, MI, United States of America; Systems, Populations and Leadership Department, School of Nursing, University of Michigan, Ann Arbor, MI, United States of America
| | - Catherine S Nagawa
- Department of Population and Quantitative Health Science, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Jessica G Wijesundara
- Department of Population and Quantitative Health Science, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Jeroan J Allison
- Department of Population and Quantitative Health Science, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Sharina D Person
- Department of Population and Quantitative Health Science, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Jeanne Morley
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States of America; Feinstein Institute for Medical Research, Manhasset, NY, United States of America
| | - Joseph Conigliaro
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States of America; Feinstein Institute for Medical Research, Manhasset, NY, United States of America
| | - Kristin M Mattocks
- Department of Population and Quantitative Health Science, University of Massachusetts Medical School, Worcester, MA, United States of America; VA Central Western Massachusetts Healthcare System, Leeds, MA, United States of America
| | - Lawrence Garber
- Reliant Medical Group, Worcester, MA, United States of America
| | - Thomas K Houston
- Department of Population and Quantitative Health Science, University of Massachusetts Medical School, Worcester, MA, United States of America; Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Rajani S Sadasivam
- Department of Population and Quantitative Health Science, University of Massachusetts Medical School, Worcester, MA, United States of America
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9
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Katz DA, Hamlin C, Vander Weg MW, Grant KM, Stewart Steffensmeier KR, Paez M, Hawley ST, Gaeth G. Veterans' preferences for tobacco treatment in primary care: A discrete choice experiment. PATIENT EDUCATION AND COUNSELING 2020; 103:652-660. [PMID: 31629558 DOI: 10.1016/j.pec.2019.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 09/25/2019] [Accepted: 10/01/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate US veterans' preferences for smoking cessation counseling and pharmacotherapy. METHODS A discrete choice experiment (DCE) was conducted in 123 Veterans Health Administration primary care outpatients who planned to quit smoking within 6 months. Key attributes of tobacco cessation treatment were based on literature review and expert opinion. We used a hierarchical Bayesian approach with a logit model to estimate the part-worth utility of each attribute level and used latent class logit models to explore preference heterogeneity. RESULTS In the aggregate, participants valued counseling options with the following attributes: higher quit rate at 1 year, emphasis on autonomy, familiarity of the counselor, counselor's communication skills, and inclusion of printed materials on smoking cessation. Participants valued pharmacotherapy options with the following attributes: higher quit rate at 1 year, lower risk of physical side effects, zero copayment, monthly check-in calls, and less weight gain. Latent class analysis revealed distinct clusters of patients with a unique preference "phenotype." CONCLUSIONS Veterans have distinct preferences for attributes of cessation counseling and pharmacotherapy. PRACTICE IMPLICATIONS Identifying patients' preferences provides an opportunity for clinicians to offer tailored treatment options that better engage veterans in their own care and boost adherence to guideline-recommended counseling and pharmacotherapy.
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Affiliation(s)
- David A Katz
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, VA Iowa City Health Care System (152), Iowa City, IA 52246-2208, USA; Department of Medicine, University of Iowa, Iowa City, IA, USA; Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA.
| | - Christine Hamlin
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, VA Iowa City Health Care System (152), Iowa City, IA 52246-2208, USA
| | - Mark W Vander Weg
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, VA Iowa City Health Care System (152), Iowa City, IA 52246-2208, USA; Department of Medicine, University of Iowa, Iowa City, IA, USA; Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - Kathleen M Grant
- VA Nebraska-Western Iowa Health Care System and the Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kenda R Stewart Steffensmeier
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, VA Iowa City Health Care System (152), Iowa City, IA 52246-2208, USA
| | - Monica Paez
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, VA Iowa City Health Care System (152), Iowa City, IA 52246-2208, USA
| | - Sarah T Hawley
- Ann Arbor Veterans Administration (VA) Healthcare System, University of Michigan, Ann Arbor, MI, USA; Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Gary Gaeth
- Tippie School of Business, University of Iowa, Iowa City, IA, USA
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10
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Duarte DA, Chen-Sankey JC, Dang K, Orozco L, Jewett B, Choi K. "Isn't there a bunch of side effects?": A focus group study on the beliefs about cessation treatments of non-college educated young adult smokers. J Subst Abuse Treat 2020; 112:36-41. [PMID: 32199544 DOI: 10.1016/j.jsat.2020.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 12/19/2019] [Accepted: 01/23/2020] [Indexed: 12/24/2022]
Abstract
Smoking remains more prevalent among non-college educated and racial/ethnic minority young adults in the U.S. These smokers are less likely than their college educated/non-Hispanic white counterparts to use cessation treatments approved by the U.S. Food and Drug Administration (FDA). Alternative cessation methods (e.g., e-cigarettes) have also grown in popularity among smokers. Therefore, we conducted a focus group study to explore perceptions and beliefs about various cessation treatments among, racially/ethnically diverse, non-college educated young adult smokers. Seventy-five 18-29-year-old current smokers without a 4-year college education were recruited from the U.S. Washington, D.C. metropolitan area and attended one of twelve focus groups to discuss their awareness, beliefs, experiences, and intention for future use of cessation treatments. Focus groups were stratified by race/ethnicity (non-Hispanic white, non-Hispanic black, and Hispanic) and educational attainment (≤ high school vs. some college without obtaining a bachelor's degree). We used a thematic approach to analyze the discussions. We found that few participants were aware of cessation counseling or cessation related programs. Many participants reported previously using nicotine replacement therapies and e-cigarettes to quit smoking. Participants had little intention to use prescription medications due to perceived side effects. Participants' awareness, beliefs, and intentions of using other cessation treatments varied by race/ethnicity and educational attainment. In conclusion, our findings, if confirmed by subsequent quantitative studies, suggest that targeted media campaigns may be needed to explain the contents and benefits of behavioral cessation programs to non-college educated young adult smokers. Targeted media messages aim to overcome negative perceptions related to nicotine replacement therapy and prescription medications among non-college educated young adult smokers, especially those from racial/ethnic minority populations, may promote successful smoking cessation in this population.
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Affiliation(s)
- Danielle A Duarte
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, 9000 Rockville Pike, Bethesda, MD 20892, USA.
| | - Julia Cen Chen-Sankey
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, 9000 Rockville Pike, Bethesda, MD 20892, USA.
| | - Kathleen Dang
- Gillings School of Global Public Health, University of North Carolina, 135 Dauer Dr, Chapel Hill, NC 27599, USA.
| | - Leah Orozco
- Department of Biology, College of the Holy Cross, 1 College St, Worcester, MA 01610, USA.
| | - Bambi Jewett
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, 9000 Rockville Pike, Bethesda, MD 20892, USA.
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, 9000 Rockville Pike, Bethesda, MD 20892, USA.
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11
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Pacek LR, McClernon FJ, Bosworth HB. Adherence to Pharmacological Smoking Cessation Interventions: A Literature Review and Synthesis of Correlates and Barriers. Nicotine Tob Res 2018; 20:1163-1172. [PMID: 29059394 PMCID: PMC6121917 DOI: 10.1093/ntr/ntx210] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 09/15/2017] [Indexed: 01/09/2023]
Abstract
Introduction Efficacious pharmacological interventions for smoking cessation are available, but poor adherence to these treatments may limit these interventions overall impact. To improve adherence to smoking cessation interventions, it is first necessary to identify and understand smoker-level characteristics that drive nonadherence (ie, nonconformance with a provider's recommendation of timing, dosage, or frequency of medication-taking during the prescribed length of time). Methods We present a literature review of studies examining correlates of, or self-reported reasons for, nonadherence to smoking cessation pharmacotherapies. Studies were identified through PubMed-using MeSH terms, Embase-using Emtree terms, and ISI Web of Science. Results and Conclusions This literature review included 50 studies that examined nonpreventable (eg, sociodemographics) and preventable (eg, forgetfulness) factors associated with adherence to smoking cessation medication and suggestions for overcoming some of the identified barriers. Systematic study of this topic would be facilitated by consistent reporting of adherence and correlates thereof in the literature, development of consistent definitions of medication adherence across studies, utilization of more objective measures of adherence (eg, blood plasma levels vs. self-report) in addition to reliance on self-reported adherence. Implications This article provides the most comprehensive review to date on correlates of adherence to pharmacological smoking cessation interventions. Challenges and specific gaps in the literature that should be a priority for future research are discussed. Future priorities include additional research, particularly among vulnerable populations of smokers, developing standardized definitions of adherence and methods for measuring adherence, regular assessment of cessation pharmacotherapy adherence in the context of research and clinical practice, and development of novel treatments aimed at preventable barriers to medication adherence.
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Affiliation(s)
- Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Hayden B Bosworth
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
- Department of Medicine, Division of General Medicine, Duke University School of Medicine, Durham, NC
- Center for Health Services Research in Primary Care, Durham VAMC, Durham, NC
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12
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Tseng TY, Krebs P, Schoenthaler A, Wong S, Sherman S, Gonzalez M, Urbina A, Cleland CM, Shelley D. Combining Text Messaging and Telephone Counseling to Increase Varenicline Adherence and Smoking Abstinence Among Cigarette Smokers Living with HIV: A Randomized Controlled Study. AIDS Behav 2017; 21:1964-1974. [PMID: 27605365 DOI: 10.1007/s10461-016-1538-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Smoking represents an important health risk for people living with HIV (PLHIV). Low adherence to smoking cessation pharmacotherapy may limit treatment effectiveness. In this study, 158 participants recruited from three HIV care centers in New York City were randomized to receive 12-weeks of varenicline (Chantix) either alone as standard care (SC) or in combination with text message (TM) support or TM plus cell phone-delivered adherence-focused motivational and behavioral therapy (ABT). Generalized linear mixed-effect models found a significant decline in varenicline adherence from week 1-12 across treatment groups. At 12-weeks, the probability of smoking abstinence was significantly higher in SC+TM+ABT than in SC. The study demonstrates the feasibility of delivering adherence-focused interventions to PLHIV who smoke. Findings suggest intensive behavioral support is an important component of an effective smoking cessation intervention for this population, and a focus on improving adherence self-efficacy may lead to more consistent adherence and higher smoking abstinence.
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Affiliation(s)
- Tuo-Yen Tseng
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Room 708, New York, NY, 10016, USA
| | - Paul Krebs
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Room 708, New York, NY, 10016, USA
| | - Antoinette Schoenthaler
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Room 708, New York, NY, 10016, USA
| | - Selena Wong
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Room 708, New York, NY, 10016, USA
| | - Scott Sherman
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Room 708, New York, NY, 10016, USA
| | - Mirelis Gonzalez
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Room 708, New York, NY, 10016, USA
| | - Antonio Urbina
- Behavioral Health Research, St. Luke's Roosevelt Hospital, New York, NY, USA
| | - Charles M Cleland
- New York University Rory Meyers College of Nursing and Center for Drug Use and HIV Research, New York, NY, USA
| | - Donna Shelley
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Room 708, New York, NY, 10016, USA.
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13
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Figueiró LR, Barros HMT, Ferigolo M, Dantas DCM. Assessment of factors related to smokers' adherence to a short-term support group for smoking cessation: a longitudinal study in a developing country. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2017; 39:19-28. [PMID: 28403319 DOI: 10.1590/2237-6089-2016-0041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 10/12/2016] [Indexed: 11/22/2022]
Abstract
Objective: The aim of this study was to determine which individual characteristics of smokers are associated with their adherence to a support group for smoking cessation. Methods: Smokers from Porto Alegre, Brazil, were invited to participate in a support group for smoking cessation consisting of four weekly sessions. Demographic data, smoking history, presence of tobacco-related diseases, severity of nicotine dependence, stage of motivation, and symptoms of anxiety and depression were evaluated at baseline. Adherence was defined as attendance at group sessions and was measured at the second and fourth sessions of the program. Results: The study recruited 167 smokers who attended the first meeting and met criteria for admission to the study. One hundred and two of the participants returned to the second session and only 55 of those who attended the first meeting completed the four-week program. For immediate adherence (second session), adult smokers over the age of 35 were more likely to adhere to the treatment (p = 0.004), whereas smoking higher numbers of cigarettes per day was associated with lower adherence to attendance at group meetings (p = 0.031). For final adherence (fourth session), only minimal level symptoms of anxiety were associated with a higher likelihood of adherence (p = 0.02). Conclusions: Older smokers, those who smoked fewer cigarettes per day, and those with lower levels of anxiety exhibited higher rates of adherence to a smoking cessation support group.
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Affiliation(s)
| | | | - Maristela Ferigolo
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
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14
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Nanovskaya TN, Oncken C, Fokina VM, Feinn RS, Clark SM, West H, Jain SK, Ahmed MS, Hankins GDV. Bupropion sustained release for pregnant smokers: a randomized, placebo-controlled trial. Am J Obstet Gynecol 2017; 216:420.e1-420.e9. [PMID: 27890648 PMCID: PMC5376363 DOI: 10.1016/j.ajog.2016.11.1036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/02/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Bupropion is used to treat depression during pregnancy. However, its usefulness as a smoking cessation aid for pregnant women is not fully known. OBJECTIVE The objective of the study was to evaluate the preliminary efficacy of bupropion sustained release for smoking cessation during pregnancy. STUDY DESIGN We conducted a randomized, prospective, double-blind, placebo-controlled, pilot trial. Pregnant women who smoked daily received individualized behavior counseling and were randomly assigned to a 12 week, twice-a-day treatment with 150 mg bupropion sustained release or placebo. The primary study objectives were to determine whether bupropion sustained release reduces nicotine withdrawal symptoms on the quit date and during the treatment period compared with placebo and whether it increases 7 day point prevalence abstinence at the end of the treatment period and at the end of pregnancy. RESULTS Subjects in the bupropion (n = 30) and placebo (n = 35) groups were comparable in age, smoking history, number of daily smoked cigarettes, and nicotine dependence. After controlling for maternal age and race, bupropion sustained release reduced cigarette cravings (1.5 ± 1.1 vs 2.1 ± 1.2, P = .02) and total nicotine withdrawal symptoms (3.8 ± 4.3 vs 5.4 ± 5.1, P = .028) during the treatment period. Administration of bupropion sustained release reduced tobacco exposure, as determined by levels of carbon monoxide in exhaled air (7.4 ± 6.4 vs 9.1 ± 5.8, P = .053) and concentrations of cotinine in urine (348 ± 384 ng/mL vs 831 ± 727 ng/mL, P = .007) and increased overall abstinence rates during treatment (19% vs 2%, P = .003). However, there was no significant difference in 7 day point prevalence abstinence rates between the 2 groups at the end of medication treatment (17% vs 3%, P = .087) and at the end of pregnancy (10% vs 3%, P = .328). CONCLUSION Individual smoking cessation counseling along with the twice-daily use of 150 mg bupropion sustained release increased smoking cessation rates and reduced cravings and total nicotine withdrawal symptoms during the treatment period. However, there was no significant difference in abstinence rates between groups at the end of medication treatment and at the end of pregnancy, likely because of the small sample size. A larger study is needed to confirm these findings and to examine the potential benefit/ risk ratio of bupropion sustained release for smoking cessation during pregnancy.
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Affiliation(s)
- Tatiana N Nanovskaya
- Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, TX
| | - Cheryl Oncken
- University of Connecticut School of Medicine, Farmington, CT
| | - Valentina M Fokina
- Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, TX
| | - Richard S Feinn
- Quinnipiac University, Frank H Netter, MD, School of Medicine, North Haven, CT
| | - Shannon M Clark
- Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, TX
| | - Holly West
- Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, TX
| | - Sunil K Jain
- Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, TX
- Department of Pediatrics, The University of Texas Medical Branch at Galveston, TX
| | - Mahmoud S Ahmed
- Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, TX
| | - Gary D V Hankins
- Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, TX
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15
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Morphett K, Carter A, Hall W, Gartner C. Medicalisation, smoking and e-cigarettes: evidence and implications. Tob Control 2016; 26:e134-e139. [PMID: 27903957 DOI: 10.1136/tobaccocontrol-2016-053348] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/28/2016] [Accepted: 11/03/2016] [Indexed: 12/13/2022]
Abstract
There is debate in the tobacco control literature about the value of a medical model in reducing smoking-related harm. The variety of medical treatments for smoking cessation has increased, health professionals are encouraged to use them to assist smoking cessation and tobacco dependence is being described as a 'chronic disease'. Some critics suggest that the medicalisation of smoking undermines the tobacco industry's responsibility for the harms of smoking. Others worry that it will lead smokers to deny personal responsibility for cessation, create beliefs in 'magic bullets' for smoking cessation, or erode smokers' confidence in their ability to quit. We argue that the medicalisation of smoking will have limited impact due to the emphasis on population-based interventions in tobacco control, the ambiguous place of nicotine among other drugs and the modest efficacy of current pharmacotherapies. These factors, as well as lay understandings of smoking that emphasise willpower, personal choice and responsibility, have contributed to the limited success of medical approaches to smoking cessation. While the rapid uptake of e-cigarettes in some countries has provided an option for those who reject medical treatments for smoking cessation, current regulatory developments could limit the potential of e-cigarettes to provide non-therapeutic nicotine for those who currently smoke tobacco.
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Affiliation(s)
- Kylie Morphett
- University of Queensland School of Public Health, Herston, Queensland, Australia.,University of Queensland School of Medicine, Royal Brisbane and Women's Hospital Site, Herston, Queensland, Australia
| | - Adrian Carter
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, Victoria, Australia
| | - Wayne Hall
- University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital Site, Herston, Queensland, Australia.,University of Queensland Centre for Youth Substance Abuse, Floor K, Mental Health Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Coral Gartner
- University of Queensland School of Public Health, Herston, Queensland, Australia.,University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital Site, Herston, Queensland, Australia
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16
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Shelley D, Tseng TY, Gonzalez M, Krebs P, Wong S, Furberg R, Sherman S, Schoenthaler A, Urbina A, Cleland CM. Correlates of Adherence to Varenicline Among HIV+ Smokers. Nicotine Tob Res 2016; 17:968-74. [PMID: 26180221 DOI: 10.1093/ntr/ntv068] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Low rates of adherence to smoking cessation pharmacotherapy may limit the effectiveness of treatment. However, few studies have examined adherence in smoking cessation trials thus, there is a limited understanding of factors that influence adherence behaviors. This brief report analyzes correlates of adherence to varenicline among people living with HIV/AIDS. METHODS Study participants were recruited from three HIV care centers in New York City and enrolled in a three-arm randomized controlled pilot study in which all subjects received varenicline. At the 1-month study visit, there were no significant differences in adherence by study condition, therefore we combined treatment arms to examine correlates of adherence (n = 127). We used pill counts to assess varenicline adherence, defined as taking at least 80% of the prescribed dose. We conducted a multivariate path analysis to assess factors proposed by the information-motivation-behavioral skills model to predict adherence. RESULTS Only 56% of smokers were at least 80% adherent to varenicline at 1 month. Adherence-related information, self-efficacy, a college degree, and non-Hispanic white race/ethnicity were associated with increased varenicline adherence. In path analysis, information and motivation were associated with increased adherence self-efficacy, and adherence self-efficacy was associated with increased adherence, but with marginal significance. These associations with adherence were no longer significant after controlling for race/ethnicity and education. CONCLUSIONS Further exploration of the role of a modifiable correlates of adherence, such as adherence-related information, motivation and self-efficacy is warranted. Interventions are needed that can address disparities in these and other psychosocial factors that may mediate poor medication adherence.
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Affiliation(s)
- Donna Shelley
- Department of Population Health, New York University School of Medicine, New York, NY;
| | - Tuo-Yen Tseng
- Department of Population Health, New York University School of Medicine, New York, NY
| | - Mirelis Gonzalez
- Department of Population Health, New York University School of Medicine, New York, NY
| | - Paul Krebs
- Department of Population Health, New York University School of Medicine, New York, NY
| | - Selena Wong
- Department of Population Health, New York University School of Medicine, New York, NY
| | - Robert Furberg
- Center for the Advancement of Health Information Technology, Research Triangle Institute, Raleigh, NC
| | - Scott Sherman
- Department of Population Health, New York University School of Medicine, New York, NY; Behavioral Health Research, St Luke's Roosevelt Hospital, New York, NY
| | | | - Anthony Urbina
- New York University College of Nursing and Center for Drug Use and HIV Research, New York, NY
| | - Charles M Cleland
- New York University College of Nursing and Center for Drug Use and HIV Research, New York, NY
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17
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Schlam TR, Fiore MC, Smith SS, Fraser D, Bolt DM, Collins LM, Mermelstein R, Piper ME, Cook JW, Jorenby DE, Loh WY, Baker TB. Comparative effectiveness of intervention components for producing long-term abstinence from smoking: a factorial screening experiment. Addiction 2016; 111:142-55. [PMID: 26581819 PMCID: PMC4692280 DOI: 10.1111/add.13153] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 04/21/2015] [Accepted: 09/08/2015] [Indexed: 11/28/2022]
Abstract
AIMS To identify promising intervention components that help smokers attain and maintain abstinence during a quit attempt. DESIGN A 2 × 2 × 2 × 2 × 2 randomized factorial experiment. SETTING Eleven primary care clinics in Wisconsin, USA. PARTICIPANTS A total of 544 smokers (59% women, 86% white) recruited during primary care visits and motivated to quit. INTERVENTIONS Five intervention components designed to help smokers attain and maintain abstinence: (1) extended medication (26 versus 8 weeks of nicotine patch + nicotine gum); (2) maintenance (phone) counseling versus none; (3) medication adherence counseling versus none; (4) automated (medication) adherence calls versus none; and (5) electronic medication monitoring with feedback and counseling versus electronic medication monitoring alone. MEASUREMENTS The primary outcome was 7-day self-reported point-prevalence abstinence 1 year after the target quit day. FINDINGS Only extended medication produced a main effect. Twenty-six versus 8 weeks of medication improved point-prevalence abstinence rates (43 versus 34% at 6 months; 34 versus 27% at 1 year; P = 0.01 for both). There were four interaction effects at 1 year, showing that an intervention component's effectiveness depended upon the components with which it was combined. CONCLUSIONS Twenty-six weeks of nicotine patch + nicotine gum (versus 8 weeks) and maintenance counseling provided by phone are promising intervention components for the cessation and maintenance phases of smoking treatment.
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Affiliation(s)
- Tanya R Schlam
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, Madison, WI, USA
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, Madison, WI, USA
| | - Michael C Fiore
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, Madison, WI, USA
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, Madison, WI, USA
| | - Stevens S Smith
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, Madison, WI, USA
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, Madison, WI, USA
| | - David Fraser
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, Madison, WI, USA
| | - Daniel M Bolt
- University of Wisconsin, Department of Educational Psychology, Madison, WI, USA
| | - Linda M Collins
- The Pennsylvania State University, The Methodology Center and Department of Human Development and Family Studies, State College, PA, USA
| | - Robin Mermelstein
- University of Illinois at Chicago, Institute for Health Research and Policy, Chicago, IL, USA
| | - Megan E Piper
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, Madison, WI, USA
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, Madison, WI, USA
| | - Jessica W Cook
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, Madison, WI, USA
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, Madison, WI, USA
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Douglas E Jorenby
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, Madison, WI, USA
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, Madison, WI, USA
| | - Wei-Yin Loh
- University of Wisconsin, Department of Statistics, Madison, WI, USA
| | - Timothy B Baker
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, Madison, WI, USA
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, Madison, WI, USA
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Morphett K, Partridge B, Gartner C, Carter A, Hall W. Why Don't Smokers Want Help to Quit? A Qualitative Study of Smokers' Attitudes towards Assisted vs. Unassisted Quitting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:6591-607. [PMID: 26068089 PMCID: PMC4483718 DOI: 10.3390/ijerph120606591] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 05/29/2015] [Accepted: 06/05/2015] [Indexed: 11/23/2022]
Abstract
The development of prescription medication for smoking cessation and the introduction of evidence-based guidelines for health professionals has increasingly medicalised smoking cessation. There are debates about whether medicalisation is a positive development, or whether it has devalued unassisted quitting. In this debate the views of smokers have been neglected. This study explored the attitudes of smokers towards a range of quitting methods, and their considerations when judging their value. We conducted semi-structured interviews with 29 smokers and analysed data using thematic analysis. The results show that the perceived nature of an individual smoker’s addiction was central to judgments about the value of pharmacological cessation aids, as was personal experience with a method, and how well it was judged to align with an individual’s situation and personality. Unassisted quitting was often described as the best method. Negative views of pharmacological cessation aids were frequently expressed, particularly concerns about side effects from prescription medications. Smokers’ views about the value of different methods were not independent: attitudes about cessation aids were shaped by positive attitudes towards unassisted quitting. Examining smokers’ attitudes towards either assisted or unassisted quitting in isolation provides incomplete information on quitting preferences.
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Affiliation(s)
- Kylie Morphett
- University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital Site, Herston, 4029 Queensland, Australia.
- University of Queensland, School of Public Health, Corner of Wyndham Street and Herston Road, Herston, 4006 Queensland, Australia.
| | - Brad Partridge
- University of Queensland Centre for Youth Substance Abuse, Mental Health Centre, Royal Brisbane and Women's Hospital, Herston, 4029 Queensland, Australia.
| | - Coral Gartner
- University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital Site, Herston, 4029 Queensland, Australia.
- University of Queensland, School of Public Health, Corner of Wyndham Street and Herston Road, Herston, 4006 Queensland, Australia.
| | - Adrian Carter
- University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital Site, Herston, 4029 Queensland, Australia.
- School of Psychological Sciences, Monash University Clinical and Imaging Neuroscience, 770 Blackburn Road, Monash University, Clayton, 3800 Victoria, Australia.
| | - Wayne Hall
- University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital Site, Herston, 4029 Queensland, Australia.
- University of Queensland Centre for Youth Substance Abuse, Mental Health Centre, Royal Brisbane and Women's Hospital, Herston, 4029 Queensland, Australia.
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Combining intensive practice nurse counselling or brief general practitioner advice with varenicline for smoking cessation in primary care: study protocol of a pragmatic randomized controlled trial. Contemp Clin Trials 2015; 41:298-312. [PMID: 25657051 DOI: 10.1016/j.cct.2015.01.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 01/23/2015] [Accepted: 01/24/2015] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Combining behavioural support and pharmacotherapy is most effective for smoking cessation and recommended in clinical guidelines. Despite that smoking cessation assistance from the general practitioner can be effective, dissemination of clinical practice guidelines and efforts on upskilling has not lead to the routine provision of smoking cessation advice among general practitioners. Intensive counselling from the practice nurse could contribute to better smoking cessation rates in primary care. However, the effectiveness of intensive counselling from a practice nurse versus usual care from a general practitioner in combination with varenicline is still unknown. MATERIALS AND METHODS A pragmatic randomized controlled trial was conducted comparing: (a) intensive individual counselling delivered by a practice nurse and (b) brief advice delivered by a general practitioner; both groups received 12-weeks of open-label varenicline. A minimum of 272 adult daily smoking participants were recruited and treated in their routine primary care setting. The primary outcome was defined as prolonged abstinence from weeks 9 to 26, biochemically validated by exhaled carbon monoxide. Data was analysed blinded according to the intention-to-treat principle and participants with missing data on their smoking status at follow-up were counted as smokers. Secondary outcomes included: one-year prolonged abstinence, short-term incremental cost-effectiveness, medication adherence, and baseline predictors of successful smoking cessation. DISCUSSION This trial is the first to provide scientific evidence on the effectiveness, cost-effectiveness, and potential mechanisms of action of intensive practice nurse counselling combined with varenicline under real-life conditions. This paper explains the methodology of the trial and discusses the pragmatic and/or explanatory design aspects. TRIAL REGISTRATION Dutch Trial Register NTR3067.
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Abstract
INTRODUCTION Smokers' treatment expectancies may influence their choice of a particular medication as well as their medication experience. AIMS This study examined the role of smokers' treatment expectancies to their smoking cessation outcomes in a completed, randomized, placebo-controlled trial of naltrexone for smoking cessation, controlling for perceptions of treatment assignment. METHODS Treatment seeking cigarette smokers (N = 315) were randomized to receive either naltrexone (50 mg) or placebo in combination with nicotine patch and behavioral counseling. Expectancies for naltrexone as a smoking cessation aid were assessed at baseline and 4 weeks after the quit date. RESULTS More positive baseline medication expectancies predicted higher quit rates at one month in the naltrexone (OR =1.45, p =.04) group but were associated with lower quit rates in the placebo group (OR =.66, p =.03). Maintaining and/or increasing positive medication expectancies in the first month of treatment was associated with better pill adherence during this interval in the naltrexone group (ps <.05). Positive baseline medication expectancies were also associated with the perception of having received naltrexone over placebo among all participants. CONCLUSIONS Positive medication expectancies in smokers may contribute to better treatment response. Assessing treatment expectancies and attempting to maintain or improve them may be important for the delivery, evaluation, and targeting of smoking cessation treatments.
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Perceived medication assignment during a placebo-controlled laboratory study of varenicline: temporal associations of treatment expectancies with smoking-related outcomes. Psychopharmacology (Berl) 2014; 231:2559-66. [PMID: 24408212 DOI: 10.1007/s00213-013-3420-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 12/17/2013] [Indexed: 12/20/2022]
Abstract
RATIONALE Expectancies regarding treatment assignment may influence outcomes in placebo-controlled trials above and beyond actual treatment assignment. For smoking pharmacotherapies, guessing enrollment in the active medication treatment is associated with higher abstinence rates. However, placebo-controlled trials of smoking pharmacotherapies rarely assess perceived treatment assignment and those that do only collect this information after reaching full dosage. OBJECTIVES To determine the temporal relationship between treatment expectancies and smoking-related variables, we assessed the impact of treatment guess during a placebo-controlled laboratory study of varenicline on measures of craving, smoking reward, and smoking reinforcement. We hypothesized that treatment guess at mid-titration would influence smoking-related measures at full dosage, above and beyond actual medication effects. We also explored factors related to guess stability and differences in blind fidelity between mid-drug titration and full dosage. METHODS Eighty-eight participants completed laboratory assessments at baseline, mid-titration, and full dosage that involved self-report and behavioral measures of tonic craving, cue-provoked craving, smoking reward, and smoking reinforcement. Participants guessed treatment assignment at mid-titration and full dosage. RESULTS Generalized linear models confirmed that, beyond actual treatment assignment, treatment guess improved model fit for both self-report and behavioral smoking-related measures. Further, accuracy of treatment guess improved from titration to full dosage, and specific demographic factors (e.g., gender, race) were associated with type of treatment guess and guess stability across time. CONCLUSIONS These results reinforce the importance of assessing perceived treatment assignment repeatedly during placebo-controlled trials and suggest that treatment expectancies during titration can affect outcomes once full dosage has been reached.
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Factors associated with discontinuation of bupropion and counseling among African American light smokers in a randomized clinical trial. Ann Behav Med 2014; 46:336-48. [PMID: 23733379 DOI: 10.1007/s12160-013-9510-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND African Americans are at risk of inadequate adherence to smoking cessation treatment, yet little is known about what leads to treatment discontinuation. PURPOSE The purpose of this study was to examine the factors associated with discontinuation of treatment in African American light smokers (≤10 cigarettes per day). METHODS Bupropion plasma levels and counseling attendance were measured among 540 African American light smokers in a placebo-controlled randomized trial of bupropion. RESULTS By week 3, 28.0 % of subjects in the bupropion arm had discontinued bupropion, and only moderate associations were found between the plasma levels and self-reported bupropion use (r s = 0.38). By week 16, 36.9 % of all subjects had discontinued counseling. Males had greater odds of discontinuing medication (OR = 2.02, 95% CI = 1.10-3.71, p = 0.02), and older adults had lower odds of discontinuing counseling (OR = 0.96, 95% CI = 0.94-0.97, p < 0.0001). CONCLUSIONS Bupropion and smoking cessation counseling are underutilized even when provided within the context of a randomized trial. Future research is needed to examine strategies for improving treatment utilization among African American smokers.
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Hoogsteder P, van Merrebach M, Otters M, van Schayck O, Kotz D. Exploring Smokers' Knowledge and Expectations Toward Nicotine Vaccination: A Qualitative Study. Subst Use Misuse 2014; 49:87-94. [PMID: 23924241 DOI: 10.3109/10826084.2013.821658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Knowledge and expectations toward smoking cessation therapies may influence effectiveness. Nicotine vaccination is a novel and promising new therapy for smoking cessation. This qualitative study explored smokers' knowledge and expectations toward nicotine vaccination as well as varenicline and counseling for smoking cessation. We conducted focus group discussions and interviews in 25 smokers at Maastricht University, the Netherlands, in 2010. Data were analyzed using conventional content analysis. Participants had serious misconceptions about the purpose of nicotine vaccination, particularly the belief that nicotine vaccines reduce craving. Expectations toward counseling were highest. These results underline misconceptions smokers can have about cessation therapies.
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Affiliation(s)
- Philippe Hoogsteder
- a School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC) , Maastricht, Netherlands
| | - Martijn van Merrebach
- a School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC) , Maastricht, Netherlands
| | - Marjanneke Otters
- a School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC) , Maastricht, Netherlands
| | - Onno van Schayck
- a School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC) , Maastricht, Netherlands
| | - Daniel Kotz
- a School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC) , Maastricht, Netherlands
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Raupach T, Brown J, Herbec A, Brose L, West R. A systematic review of studies assessing the association between adherence to smoking cessation medication and treatment success. Addiction 2014; 109:35-43. [PMID: 23919621 DOI: 10.1111/add.12319] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 07/01/2013] [Accepted: 07/29/2013] [Indexed: 12/01/2022]
Abstract
AIMS Lack of adherence to smoking cessation medication regimens is assumed to play a significant role in limiting their effectiveness. This study aimed to assess evidence for this assumption. METHODS A systematic search was conducted, supplemented by expert consultation, of papers reporting on randomized trials and observational studies examining the association between adherence to cessation medication and the success of quit attempts. To rule out reverse causality, only studies where adherence was assessed prior to relapse were included. Five studies met the inclusion criteria and results were extracted independently by two researchers. Heterogeneity between studies precluded a pooled analysis of the data. RESULTS Studies varied widely with regard to both the definition of adherence and outcome measures. The included studies only addressed adherence to nicotine replacement therapy. One study of lozenge use found that the amount of medication used between 1 and 2 weeks after the quit date predicted abstinence at 6 weeks [adjusted odds ratio (OR) for 'high' versus 'low' lozenge use 1.25; 95% confidence interval (CI) = 1.05-1.50; P < 0.02]. Similarly, one study found a significant impact of oral nicotine consumption during the first week on abstinence at 4 weeks (adjusted OR per additional mg/day = 1.05; CI = 1.01-1.10). Another study found that participants using nicotine replacement therapy for at least 5 weeks were significantly more likely to self-report continuous abstinence at 6 months. The remaining two studies failed to find a significant effect of treatment duration on outcome at 1 and 2 years but had very low power to detect such an effect. CONCLUSIONS There is modest evidence to support the assumption that lack of adherence to nicotine replacement therapy regimens undermines effectiveness in clinical studies.
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Affiliation(s)
- Tobias Raupach
- Department of Cardiology and Pneumology, University Hospital Göttingen, Göttingen, Germany; Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
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Doyle S, Lloyd A, Birt J, Curtis B, Ali S, Godbey K, Sierra-Johnson J, Halford JCG. Willingness to pay for obesity pharmacotherapy. Obesity (Silver Spring) 2012; 20:2019-26. [PMID: 22301901 DOI: 10.1038/oby.2011.387] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Several treatments for obesity have received regulatory approval, but health insurers and other payers typically refuse to support access to them. Thus, patients are left to bear significant out-of-pocket costs for obesity pharmacotherapy. This study aimed to assess preferences and willingness to pay (WTP) for obesity medications among people seeking weight loss in the United States and United Kingdom. An online survey was developed based on literature review, clinician interviews, and profiles of available therapies. Participants indicated their preference for hypothetical treatments which varied by seven attributes: percentage of weight loss, long-term health risk reduction, time to noticeable weight loss, delivery mode, side effects, lifestyle modification, and cost; 502 obese participants completed the survey (mean BMI 37.12 kg/m(2) (±4.63); 73.5% female; 47.7 (±12.9) years of age). The participants deemed weight loss of >21 kg (United Kingdom) and >28 kg (United State) as "acceptable". All treatment attributes were important (P < 0.001) except "time to noticeable weight loss." The survey found that percentage weight loss was the most important factor for patients and a reduction in long-term health risk was relatively less important. Patients were willing to pay £6.51/$10.49 per month per percentage point of weight loss that a pharmacotherapy could provide. Participants also highly valued therapies that did not require substantial lifestyle modifications and were willing to pay £17.78/$30.77 more per month for a one-pill-per-day treatment vs. a weekly injectable. Participants placed a high value on weight loss and avoiding changes to their lifestyle, and less value on reducing long-term risks to health.
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Catz SL, Jack LM, McClure JB, Javitz HS, Deprey M, Zbikowski SM, McAfee T, Richards J, Swan GE. Adherence to varenicline in the COMPASS smoking cessation intervention trial. Nicotine Tob Res 2011; 13:361-8. [PMID: 21350041 PMCID: PMC3082504 DOI: 10.1093/ntr/ntr003] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 01/04/2011] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Patient adherence to smoking cessation medications can impact their effectiveness. It is important to understand the extent to which prescribed medications are actually taken by smokers, how this influences smoking cessation outcomes, and what factors may influence adherence. METHODS Smokers recruited from a large health plan were randomized to receive different modes of cessation counseling in combination with varenicline (Swan, G. E., McClure, J. B., Jack, L. M., Zbikowski, S. M., Javitz, H. S., Catz, S. L., et al. 2010.Behavioral counseling and varenicline treatment for smoking cessation. American Journal of Preventive Medicine, 38, 482-490). One thousand one hundred and sixty-one participants were mailed a 28-day varenicline supply when they set a quit date and were able to request up to two refills from the health plan pharmacy at no cost. Pharmacy fill records were obtained and telephone surveys completed at baseline, 21 days, 12 weeks, and 6 months post target quit date. RESULTS Good adherence to varenicline (≥80% of days taken) was associated with a twofold increase in 6-month quit rates compared with poor adherence (52% vs. 25%). Smokers were more likely than nonsmokers to stop varenicline early. Purposeful nonadherence was associated with smoking at 12 weeks and was predicted in multivariate analyses by age, gender, adherence self-efficacy, and initial medication side effect severity. CONCLUSIONS Innovative methods for increasing adherence to smoking cessation medications are needed, particularly early in the quit process. Simple metrics of adherence such as number of days cessation medication is taken can and should be routinely incorporated in effectiveness trials and reported to advance future attempts to understand and reduce nonadherence.
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Affiliation(s)
- Sheryl L Catz
- Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
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Abstract
Promoting smoking cessation is among the key medical interventions aimed at reducing worldwide morbidity and mortality in this century. Both behavioural counselling and pharmacotherapy have been shown to significantly increase long-term abstinence rates, and combining the two treatment modalities is recommended. This article provides an update on pharmacotherapy for smoking cessation in the general population. Current first-line agents used to support quit attempts are nicotine replacement therapy (NRT), bupropion and varenicline. Research suggests that abstinence rates can be increased by combining different forms of NRT or simultaneously administering NRT and non-nicotine medications. New treatments targeting the nicotinic acetylcholine receptor as well as other pathophysiological pathways involved in nicotine addiction are being developed, with nicotine vaccines now being tested in phase III clinical trials. Among the numerous research topics currently addressed, pharmacogenetics and tailoring therapy to specific groups of smokers look most promising. However, substantial progress is unlikely to be made unless social gradients impeding effective treatment of all smokers are overcome. In addition, public smoking bans and reimbursement of medication costs are crucial in reducing the future burden of disease caused by smoking on a global level.
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Affiliation(s)
- Tobias Raupach
- Department of Cardiology and Pneumology, University Hospital Gttingen, Gttingen, Germany.
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