1
|
Orenstein L, Chetrit A, Kalter-Leibovici O. Factors associated with attempting and succeeding in smoking cessation following a National Tobacco Control Plan: Analysis of two nationwide surveys (2010 and 2017). Addict Behav 2024; 149:107912. [PMID: 37979463 DOI: 10.1016/j.addbeh.2023.107912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/09/2023] [Accepted: 11/12/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION Lower rates of smoking cessation among disadvantaged groups contribute to widening health-disparities. With this recognition, in 2010 free-of-charge/subsidized smoking cessation services became available to all Israeli residents through the not-for-profit health plans. METHODS Based on two cross-sectional National Social Surveys, data on adult ever-smokers were used (n = 2,998 in 2010 and 2,859 in 2017). The outcome variable comprised three categories: no quit attempt, unsuccessful quit attempt and successful quit attempt. Changes over-time and demographic, socioeconomic, health- and smoking-related factors associated with quitting attempts and success were tested in the pooled sample, using multivariable multinomial logistic regression models. RESULTS The pooled sample of the two surveys included 2,611 participants (44.2%) who were successful quitters, 1,941 (32.7%) who reported an unsuccessful quit attempt, and 1,305 (23.1%) smokers who did not attempt to quit. Compared to 2010, ever-smokers in 2017 were less likely to report an unsuccessful quit attempt (adjusted OR = 0.81, 95%CI: 0.70-0.94). The likelihood of successfully quitting was similar in both surveys. Older age and self-reported health problem were associated with higher likelihood of quitting attempt. Meeting living expenses, being overweight/obese, engaging in physical activity and heavy smoking were associated with higher likelihood of successful smoking cessation; while environmental tobacco exposure was associated with 43% lower likelihood of successful cessation. Finally, there was an interaction between education and ethnicity. Higher education level was associated with a greater likelihood both to attempt to quit smoking and to succeed among Jewish participants, while the opposite phenomenon was observed among Arab smokers. CONCLUSIONS Despite the availability of subsidized smoking cessation services, social disparities in smoking cessation rates persist. Efforts should focus on proactively reaching subpopulations with low cessation rates, using tailored strategies for successful smoking cessation. Promoting smoke free homes and workplaces should be prioritized.
Collapse
Affiliation(s)
- Liat Orenstein
- Research Center for Population Health, The Gertner Institute for Epidemiology and Health Policy Research, Chaim Sheba Medical Center, Ramat-Gan 52621, Israel; Epidemiology & Preventive Medicine Department, School of Public Health, Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel.
| | - Angela Chetrit
- Research Center for Population Health, The Gertner Institute for Epidemiology and Health Policy Research, Chaim Sheba Medical Center, Ramat-Gan 52621, Israel; School of Public Health, Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel.
| | - Ofra Kalter-Leibovici
- Research Center for Population Health, The Gertner Institute for Epidemiology and Health Policy Research, Chaim Sheba Medical Center, Ramat-Gan 52621, Israel; Epidemiology & Preventive Medicine Department, School of Public Health, Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel.
| |
Collapse
|
2
|
Jagielo AD, Chieng A, Tran C, Pirkl A, Cao-Nasalga A, Bragg A, Mirkin R, Prochaska JJ. Predictors of Patient Engagement in Telehealth-Delivered Tobacco Cessation Treatment during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:131. [PMID: 38397622 PMCID: PMC10887648 DOI: 10.3390/ijerph21020131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024]
Abstract
Smoking causes one in three cancer deaths and may worsen COVID-19 outcomes. Telehealth tobacco cessation treatment is offered as a covered benefit for patients at the Stanford Cancer Center. We examined predictors of engagement during the COVID-19 pandemic. Data were abstracted from the Electronic Health Record between 3/17/20 (start of pandemic shelter-in-place) and 9/20/22, including patient tobacco use, demographics, and engagement in cessation treatment. Importance of quitting tobacco was obtained for a subset (53%). During the first 2.5 years of the pandemic, 2595 patients were identified as recently using tobacco, and 1571 patients were contacted (61%). Of the 1313 patients still using tobacco (40% women, mean age 59, 66% White, 13% Hispanic), 448 (34%) enrolled in treatment. Patient engagement was greater in pandemic year 1 (42%) than in year 2 (28%) and year 3 (19%). Women (41%) engaged more than men (30%). Patients aged 36-45 (39%), 46-55 (43%), 56-65 (37%), and 66-75 (33%) engaged more than patients aged 18-35 (18%) and >75 (21%). Hispanic/Latinx patients (42%) engaged more than non-Hispanic/Latinx patients (33%). Engagement was not statistically significantly related to patient race. Perceived importance of quitting tobacco was significantly lower in pandemic year 1 than year 2 or 3. Nearly one in three cancer patients engaged in telehealth cessation treatment during the COVID-19 pandemic. Engagement was greater earlier in the pandemic, among women, Hispanic/Latinx individuals, and patients aged 36 to 75. Sheltering-in-place, rather than greater perceived risk, may have facilitated patient engagement in tobacco cessation treatment.
Collapse
Affiliation(s)
- Annemarie D. Jagielo
- PGSP-Stanford PsyD Consortium, Palo Alto University, Palo Alto, CA 94304, USA;
- Department of Psychiatry & Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Amy Chieng
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Palo Alto, CA 94304, USA;
| | - Cindy Tran
- Health Education, Engagement and Promotion, Stanford Healthcare, Menlo Park, CA 94025, USA; (C.T.); (A.P.); (A.C.-N.); (A.B.); (R.M.)
| | - Amy Pirkl
- Health Education, Engagement and Promotion, Stanford Healthcare, Menlo Park, CA 94025, USA; (C.T.); (A.P.); (A.C.-N.); (A.B.); (R.M.)
| | - Ann Cao-Nasalga
- Health Education, Engagement and Promotion, Stanford Healthcare, Menlo Park, CA 94025, USA; (C.T.); (A.P.); (A.C.-N.); (A.B.); (R.M.)
| | - Ashley Bragg
- Health Education, Engagement and Promotion, Stanford Healthcare, Menlo Park, CA 94025, USA; (C.T.); (A.P.); (A.C.-N.); (A.B.); (R.M.)
| | - Rachelle Mirkin
- Health Education, Engagement and Promotion, Stanford Healthcare, Menlo Park, CA 94025, USA; (C.T.); (A.P.); (A.C.-N.); (A.B.); (R.M.)
| | - Judith J. Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Palo Alto, CA 94304, USA;
| |
Collapse
|
3
|
Sancho-Domingo C, Carballo JL, Coloma-Carmona A, van der Hofstadt C, García Del Castillo-López Á, Asensio Sánchez S. Effectiveness of the Brief Guided Self-Change Therapy Combined with Varenicline under "Real-Life" Conditions and Mediators for Smoking Cessation. Subst Use Misuse 2023; 59:110-118. [PMID: 37750391 DOI: 10.1080/10826084.2023.2262021] [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: 09/27/2023]
Abstract
Background: Brief therapies have proven to reduce tobacco cost-effectively, however, unsuccessful quit attempts remain notable in real-life conditions, and the underlying mechanisms of treatment success are still unclear. Objectives: We aimed to analyze the effectiveness of the Guided Self-Change (GSC) therapy combined with varenicline (VAR+T) in public health services against varenicline alone (VAR), and to identify mediators of treatment outcomes. We conducted a two-arm quasi-experimental study with 126 treatment-seeking smokers (age=57.3±9.1 years; 59.5% women). Before treatment, and at weeks 12 and 24, we assessed tobacco use and five potential mediators: withdrawal, craving, motivation to quit, anxiety, and depression. Results: Only 25% of participants adhered to varenicline prescription, and 54% to GSC therapy. VAR+T group showed a greater proportion of abstainers compared to VAR group at week 12 (75% vs 57.4%; φc=0.21) and week 24 (62.9% vs 52.5%; φc=0.10). When controlling for weeks taking varenicline, motivation showed a significant indirect effect over abstinence rates in VAR+T compared with VAR (a1b1=1.34; 95%CI=0.04, 5.03). Conclusions: The GSC effectiveness seems to increase motivation which in turn contributes to reducing tobacco use. The implementation of GSC therapy in public health services could minimize treatment duration and increase smoking abstinence in 'real-life' conditions where varenicline adherence remains low.
Collapse
Affiliation(s)
- Clara Sancho-Domingo
- Health Psychology Department of Miguel Hernández University of Elche, Alicante, Spain
| | - José Luis Carballo
- Health Psychology Department of Miguel Hernández University of Elche, Alicante, Spain
- Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Ainhoa Coloma-Carmona
- Health Psychology Department of Miguel Hernández University of Elche, Alicante, Spain
- Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Carlos van der Hofstadt
- Health Psychology Department of Miguel Hernández University of Elche, Alicante, Spain
- Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Health Psychology Unit of Dr. Balmis General University Hospital, Alicante, Spain
| | | | - Santos Asensio Sánchez
- Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Pneumology Service of the General University Hospital of Alicante, Alicante, Spain
| |
Collapse
|
4
|
Fahey MC, Krukowski RA, Anderson RT, Cohn WF, Porter KJ, Reid T, Wiseman KP, You W, Wood CH, Rucker TW, Little MA. Reaching adults who smoke cigarettes in rural Appalachia: Rationale, design & analysis plan for a mixed-methods study disseminating pharmacy-delivered cessation treatment. Contemp Clin Trials 2023; 134:107335. [PMID: 37730197 PMCID: PMC10841546 DOI: 10.1016/j.cct.2023.107335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/25/2023] [Accepted: 09/15/2023] [Indexed: 09/22/2023]
Abstract
INTRODUCTION Unlike other U.S. geographical regions, cigarette smoking prevalence remains stagnant in rural Appalachia. One avenue for reaching rural residents with evidence-based smoking cessation treatments could be utilizing community pharmacists. This paper describes the design, rationale, and analysis plan for a mixed-method study that will determine combinations of cessation treatment components that can be integrated within community pharmacies in rural Appalachia. The aim is to quantify the individual and synergistic effects of five highly disseminable and sustainable cessation components in a factorial experiment. METHODS This sequential, mixed-method research design, based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, will use a randomized controlled trial with a 25 fully crossed factorial design (32 treatment combinations) to test, alone and in combination, the most effective evidence-based cessation components: (1) QuitAid (yes vs. no) (2) tobacco quit line (yes vs. no) (3) SmokefreeTXT (yes vs. no) (4) combination NRT lozenge + NRT patch (vs. NRT patch alone), and (5) eight weeks of NRT (vs. standard four weeks). RESULTS Logistic regression will model abstinence at six-months, including indicators for the five treatment factors and all two-way interactions between the treatment factors. Demographic and smoking history variables will be considered to assess potential effect modification. Poisson regression will model quit attempts and percent of adherence to treatment components as secondary outcomes. CONCLUSION This study will provide foundational evidence on how community pharmacies in medically underserved, rural regions can be leveraged to increase utilization of existing evidence-based tobacco cessation resources for treating tobacco dependence. CLINICAL TRIALS NCT05660525.
Collapse
Affiliation(s)
- M C Fahey
- Medical University of South Carolina, Charleston, SC, USA
| | - R A Krukowski
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA, USA
| | - R T Anderson
- University of Virginia, School of Medicine, Charlottesville, VA, USA
| | - W F Cohn
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA, USA
| | - K J Porter
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA, USA
| | - T Reid
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA, USA
| | - K P Wiseman
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA, USA
| | - W You
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA, USA
| | - C H Wood
- My Pharmacy, Greensboro, NC, USA
| | - T W Rucker
- University of Virginia, Health Systems, Nellysford, VA, USA
| | - M A Little
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA, USA.
| |
Collapse
|
5
|
Bernstein EY, Chang Y, Levy DE, Baggett TP, Lee SS, Tindle HA, Rigotti NA. Tobacco-Related Disease, Health Beliefs, and Post-hospital Tobacco Abstinence. Am J Prev Med 2023; 65:792-799. [PMID: 37217039 PMCID: PMC10592560 DOI: 10.1016/j.amepre.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/16/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Most hospitalized patients who smoke resume after discharge. Associations of tobacco-related disease and health beliefs with post-hospitalization abstinence were examined. METHODS This was a cohort study using data from a 2018-2020 multicenter trial of hospitalized adults who smoked and wanted to quit. Tobacco-related disease was defined using primary discharge diagnosis codes. Baseline health beliefs included (1) smoking caused hospitalization, (2) quitting speeds recovery, and (3) quitting prevents future illness. Outcomes included self-reported 7-day point prevalence abstinence 1, 3, and 6 months after discharge. Separate logistic regression models for each of the three health beliefs were constructed. Models stratified by tobacco-related disease explored effect modification. Analysis was performed in 2022-2023. RESULTS Of 1,406 participants (mean age 52 years, 56% females, 77% non-Hispanic White), 31% had tobacco-related disease, 42% believed that smoking caused hospitalization, 68% believed that quitting speeds recovery, and 82% believed that quitting prevents future illness. Tobacco-related disease was associated with higher 1-month point prevalence abstinence in each health belief model (AOR=1.55, 95% CI=1.15, 2.10; 1.53, 95% CI=1.14, 2.05; and 1.64, 95% CI=1.24, 2.19, respectively) and higher 6-month point prevalence abstinence in models including health beliefs 2 and 3. Quitting speeds recovery was the only belief associated with higher 1-month point prevalence abstinence (AOR=1.39, 95% CI=1.05, 1.85). Among patients with tobacco-related disease, the belief that quitting prevents future illness was associated with higher 1-month point prevalence abstinence (AOR=2.00, 95% CI=1.06, 3.78). CONCLUSIONS Tobacco-related disease predicts abstinence 1 and 6 months after hospitalization independent of health beliefs. Beliefs that quitting speeds recovery and prevents future illness may serve as targets for smoking-cessation interventions.
Collapse
Affiliation(s)
- Eden Y Bernstein
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Yuchiao Chang
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Tobacco Research & Treatment Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Douglas E Levy
- Harvard Medical School, Boston, Massachusetts; Tobacco Research & Treatment Center, Massachusetts General Hospital, Boston, Massachusetts; Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts
| | - Travis P Baggett
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Tobacco Research & Treatment Center, Massachusetts General Hospital, Boston, Massachusetts; Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts
| | - Scott S Lee
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hilary A Tindle
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Nancy A Rigotti
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Tobacco Research & Treatment Center, Massachusetts General Hospital, Boston, Massachusetts; Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|
6
|
Nam JK, Piper ME, Tong Z, Li R, Yang JJ, Jorenby DE, Buu A. Dependence motives and use contexts that predicted smoking cessation and vaping cessation: A two-year longitudinal study with 13 waves. Drug Alcohol Depend 2023; 250:110871. [PMID: 37406572 PMCID: PMC10623667 DOI: 10.1016/j.drugalcdep.2023.110871] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/10/2023] [Accepted: 06/19/2023] [Indexed: 07/07/2023]
Abstract
INTRODUCTION Prior studies examining the impact of e-cigarette use, dependence, cessation motivation/goals, and environmental restriction on smoking cessation were based on cross-sectional or shorter-term longitudinal data with binary outcomes. There is also a critical knowledge gap in corresponding impact on vaping cessation. This study aims to fill in these gaps by investigating these factors' effects on speed of progression to smoking and vaping cessation. METHODS This study conducted secondary analysis of data from 13 waves of assessment of adult cigarette users in Wisconsin from October 2015 through July 2019. Cox regression was employed to examine baseline predictors' effects on speed of progression to smoking cessation (past-month abstinence) among 405 exclusive combustible cigarette users and dual users of combustible and electronic cigarettes, as well as progression to vaping cession among 178 dual users. RESULTS Dual use of e-cigarettes with cigarettes, lower primary dependence motives of smoking, higher secondary dependence motives of smoking, higher motivation to quit smoking, more ambitious future goals to quit smoking, and more restrictive environment for smoking all contributed to quicker progression to smoking cessation. Dual users with higher secondary dependence motives of smoking or with lower primary dependence motives of vaping progressed faster to vaping cessation. CONCLUSIONS The findings support that nicotine dependence is product-specific with two distinct constructs: the primary dependence motives are associated with more difficulty to quit, whereas the secondary dependence motives have the opposite effect. Dual users with strong instrumental reasons for smoking may not find e-cigarettes as an effective substitute for cigarettes.
Collapse
Affiliation(s)
- Joon Kyung Nam
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center, 7000 Fannin St.Houston, TX77030USA
| | - Megan E Piper
- Center for Tobacco Research & Intervention, University of Wisconsin, 1930 Monroe Street, Suite 200Madison, WI53711USA
| | - Zhaoxue Tong
- Department of Statistics, Pennsylvania State University, 413 Thomas Building, University Park, PA16802-2111USA
| | - Runze Li
- Department of Statistics, Pennsylvania State University, 413 Thomas Building, University Park, PA16802-2111USA
| | - James J Yang
- Department of Biostatistics and Data Science, University of Texas Health Science Center, 1200 Pressler St.Houston, TX77030USA
| | - Douglas E Jorenby
- Center for Tobacco Research & Intervention, University of Wisconsin, 1930 Monroe Street, Suite 200Madison, WI53711USA
| | - Anne Buu
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center, 7000 Fannin St.Houston, TX77030USA.
| |
Collapse
|
7
|
Shorey Fennell B, Cottrell-Daniels C, Hoover DS, Spears CA, Nguyen N, Piñeiro B, McNeill LH, Wetter DW, Vidrine DJ, Vidrine JI. The implementation of ask-advise-connect in a federally qualified health center: a mixed methods evaluation using the re-aim framework. Transl Behav Med 2023; 13:551-560. [PMID: 37000697 PMCID: PMC10415728 DOI: 10.1093/tbm/ibad007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
Ask-Advise-Connect (AAC) efficiently links smokers in healthcare settings with evidence-based Quitline-delivered tobacco treatment through training clinic staff to systematically ask patients about smoking status, advise smokers to quit, and connect patients with state Quitlines using the electronic health record. This study utilized a mixed-methods approach, guided by the RE-AIM framework, to evaluate the implementation of AAC in a Federally Qualified Health Center (FQHC). AAC was implemented for 18 months at a FQHC serving primarily low-socioeconomic status (SES) Latinos and Latinas. Results are presented within the RE-AIM conceptual framework which includes dimensions of reach, effectiveness, adoption, implementation, and maintenance. Quantitative patient-level outcomes of reach, effectiveness, and Impact were calculated. Post-implementation, in-depth interviews were conducted with clinic leadership and staff (N = 9) to gather perceptions and inform future implementation efforts. During the implementation period, 12.0% of GNHC patients who reported current smoking both agreed to have their information sent to the Quitline and were successfully contacted by the Quitline (Reach), 94.8% of patients who spoke with the Quitline enrolled in treatment (Effectiveness), and 11.4% of all identified smokers enrolled in Quitline treatment (Impact). In post-implementation interviews assessing RE-AIM dimensions, clinic staff and leadership identified facilitators and advantages of AAC and reported that AAC was easy to learn and implement, streamlined existing procedures, and had a positive impact on patients. Staff and leadership reported enthusiasm about AAC implementation and believed AAC fit well in the clinic. Staff were interested in AAC becoming the standard of care and made suggestions for future implementation. Clinic staff at a FQHC serving primarily low-SES Latinos and Latinas viewed the ACC implementation process positively. Findings have implications for streamlining clinical smoking cessation procedures and the potential to reduce tobacco-related disparities.
Collapse
Affiliation(s)
| | | | | | - Claire A Spears
- Division of Health Promotion and Behavior, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Nga Nguyen
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bárbara Piñeiro
- Centre d’Estudis Demogràfics, Universitat Autònoma de Barcelona, 08193 Bellaterra, Catalonia, Spain
| | - Lorna H McNeill
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David W Wetter
- Department of Population Health Sciences, Center for Health Outcomes and Population Equity, Huntsman Cancer Institute and the University of Utah, Salt Lake City, UT, USA
| | - Damon J Vidrine
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Jennifer I Vidrine
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| |
Collapse
|
8
|
Yang X, Zhang L, Lin H, Lin H, Cao W, Chang C. Psychiatric symptoms and intentions to quit smoking: How regularity and volume of cigarette consumption moderate the relationship. Tob Induc Dis 2023; 21:78. [PMID: 37323507 PMCID: PMC10266331 DOI: 10.18332/tid/163258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/10/2023] [Accepted: 04/14/2023] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION Smoking prevalence is disproportionately higher in those with psychiatric symptoms. Smokers with psychiatric symptoms are less likely to have an intention to quit smoking and attain eventual smoking abstinence. This study presents the relationship between depressive/anxiety symptoms and the intention to quit smoking and related influencing factors. METHODS A cross-sectional study recruited 931 current smoking individuals covering two provinces in China in July 2022. The online survey comprised questions concerning sociodemographic characteristics, smoking conditions and psychiatric symptoms. Chi-squared analyses and moderation analyses were applied. RESULTS The proportion of smokers who had the intention to quit smoking within six months was 46.1%. In comparison with subjects without depressive/anxiety symptoms, individuals who had both psychiatric symptoms were less likely to have the intention to quit smoking (39.3% vs 49.8%, χ2=9.130, p=0.028). As for the moderating model of depression, the interaction term of depressive symptoms and smoking regularly was significant (β=0.554, t=3.260, p=0.001). For those who were occasional smokers, depressive symptoms significantly lowered their quitting intentions. The regularity of smoking similarly moderated the effect of anxiety symptoms on quitting intentions. When the number of cigarettes used weekly served as the moderator, the interaction of this number and depressive symptoms was significant, as well as for anxiety (p<0.001), indicating that the volume of cigarette consumption moderated the relationship between depressive/anxiety symptoms and intention to quit smoking. CONCLUSIONS Psychiatric symptoms were significant factors in reducing the willingness of smokers to quit smoking, and the effects were moderated by smokers' cigarette consumption conditions. Interventions are urged to enhance quitting intentions of these vulnerable smokers.
Collapse
Affiliation(s)
- Xiaochen Yang
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Lanchao Zhang
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Hao Lin
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Haoxiang Lin
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Wangnan Cao
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Chun Chang
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| |
Collapse
|
9
|
Brett EI, Feather AR, Lee Z, Fridberg DJ, Asvat Y, King AC. Courage to Quit® rolling group: Implementation in an urban medical center in primarily low-income Black smokers. HEALTHCARE (AMSTERDAM, NETHERLANDS) 2023; 11:100674. [PMID: 37028112 PMCID: PMC10330217 DOI: 10.1016/j.hjdsi.2023.100674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 01/10/2023] [Accepted: 01/17/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Continuous "rolling" tobacco group treatments may help reduce cessation disparities by increasing access among underserved people who smoke cigarettes. We evaluated the implementation of a rolling enrollment adaptation of an evidence-based tobacco treatment group intervention, Courage to Quit®-Rolling (CTQ®-R). METHODS The 4-session CTQ®-R incorporating psychoeducation, motivational enhancement, and cognitive behavioral skills was evaluated by examining feasibility and preliminary program outcomes with a pre-post design using the SQUIRE method in a sample of 289 primarily low-income, Black people who smoke. Feasibility was measured by examining program retention. Paired t-tests evaluated changes in behavioral intentions and knowledge about smoking cessation and differences in average daily cigarettes smoked from first to last session attended. RESULTS CTQ-R was feasible to implement in an urban medical center program enrolling primarily low-income Black people who smoke, with 52% attending at least 2 sessions and 24% completing the full program. Participants demonstrated improvements in knowledge of smoking cessation strategies and confidence in quitting (ps < .004). Preliminary effectiveness analyses showed a 30% reduction in average daily cigarette use, with group completers reporting greater reduction than non-completers. CONCLUSIONS CTQ®-R is feasible and showed preliminary effectiveness for increasing knowledge about stop smoking skills and reducing cigarette smoking. IMPLICATIONS A rolling enrollment smoking group treatment is feasible and may be effective among people who smoke who face historical and systemic barriers to tobacco treatment engagement. Evaluation in other settings and over longer periods of time is needed.
Collapse
Affiliation(s)
- Emma I Brett
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience, USA
| | - Abigayle R Feather
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience, USA
| | - Zoe Lee
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience, USA
| | - Daniel J Fridberg
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience, USA
| | - Yasmin Asvat
- Rush University Medical Center, Supportive Oncology, USA
| | - Andrea C King
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience, USA.
| |
Collapse
|
10
|
Effects of psychoeducation combined with transcranial direct current stimulation on reducing cigarette craving and consumption in male smokers. Addict Behav 2023; 141:107643. [PMID: 36791642 DOI: 10.1016/j.addbeh.2023.107643] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/20/2022] [Accepted: 02/02/2023] [Indexed: 02/09/2023]
Abstract
Psychoeducation (PE) has been widely used in smoking interventions, but its long-term effects are limited. Recent studies have reported that, in some fields, a combination of transcranial direct current stimulation (tDCS) and cognitive training (e.g., working memory tasks) may improve cognitive outcomes; thus, we aimed to investigate whether such a combined intervention has a better effect than a PE intervention for reducing smoking cravings and cigarette consumption. In Exp. 1, 19 male smokers received four types of interventions at one-week intervals. In each session, participants were presented with audio PE (or control) while receiving 2-mA active (or sham) tDCS of the dorsolateral prefrontal cortex (DLPFC). In Exp. 2, 48 male smokers were randomized into four experimental groups (PE + Active, Control + Active, PE + Sham, or Control + Sham). Each participant received one type of five-day intervention (i.e., watching a five-minute PE/Control video twice while receiving 2-mA active/sham tDCS) and was followed up for one week. The results showed (a) an enhancement effect of tDCS on PE's ability to reduce cigarette consumption; (b) that repeated PE has a cumulative effect on reducing both craving and cigarette consumption during the intervention period; and (c) that, compared with PE alone, PE combined with tDCS is capable of helping participants maintain a low intake of cigarettes over one week. These findings suggest that repeated interventions of PE combined with tDCS may be effective in reducing smoking consumption and that further studies are warranted to confirm its application.
Collapse
|
11
|
LaRowe LR, Dunsiger SI, Williams DM. Acute exercise-induced changes in motivation and behavioral expectation for quitting smoking as predictors of smoking behavior in women. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2023; 37:475-482. [PMID: 36455006 PMCID: PMC10164050 DOI: 10.1037/adb0000901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Temporally static self-reports of motivation and behavioral expectation are established predictors of addictive behavior. However, previous research has not tested intervention effects on within-day changes in motivation/behavioral expectation for smoking cessation as mediators of smoking abstinence. The goals of this study were to test whether aerobic exercise exerts acute pre-postexercise effects on motivation and behavioral expectation and to test the main and interactive effects of change in motivation/behavioral expectation for cessation on subsequent smoking abstinence. METHOD We conducted secondary analyses of ecological momentary assessment data collected among N = 105 women who participated in a 12-week randomized controlled trial (RCT) examining thrice weekly aerobic exercise (vs. contact control) as an adjunct to cessation treatment. A multilevel, longitudinal mixed-effects model was used to test all pathways simultaneously. RESULTS Exercise (vs. control) was associated with greater increases in motivation (p = .04), but not behavioral expectation (p > .05), pre-to-postexercise session. Increases in motivation and behavioral expectation were associated with higher odds of abstinence at next session (ps < .05), and for those with larger changes in behavioral expectation, larger changes in motivation were associated with greater odds of abstinence (p = .02). There was also an indirect effect of exercise on abstinence via acute changes in motivation (p < .05). CONCLUSIONS A single bout of exercise can increase motivation for quitting smoking, which may improve quit success. Moreover, increasing behavioral expectation may enhance the effect of increased motivation on cessation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Collapse
Affiliation(s)
- Lisa R LaRowe
- Center for Health Promotion and Health Equity, Department of Behavioral and Social Sciences, Brown University School of Public Health
| | - Shira I Dunsiger
- Center for Health Promotion and Health Equity, Department of Behavioral and Social Sciences, Brown University School of Public Health
| | - David M Williams
- Center for Health Promotion and Health Equity, Department of Behavioral and Social Sciences, Brown University School of Public Health
| |
Collapse
|
12
|
Klemperer EM, Streck JM, Lindson N, West JC, Su A, Hughes JR, Carpenter MJ. A systematic review and meta-analysis of interventions to induce attempts to quit tobacco among adults not ready to quit. Exp Clin Psychopharmacol 2023; 31:541-559. [PMID: 35771496 PMCID: PMC10106992 DOI: 10.1037/pha0000583] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The prevalence of past-year smoking cessation remains below 10% in the U.S. Most who smoke are not ready to quit in the near future. Cessation requires both (a) initiating a quit attempt (QA) and (b) maintaining abstinence. Most research has focused on abstinence among people already motivated to quit. We systematically reviewed interventions to promote QAs among people not motivated to quit tobacco. We searched PubMed, CENTRAL, PsycINFO, Embase, and our personal libraries for randomized trials of tobacco interventions that reported QAs as an outcome among adults not ready to quit. We screened studies and extracted data in duplicate. We pooled findings of the 25 included studies using Mantel-Haenszel random effects meta-analyses when ≥ 2 studies tested the same intervention. Most (24) trials addressed cigarettes and one addressed smokeless tobacco. Substantial heterogeneity among trials resulted in a series of small meta-analyses. Findings indicate varenicline may increase QAs more than no varenicline, n = 320; RR = 1.4, 95% CI [1.1, 1.7]; I² = 0%, and nicotine replacement therapy (NRT) may increase QAs more than no NRT, n = 2,568; RR = 1.1, 95% CI [1.02, 1.3]; I² = 0%. Pooled effects for motivational counseling, reduction counseling, and very low nicotine content cigarettes showed no clear evidence of benefit or harm. The evidence was judged to be of medium to very low certainty due to imprecision, inconsistency, and risk of bias, suggesting that further research is likely to change interpretation of our results. Findings demonstrate the need for more high-quality research on interventions to induce QAs among adults not ready to quit tobacco. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Collapse
Affiliation(s)
- Elias M. Klemperer
- Vermont Center on Behavior & Health, Department of Psychiatry, University of Vermont
- Department of Psychological Science, University of Vermont
| | - Joanna M. Streck
- Tobacco Research & Treatment Center, Division of General Internal Medicine and Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford
| | - Julia C. West
- Vermont Center on Behavior & Health, Department of Psychiatry, University of Vermont
- Department of Psychological Science, University of Vermont
| | - Alan Su
- University of Vermont Medical Center
| | - John R. Hughes
- Vermont Center on Behavior & Health, Department of Psychiatry, University of Vermont
- Department of Psychological Science, University of Vermont
| | - Matthew J. Carpenter
- Department of Psychiatry and Behavioral Sciences & Hollings Cancer Center, Medical University of South Carolina
| |
Collapse
|
13
|
Zeren OG, Ilknur D, Rumeysa DH, Gunher AS. The Evaluation Of Smoking Cessation Treatment Success and Related Factors in Adults Age 65 Years and Older. Clin Gerontol 2022; 46:424-432. [PMID: 36576075 DOI: 10.1080/07317115.2022.2158767] [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: 12/29/2022]
Abstract
OBJECTIVES The aim was to evaluate smoking cessation treatment success and factors associated in older adults. METHODS In the retrospective cohort study, the patients' sociodemographic data, smoking history, Fagerström Test for Nicotine Dependence scores (FTND), type of treatments (Pharmacological treatments, behavioral counseling, and/or both) and the number of follow-up sessions in the Smoking Cessation Outpatient Clinic were taken from hospital files of the patients. Treatment success was evaluated as one year of abstinence from smoking. RESULTS Participants' reported with 53% classified as high-very high nicotine dependence. Overall, 36% reported abstinence from smoking for one year or more. Treatment success was associated with higher attendance at follow-up sessions. Using pharmacologic treatments and behavioral counseling together was proved to be more effective than behavioral counseling alone. CONCLUSIONS One-year smoking cessation was achieved in one-third of older adults attending a smoking cessation clinic. In older adults in this sample low FTND scores, use of combined pharmacologic and behavioral treatment, and attendance at follow up sessions were associated with one year smoking abstinence. CLINICAL IMPLICATIONS Older adults should be referred for smoking cessation treatment. Use of combined pharmacological and behavioral counseling is recommended. Efforts to enhance attendance at follow-up sessions should be considered.
Collapse
Affiliation(s)
- Ozturk Guzin Zeren
- Family Medicine Depertmant, Sisli Hamidiye Etfal Research and Training Hospital, İstanbul, Turkey
| | - Demir Ilknur
- Family Medicine Depertmant, Sisli Hamidiye Etfal Research and Training Hospital, İstanbul, Turkey
| | | | - Arıca Secıl Gunher
- Family Medicine Department, Cemil Tasçıoğlu City Hospital, İstanbul, Turkey
| |
Collapse
|
14
|
Morjaria JB, Campagna D, Caci G, O'Leary R, Polosa R. Health impact of e-cigarettes and heated tobacco products in chronic obstructive pulmonary disease: current and emerging evidence. Expert Rev Respir Med 2022; 16:1213-1226. [PMID: 36638185 DOI: 10.1080/17476348.2023.2167716] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Quitting is the only proven method to attenuate the progression of chronic obstructive pulmonary disease (COPD). However, most COPD smokers do not seem to respond to smoking cessation interventions and may benefit by lessening the negative health effects of long-term cigarette smoke exposure by switching to non-combustible nicotine delivery alternatives, such as heated tobacco products (HTPs) and e-cigarettes (ECs). AREAS COVERED Compared with conventional cigarettes, HTPs and ECs offer substantial reduction in exposure to toxic chemicals and have the potential to reduce harm from cigarette smoke when used as tobacco cigarette substitutes. In this review, we examine the available clinical studies and population surveys on the respiratory health effects of ECs and HTPs in COPD patients. EXPERT OPINION The current research on the impact of ECs and HTPs on COPD patients' health is limited, and more high-quality studies are needed to draw definitive conclusions. However, this review provides a comprehensive overview of the available literature for health professionals looking to advise COPD patients on the use of these products. While ECs and HTPs may offer some benefits in reducing harm from cigarette smoke, their long-term effects on COPD patients' health are still unclear.
Collapse
Affiliation(s)
- Jaymin B Morjaria
- Department of Respiratory Medicine, Guy's & St Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, UK
| | - Davide Campagna
- U.O.C. MCAU, University Teaching Hospital 'Policlinico-Vittorio Emanuele', University of Catania, Catania, Italy
- Centre for the Prevention and Treatment of Tobacco Addiction (CPCT), Teaching Hospital "Policlinico - V. Emanuele", University of Catania, Catania, Italy
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Grazia Caci
- Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), Università di Catania, Catania, Italy
| | - Renee O'Leary
- Centre for the Prevention and Treatment of Tobacco Addiction (CPCT), Teaching Hospital "Policlinico - V. Emanuele", University of Catania, Catania, Italy
- ECLAT Srl, Spin-off of the University of Catania, Catania, Italy
| | - Riccardo Polosa
- U.O.C. MCAU, University Teaching Hospital 'Policlinico-Vittorio Emanuele', University of Catania, Catania, Italy
- Centre for the Prevention and Treatment of Tobacco Addiction (CPCT), Teaching Hospital "Policlinico - V. Emanuele", University of Catania, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- ECLAT Srl, Spin-off of the University of Catania, Catania, Italy
- Institute of Internal Medicine, AOU "Policlinico - V. Emanuele - S. Marco", Catania, Italy
| |
Collapse
|
15
|
Krishnan N, Berg CJ, Elmi A, Klemperer EM, Sherman SE, Abroms LC. Predictors of electronic nicotine product quit attempts and cessation: Analysis of waves 3 and 4 of the PATH study. Addict Behav 2022; 134:107419. [PMID: 35810644 DOI: 10.1016/j.addbeh.2022.107419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/17/2022] [Accepted: 06/28/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Identifying theory-based predictors of electronic nicotine product (ENP) quit attempts and cessation can guide the development of effective vaping cessation interventions, which are currently limited. This study examined predictors of ENP quit attempts and cessation among adult ENP users. METHODS Using data from wave 3 (W3; 2015-2016) current established ENP users in the Population Assessment of Tobacco and Health study, we used multivariable logistic regression to identify predictors of (i) wave 4 (W4; 2016-2018) quit attempts (unweighted n = 1,135); and (ii) W4 cessation among those who made a quit attempt (unweighted n = 610). Predictors included Social Cognitive Theory (SCT)-based cognitive (interest in quitting, self-efficacy to quit, outcome expectancies, risk perception), behavioral (smoking status, and use of combustibles, non-combustibles, cannabis, and alcohol), and socio-environmental (perceived disapproval, household rules, exposure to advertising) factors. RESULTS Between W3 and W4, 51.7% of W3 ENP users made a quit attempt. Among those who tried quitting, 68.4% stopped using ENPs. SCT-based predictors of ENP quit attempts included higher interest in quitting ENPs (aOR = 1.18), greater self-efficacy to quit ENPs (aOR = 1.31), and currently using cigarettes (vs non-smoker; aOR = 1.71), non-combustibles (aOR = 2.25), and cannabis (aOR = 1.80). Predictors of ENP cessation included greater self-efficacy to quit ENPs (aOR = 1.33), greater perceived risk of ENPs (aOR = 1.35), and being a current smoker (vs non-smoker; aOR = 3.28). CONCLUSIONS ENP cessation interventions should address cognitive factors, particularly self-efficacy, as it predicted quit attempts and cessation. Cigarette smoking among dual users should be monitored and addressed to ensure that those who quit using ENPs do not maintain cigarette use.
Collapse
Affiliation(s)
- Nandita Krishnan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Angelo Elmi
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Elias M Klemperer
- Vermont Center on Behavior & Health, Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Scott E Sherman
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| |
Collapse
|
16
|
Dülger S. The relationship between smoking cessation success and health literacy in patients given cognitive behavioral therapy and medical treatment. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2084786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Seyhan Dülger
- Pulmonary Diseases Deparment, Health Sciences University Bursa Yüksek İhtisas Education & Research Hospital, Bursa, Türkiye
| |
Collapse
|
17
|
Erdmann M, Edwards B, Adewumi MT. Effect of Electronic Portal Messaging With Embedded Asynchronous Care on Physician-Assisted Smoking Cessation Attempts: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e220348. [PMID: 35226082 PMCID: PMC8886534 DOI: 10.1001/jamanetworkopen.2022.0348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IMPORTANCE Despite the substantial health and financial burdens of smoking and the availability of effective, evidence-based interventions in primary care settings, few smokers and physicians use these strategies for smoking cessation. OBJECTIVE To evaluate whether electronic outreach to smokers with embedded asynchronous care increases the number of quit attempts and explore the roles of the message sender (ie, primary care physician [PCP] vs health care system) and patient-related characteristics. DESIGN, SETTING, AND PARTICIPANTS This quality improvement randomized clinical trial was designed to measure 2 factors: (1) electronic outreach messaging with and without a survey link to asynchronous care and (2) messaging by a personal PCP or health system. The study was conducted within the electronic health record and portal messaging platform of a large health system in the South Central US. Participants were adult patients 18 years or older who were designated as smokers in their electronic health records. Data were collected from January 13 to February 24, 2020, with participating PCPs surveyed in July 2020. INTERVENTIONS Portal messages encouraging a quit attempt and offering physician assistance were sent to smokers who were randomly selected and assigned to 1 of 4 conditions (message with or without embedded asynchronous care and PCP or system as sender). Half of the messages contained an invitation to come to clinics and the other half contained a link to access asynchronous care. MAIN OUTCOMES AND MEASURES The primary outcome was electronic health record-documented quit attempts (1 indicates quit attempt; 0, no quit attempt), which were tracked 30 days after the electronic outreach. Secondary outcomes included physician perceptions of the electronic outreach intervention, using a 5-point scale to assess perceptions of workload, comfort with providing medication from survey information, and further interest in the program 6 months after the intervention. RESULTS A total of 188 participants (99 women [52.4%] and 89 men [47.3%]) with mean (SD) age of 55.2 (13.9) years were randomized to 1 of 4 conditions. Group 1 (n = 46) received a message from the PCP without a link to the survey; group 2 (n = 48) received a message from the PCP with a link to asynchronous care in the form of the survey. Group 3 (n = 47) received a message from the health system without a link to the survey; group 4 (n = 47) received a message from the health system with a link to the survey. No statistically significant difference in documented quite attempts was found among the 4 study groups. There was also no statistically significant difference in quit attempts between the group that received the asynchronous care survey link and the group that did not (odds ratio, 2.50 [95% CI, 0.72-8.72]). However, the quit attempt rate for those with asynchronous care offered (9 of 95 [9.5%]) was more than double the quit attempt rate for those with in-person care offered (4 of 93 [4.3%]). CONCLUSIONS AND RELEVANCE This quality improvement randomized clinical trial did not find a statistically significant difference in physician-assisted quit attempts among patients who received electronic with asynchronous care vs those who received outreach alone, regardless of whether the message source was a PCP or a health system. However, the program engaged patients in difficult-to-reach rural areas as well as younger patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05172219.
Collapse
Affiliation(s)
- Marjorie Erdmann
- Center for Health Systems Innovation, Spears School of Business, Oklahoma State University, Tulsa
| | - Bryan Edwards
- Department of Management, Spears School of Business, Oklahoma State University, Tulsa
| | - Mopileola Tomi Adewumi
- College of Osteopathic Medicine, Center for Health Sciences, Oklahoma State University, Tulsa
| |
Collapse
|
18
|
Pang RD, Tucker CJ, D’Orazio LM, Weinberger AH, Guillot CR. Affect and subjective cognitive functioning by depression symptom levels during naturalistic cigarette smoking in premenopausal females who smoke daily. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2022; 36:90-99. [PMID: 33844567 PMCID: PMC8505572 DOI: 10.1037/adb0000741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Objective: High negative affect, low positive affect, and low cognitive functioning are depression-related states that may be particularly relevant to females who smoke cigarettes and may be more prominent following overnight tobacco abstinence. This study aimed to assess relations between depression symptom levels and negative affect, positive affect, and subjective cognitive functioning in premenopausal females who smoke. Methods: Premenopausal females who smoke daily with low (n = 66) or elevated (n = 33) baseline depression symptoms completed subjective ratings of negative affect, positive affect, and cognitive functioning pre-first cigarette (i.e., after overnight tobacco abstinence) and at random prompts throughout the day via ecological momentary assessment (EMA) for 35 days. Results: Participants with elevated depression symptoms reported overall higher negative affect (p = .01). Positive affect was significantly lower prior to the first cigarette of the day (p < .001), but did not significantly differ between depression symptom groups. Subjective cognitive functioning was significantly lower pre-first cigarette of the day (p < .001). There was a significant Depression Symptom × Prompt Type interaction for subjective cognitive functioning (p = .01). Subjective cognitive functioning did not significantly differ by depression symptom group pre-first cigarette of the day but was significantly different at random prompts throughout the day. Conclusions: As participants smoked as usual, findings identify naturalistic factors which may influence smoking behavior among premenopausal females who smoke with elevated depression symptoms. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Collapse
Affiliation(s)
- Raina D. Pang
- Department of Preventive Medicine and Department of Psychology, University of Southern California
| | - Chyna J. Tucker
- Department of Preventive Medicine, University of Southern California
| | | | - Andrea H. Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University and Department of Epidemiology, and Population Health, Albert Einstein College of Medicine
| | | |
Collapse
|
19
|
Buettner-Schmidt K, Swanson K, Maack B, Barnacle M, Miller D, Orr M, Gag MH. E-cigarettes for tobacco cessation: Not the solution. Nurse Pract 2021; 46:7-11. [PMID: 34808639 DOI: 10.1097/01.npr.0000798228.69915.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
Zacharia M, Ioannou M, Theofanous A, Vasiliou VS, Karekla M. Does Cognitive Fusion show up similarly across two behavioral health samples? Psychometric properties and invariance of the Greek–Cognitive Fusion Questionnaire (G-CFQ). JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
|
21
|
de Granda-Orive JI, Pascual-Lledó JF, Asensio-Sánchez S, Solano-Reina S, García-Rueda M, Martínez-Muñiz MÁ, Lázaro-Asegurado L, Buljubasich D, Luhning S, Pendino RL, Cienfuegos-Agustín I, Jiménez-Ruiz CA. Is the motivation to quit smoking a predictor of abstinence maintenance? Tob Prev Cessat 2021; 7:48. [PMID: 34239998 PMCID: PMC8240875 DOI: 10.18332/tpc/136506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The aim of this study was to explore the utility of measuring motivation to quit smoking as a predictor of abstinence maintenance among smokers who wanted to quit and who were included in a multicenter study conducted in daily clinical practice. METHODS This observational, longitudinal (prospective cohort), multicenter study was conducted in smoking clinics in Spain and the Argentine Republic in daily clinical practice. Motivation was assessed using three quantitative motivation tests and a Visual Analogue Scale. Statistical analysis included descriptive, association measures and logistic regression models. RESULTS Of a total of 404 subjects, 273 were ultimately included for analysis (147 women; 53.8%), mean age 51±11 years). In one year, 53.5% (36.13% by intention to treat) of subjects (146) were successful in quitting smoking [men: 45.2% (66) and women: 54.8% (80)], with no differences between sexes. None of the scales utilized was associated, in an unquestionable or direct way, with long-term abstinence, although three of them, in a very complex model, with additional variables and added interactions, were associated with the ‘result’ variable, when other variables intervened in certain circumstances. CONCLUSIONS None of the analyzed motivational scales alone demonstrated an association with success or failure in quitting smoking; thus, their use in isolation is of no value. Some of the scales analyzed might be related to the maintenance of abstinence but in complex models where other variables intervene, which makes interpretation considerably difficult. Therefore, the predictive capacity of the tests analyzed, based on the models, was low.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Daniel Buljubasich
- Respiratory Department, Sanatorio Nuestra Señora del Rosario, IPAM Medical Center, Rosario, Argentine Republic
| | - Susana Luhning
- Pneumonology Department, Humana Private Medical Institute, External Consultation Assistance Center, Córdoba, Argentine Republic
| | - Roge-Lio Pendino
- Respiratory Department, Sanatorio Nuestra Señora del Rosario, IPAM Medical Center, Rosario, Argentine Republic
| | | | - Carlos A Jiménez-Ruiz
- Madrid Community Specialized Smoking Unit, San Carlos Clinical Hospital, Madrid, Spain
| |
Collapse
|
22
|
Hu Y, Xie J, Chang X, Chen J, Wang W, Zhang L, Zhong R, Chen O, Yu X, Zou Y. Characteristics and Predictors of Abstinence Among Smokers of a Smoking Cessation Clinic in Hunan China. Front Public Health 2021; 9:615817. [PMID: 33816416 PMCID: PMC8017299 DOI: 10.3389/fpubh.2021.615817] [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] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/23/2021] [Indexed: 11/25/2022] Open
Abstract
Background: More than 300 million smokers make China the largest cigarette consumer globally, which is a huge economic burden. Smoking cessation (SC) clinics can offer counseling and follow-up services. The operational experience of SC clinics in China needs to be summarized and improved based on research evidence. Purpose: The objectives of this study were to describe quit rates among attendees of SC clinics in Hunan and assess predictors of successful SC. Methods: The participants in this study were smokers who visited the SC clinic of Hunan Cancer Hospital from February 1, 2015 to September 30, 2018. Individuals who received individual counseling and assessment from the SC clinic staff and were willing to quit smoking were eligible for inclusion. Those with critical illness or cancer were excluded. Application of smoking cessation clinic registration form (unified by Chinese Center for Disease Control and Prevention) was used to assess participants at the consultation. Follow-ups and counseling were performed over telephone at 1 week, 1 month, and 3 months after the initial cessation consultation or in times of need. Successful SC was checked for at 3 months after the start of SC. Results: A total of 328 smokers (mean age 45.67 ± 12.38 years) had participated. The abstinence rate at 3 months was 28.4%. Binary regression analysis revealed significant independent predictors to be the total numbers of SC follow up sessions, previous SC attempts, and participants' decision on when to quit smoking (The relative to quit immediately group, quit within 30 days, quit after 30 days, and undecided quit were less likely to succeed in quitting. while quit within seven days had no statistical significance. Conclusion: SC clinics can achieve a desirably high quit rate. Participant's previous attempts at quitting, three or more follow-ups, and the decision to quit immediately or within seven days were factors helpful in predicting the success of SC.
Collapse
Affiliation(s)
- Yina Hu
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Jianghua Xie
- Hunan University of Chinese Medicine, Changsha, China
| | - Xiaochang Chang
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Jianhua Chen
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Wei Wang
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Lemeng Zhang
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Rui Zhong
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Ouying Chen
- Hunan University of Chinese Medicine, Changsha, China
| | - Xinhua Yu
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Yanhui Zou
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| |
Collapse
|
23
|
Laochai W, Preechawong S. Quit rates and predictors of smoking abstinence in Thai Buddhist monks with noncommunicable diseases. JOURNAL OF HEALTH RESEARCH 2021. [DOI: 10.1108/jhr-08-2020-0336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
The purpose of this study is to calculate the smoking quit rate and to examine the factors influencing smoking abstinence among Thai Buddhist monks with noncommunicable diseases (NCDs).
Design/methodology/approach
This was a cross-sectional study of 136 Buddhist monks with NCDs purposively sampled from the Priest Hospital. The participants were between 20 and 59 years of age, smoked at least one cigarette a day and received cessation advice from nurses or other health professionals. The dependent variable was self-reported 7-day point-prevalence smoking abstinence assessment at a three-month follow-up. Independent variables were age, schooling level, nicotine dependence, intention to quit, physical activity and perceived self-efficacy in quitting cessation. Logistic regression was performed to evaluate the factors influencing smoking cessation.
Findings
50 of the 136 Thai Buddhist monks (36.8%) reported the 7-day point prevalence abstinence at a three-month follow-up. About two-thirds of the participants indicated health concern as the motivation to quit smoking. Perceived self-efficacy of abstinence (odds ratio 1.04; 95% confidence interval 1.014–1.074) and intention to quit smoking (odds ratio 1.34; 95% confidence interval 1.129–1.599) were significant predictors of abstinence.
Originality/value
This is the first study of its kind to investigate the predictors of smoking cessation in Thai Buddhist monks with NCDs. The findings will be of help to healthcare counselors seeking to motivate monks to quit smoking.
Collapse
|
24
|
Park M, Kang B, Ryu A, Li Y, Song R. Motivational Factors for Smoking Behaviors in Individuals with Metabolic Syndrome. Patient Prefer Adherence 2021; 15:2847-2854. [PMID: 34992353 PMCID: PMC8711733 DOI: 10.2147/ppa.s343874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/07/2021] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Smoking, which is one of the major risk factors for metabolic syndrome that causes cardiovascular disease or diabetes, is a crucial risk factor, which is modifiable. This study aimed to determine the factors that promote smoking behaviors according to smoking status among adults with metabolic syndrome. PATIENTS AND METHODS A survey of structured self-reported questionnaires was conducted on 152 adults with metabolic syndrome. Outcome variables included cognitive motivations (self-efficacy, and perceived benefits and barriers), emotional motivation (emotional salience), and autonomous and controlled motivation based on self-determination theory. The participants were categorized by their smoking status (never smoking, quit smoking, or current smoking). Their sociodemographic and motivational factors were examined using one-way analysis of variance, analysis of covariance, and multinomial logistic regression analysis. RESULTS Data on 152 individuals with metabolic syndrome with a mean age of 57.5 years were included. The findings indicated that the motivational factors for the never-smoking and quit-smoking groups significantly differed from those for the current-smoking group in terms of self-efficacy, perceived benefits, perceived barriers, and autonomous motivation. Based on multinomial logistic regression with current smoking as the reference group, sex (being female, OR=57.69) and perceived barriers (OR=0.39) were the significant predictors for the never-smoking group, while autonomous motivation (OR=1.96) was the significant predictor for the quit-smoking group. CONCLUSION The motivational factors for smoking behaviors varied according to the smoking status of adults with metabolic syndrome. Autonomous motivation was the significant predictor of smoking cessation for individuals who successfully quit, whereas cognitive motivation was influential in the prevention of smoking by individuals who have never smoked. Further studies are warranted to develop smoking cessation strategies, which should focus on specific motivational factors to lead effective smoking prevention programs in this population.
Collapse
Affiliation(s)
- Moonkyoung Park
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Baram Kang
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea
- Correspondence: Baram Kang Tel +1 512 839 7227Fax +82 42 580 8309 Email
| | - Ahyun Ryu
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - YueLin Li
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Rhayun Song
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| |
Collapse
|
25
|
Carpenter MJ, Hughes JR. If at First You Don't Try …. Nicotine Tob Res 2020; 22:1431-1432. [PMID: 32266393 DOI: 10.1093/ntr/ntaa062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/06/2020] [Indexed: 01/31/2023]
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
| | - John R Hughes
- Department of Psychiatry, University of Vermont, Burlington, VT
| |
Collapse
|
26
|
Polosa R, Morjaria JB, Prosperini U, Busà B, Pennisi A, Malerba M, Maglia M, Caponnetto P. COPD smokers who switched to e-cigarettes: health outcomes at 5-year follow up. Ther Adv Chronic Dis 2020; 11:2040622320961617. [PMID: 33101622 PMCID: PMC7549158 DOI: 10.1177/2040622320961617] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 09/04/2020] [Indexed: 01/03/2023] Open
Abstract
Background and Aims: The long-term health effects of the use of electronic cigarettes (ECs) in
patients with chronic obstructive pulmonary disease (COPD) are largely
unexplored. We present findings from a 5-year prospective assessment of
respiratory parameters in a cohort of COPD patients who substantially
reduced conventional smoking or achieved abstinence by switching to ECs. Methods: Patients were evaluated prospectively for their measurements of respiratory
exacerbations, spirometric indices, quality of life using the COPD
assessment tool (CAT), 6-min walk distance (6MWD), as well as conventional
cigarette consumption. Baseline measurements prior to switching to EC use
were compared with follow-up visits at 12-, 24-, 48- and 60-months. Age- and
sex-matched COPD patients reporting to be regular smokers (not using ECs)
were the reference group for the analysis. Results: Complete data were available from 39 patients. Those in the EC user group
achieved a marked decline in cigarette smoking or abstinence. COPD EC users
had a significant diminution in COPD exacerbations; with the mean (±SD)
exacerbation rate falling from 2.3 (±0.9) at baseline to 1.1 (±1.0) at
5 years (p < 0.001), whereas no significant changes were
observed in the control group. Significant and constant improvements in lung function, CAT scores and 6MWD
were reported in the EC user group over the 5-year observation period
compared with the reference group (p < 0.05). Conclusion: The present study suggests that EC use may ameliorate objective and
subjective COPD outcomes, and that the benefits gained appear to persist
long term. EC use for abstinence and smoking reduction may ameliorate some
of the harm resulting from tobacco smoking in COPD patients.
Collapse
Affiliation(s)
- Ricardo Polosa
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Jaymin B Morjaria
- Department of Respiratory Medicine, Royal Brompton and Harefield Hospital Foundation Trust, Harefield Hospital, Hill End Road, Harefield UB9 6JH, UK
| | | | - Barbara Busà
- UOC Farmacia Ospedaliera, Hospital ARNAS Garibaldi, Catania, Italy
| | - Alfio Pennisi
- Department of Respiratory Medicine, Hospital Clinics 'Musumeci-Gecas', Catania, Italy
| | - Mario Malerba
- Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), Università di Catania, Catania, Italy
| | - Marilena Maglia
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Pasquale Caponnetto
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| |
Collapse
|
27
|
Heffner JL, Catz SL, Klasnja P, Tiffany B, McClure JB. Development of a Mobile Health Intervention with Personal Experiments for Smokers Who Are Ambivalent About Quitting: Formative Design and Testing. JMIR Form Res 2020; 4:e21784. [PMID: 32852278 PMCID: PMC7484775 DOI: 10.2196/21784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/03/2020] [Indexed: 11/13/2022] Open
Abstract
Background The majority of cigarette smokers want to quit someday but are not ready to commit to long-term abstinence. However, available smoking cessation treatments are not well-suited to meet the needs of these ambivalent smokers. Low-cost, high-reach mobile health (mHealth) interventions may be a cost-efficient means of offering assistance to ambivalent smokers, yet there are currently no evidence-based options available for this group. Objective The aim of this study was to develop and preliminarily evaluate the core content for an mHealth program targeting adult smokers who are ambivalent about quitting. The core content consisted of a series of “personal experiments” similar to those tested as part of a counseling intervention in prior work, including brief cognitive or behavioral tasks designed to boost readiness for changing smoking behavior. Methods We conducted individual user interviews (N=3) to refine program content, and then conducted a one-arm pilot study (N=25) to assess user receptivity and the potential impact of the experiments on motivation and self-efficacy to quit or reduce smoking. Results In user interviews, participants liked the concept of the personal experiments. Participants in the pilot study found a medium-fidelity prototype to be highly acceptable. After watching a brief orientation video that explained how the program works, most participants (80%, 20/25) indicated that it sounded interesting, primarily because it did not require any commitment to quit. All participants (100%, 25/25) completed all 7 experiments, including a 24-hour quit attempt, although not all were able to refrain from smoking for a full day based on qualitative feedback on the experiment. The mean rating of usefulness of the overall program was 4.12 (SD 1.09) out of 5, and the average rating of the difficulty of the experiments was 2.16 (SD 1.18) out of 5. At the last assessment point, 92% (23/25) of the participants indicated that they were more interested in either quitting or cutting back than when they began the program, and 72% (18/25) said that if the program had included a free trial of nicotine replacement therapy, they would have used it to try to quit smoking. Conclusions This formative work confirmed that ambivalent smokers are willing to use and will remain engaged with an mHealth intervention that employs the novel concept of personal experiments to enhance their motivation for and ability to quit smoking. The addition of action-oriented treatment (self-help and free nicotine replacement therapy, quitline referral) could further support users’ efforts to stop smoking and remain quit.
Collapse
Affiliation(s)
- Jaimee L Heffner
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Sheryl L Catz
- Betty Irene Moore School of Nursing, University of California, Sacramento, CA, United States
| | - Predrag Klasnja
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States.,University of Michigan, Ann Arbor, MI, United States
| | - Brooks Tiffany
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Jennifer B McClure
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| |
Collapse
|