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Cohen JF, Ward KM, Gittleman J, Perez E, Pia T, Shuter J, Weinberger AH, Sulkowski M. Hepatitis C and Cigarette Smoking Behavior: Themes From Focus Groups. Nicotine Tob Res 2024; 26:1029-1037. [PMID: 38422381 DOI: 10.1093/ntr/ntae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/12/2024] [Accepted: 02/13/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION People with chronic hepatitis C virus (HCV; PWHC) use cigarettes at a much higher prevalence than other individuals, and smoking can exacerbate the harms specifically related to HCV (eg, hepatocellular carcinoma). Little is known about factors related to cigarette use among PWHC. AIMS AND METHODS This study examined focus group data to explore beliefs and behaviors related to cigarette use among PWHC. Qualitative data from two focus groups of PWHC reporting current cigarette smoking (n = 15, 60% male) were collected using a semi-structured interview guide. Participants were asked about reasons for smoking, barriers to quitting smoking, and the relationship of HCV to smoking. Focus groups were transcribed verbatim and coded in NVivo 12. Four coders examined themes that arose in the focus groups. Common themes are described and supported with quotes. RESULTS Reasons for smoking included addiction to cigarettes, stress, substituting cigarettes for other drugs, and social norms, while reasons for quitting included health and being free from the use of all drugs. Barriers to quitting included concerns about coping with stress, weight gain, and having a lack of support for and education about quitting. Many participants believed there was a link between smoking and HCV and discussed smoking in relation to the stress of an HCV diagnosis. CONCLUSIONS Participants identified both HCV-related and non-HCV-related aspects of cigarette smoking and cessation-related behaviors that could be targeted in cessation treatment. More research is needed to identify the best treatment approaches that reduce the significant medical consequences of cigarette use among PWHC. IMPLICATIONS People with chronic hepatitis C virus (HCV; PWHC) smoke cigarettes at a high prevalence, yet little is known about their smoking behaviors. Moreover, there are no cessation treatments targeting PWHC. This is the first study to collect focus group data from PWHC who smoke in order to identify reasons for cigarette use (HCV-related and non-HCV-related), and motivators and barriers to quitting cigarettes. PWHC reports using cigarettes to cope with the stress of an HCV diagnosis and to celebrate HCV cure. These findings suggest there are specific times during the HCV care continuum where providers can aid with cessation efforts.
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Affiliation(s)
- Julia F Cohen
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Kathleen M Ward
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Jennifer Gittleman
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Esther Perez
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Tyler Pia
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Jonathan Shuter
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- AIDS Center and Division of Infectious Diseases, Montefiore Medical Center, Bronx, NY, USA
| | - Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Psychiatry & Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mark Sulkowski
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
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Bontemps AP, Piper ME, Cropsey KL. Psychometric Properties of the FTCD and Brief WISDM: Support for Validity in a Legal-System-Involved Sample. Nicotine Tob Res 2024; 26:976-983. [PMID: 38267236 PMCID: PMC11260893 DOI: 10.1093/ntr/ntae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 01/26/2024]
Abstract
INTRODUCTION The Fagerström test for cigarette dependence (FTCD) and Brief Wisconsin index of smoking dependence motives (WISDM) are widely used measures of smoking dependence. The FTCD was previously found to have 1-factor and 2-factor structures and Brief WISDM has been found to have an 11-factor and 11-factor hierarchical structure. As such, the current study sought to further investigate the psychometric properties of the FTCD and Brief WISDM with a novel criminal-legal system-involved sample using both a factor-analytic and an item response theory (IRT) approach. AIMS AND METHODS Data from 517 criminal-legal system-involved adults (ie, 18 years of age or older) who smoke from Alabama, USA were analyzed. Confirmatory factor analyses (CFA) were conducted on 1-factor and 2-factor structures of the FTCD and 1-factor, 11-factor, and 11-factor hierarchical structures of the Brief WISDM. IRT analyses investigating item discrimination and threshold parameters were also conducted on the brief WISDM. RESULTS The CFA showed poor fit for a single-factor structure and mixed results for two 2-factor results for the FTCD. CFA also showed poor fit for a single-factor and mixed results for the 11-factor model. Initial IRT investigations using the 11-factor model showed strong item discrimination, but non-ordered threshold parameters. CONCLUSIONS Two-factor structures for the FTCD and the 11-factor model for the Brief WISDM were partially supported in a criminal-legal population, suggesting continued support for the multidimensional structure of the measures. Additionally, exploratory IRT analyses suggested good discrimination across the use spectrum for the Brief WISDM. IMPLICATIONS The Fagerström Test of Cigarette Dependence (FTCD) and Brief Wisconsin index of smoking dependence motives (WISDM) are two widely used measures of nicotine dependence, though previous research has shown mixed results for their internal consistency and factor structure. The current study used a unique sample of criminal-legal-involved participants who generally have moderate to high levels of nicotine dependence. The current study found that the FTCD displayed poor internal consistency, a poor fit for a single-factor model, but mixed support for two two-factor models. The Brief-WISDM was found to have strong internal consistency, a poor fit for a single-factor model, but mixed fit for an 11-factor model and good item discrimination.
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Affiliation(s)
- Andrew P Bontemps
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Megan E Piper
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin––Madison, Madison, WI, USA
| | - Karen L Cropsey
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
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Erinoso O, Watts T, Koning S, Lu M, Wagner K, Pearson J. Choice of smoking cessation products among people with substance use problems in the US: Findings from the Population Assessment of Tobacco and Health (PATH) study Wave 6. Addict Behav 2024; 158:108104. [PMID: 39042998 DOI: 10.1016/j.addbeh.2024.108104] [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: 05/02/2024] [Revised: 07/06/2024] [Accepted: 07/15/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVE The aim of this study was to compare past 12-month use of cigarette smoking cessation aids (e.g., Food and Drug Administration (FDA)-approved cessation products or e-cigarettes for smoking cessation) among people with substance use problems (PWSUPs) who currently smoke to people without substance use problems (SUPs) who currently smoke cigarettes in a nationally representative US sample. METHODS We used the Population Assessment of Tobacco and Health (PATH) Wave 6 Study [n = 30,516]. Our sample comprised adult (18+) established cigarette smokers (100+ lifetime-sticks with daily/non-daily use) [n = 5,895]. The independent variable was SUP status (no, moderate, and high). The dependent variables were past-year use of: nicotine replacement therapies (NRTs), cessation medications [i.e., varenicline or bupropion], or e-cigarettes [for cigarette cessation and reduction]. Weighted multivariable logistic regression models for each dependent variable examined the associations between SUP status and each cessation aid, adjusting for cigarette dependence, daily cigarette smoking, and demographic factors. RESULTS Among people who smoke, a higher proportion of respondents with high SUP severity used NRTs, cessation medications, and e-cigarettes for cigarette cessation, respectively (12.3%, 8.4%, 15.7%), compared to those with no/low SUP severity (9.8%, 6.0%, 8.9%). In the multivariable models, respondents with high SUPs had 63% (95% CI:1.16-2.29) higher odds of using e-cigarettes for cessation than those without SUPs. No significant differences were seen between high (vs. no/low SUPs) in the past-year use of NRTs and cessation medications. CONCLUSION Our findings indicate that cigarette smokers with high SUPs had higher odds of using e-cigarettes for cessation and reduction compared to smokers without SUPs.
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Affiliation(s)
- Olufemi Erinoso
- Department of Health Behavior, Policy, and Administration Sciences, School of Public Health, University of Nevada, Reno, United States.
| | - Theresa Watts
- Orvis School of Nursing, University of Nevada, Reno, United States
| | - Stephanie Koning
- Department of Health Behavior, Policy, and Administration Sciences, School of Public Health, University of Nevada, Reno, United States
| | - Minggen Lu
- Department of Health Behavior, Policy, and Administration Sciences, School of Public Health, University of Nevada, Reno, United States
| | - Karla Wagner
- Department of Health Behavior, Policy, and Administration Sciences, School of Public Health, University of Nevada, Reno, United States
| | - Jennifer Pearson
- Department of Health Behavior, Policy, and Administration Sciences, School of Public Health, University of Nevada, Reno, United States
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Giummo R, Oliver JA, McClernon FJ, Sweitzer MM. Associations between compliance with very low nicotine content (VLNC) cigarettes, abstinence self-efficacy, and quit outcomes in a pilot smoking cessation trial. Drug Alcohol Depend 2024; 262:111393. [PMID: 39024797 DOI: 10.1016/j.drugalcdep.2024.111393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 06/04/2024] [Accepted: 06/22/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Switching to Very Low Nicotine Content (VLNC) cigarettes reduces toxicant exposure and nicotine dependence, and may improve smoking cessation. However, non-compliance with VLNCs is often high, which may reduce their effectiveness. Here, we conducted secondary analyses of a pilot smoking cessation trial utilizing VLNCs to examine associations between pre-cessation VLNC compliance and changes in smoking rate, dependence, and abstinence self-efficacy, as well as quit outcomes. METHODS People who smoke daily (n=35) engaged in a 4-week pre-cessation intervention including VLNCs, transdermal nicotine patch, and behavioral counseling. After quit date, participants received 8 weeks of nicotine replacement therapy and 4 additional behavioral sessions, and were followed for 10 weeks to assess abstinence. Compliance with VLNCs was assessed biweekly during pre-cessation using timeline follow-back. Statistical analyses examined associations between VLNC compliance and a) changes in smoking rate, dependence and abstinence self-efficacy over the course of study cigarette use; and b) time to relapse, controlling for other smoking variables. RESULTS Greater compliance during the second half of study cigarette use was associated with subsequent improvement in self-efficacy (p<.05). Increased self-efficacy and VLNC compliance both predicted lower likelihood of relapse. Nicotine dependence and cigarettes per day both decreased following study cigarette use, but were unrelated to compliance or relapse. CONCLUSIONS Compliance with VLNCs prior to quitting increased abstinence self-efficacy and predicted better quit outcomes above and beyond baseline smoking characteristics. Although preliminary, these findings suggest that identifying strategies to promote exclusive use of VLNCs during a brief pre-cessation window may be beneficial.
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Affiliation(s)
- Ryann Giummo
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, USA
| | - Jason A Oliver
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, USA
| | - F Joseph McClernon
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, USA
| | - Maggie M Sweitzer
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, USA.
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Clausen BK, Yaggi A, Bakhshaie J, Jones AA, Zvolensky MJ. Anxiety sensitivity in relation to smoking dependence motives among Latinx persons who smoke. J Behav Med 2024:10.1007/s10865-024-00504-3. [PMID: 38980459 DOI: 10.1007/s10865-024-00504-3] [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: 10/30/2023] [Accepted: 06/14/2024] [Indexed: 07/10/2024]
Abstract
Hispanic/Latinx (hereafter Latinx) persons are an established tobacco disparities population in the United States (US). Past work has suggested that individual differences in anxiety sensitivity, or the fear of arousal-based sensations, is one important cognitive construct for smoking maintenance and relapse among Latinx persons who smoke. However, previous research has not examined if anxiety sensitivity is associated with motivational facets of smoking dependence among this tobacco disparities population. In the current study, anxiety sensitivity was explored in terms of smoking motives for primary, secondary, and overall cigarette dependence. Participants included 336 English-speaking Latinx adults in the US who smoked cigarettes daily (Mage = 35.53, SD = 8.65, 37.3% Female). Results indicated that anxiety sensitivity was statistically significantly and positively related to higher primary and secondary dependence motives and marginally statistically significant to cigarette dependence; findings were evident after adjusting for numerous theoretically relevant variables (e.g., depression). Overall, the current study is the first to document linkages between anxiety sensitivity and numerous motivational bases of tobacco dependence among Latinx persons who smoke from the US.
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Affiliation(s)
- Bryce K Clausen
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
| | - Anna Yaggi
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jafar Bakhshaie
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Ava A Jones
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA.
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- HEALTH Institute, University of Houston, Houston, TX, USA.
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Zhang D, Chen WJ, Meng XX, Zhao X, Liu RH, Tian HY. Breaking down barriers: rationalisations and motivation to stop among Chinese male smokers under cigarette dependence. BMC Public Health 2024; 24:1812. [PMID: 38972984 PMCID: PMC11229221 DOI: 10.1186/s12889-024-19295-y] [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: 03/29/2024] [Accepted: 06/27/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND Smoking rationalisation beliefs are a huge barrier to quitting smoking. What types of rationalisations should be emphasised in smoking cessation interventions? Although past literature has confirmed the negative relationship between those beliefs and motivation to stop smoking, little is known regarding the importance and performance of those beliefs on motivation with varying cigarette dependence. The study aimed to ascertain rationalisations that are highly important for motivation yet perform poorly in different cigarette dependence groups. METHODS The cross-sectional study was conducted from November 19 to December 9, 2023 in Guiyang City, China. Adult male current smokers were enrolled. Partial least squares structural equation modelling was used to test the hypothesis. The multi-group analysis was used to determine the moderating effect of cigarette dependence, and the importance-performance map analysis was utilised to assess the importance and performance of rationalisations. RESULTS A total of 616 adult male current smokers were analysed, and they were divided into the low cigarette dependence group (n = 297) and the high cigarette dependence group (n = 319). Except for risk generalisation beliefs, smoking functional beliefs (H1: -β = 0.131, P < 0.01), social acceptability beliefs (H3: β = -0.258, P < 0.001), safe smoking beliefs (H4: β = -0.078, P < 0.05), self-exempting beliefs (H5: β = -0.244, P < 0.001), and quitting is harmful beliefs (H6: β = -0.148, P < 0.01) all had a significant positive influence on motivation. Cigarette dependence moderated the correlation between rationalisations and motivation. In the high-dependence group, the social acceptability beliefs and smoking functional beliefs were located in the "Concentrate Here" area. In the low-dependence group, the social acceptability beliefs were also situated in there. CONCLUSIONS Social acceptability beliefs and smoking functional beliefs showed great potential and value for improvement among high-dependence smokers, while only social acceptability beliefs had great potential and value for improvement among low-dependence smokers. Addressing these beliefs will be helpful for smoking cessation. The multi-group analysis and the importance-performance map analysis technique have practical implications and can be expanded to other domains of health education and intervention practice.
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Affiliation(s)
- Dan Zhang
- School of Medicine and Health Management, Guizhou Medical University, No. 6 Ankang Avenue, Guiyang City, 561113, China
- Guizhou Institute of Health Development, Guizhou Medical University, Guiyang, China
| | - Wen-Jiao Chen
- School of Medicine and Health Management, Guizhou Medical University, No. 6 Ankang Avenue, Guiyang City, 561113, China
- School of Sociology, Guizhou Minzu University, Guiyang, China
| | - Xiao-Xia Meng
- School of Medicine and Health Management, Guizhou Medical University, No. 6 Ankang Avenue, Guiyang City, 561113, China
- Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, China
| | - Xiong Zhao
- School of Medicine and Health Management, Guizhou Medical University, No. 6 Ankang Avenue, Guiyang City, 561113, China
- Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, China
| | - Run-Hua Liu
- School of Medicine and Health Management, Guizhou Medical University, No. 6 Ankang Avenue, Guiyang City, 561113, China.
- Center of Medicine Economics and Management Research, Guizhou Medical University, Guiyang, China.
| | - Hai-Yu Tian
- School of Medicine and Health Management, Guizhou Medical University, No. 6 Ankang Avenue, Guiyang City, 561113, China.
- One Health Institute, Guizhou Medical University, Guiyang, China.
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Robinson LE, Didier N, Thomas R, Vena A, King A. Combination Treatment With Varenicline and Nicotine Patch on Smoking Cessation Outcomes in Heavy Drinkers at 26-Week Follow-up. J Clin Psychopharmacol 2024; 44:362-368. [PMID: 38752924 PMCID: PMC11211054 DOI: 10.1097/jcp.0000000000001864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
PURPOSE/BACKGROUND People who smoke cigarettes and drink alcohol heavily are less likely to quit smoking compared with those who do not drink heavily. The current study examined the effects of a 12-week treatment phase of combination varenicline and nicotine patch compared with placebo and nicotine patch on smoking cessation (primary outcome) and alcohol consumption (secondary outcome) in heavy drinking smokers at 26-week follow-up. METHODS/PROCEDURES Participants were daily smokers who met heavy drinking criteria. They were randomly assigned to receive either varenicline and nicotine patch (n = 61) or placebo and nicotine patch (n = 61) for 12 weeks. At week 26, self-reports of point prevalence cigarette abstinence were biochemically confirmed, and past-month alcohol drinking days and heavy drinking days were assessed. FINDINGS/RESULTS At week 26, smoking quit rates did not differ by treatment group (25% varenicline and 26% placebo). Relative to week 12 outcomes, week 26 quit rates significantly dropped off in the varenicline group but not in the placebo group. Alcohol drinking reductions for the whole sample that were previously observed from baseline to week 12 were sustained at week 26, although they did not differ between treatment groups. IMPLICATIONS/CONCLUSIONS In heavy drinking smokers, smoking cessation success was evident in a quarter of the total sample at 3 months postmedication discontinuation. At this time, quit rates were the same between those who received varenicline and nicotine patch and those who received nicotine patch alone. Future research is warranted to examine what may aid in longer-term smoking quit rates in heavy drinking smokers.
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Affiliation(s)
- Layne E Robinson
- From the Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago IL
| | - Nathan Didier
- From the Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago IL
| | - Riya Thomas
- From the Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago IL
| | | | - Andrea King
- From the Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago IL
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Lin CH, Wang CY, Chen KF, Chiu SP, Huang WT, Fan SY. The trajectory of smoking cessation after treatment and its related factors in Taiwan. Sci Rep 2024; 14:13270. [PMID: 38858540 PMCID: PMC11164964 DOI: 10.1038/s41598-024-64311-1] [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: 02/09/2023] [Accepted: 06/07/2024] [Indexed: 06/12/2024] Open
Abstract
Smoking has multiple negative effects on health; therefore, the Taiwanese government provides smoking cessation clinics to smokers. This study aimed to explore the trajectory of smoking cessation after smokers received treatment and the variables related to different trajectories. A retrospective longitudinal study was conducted, in which 735 adult smokers who received smoking cessation medications were recruited. The participants' demographic characteristics, chronic diseases, smoking characteristics, and cigarette dependence were collected from chart review. The amount of smoking was collected at baseline, and at 1 week, 1 month, 3 months, and 6 months after treatment. The Proc Traj procedure for group-based modeling and multinomial logistic regression were used for statistical analysis. Three trajectories were identified: early quitters (28.03%), late quitters (11.43%) and reducers (60.54%). Compared with early quitters, reducers were younger and had a higher probability of severe cigarette dependence. Compared with early quitters, late quitters had a higher number of taking smoking cessation medications. The findings revealed that approximately 60% of participants who received smoking cessation treatment could not completely quit smoking, and that age, number of medications taken, and cigarette dependence were significant predictors of different trajectories.
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Affiliation(s)
- Chia-Hong Lin
- Department of Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Cing-Ya Wang
- Community Nursing Room, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Kuan-Fen Chen
- Community Nursing Room, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Shu-Pi Chiu
- Community Nursing Room, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Wan-Ting Huang
- Clinical Medicine Research Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Sheng-Yu Fan
- Institute of Gerontology, College of Medicine, National Cheng Kung University, No. 1 University Road, Tainan, 701, Taiwan.
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Smits JAJ, Zvolensky MJ, Cheney MK, Rosenfield D, Brown RA, Manser SS, Otto MW, Freeman SZ, Sarmiento MI, Thureen SE. Efficacy and implementation of exercise-based smoking cessation treatment for adults with high anxiety sensitivity (STEP): Study protocol for a randomized controlled trial. Contemp Clin Trials 2024; 141:107521. [PMID: 38580103 PMCID: PMC11139226 DOI: 10.1016/j.cct.2024.107521] [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: 11/14/2023] [Revised: 03/14/2024] [Accepted: 04/02/2024] [Indexed: 04/07/2024]
Abstract
Anxiety sensitivity (AS), reflecting the fear of bodily sensations, is a transdiagnostic vulnerability factor that underpins both affective psychopathology and smoking. Phase II research supports the efficacy of a 15-week community-based intervention (STEP) that combines high-intensity exercise offered by the YMCA with standard smoking cessation treatment (tobacco quitline and nicotine replacement therapy) for sedentary smokers with elevated AS. This Phase III study aims to enroll 360 adults to evaluate whether STEP efficacy for achieving smoking abstinence generalizes to Black and Hispanic smokers with elevated AS.
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Affiliation(s)
- Jasper A J Smits
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, Austin, TX 78712, USA.
| | - Michael J Zvolensky
- Department of Psychology and Health Institute, The University of Houston, Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Marshall K Cheney
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK 73019, USA
| | - David Rosenfield
- Department of Psychology, Southern Methodist University, Dallas, TX 75205, USA
| | - Richard A Brown
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, Austin, TX 78712, USA; School of Nursing, The University of Texas at Austin, Austin, TX 78712, USA
| | | | - Michael W Otto
- Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, USA
| | - Slaton Z Freeman
- Department of Psychology, University of Colorado Denver, Denver, CO 80204, USA
| | - Marla I Sarmiento
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, Austin, TX 78712, USA
| | - Sydney E Thureen
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, Austin, TX 78712, USA
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Barroso-Hurtado M, López-Durán A, Martínez-Vispo C, Suárez-Castro D, Becoña E. Evaluation of effectiveness and acceptability of a psychological treatment for smoking cessation combined with a smartphone App: A pilot study. Internet Interv 2024; 36:100737. [PMID: 38596255 PMCID: PMC11002307 DOI: 10.1016/j.invent.2024.100737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 03/08/2024] [Accepted: 03/26/2024] [Indexed: 04/11/2024] Open
Abstract
Despite the increasing number of mobile-based interventions to quit smoking over the last years, few studies have investigated the efficacy of smoking cessation interventions blended with smartphone Apps. The present pilot study aims to examine the preliminary effectiveness and acceptability of a cognitive-behavioral treatment combined with a smartphone App, compared to the same psychological treatment without the App. The sample comprised 206 treatment-seeking smokers, who were assigned to: 1) an experimental group receiving a cognitive-behavioral intervention combined with the "Non Fumo" App (n = 102), and 2) a control group receiving only the cognitive-behavioral intervention to quit smoking (n = 104). Results concerning the primary outcomes showed no significant differences between conditions in point-prevalence abstinence rates at 12-month follow-up (35.30 % in the experimental group vs. 31.70 % in the control group) and in treatment acceptability. Regarding the secondary outcomes, both groups obtained similar point-prevalence abstinence rates at the end of treatment (61.80 % vs. 65.40 %), at 3-month (42.20 % vs. 45.20 %, respectively) and 6-month follow-ups (37.30 % vs. 37.50 %). No significant differences were found between conditions in prolonged abstinence rates at 6-month (35.3 % vs. 35.6 %) and 12-month follow-ups (30.4 % vs. 26.9 %). Overall, good abstinence rates and treatment acceptability were obtained, although there were no significant differences between conditions. More research is needed to establish clear conclusions about the efficacy of psychological smoking cessation treatments blended with smartphone Apps.
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Affiliation(s)
- María Barroso-Hurtado
- Smoking and Addictive Disorders Unit, Department of Clinical Psychology and Psychobiology University of Santiago de Compostela, Campus Vida, 15782, Spain
| | - Ana López-Durán
- Smoking and Addictive Disorders Unit, Department of Clinical Psychology and Psychobiology University of Santiago de Compostela, Campus Vida, 15782, Spain
| | - Carmela Martínez-Vispo
- Smoking and Addictive Disorders Unit, Department of Clinical Psychology and Psychobiology University of Santiago de Compostela, Campus Vida, 15782, Spain
| | - Daniel Suárez-Castro
- Smoking and Addictive Disorders Unit, Department of Clinical Psychology and Psychobiology University of Santiago de Compostela, Campus Vida, 15782, Spain
| | - Elisardo Becoña
- Smoking and Addictive Disorders Unit, Department of Clinical Psychology and Psychobiology University of Santiago de Compostela, Campus Vida, 15782, Spain
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Blondé J, Falomir-Pichastor JM, Desrichard O. Unveiling the psychological mechanisms of mutual help groups for addiction recovery: The role of social identity factors. BRITISH JOURNAL OF SOCIAL PSYCHOLOGY 2024. [PMID: 38809032 DOI: 10.1111/bjso.12771] [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: 11/29/2023] [Revised: 04/08/2024] [Accepted: 05/10/2024] [Indexed: 05/30/2024]
Abstract
The effectiveness of mutual help groups (MHGs) in promoting addiction recovery has been widely acknowledged. However, the psychological mechanisms underlying the impact of MHGs remain somewhat uncertain. Drawing on a social identity perspective, this study investigated a sequential mediation model in which social support is posited as a driving factor that enhances abstinence maintenance through group identification, recovery identity, and self-efficacy. A sample of 820 smokers, participating in a 6-month collective smoking cessation programme which included access to an online help group, completed measures of social support, group identification, smoker/ex-smoker identity, and self-efficacy at the programme's outset. Smoking abstinence was assessed 6 and 9 months later. The findings supported the proposed model, indicating that social support was positively associated with MHG identification, which, in turn, was related to a stronger recovery identity. Subsequently, recovery identity was associated with increased self-efficacy, and indirectly, with smoking abstinence at both measurement times. Additional analyses testing alternative mediation models further supported the validity of the proposed model. These findings suggest that social identity factors play significant roles in accounting for the effectiveness of MHGs for addiction recovery.
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File D, Petro B, Kojouharova P, Kővári L, Gaál ZA, Demetrovics Z, Czigler I. The imbalance of self-reported wanting and liking is associated with the degree of attentional bias toward smoking-related stimuli in low nicotine dependence smokers. Front Psychol 2024; 15:1356434. [PMID: 38807953 PMCID: PMC11132262 DOI: 10.3389/fpsyg.2024.1356434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 04/25/2024] [Indexed: 05/30/2024] Open
Abstract
Background and aims The Incentive Sensitization Theory (IST) offers a comprehensive framework that explains how attentional mechanisms contribute to the maintenance and relapse of addictive behavior. However, the extent to which the underlying neuropsychological mechanisms are consciously accessible for report remains unknown. Thus, the aim of this study was to investigate the association between self-reported wanting and liking among smokers and its relationship with detecting changes in smoking-related stimuli. Design An online experiment was designed deploying a flicker paradigm with neutral and smoking-related changes, completed by 422 individuals (mean age = 29.1 years, 214 non-smokers, 123 current smokers, and 85 former smokers). Additionally, the Fagerström Test for Cigarette Dependence and the Imaginative Wanting and Liking Questionnaire were administered. Findings Consistent with prior research findings, smokers exhibited faster detection of smoking-related changes compared to non-smokers, while former smokers displayed an intermediate level of attentional bias, falling between the levels observed in smokers and non-smokers. Further, higher levels of nicotine dependence were associated with a greater discrepancy between self-reported wanting and liking, which was associated with better change detection performance for high salience smoking-related stimuli in smokers. Conclusion These findings support the predictions of IST and support the notion that attentional bias might develops early in the course of nicotine addiction. Furthermore, the results indicate that the underlying cognitive mechanisms might be partially within conscious awareness, which opens up potential avenues for research design, treatment, and interventions.
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Affiliation(s)
- Domonkos File
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Institute of Cognitive Neuroscience and Psychology, HUN-REN Research Centre for Natural Sciences, Budapest, Hungary
| | - Bela Petro
- Institute of Psychology, Pázmány Péter Catholic University, Budapest, Hungary
| | - Petia Kojouharova
- Institute of Cognitive Neuroscience and Psychology, HUN-REN Research Centre for Natural Sciences, Budapest, Hungary
| | - Lili Kővári
- Institute of Cognitive Neuroscience and Psychology, HUN-REN Research Centre for Natural Sciences, Budapest, Hungary
| | - Zsófia Anna Gaál
- Institute of Cognitive Neuroscience and Psychology, HUN-REN Research Centre for Natural Sciences, Budapest, Hungary
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Center of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - István Czigler
- Institute of Cognitive Neuroscience and Psychology, HUN-REN Research Centre for Natural Sciences, Budapest, Hungary
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13
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Afolalu EF, Salzberger T, Abetz-Webb L, Cano S, Weitkunat R, Rose JE, Chrea C. Development and initial validation of a new self-report measure to assess perceived dependence on tobacco and nicotine products. Sci Rep 2024; 14:10098. [PMID: 38698227 PMCID: PMC11066063 DOI: 10.1038/s41598-024-60790-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/26/2024] [Indexed: 05/05/2024] Open
Abstract
How nicotine is administered has evolved from cigarettes to various delivery systems. Assessing perceived dependence on nicotine-containing products now requires accounting for product specificity while allowing comparisons across products and users. This study aims to develop a new self-report measure to assess perceived dependence on tobacco and nicotine products (TNPs) among exclusive and poly-TNP users. A draft version of the new measure, the ABOUT-Dependence, was constructed based on literature review, qualitative research, and expert opinion. Data for scale formation and psychometric assessment was obtained through a US-based web survey (n = 2334) that included additional dependence measures for convergent validity assessment. Qualitative research confirmed a preliminary conceptual framework with seven sub-concepts. Following a cognitive debriefing, 19 items were considered to best represent the different sub-concepts. Psychometric findings supported a three-domain structure [i.e., behavioral impact (five items), signs and symptoms (five items), and extent/timing of use (two items)] and an overall total composite score. The data confirmed convergent and known-group validity, as well as test-retest reliability. The ABOUT-Dependence is a 12-item, psychometrically sound, self-report measure that may be used as a tool for research and further understanding of perceived dependence across the spectrum of TNP and TNP users.
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Affiliation(s)
- Esther F Afolalu
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland.
| | - Thomas Salzberger
- Institute for Statistics and Mathematics, WU Wien (Vienna University of Economics and Business), Welthandelsplatz 1, 1020, Vienna, Austria
| | - Linda Abetz-Webb
- Patient-Centered Outcomes Assessments Ltd., 1 Springbank, Bollington, Macclesfield, Cheshire, SK10 5LQ, United Kingdom
| | - Stefan Cano
- Modus Outcomes, St. James House, St. James Square, Cheltenham, GL50 3PR, United Kingdom
| | - Rolf Weitkunat
- Department of Psychology, University of Fribourg, Rue P.-A.-de-Faucigny 2, 1700, Fribourg, Switzerland
| | - Jed E Rose
- Rose Research Center, 7240 ACC Blvd., Raleigh, NC, 27617, USA
| | - Christelle Chrea
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, 2000, Neuchâtel, Switzerland
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14
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Fuchshuber J, Schöber H, Wohlmuth M, Senra H, Rominger C, Schwerdtfeger A, Unterrainer HF. The effectiveness of a standardized tobacco cessation program on psychophysiological parameters in patients with addiction undergoing long-term rehabilitation: a quasi-experimental pilot study. BMC Med 2024; 22:184. [PMID: 38693570 PMCID: PMC11064355 DOI: 10.1186/s12916-024-03405-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/25/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Although there is a very high comorbidity between tobacco dependence and other addictive disorders, there are only few studies examining the implementation and outcomes of a tobacco cessation program in patients with addictive diseases. Therefore, the aim of this study is to investigate to what extent a standardized tobacco cessation program leads to improvements regarding psychological/physical parameters in patients with addiction undergoing therapy and whether there is a reduction in tobacco consumption. METHODS The study took place in a therapeutic community specialized in addiction therapy. A total sample of 56 participants were non-randomly assigned to an intervention group (IG; n = 31) and a treatment as usual group (TAUG; n = 25). The IG participated in a 6-week tobacco cessation program, while the TAUG received no additional treatment. Both groups were assessed for changes in primary outcomes (tobacco dependence, smoked cigarettes per day (CPD), and general substance-related craving) and secondary outcomes (heart rate variability (HRV): root mean square of successive differences, self-efficacy, and comorbid psychiatric symptoms) at two measurement time points (pre- and post-treatment/6 weeks). RESULTS We observed significant improvements in self-efficacy (F(1,53) = 5.86; p < .05; ηp2 = .11) and decreased CPD in the IG (β = 1.16, ρ < .05), while no significant changes were observed in the TAUG. No significant interaction effects were observed in psychiatric symptoms, general substance-related craving, and HRV. CONCLUSIONS The results highlight the potential benefit of an additional tobacco cessation program as part of a general addiction treatment. Although no improvements in the physiological domain were observed, there were significant improvements regarding self-efficacy and CPD in the IG compared to the TAUG. Randomized controlled trials on larger samples would be an important next step. TRIAL REGISTRATION ISRCTN15684371.
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Affiliation(s)
- J Fuchshuber
- Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Vienna, Austria
- Center for Integrative Addiction Research (CIAR), Grüner Kreis Society, Vienna, Austria
| | - H Schöber
- Institute of Psychology, University of Graz, Graz, Austria
| | - M Wohlmuth
- Institute of Psychology, University of Graz, Graz, Austria
| | - H Senra
- IEETA, University of Aveiro, Aveiro, Portugal
- School of Health and Social Care, University of Essex, Colchester, UK
| | - C Rominger
- Institute of Psychology, University of Graz, Graz, Austria
| | | | - H F Unterrainer
- Center for Integrative Addiction Research (CIAR), Grüner Kreis Society, Vienna, Austria.
- Institute of Psychology, University of Graz, Graz, Austria.
- University Clinic for Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria.
- Department of Religious Studies, University of Vienna, Vienna, Austria.
- Faculty of Psychotherapy Science, Sigmund Freud University, Vienna, Austria.
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Pesola F, Smith KM, Phillips-Waller A, Przulj D, Griffiths C, Walton R, McRobbie H, Coleman T, Lewis S, Whitemore R, Clark M, Ussher M, Sinclair L, Seager E, Cooper S, Bauld L, Naughton F, Sasieni P, Manyonda I, Hajek P. Safety of e-cigarettes and nicotine patches as stop-smoking aids in pregnancy: Secondary analysis of the Pregnancy Trial of E-cigarettes and Patches (PREP) randomized controlled trial. Addiction 2024; 119:875-884. [PMID: 38229538 DOI: 10.1111/add.16422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/16/2023] [Indexed: 01/18/2024]
Abstract
AIMS The aim of this study was to examine the safety of e-cigarettes (EC) and nicotine patches (NRT) when used to help pregnant smokers quit. DESIGN A recent trial of EC versus NRT reported safety outcomes in the randomized arms. We conducted a further analysis based on product use. SETTING Twenty-three hospitals in England and a stop-smoking service in Scotland took part. PARTICIPANTS The participants comprised 1140 pregnant smokers. INTERVENTIONS We compared women using and not using EC and NRT regularly during pregnancy. MEASUREMENTS Measurements included nicotine intake compared with baseline, birth weight, other pregnancy outcomes, adverse events, maternal respiratory symptoms and relapse in early abstainers. FINDINGS Use of EC was more common than use of NRT (47.3% vs 21.6%, P < 0.001). Women who stopped smoking (abstainers) and used EC at the end-of-pregnancy (EOP) reduced their salivary cotinine by 45% [49.3 ng/ml, 95% confidence interval (CI) = -79.8 to -10]. Only one abstainer used NRT at EOP. In dual users, cotinine increased by 19% (24 ng/ml, 95% CI = 3.5-68). In women reporting a reduction of at least 50% in cigarette consumption, cotinine levels increased by 10% in those using nicotine products and by 9% in those who did not. Birth weights in dual users and exclusive smokers were the same (3.1 kg). Birth weight in abstainers using either nicotine product was higher than in smokers [3.3 kg, standard deviation (SD) = 0.7] versus 3.1 kg, SD = 0.6; difference = 0.15 kg, 95% CI = 0.05-0.25) and not different from abstainers not using nicotine products (3.1 kg, SD = 0.8). Abstainers and smokers using nicotine products had no worse pregnancy outcomes or more adverse events than abstainers and smokers not using them. EC users reported more improvements than non-users in cough [adjusted relative risk (aRR) = 0.59, 95% CI = 0.37-0.93] and phlegm (aRR = 0.53, 95% CI = 0.31-0.92), controlling for smoking status. EC or NRT use had no association with relapse. CONCLUSIONS Regular use of e-cigarettes or nicotine patches by pregnant smokers does not appear to be associated with any adverse outcomes.
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Affiliation(s)
- Francesca Pesola
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Katie Myers Smith
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Anna Phillips-Waller
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Dunja Przulj
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | | | - Robert Walton
- Blizard Institute, Queen Mary University of London, London, UK
| | - Hayden McRobbie
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Tim Coleman
- Centre for Academic Primary Care, University of Nottingham, Nottingham, UK
| | - Sarah Lewis
- Centre for Academic Primary Care, University of Nottingham, Nottingham, UK
| | - Rachel Whitemore
- Centre for Academic Primary Care, University of Nottingham, Nottingham, UK
| | - Miranda Clark
- Centre for Academic Primary Care, University of Nottingham, Nottingham, UK
| | - Michael Ussher
- Division of Population Health Sciences and Education, St George's, University of London and Institute of Social Marketing and Health, University of Stirling, Stirling, UK
| | - Lesley Sinclair
- Usher Institute and SPECTRUM Consortium, University of Edinburgh, Edinburgh, UK
| | - Emily Seager
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Sue Cooper
- Centre for Academic Primary Care, University of Nottingham, Nottingham, UK
| | - Linda Bauld
- Usher Institute and SPECTRUM Consortium, University of Edinburgh, Edinburgh, UK
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Peter Sasieni
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Isaac Manyonda
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Peter Hajek
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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16
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Gollan JK, Liverant G, Jao NC, Lord KA, Whitton AE, Hogarth L, Fox E, Bauer AM, Quinn MH, Pizzagalli DA, Leone FT, Papandonatos GD, Schnoll RA, Hitsman B. Depression Severity Moderates Reward Learning Among Smokers With Current or Past Major Depressive Disorder in a Smoking Cessation Randomized Clinical Trial. Nicotine Tob Res 2024; 26:639-644. [PMID: 37943674 PMCID: PMC11033567 DOI: 10.1093/ntr/ntad221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 10/11/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Behavioral and pharmacological smoking cessation treatments are hypothesized to increase patients' reward learning to reduce craving. Identifying changes in reward learning processes that support effective tobacco-dependence interventions among smokers who experience depression may guide patients toward efficient treatment strategies. The objective was to investigate the extent to which adult daily cigarette smokers with current or past major depressive disorder (MDD) learned to seek reward during 12 weeks of treatment combining behavioral activation and varenicline. We hypothesized that a decline in reward learning would be attenuated (least to most) in the following order: (1) behavioral activation integrated with ST (BASC) + varenicline, (2) BASC + placebo, (3) standard behavioral cessation treatment (ST) + varenicline, (4) ST + placebo. METHODS We ran a phase IV, placebo-controlled, randomized clinical trial with 300 participants receiving 12 weeks of one of four conditions across two urban medical centers. Depressive symptoms were measured using the Beck Depression Inventory-II (BDI). Reward learning was ascertained at weeks 1, 7, and 14 using the Probabilistic Reward Task (PRT), a laboratory task that uses an asymmetric reinforcement schedule to assess (a) learning to seek reward (response bias), (b) differentiate between stimuli, and (c) time to react to cues. RESULTS There was a significant interaction of BDI group × PRT response bias. Response bias declined from weeks 7 to 14 among participants with high baseline depression symptoms. The other two BDI groups showed no change in response bias. CONCLUSIONS Controlling for baseline depression, participants showed a decrease in response bias from weeks 1 to 14, and from weeks 7 to 14. Treatment condition and abstinence status were unassociated with change in reward learning. IMPLICATIONS Smokers who report greater depression severity show a decline in reward learning despite their participation in smoking cessation treatments, suggesting that depressed populations pose unique challenges with standard smoking cessation approaches. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02378714.
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Affiliation(s)
- Jacqueline K Gollan
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | | | - Nancy C Jao
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Kayla A Lord
- Institute of Living, Hartford Hospital, Hartford, CT, USA
| | - Alexis E Whitton
- Black Dog Institute, The University of New South Wales, Sydney, New South Wales, Australia
| | - Lee Hogarth
- Department of Psychology, University of Exeter, Exeter, UK
| | - Erica Fox
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Anna-Marika Bauer
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mackenzie Hosie Quinn
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Frank T Leone
- Pulmonary, Allergy & Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Robert A Schnoll
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Statistical Sciences, Brown University, Providence, RI, USA
| | - Brian Hitsman
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Abrantes AM, Browne J, Uebelacker LA, Anderson BJ, Barter S, Shah Z, Kunicki ZJ, Caviness C, Price LH, Desaulniers J, Brown RA. Randomized Controlled Trial of Aerobic Exercise for Smoking Cessation Among Individuals With Elevated Depressive Symptoms. Nicotine Tob Res 2024; 26:634-638. [PMID: 37819741 PMCID: PMC11033564 DOI: 10.1093/ntr/ntad201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 08/28/2023] [Accepted: 10/09/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Adults with depression have higher rates of cigarette smoking and are more likely to relapse than those without depression. Pharmacological, psychological, and combined interventions have largely yielded small improvements in smoking outcomes for adults with depression. Aerobic exercise (AE) may facilitate smoking cessation in this subpopulation. METHODS This study was a 12-week two-arm randomized controlled trial that evaluated the effect of a moderate-intensity AE program compared to a health education contact (HEC) control on smoking cessation in adults with elevated depressive symptoms (mild to severe). Participants (n = 231) were randomized to AE or HEC and received smoking cessation treatment (telephone counseling and nicotine replacement therapy). Primary (biologically confirmed 7-day point prevalence abstinence) and secondary (depressive symptoms, objective and self-reported physical activity, and cardiorespiratory fitness) outcomes were assessed at baseline, 3, 6, and 12 months. Data were analyzed with mixed-effects generalized linear models controlling for age, gender, nicotine dependence, history of major depression disorder, and month of follow-up assessment. RESULTS There were no significant differences in primary or secondary outcomes between the AE and HEC groups. CONCLUSIONS The AE program was not superior to HEC in facilitating smoking cessation, increases in physical activity, or improved depressive symptoms. Given evidence for the positive acute effects of exercise on mood and smoking urges, future research should consider testing alternative exercise approaches for aiding smoking cessation beyond structured, AE programs. IMPLICATIONS This study found that an adjunctive aerobic exercise (AE) program was not superior to a health education contact control for adults with elevated depressive symptoms, all of whom also received standard smoking cessation treatment. This finding adds to the growing body of literature that structured AE programs for smoking cessation may have limited efficacy for cessation outcomes. Future research is needed to test alternative methods of integrating AE into smoking cessation treatment, such as strategically using exercise to manage cravings and low mood in the moment.
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Affiliation(s)
- Ana M Abrantes
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Julia Browne
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Department of Psychology and School of Nursing, Research Service, VA Providence Healthcare System, Providence, RI, USA
| | - Lisa A Uebelacker
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Bradley J Anderson
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, USA
| | - Sarah Barter
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, USA
| | - Zainab Shah
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, USA
| | - Zachary J Kunicki
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Celeste Caviness
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, USA
| | - Lawrence H Price
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Julie Desaulniers
- Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, USA
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Schnoll R, Wileyto EP, Bauer AM, Fox EN, Blumenthal D, Hosie Quinn M, Leone F, Huffman MD, Khan SS, Gollan JK, Papandonatos GD, Hitsman B. Seeing Through the Blind: Belief About Treatment Randomization and Smoking Cessation Outcome Among People With Current or Past Major Depressive Disorder Who Smoke in a Placebo-Controlled Trial of Varenicline. Nicotine Tob Res 2024; 26:597-603. [PMID: 37934573 PMCID: PMC11033566 DOI: 10.1093/ntr/ntad218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/20/2023] [Accepted: 10/27/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Blinding participants to randomization is a cornerstone of science. However, participant beliefs about their allocation can influence outcomes. We examined blind integrity, the association between trial arm belief and cessation, and potential mechanisms linking treatment arm and treatment arm belief among people with major depressive disorder (MDD) who smoke receiving varenicline in a placebo-controlled trial. AIMS AND METHODS 175 participants were asked at the end of treatment (EOT) if they thought they received placebo, varenicline, or were not sure. We assessed the relationship between treatment arm belief and actual treatment allocation, examined the association between treatment arm belief and EOT cessation, and evaluated changes in craving, withdrawal, side effects, depression symptoms, and smoking reward as mediators through which treatment arm was believed. RESULTS Treatment arm belief was significantly associated with actual arm assignment (χ2(2) = 13.0, p = .002). Participants in the varenicline arm were >3 times as likely to believe they were taking varenicline, versus "not sure" (RR = 3.05 [1.41-6.60], p = .005). Participants in the placebo arm were just as likely to believe they were taking placebo versus "not sure" (χ2[2] = 0.75, p = .69). Controlling for treatment arm, belief that one received varenicline was significantly associated with an increase in cessation rate (OR = 5.91 [2.06-16.92], p = .001). Change in the rewarding experience of smoking may mediate participant ability to discern getting varenicline (B = 0.077 [0.002-0.192], p < .05). CONCLUSIONS Participants receiving varenicline can discern that they received varenicline and this belief is associated with higher cessation rates. Research is needed to continue to examine how participants correctly identify their allocation to varenicline. TRIAL REGISTRATION Data come from the trial NCT02378714. IMPLICATIONS The present study adds to the sparse literature on blind integrity, particularly in the field of tobacco cessation. Randomized clinical trial participants can discern their assignment to varenicline, and believing that one received varenicline was associated with significantly higher cessation rates. Identifying treatment arm allocation may be associated with changes in the rewarding aspects of smoking that have been well documented with varenicline use. Masking allocation to varenicline is challenging. The effects of this medication in clinical trials may represent both pharmacological effects and participants' abilities to recognize that they are receiving the medication.
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Affiliation(s)
- Robert Schnoll
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, United States
| | - E Paul Wileyto
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, United States
| | - Anna-Marika Bauer
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Erica N Fox
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Daniel Blumenthal
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Mackenzie Hosie Quinn
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Frank Leone
- Department of Medicine, Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania, Philadelphia, PA, United States
| | - Mark D Huffman
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Sadiya S Khan
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Jacqueline K Gollan
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - George D Papandonatos
- Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Brian Hitsman
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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19
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Francis AN, Sebille S, Whitfield-Gabrieli S, Camprodon JA. Multimodal 7T imaging reveals enhanced functional coupling between salience and frontoparietal networks in young adult tobacco cigarette smokers. Brain Imaging Behav 2024:10.1007/s11682-024-00882-x. [PMID: 38639847 DOI: 10.1007/s11682-024-00882-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 04/20/2024]
Abstract
Tobacco cigarette smoking is associated with disrupted brain network dynamics in resting brain networks including the Salience (SN) and Fronto parietal (FPN). Unified multimodal methods [Resting state connectivity analysis, Diffusion Tensor Imaging (DTI), neurite orientation dispersion and density imaging (NODDI), and cortical thickness analysis] were employed to test the hypothesis that the impact of cigarette smoking on the balance among these networks is due to alterations in white matter connectivity, microstructural architecture, functional connectivity and cortical thickness (CT) and that these metrics define fundamental differences between people who smoke and nonsmokers. Multimodal analyses of previously collected 7 Tesla MRI data via the Human Connectome Project were performed on 22 people who smoke (average number of daily cigarettes was 10 ± 5) and 22 age- and sex-matched nonsmoking controls. First, functional connectivity analysis was used to examine SN-FPN-DMN interactions between people who smoke and nonsmokers. The anatomy of these networks was then assessed using DTI and CT analyses while microstructural architecture of WM was analyzed using the NODDI toolbox. Seed-based connectivity analysis revealed significantly enhanced within network [p = 0.001 FDR corrected] and between network functional coupling of the salience and R-frontoparietal networks in people who smoke [p = 0.004 FDR corrected]. The network connectivity was lateralized to the right hemisphere. Whole brain diffusion analysis revealed no significant differences between people who smoke and nonsmokers in Fractional Anisotropy, Mean diffusivity and in neurite orienting and density. There were also no significant differences in CT in the hubs of these networks. Our results demonstrate that tobacco cigarette smoking is associated with enhanced functional connectivity, but anatomy is largely intact in young adults. Whether this enhanced connectivity is pre-existing, transient or permanent is not known. The observed enhanced connectivity in resting state networks may contribute to the maintenance of smoking frequency.
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Affiliation(s)
- Alan N Francis
- Department of Neuroscience, University of Texas, Rio Grande Valley, Edinburg, TX, USA.
| | - Sophie Sebille
- Department of Neuroscience GHU Paris Psychiatrie et Neurosciences, Paris, France
| | | | - Joan A Camprodon
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, USA
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20
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Mifsud JL, Galea J. Cardiovascular Risk Factors Among First-Degree Relatives of Patients with Premature Cardiovascular Disease in Malta. Baseline Findings from the CRISO Project. Vasc Health Risk Manag 2024; 20:167-176. [PMID: 38616927 PMCID: PMC11015845 DOI: 10.2147/vhrm.s449672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/29/2024] [Indexed: 04/16/2024] Open
Abstract
Purpose A family history of premature atherosclerotic cardiovascular disease (ASCVD) confers a greater risk of developing ASCVD. However, the prevalence of ASCVD risk factors among asymptomatic Maltese adults with parental or fraternal history of premature ASCVD is unknown. The study aimed to evaluate and compare their risk with the general population. Patients and Methods Posters to market the project were distributed in cardiac rehabilitation areas. Patients with premature cardiovascular disease facilitated recruitment by informing their relatives about the project. Medical doctors and cardiac rehabilitation nurses referred first-degree relatives. Posters were put up in community pharmacies, and an explanatory video clip was shared on social media for interested individuals to contact researchers. Those eligible were enrolled in a preventive cardiology lifestyle intervention. Their data were compared with the risk in the general population. Results Many first-degree relatives had a suboptimal risk profile, with 60% (N = 89) having a total cholesterol level of >5.0 mmol/L; 54% having a low-density lipoprotein-cholesterol level of >3 mmol/L; 70.5% being overweight/obese, with 62% having a waist circumference greater than the recommended values; 34.8% having hypertension; 56.2% being inadequately adherent to the Mediterranean diet; 62% being underactive, with 18% being sedentary; and 25.8% being smokers. First-degree relatives had significantly higher proportions of underactive lifestyle (p = 0.00016), high body mass index (>25kg/m2) (p = 0.006), and systolic blood pressure (p = 0.001) than the general population, with 30% having metabolic syndrome. Conclusion This study determined the prevalence of lifestyle, biochemical, physiological, and anthropometric cardiovascular risk factors among asymptomatic first-degree relatives of Maltese patients with premature ASCVD. First-degree relatives had considerable prevalences of an underactive lifestyle, hypertension, and obesity, suggesting better screening and early risk factor intervention are needed to modify their risk of ASCVD.
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Affiliation(s)
- Justin Lee Mifsud
- Department of Nursing, Faculty of Health Sciences, University of Malta, Msida, Malta
- Department of Medicine, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Joseph Galea
- Department of Medicine, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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21
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Kale D, Brown J, Dawkins L, Goniewicz ML, Leppin C, Tattan-Birch H, Shahab L. Comparing identity, attitudes, and indicators of effectiveness in people who smoke, vape or use heated tobacco products: A cross-sectional study. Addict Behav 2024; 151:107933. [PMID: 38142579 DOI: 10.1016/j.addbeh.2023.107933] [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: 08/04/2023] [Revised: 11/27/2023] [Accepted: 12/05/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND There is limited long-term and independent research on heated tobacco products (HTPs). We compared people who used HTPs with those who used nicotine vaping products (NVP) or cigarettes on smoker identity, indicators of effectiveness and, among NVP/HTP users, perceptions of these products. METHODS Adults exclusive cigarette smokers (N = 45) and ex-smokers with medium/long-term (>3months) NVP (N = 46) or HTP use (N = 45) were recruited in London, UK. Participants completed a questionnaire assessing socio-demographics, smoking characteristics, smoker identity, dependence, intention to stop and attitudes towards HTP/NVP. RESULTS In adjusted analysis, people who used cigarettes (Mean Difference (MD) = 1.4, 95%Confidence Intervals (CI) 0.7,2.0) and HTPs (MD = 0.8, 95%CI 0.1, 1.5) reported stronger smoker identities than those who used NVPs. Compared with smokers, HTP/NVP users had lower cravings for cigarettes (MD = 3.0, 95%CI 1.6, 4.3; MD = 3.1, 95%CI 1.9, 4.3, respectively), and higher intention to stop product use (MD = -0.8, 95%CI -1.7,-0.01; MD = -1.2, 95%CI -2.0, -0.3, respectively). People using HTPs or NVPs reported similar perceived product satisfaction (HTP:M = 3.4, 95%CI 2.8, 3.9; NVP:M = 3.0, 95%CI 2.5, 3.5), efficacy for smoking cessation (HTP:M = 4.5, 95%CI 4.2, 4.9; NVP:M = 4.6, 95%CI 4.3, 4.9) and safety (HTP:M = 2.1, 95%CI 2.0, 2.2; NVP:M = 2.0, 95%CI 1.8, 2.1). HTP users reported greater perceived addictiveness than NVPs (MD = 0.3, 95%CI 0.2, 0.6). CONCLUSIONS HTP and NVP users perceived products to be similarly acceptable and effective suggesting that HTPs, like NVPs, may support smoking cessation. However, since HTP use appears to maintain a stronger smoker identity and perceived addiction, this may suggest a more limited role of HTP for a permanent transition away from cigarettes.
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Affiliation(s)
- Dimitra Kale
- Department of Behavioural Science and Health, University College London, UK; SPECTRUM Consortium, UK.
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, UK; SPECTRUM Consortium, UK
| | - Lynne Dawkins
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, UK
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Corinna Leppin
- Department of Behavioural Science and Health, University College London, UK; SPECTRUM Consortium, UK
| | - Harry Tattan-Birch
- Department of Behavioural Science and Health, University College London, UK; SPECTRUM Consortium, UK
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, UK; SPECTRUM Consortium, UK
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22
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Schöttl SE, Insam K, Frühauf A, Kopp-Wilfling P, Holzner B, Kopp M. Acute effects of outdoor and indoor walking on cigarette cravings, withdrawal symptoms and affective response during temporary smoking abstinence. Psychopharmacology (Berl) 2024; 241:739-752. [PMID: 38001265 PMCID: PMC10927848 DOI: 10.1007/s00213-023-06506-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023]
Abstract
RATIONALE Cigarette smoking is one of the leading preventable causes of premature death worldwide. There is evidence in the literature that brief exercise units indoors can improve well-being in temporarily abstinent smokers and reduce cigarette cravings and withdrawal symptoms. OBJECTIVE Because exercise in natural environments showed enhanced psychological effects, the aim of our study was to examine the acute effects of outdoor exercise compared with indoor exercise on craving, withdrawal symptoms and affective response in temporarily abstinent smokers. METHODS In a randomized controlled within-subject-design, temporarily abstinent smokers (N = 16) participated in three interventions lasting 10 min: outdoor walking (OUT-EX), indoor walking (IN-EX) and a sedentary control condition (CC). Self-reported cigarette craving, withdrawal symptoms and affective response were assessed pre-, mid-, post-interventions and at follow-up. RESULTS In contrast to CC, OUT-EX and IN-EX significantly reduced cigarette cravings during and at the end of the intervention compared to pre-intervention, but not at 20 min follow-up. Cigarette withdrawal symptoms decreased significantly over time in all three groups, but no significant group differences were found. OUT-EX and IN-EX, but not CC, showed significantly improved affective valence at the end of the intervention and at follow-ups. Outdoor walking resulted in significantly lower cigarette cravings than indoor walking at the end of the intervention. CONCLUSION The study adds to existing evidence that short bouts of indoor or outdoor exercise can help reduce cigarette cravings and increase well-being in abstinent smokers. Further studies are needed to address the potential additional effect of outdoor exercise on craving, affective states and smoking cessation.
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Affiliation(s)
- Stefanie E Schöttl
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria.
| | - Kathrin Insam
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria
| | - Anika Frühauf
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria
| | - Prisca Kopp-Wilfling
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatry I, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Bernhard Holzner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatry I, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Martin Kopp
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria
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23
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Schröder B, Kroczek A, Kroczek LOH, Ehlis AC, Batra A, Mühlberger A. Cigarette craving in virtual reality cue exposure in abstainers and relapsed smokers. Sci Rep 2024; 14:7538. [PMID: 38553517 PMCID: PMC10980682 DOI: 10.1038/s41598-024-58168-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 03/26/2024] [Indexed: 04/02/2024] Open
Abstract
Cue exposure therapy (CET) in substance-use disorders aims to reduce craving and ultimately relapse rates. Applying CET in virtual reality (VR) was proposed to increase its efficacy, as VR enables the presentation of social and environmental cues along with substance-related stimuli. However, limited success has been reported so far when applying VR-CET for smoking cessation. Understanding if effects of VR-CET differ between future abstainers and relapsing smokers may help to improve VR-CET. Data from 102 participants allocated to the intervention arm (VR-CET) of a recent RCT comparing VR-CET to relaxation in the context of smoking cessation was analyzed with respect to tolerability, presence, and craving during VR-CET. Cue exposure was conducted in four VR contexts (Loneliness/Rumination, Party, Stress, Café), each presented twice. Relapsed smokers compared to abstainers experienced higher craving during VR-CET and stronger craving responses especially during the Stress scenario. Furthermore, lower mean craving during VR-CET positively predicted abstinence at 6-month follow-up. Attempts to improve smoking cessation outcomes of VR-CET should aim to identify smokers who are more at risk of relapse based on high craving levels during VR-CET. Specifically measuring craving responses during social stress seems to be well suited to mark relapse. We propose to investigate individualized treatment approaches accordingly.
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Affiliation(s)
- Benedikt Schröder
- Department for Psychology, Clinical Psychology and Psychotherapy, University of Regensburg, Universitätsstraße 31, 93053, Regensburg, Germany.
| | - Agnes Kroczek
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University Hospital Tübingen, Tübingen, Germany
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), Section for Addiction Research and Medicine University Hospital Tübingen, Tübingen, Germany
| | - Leon O H Kroczek
- Department for Psychology, Clinical Psychology and Psychotherapy, University of Regensburg, Universitätsstraße 31, 93053, Regensburg, Germany
| | - Ann-Christine Ehlis
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University Hospital Tübingen, Tübingen, Germany
- German Center for Mental Health (DZPG), partner site Tübingen, Tübingen, Germany
| | - Anil Batra
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University Hospital Tübingen, Tübingen, Germany
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), Section for Addiction Research and Medicine University Hospital Tübingen, Tübingen, Germany
- German Center for Mental Health (DZPG), partner site Tübingen, Tübingen, Germany
| | - Andreas Mühlberger
- Department for Psychology, Clinical Psychology and Psychotherapy, University of Regensburg, Universitätsstraße 31, 93053, Regensburg, Germany
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24
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Lin HX, Liu Z, Hajek P, Zhang WT, Wu Y, Zhu BC, Liu HH, Xiang Q, Zhang Y, Li SB, Pesola F, Wang YY. Efficacy of Electronic Cigarettes vs Varenicline and Nicotine Chewing Gum as an Aid to Stop Smoking: A Randomized Clinical Trial. JAMA Intern Med 2024; 184:291-299. [PMID: 38285562 PMCID: PMC10825782 DOI: 10.1001/jamainternmed.2023.7846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/30/2023] [Indexed: 01/31/2024]
Abstract
Importance Electronic cigarettes (ECs) are often used by smokers as an aid to stopping smoking, but evidence is limited regarding their efficacy compared with nicotine replacement therapy (NRT), and no evidence is available on how their efficacy compares with that of varenicline. Objective To evaluate whether ECs are superior to NRT and noninferior to varenicline in helping smokers quit. Design, Setting, and Participants This was a randomized clinical trial conducted at 7 sites in China and including participants who were smoking at least 10 cigarettes per day and motivated to quit, not using stop-smoking medications or EC, and willing to use any of the study products. Participants were first recruited in May 2021, and data analysis was conducted in December 2022. Interventions A cartridge-based EC (30 mg/mL nicotine salt for 2 weeks and 50 mg/mL after that), varenicline (0.5 mg, once a day for 3 days; 0.5 mg, twice a day for 4 days; and 1 mg, twice a day, after that), and 2 mg (for smokers of ≤20 cigarettes per day) or 4 mg (>20 cigarettes per day) nicotine chewing gum, all provided for 12 weeks and accompanied by minimal behavioral support (an invitation to join a self-help internet forum). Main Outcomes and Measures The primary outcome was sustained abstinence from smoking at 6 months as validated by an expired-air carbon monoxide reading (<8 parts per million). Participants lost to follow-up were included as nonabstainers. Results Of 1068 participants, 357 (33.5%) were female, and the mean (SD) age was 33.9 (3.1) years. A total of 409 (38.3%), 409 (38.3%), and 250 (23.4%) participants were randomized to the EC, varenicline, and NRT arms, respectively. The 6-month biochemically validated abstinence rates were 15.7% (n = 64), 14.2% (n = 58), and 8.8% (n = 22) in the EC, varenicline, and NRT study arms, respectively. The quit rate in the EC arm was noninferior to the varenicline arm (absolute risk reduction, 1.47%; 95% CI, -1.41% to 4.34%) and higher than in the NRT arm (odds ratio, 1.92; 95% CI, 1.15-3.21). Treatment adherence was similar in all study arms during the initial 3 months, but 257 participants (62.8%) in the EC arm were still using ECs at 6 months, with no further use in the 2 other study arms. The most common adverse reactions were throat irritation (32 [7.8%]) and mouth irritation (28 [6.9%]) in the EC arm, nausea (36 [8.8%]) in the varenicline arm, and throat irritation (20 [8.0%]) and mouth irritation (22 [8.8%]) in the NRT arm. No serious adverse events were recorded. Conclusions and Relevance The results of this randomized clinical trial found that when all treatments were provided with minimal behavior support, the efficacy of EC was noninferior to varenicline and superior to nicotine chewing gum. Trial Registration Chinese Clinical Trial Registry: ChiCTR2100048156.
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Affiliation(s)
- Hao-Xiang Lin
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Zhao Liu
- Department of Tobacco Control and Prevention of Respiratory Disease, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Peter Hajek
- Wolfson Institute of Population Health, Queen Mary University of London, London, England
| | - Wan-Tong Zhang
- Institute of Clinical Pharmacology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuan Wu
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Bao-Chen Zhu
- Department of Pharmacy, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hai-Hua Liu
- Department of Traditional Chinese Medicine, Beijing Geriatric Hospital, Beijing, China
| | - Qiu Xiang
- Respiratory Intensive Care Unit, Tongji Hospital Affiliated with Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Yan Zhang
- Office of China Journal of Traditional Chinese Medicine and Pharmacy, Beijing, China
| | - Shu-Bin Li
- Beijing PL Technology Co, Ltd, Beijing, China
| | - Francesca Pesola
- Wolfson Institute of Population Health, Queen Mary University of London, London, England
| | - Ying-Ying Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
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25
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Petzold J, Pochon JBF, Ghahremani DG, London ED. Structural indices of brain aging in methamphetamine use disorder. Drug Alcohol Depend 2024; 256:111107. [PMID: 38330525 DOI: 10.1016/j.drugalcdep.2024.111107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/01/2024] [Accepted: 01/17/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Methamphetamine use is surging globally. It has been linked to premature stroke, Parkinsonism, and dementia, suggesting that it may accelerate brain aging. METHODS We performed a retrospective study to determine if structural indices of brain aging were more prevalent prior to old age (26 - 54 years) in individuals with Methamphetamine Use Disorder (MUD), who were in early abstinence (M ± SD = 22.1 ± 25.6 days) than in healthy control (HC) participants. We compared T1-weighted MRI brain scans in age- and sex-matched groups (n = 89/group) on three structural features of brain aging: the brain volume/cerebrospinal fluid (BV/CSF) index, volume of white matter hypointensities/lesions, and choroid plexus volume. RESULTS The MUD group had a lower mean BV/CSF index and larger volumes of white matter hypointensities and choroid plexus (p-values < 0.01). Regression analyses showed significant age-by-group effects, indicating different age trajectories of the BV/CSF index and choroid plexus volume, consistent with abnormal global brain atrophy and choroid plexus pathology in the MUD group. Significant age and group main effects reflected a larger volume of white matter hypointensities for older participants across groups and for the MUD group irrespective of age. None of the three measures of brain aging correlated significantly with recent use or duration of recent abstinence from methamphetamine. CONCLUSIONS Premature brain pathology, which may reflect cerebrovascular damage and dysfunction of the choroid plexus, occurs in people with MUD. Such pathology may affect cognition and thereby efficacy of behavioral treatments for MUD.
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Affiliation(s)
- Johannes Petzold
- Jane and Terry Semel Institute of Neuroscience and Human Behavior, and Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA, USA; Department of Psychiatry and Psychotherapy, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Jean-Baptiste F Pochon
- Jane and Terry Semel Institute of Neuroscience and Human Behavior, and Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA, USA
| | - Dara G Ghahremani
- Jane and Terry Semel Institute of Neuroscience and Human Behavior, and Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA, USA
| | - Edythe D London
- Jane and Terry Semel Institute of Neuroscience and Human Behavior, and Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA, USA; The Brain Research Institute, University of California at Los Angeles, Los Angeles, CA, USA; Department of Molecular and Medical Pharmacology, University of California at Los Angeles, Los Angeles, CA, USA.
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26
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West AL, Correll L, Kirschner JH. Reducing tobacco and nicotine use among women in treatment for substance use disorder: evaluation of the knit to quit program. Arts Health 2024:1-16. [PMID: 38420998 DOI: 10.1080/17533015.2024.2321944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Tobacco and nicotine use are prevalent in residential substance use disorder (SUD) treatment programs that serve pregnant and parenting women. This study evaluated a group intervention that integrates knitting instruction, psychoeducation, and social support to improve readiness to quit and reduce tobacco and nicotine use among this population. METHODS Clients and staff in four residential SUD treatment programs were assigned to a six-week group intervention or a wait-list control group. Intervention implementation and preliminary effectiveness were assessed using surveys, interviews, and observational measures. RESULTS From pre- to post-test, knowledge related to tobacco and nicotine use increased and number of cigarettes smoked per day and nicotine dependence decreased, on average. Additionally, the intervention group reported lower levels of nicotine dependence relative to the control group. Participants described knitting as an enjoyable replacement for smoking and a strategy to regulate stress and emotions. CONCLUSIONS Smoking cessation interventions that include knitting are promising and warrant further testing.
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Affiliation(s)
- Allison L West
- Department of Population, Family, & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Leeya Correll
- Department of Population, Family, & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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27
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DeAtley T, Stone MD, Strasser AA, Audrain-McGovern J. The role of IQOS risk perceptions on cigarette smoking behaviours: results from a prospective pilot study. Tob Control 2024; 33:263-266. [PMID: 36002165 PMCID: PMC10394684 DOI: 10.1136/tc-2022-057461] [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: 04/11/2022] [Accepted: 08/09/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND IQOS is a heated tobacco product marketed as an alternative to combustible cigarette smoking. Little is known about cigarette smokers' IQOS health risk perceptions and if these risk perceptions impact IQOS use and cigarette smoking behaviour. METHODS Adult, daily, non-treatment-seeking cigarette smokers (n=27), naïve to IQOS, were recruited from Philadelphia, Pennsylvania, USA. Participants were introduced to IQOS and then completed measures of risk perceptions. Participants were given an IQOS 2.4 holder, charger and HeatSticks, and asked to switch completely from cigarettes to IQOS for 14 days. The effects of risk perceptions on changes in IQOS use, cigarettes per day (CPD), the substitution of IQOS for cigarettes and motivation to quit smoking were evaluated. RESULTS Over the 14-day switch period, CPD significantly decreased (B=-0.18, 95% CI=-0.26 to -0.09, p<0.0001), IQOS use significantly increased (B=0.02, 95% CI=0.00 to 0.03, p=0.042), as did the percentage IQOS HeatSticks that replaced CPD (B=0.02, 95% CI=0.01 to 0.03, p=0.005). Participants who perceived IQOS as less risky than cigarettes used fewer IQOS HeatSticks per day. A lower percentage of IQOS HeatStick substitution for cigarettes was observed for participants with higher versus lower risk perceptions (B=-0.14, 95% CI=-0.28 to -0.01, p=0.042). Motivation to quit increased from a mean of 5.53 to 6.79 on the contemplation ladder from baseline to day 14 (B=1.26, 95% CI=0.54 to 1.97, p<0.001). CONCLUSIONS Smokers reduced their smoking rate and increased motivation to quit smoking while using IQOS. IQOS risk perceptions did not directly account for reductions in smoking, although they may contribute indirectly through increased IQOS use.
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Affiliation(s)
- Teresa DeAtley
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew D Stone
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew A Strasser
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Janet Audrain-McGovern
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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28
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Bou-Hamad I, Hoteit J, Yehya N, Ghandour L. Personality traits and high cigarette dependence among university students: Insights from Lebanon. PLoS One 2024; 19:e0298193. [PMID: 38359081 PMCID: PMC10868771 DOI: 10.1371/journal.pone.0298193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 01/20/2024] [Indexed: 02/17/2024] Open
Abstract
PURPOSE The use of tobacco and cigarette products remains widespread globally, with varying patterns across countries. Understanding the factors influencing cigarette dependence among young adults is crucial for effective smoking prevention and control programs. Personality traits are one of the factors that influence smoking behaviour, yet the evidence on their role in high cigarette dependence among young adults remains inconclusive. This study aims to provide insights and initial evidence on the potential association between personality dimensions, sociodemographic factors, lifestyle habits, and high cigarette dependence among Lebanese university students. METHODS A convenient sample of 212 student smokers from one private and one public university in Lebanon participated in an online survey. The survey included measures of personality traits using the Big-Five framework, sociodemographic factors, lifestyle habits, and the Fagerström Test for Cigarette Dependence (FTCD). Logistic regression models and mediation analysis were used to analyze the data. RESULTS The results revealed significant associations between personality dimensions and high cigarette dependence among Lebanese university students. Smokers with higher levels of Openness to Experience were more likely to have high cigarette dependence (β = 0.408, p < = 0.015). Conversely, smokers with higher levels of Conscientiousness (β = -0.500, p < 0.001) and Agreeableness (β = -0.491, p < 0.01) were less likely to have high cigarette dependence. Additionally, attending a public university (β = 1.198, p = 0.018), having more close friends who smoke (β = 0.525, p < 0.01), and switching to a cheaper cigarette brand (β = 0.928, p < 0.05) were associated with a higher cigarette dependence. CONCLUSION These findings highlight the importance of considering personality dimensions, sociodemographic factors, and lifestyle habits in understanding high cigarette dependence among Lebanese university students. The results can inform the development of targeted interventions to address high cigarette dependence in this population.
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Affiliation(s)
- Imad Bou-Hamad
- Department of Business Information and Decision Systems, Suliman S. Olayan School of Business, American University of Beirut, Beirut, Lebanon
| | - Jaafar Hoteit
- Department of Business Information and Decision Systems, Suliman S. Olayan School of Business, American University of Beirut, Beirut, Lebanon
| | - Nadine Yehya
- Department of Public Affairs and Marketing, University of California, Davis, California, United States of America
| | - Lilian Ghandour
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Lüthi H, Lengsfeld S, Burkard T, Meienberg A, Jeanloz N, Vukajlovic T, Bologna K, Steinmetz M, Bathelt C, Sailer CO, Laager M, Vogt DR, Hemkens LG, Speich B, Urwyler SA, Kühne J, Baur F, Lutz LN, Erlanger TE, Christ-Crain M, Winzeler B. Effect of dulaglutide in promoting abstinence during smoking cessation: 12-month follow-up of a single-centre, randomised, double-blind, placebo-controlled, parallel group trial. EClinicalMedicine 2024; 68:102429. [PMID: 38371479 PMCID: PMC10873660 DOI: 10.1016/j.eclinm.2024.102429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 02/20/2024] Open
Abstract
Background Smoking cessation is challenging, despite making use of established smoking cessation therapies. Preclinical studies and one clinical pilot study suggest the antidiabetic drug glucagon-like peptide-1 (GLP-1) analogue to modulate addictive behaviours and nicotine craving. Previously, we reported the short-term results of a randomised, double-blind, placebo-controlled trial. Herein we report long-term abstinence rates and weight developments after 24 and 52 weeks. Methods This single-centre, randomised, double-blind, placebo-controlled, parallel group trial was done at the University Hospital Basel in Switzerland. We randomly assigned (1:1) individuals with at least a moderate nicotine dependence willing to quit smoking to either a 12-week treatment with dulaglutide 1.5 mg or placebo subcutaneously once weekly in addition to standard of care smoking cessation therapy (varenicline 2 mg/day and behavioural counselling). After 12 weeks, dulaglutide or placebo injections were discontinued and the participants were followed up at week 24 and 52. The primary outcome of self-reported and biochemically confirmed point prevalence abstinence rate, and secondary outcome of secondary outcome of weight change were assessed at weeks 24 and 52. All participants who received one dose of the study drug were included in the intention to treat set and participants who received at least 10/12 doses of the study drug formed the per protocol set. The trial was registered at ClinicalTrials.gov, NCT03204396. Findings Of the 255 participants who were randomly assigned between June 22, 2017 and December 3, 2020, 63% (80/127) (dulaglutide group) and 65% (83/128) (placebo group) were abstinent after 12 weeks. These abstinence rates declined to 43% (54/127) and 41% (52/128), respectively, after 24 weeks and to 32% (41/127) and 32% (41/128), respectively, after 52 weeks. Post-cessation weight gain was prevented in the dulaglutide group (-1.0 kg, standard deviation [SD] 2.7) as opposed to the placebo group (+1.9 kg, SD 2.4) after 12 weeks. However, at week 24, increases in weight from baseline were observed in both groups (median, interquartile range [IQR]: dulaglutide: +1.5 kg, [-0.4, 4.1], placebo: +3.0 kg, [0.6, 4.6], baseline-adjusted difference in weight change -1.0 kg (97.5% CI [-2.16, 0.16])), and at week 52 the groups showed similar weight gain (median, IQR: dulaglutide: +2.8 kg [-0.4, 4.7], placebo: +3.1 kg [-0.4, 6.0], baseline-adjusted difference in weight change: -0.35 kg (95% CI [-1.72, 1.01])). In the follow-up period (week 12 to week 52) 51 (51%) and 48 (48%) treatment-unrelated adverse events were recorded in the dulaglutide and the placebo group, respectively. No treatment-related serious adverse events or deaths occurred. Interpretation Dulaglutide does not improve long-term smoking abstinence, but has potential to counteract weight gain after quitting. However, 3 months of treatment did not have a sustained beneficial effect on weight at 1 year. As post-cessation weight gain is highest in the first year after quitting smoking, future studies should consider a longer treatment duration with a GLP-1 analogue in abstinent individuals. Funding Swiss National Science Foundation, the Gottfried and Julia Bangerter-Rhyner Foundation, the Goldschmidt-Jacobson Foundation, the Hemmi-Foundation, the University of Basel, the Swiss Academy of Medical Sciences.
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Affiliation(s)
- Hualin Lüthi
- Department of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sophia Lengsfeld
- Department of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Thilo Burkard
- Medical Outpatient Department, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Andrea Meienberg
- Medical Outpatient Department, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Faculty of Medicine University of Basel, Basel, Switzerland
| | - Nica Jeanloz
- Department of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Tanja Vukajlovic
- Department of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Katja Bologna
- Department of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Michelle Steinmetz
- Department of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Cemile Bathelt
- Department of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Clara O. Sailer
- Department of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Mirjam Laager
- Department of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Deborah R. Vogt
- Department of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Lars G. Hemkens
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
- Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Benjamin Speich
- CLEAR Methods Center, Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sandrine A. Urwyler
- Department of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jill Kühne
- Department of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Fabienne Baur
- Department of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Linda N. Lutz
- Department of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Tobias E. Erlanger
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Mirjam Christ-Crain
- Department of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Bettina Winzeler
- Department of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
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Saenz-de-Miera B, Lambert VC, Chen B, Gallegos-Carrillo K, Barrientos-Gutierrez I, Arillo-Santillán E, Thrasher JF. Smoking Dependence, Time-Discounting, and Sustained Cessation Behavior: A Longitudinal Study of Predominantly Light Smokers. Nicotine Tob Res 2024; 26:220-228. [PMID: 37648272 PMCID: PMC10803115 DOI: 10.1093/ntr/ntad166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 08/23/2023] [Accepted: 08/28/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION This study aimed to assess whether two established psychosocial predictors of smoking abstinence, nicotine dependence and time-discounting, also apply to a population of predominantly cigarette light smokers, which is the dominant pattern of smoking in countries like Mexico. Relatively infrequent smoking is increasingly prevalent, yet still harmful, making it important to understand the predictors of cessation in this population. AIMS AND METHODS Mexican adult smokers recruited from an online consumer panel were surveyed every 4 months between November 2018 and July 2020. We considered respondents who reported a quit attempt in between surveys (n = 1288). Dependence was measured with a 10-item version of the Wisconsin Inventory of Smoking Dependence Motives (WISDM). Time-discounting was assessed with five branching questions about hypothetical reward scenarios. Logistic models regressed sustained quit attempts (≥30 days of abstinence) at time t + 1 on study variables at time t. RESULTS We found strong interitem reliability (α = 0.92) and intraindividual consistency of our brief WISDM (ρ = 0.68), but moderate intraindividual consistency of the time-discounting measure (ρ = 0.48). Forty-eight percent of the sample reported sustained quit attempts, and 79% were non-daily or light daily smokers (≤5 cigarettes per day). Smokers with higher WISDM-10 had lower odds of sustained quitting and this result remained when controlling for smoking frequency and the Heaviness of Smoking Index (adjusted odds ratio [AOR] = 0.768). Time-discounting was unassociated with sustained quitting. CONCLUSIONS Our findings suggest that a brief, 10-item multidimensional measure of dependence is useful for predicting sustained quitting in a context of relatively light smoking; time-discounting appears less relevant, although our results are not conclusive because of the low test-retest reliability of our measure. IMPLICATIONS Given the increase in non-daily and light daily cigarette smoking in many countries, including in Mexico, and the health risks this still poses, it is important to understand the predictors of cessation among relatively light smokers. The WISDM-10 multidimensional measure seems to be a good instrument to assess dependence and predict successful quitting in this population, and possibly more appropriate than physical dependence measures. As such, it could help design and target more suitable cessation treatments for non-daily and daily light cigarette smokers. While this study did not find time-discounting to be a relevant predictor of smoking abstinence, future studies should explore other measures.
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Affiliation(s)
- Belen Saenz-de-Miera
- Department of Economics, Universidad Autonoma de Baja California Sur, La Paz, Mexico
| | - Victoria C Lambert
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Brian Chen
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Katia Gallegos-Carrillo
- Evaluation and Surveys Research Center, National Institute of Public Health, Cuernavaca, Mexico
- Epidemiology and Health Services Research Unit, Mexican Institute of Social Security, Cuernavaca, Morelos, Mexico
| | | | - Edna Arillo-Santillán
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, Mexico
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
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Smiley SL, Shin H. Motivation to Quit Smoking Among Black Adults Residing in Los Angeles County Communities With Menthol Cigarette Sales Restrictions. Subst Use Misuse 2024; 59:727-731. [PMID: 38226661 DOI: 10.1080/10826084.2023.2294984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
Background: Research is needed to identify the determinants of motivation to quit smoking among non-Hispanic Black (NHB) adults who smoke menthol cigarettes and reside in communities covered by menthol cigarette bans. Objectives: This study examined the associations between motivation to quit smoking and a range of individual-level predictors, including measures of demographics, harm/risk perception of menthol cigarettes, and awareness of a ban on menthol cigarettes in Los Angeles County unincorporated communities. Self-identified NHB adults who currently smoke menthol cigarettes (N=50; M=47.2 years; SD=13.7; 46% female) were recruited in Los Angeles County unincorporated communities. Participants completed an interviewer-administered cross-sectional survey between January to September 2021. Results: Participants (74%) reported an annual household income of less than $25,000. Participants' mean age at cigarette initiation was 15.7 years old (SD=5.68). Most (88%) were aware of the ordinance banning menthol cigarette sales. Employing multivariable linear regression analysis, harm/risk perception of menthol cigarettes (B=14.69, p<0.01) and awareness of the local menthol ban (B=26.18, p<0.05) were found to be independently associated with motivation to quit smoking. Conclusions: Findings from this community-based sample suggest that among NHB adults who smoke menthol cigarettes, motivation to quit smoking is influenced by their perception of menthol cigarettes as harmful and awareness of local policy banning the sale of menthol cigarettes. Findings underscore the need for community-centered and culturally grounded interventions to facilitate quitting among NHB adults who smoke in order for communities covered by menthol bans to achieve health equity in reducing preventable racial inequities due to menthol cigarettes.
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Affiliation(s)
- Sabrina L Smiley
- Division of Health Promotion and Behavioral Science, School of Public Health, College of Health and Human Services, San Diego State University, San Diego, California, USA
| | - Heesung Shin
- Division of Health Promotion and Behavioral Science, School of Public Health, College of Health and Human Services, San Diego State University, San Diego, California, USA
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Cooley C, Pickner W, Widome R, Jennings D, Stately A, Cole AB, Cash J, Dorr C, Hernadez C, Hatsukami D, Businelle M, Carroll DM. American Indian Perspectives on Culturally Aligning a Digital Smoking Cessation Resource. Nicotine Tob Res 2024; 26:39-45. [PMID: 37535663 PMCID: PMC10734387 DOI: 10.1093/ntr/ntad142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/18/2023] [Accepted: 08/01/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION Innovative smoking cessation approaches that overcome barriers such as traveling to program site or that require the staff and infrastructure for sustaining are likely needed to improve smoking quit rates among American Indian (AI) peoples in the United States. In this study, qualitative methods identified recommendations from AI peoples to guide alignment of an evidence-based smoking cessation smartphone app (i.e., QuitGuide) to the culture and needs of AI persons. METHODS Semi-structured interviews were conducted with AI adults who smoke (n = 40) and with public health professionals (n = 6). Questions included: "The app asks if something triggered you to slip and lists several options. What options were you expecting to see on this list?" as well as how to make the app more engaging such as "What would make the app more helpful for AI peoples, like you, who want to quit smoking?." Constant comparative techniques were used to develop codes and themes. RESULTS Loss, grief, and not accessing traditional tobacco were put forward as smoking triggers to be addressed in the app. Features that help users connect with and learn about AI cultures and promote healing, such as encouraging traditional tobacco use, being in community, embracing Native spirituality, and participating in cultural crafting were recommended. Some noted the need to motivate AI peoples to think about legacy and ability to care for younger generations and Indigenizing the app with Native imagery. CONCLUSIONS Themes pointed towards promotion of strengths-based factors, such as healing, cultural connectedness and traditional tobacco use, in the app. IMPLICATIONS Results will be used to culturally align a smartphone app for smoking cessation among AI peoples and may be insightful for other tribal, federal, and state public health efforts aimed at advancing health equity for AI peoples.
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Affiliation(s)
| | - Wyatt Pickner
- American Indian Cancer Foundation, Minneapolis, MN, USA
| | - Rachel Widome
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Dylan Jennings
- Sigurd Olsen Environmental Institute, Northland College, Ashland, WI, USA
| | | | - Ashley B Cole
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | | | - Casey Dorr
- Department of Nephrology, Hennepin Healthcare Research Institute; University of Minnesota Medical School, Minneapolis, MN, USA
| | - Carol Hernadez
- Minnesota Cancer Clinical Trials Network, Minneapolis, MN, USA
| | - Dorothy Hatsukami
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Michael Businelle
- Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Dana Mowls Carroll
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, MN, USA
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Avey JP, Schaefer KR, Noonan CJ, Trinidad SB, Muller CJ, Claw KG, Dillard DA, Todd MR, Beans JA, Tyndale RF, Robinson RF, Thummel KE. Identification of Sociodemographic, Clinical, and Genetic Factors to Aid Alaska Native and American Indian People to Successfully Quit Smoking. Nicotine Tob Res 2024; 26:79-86. [PMID: 37527452 PMCID: PMC10734384 DOI: 10.1093/ntr/ntad133] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/24/2023] [Accepted: 07/30/2023] [Indexed: 08/03/2023]
Abstract
INTRODUCTION Alaska Native and American Indian (ANAI) people have a smoking prevalence of 23%. Nicotine metabolite ratio (NMR) and genetic testing may enable tailored selection of tobacco cessation medication. AIMS AND METHODS The purpose of this study was to evaluate the relative contributions of NMR, cessation medication, demographics, and tobacco use history to cessation. Participants were recruited into an observational cohort study consisting of a baseline visit prior to their quit date and 6-week follow-up. Demographic and tobacco use surveys and blood, urine, and breath samples were collected at each visit. Electronic health records were queried for cessation medications. NMR was categorized into slow or normal nicotine metabolism phenotypes (<0.31 and ≥ 0.31, respectively). The main outcome was cessation at 6 weeks. Analyses consisted of descriptive statistics, medication and phenotype concordance, and estimates of relative risk (RR) of quitting. RESULTS We enrolled 151 ANAI adults who smoked cigarettes daily. Two-thirds had normal nicotine metabolism phenotype. Retrospective medication and phenotype concordance was 39%. The overall quit rate was 25%. No demographic factors or tobacco use history were associated with quit success. Varenicline and bupropion increased the likelihood of quitting (RR = 2.93 [1.42, 6.03] and RR = 2.52 [1.12, 5.64], respectively) compared to nicotine replacement therapy. Non-optimal medication and phenotype concordance decreased likelihood of quit success (RR = 0.44 [0.22, 0.91]) compared to optimal concordance. CONCLUSIONS This exploratory study found associations between quit success and tobacco cessation medication as well as medication and phenotype concordance. Additional research is needed to assess use of NMR for treatment selection among ANAI people. IMPLICATIONS These results broadly support additional community-engaged research to improve medication and phenotype concordance in tribal health settings. Such future research on implementing meditcation and phenotype concordance holds promise to improve expectations, quit success, and health outcomes amongst individuals attempting to quit smoking.
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Affiliation(s)
- Jaedon P Avey
- Research Department, Southcentral Foundation, Anchorage, AK, USA
| | | | - Carolyn J Noonan
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA, USA
| | - Susan B Trinidad
- Department of Bioethics and Humanities, University of Washington, Seattle, WA, USA
| | - Clemma J Muller
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA, USA
| | - Katrina G Claw
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Denise A Dillard
- Research Department, Southcentral Foundation, Anchorage, AK, USA
| | - Michael R Todd
- Research Department, Southcentral Foundation, Anchorage, AK, USA
| | - Julie A Beans
- Research Department, Southcentral Foundation, Anchorage, AK, USA
| | - Rachel F Tyndale
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Renee F Robinson
- Department of Pharmacy, Idaho State University, Pocatello, ID; University of Alaska Anchorage, Anchorage, AK, USA
| | - Kenneth E Thummel
- Department of Pharmaceutics, University of Washington, Seattle, WA, USA
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Rojewski AM, Palmer AM, Baker NL, Toll BA. Smoking Cessation Pharmacotherapy Efficacy in Comorbid Medical Populations: Secondary Analysis of the Evaluating Adverse Events in a Global Smoking Cessation Study (EAGLES) Randomized Clinical Trial. Nicotine Tob Res 2024; 26:31-38. [PMID: 37474127 PMCID: PMC10734386 DOI: 10.1093/ntr/ntad126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/11/2023] [Accepted: 07/18/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION This study sought to compare medication efficacy in participants with medical comorbidities who smoke in the Evaluating Adverse Events in a Global Smoking Cessation Study (EAGLES) trial, a double-blind, triple-dummy, placebo- and active-controlled randomized controlled trial. AIMS AND METHODS Participants were from the U.S. cohort of the main trial and randomized (1:1:1:1) to varenicline, bupropion, nicotine replacement therapy (NRT) patch, or placebo for 12 weeks with follow-up through week 24. Medical comorbidity data were derived from the baseline medical screening questionnaire and categorized into four subgroups (cardiac, respiratory, vascular, and diabetes). Within each comorbidity, generalized linear mixed models were used to assess the association between treatment and continuous abstinence rates from weeks 9-12 to 9-24. Similar models were used to test the effect of number of comorbidities on abstinence. RESULTS Varenicline resulted in the highest week 12 abstinence rates across all pharmacotherapies and compared to placebo in all comorbidity subgroups: Cardiac (40.0% vs. 3.6%; odds ratios [OR] = 23.3 [5.1-107.1]), respiratory (24.7% vs. 12.8%; OR = 2.2 [1.3-3.8]), vascular (29.1% vs. 10.4%; OR = 3.6 [2.3-5.7]), and diabetes (30.9% vs. 8.3%; OR = 6.5 [2.3-19.0]). This was maintained at week 24 for those with cardiac (23.3% vs. 1.8%; OR = 21.7 [2.7-178.2]), vascular (18.9% vs. 7.1%; OR = 3.1 [1.8-5.3]), and diabetes (20.6% vs. 4.2%; OR = 8.4 [2.1-33.7]) comorbidities. Treatment contrasts within some comorbidity subgroups revealed superior efficacy of varenicline over other pharmacotherapies. All pharmacotherapies increased the odds of abstinence regardless of number of comorbidities. CONCLUSIONS Varenicline is the most efficacious option for patients with manageable cardiac, respiratory, vascular, and diabetes conditions to quit smoking, supporting recent clinical practice guidelines that recommend varenicline as first-line pharmacotherapy. Bupropion and NRT demonstrated efficacy for some comorbidity subgroups. IMPLICATIONS This secondary analysis of the EAGLES trial demonstrated that varenicline is the most efficacious option for patients with cardiac, respiratory, vascular, and diabetes diagnoses to quit smoking. This demonstration of varenicline efficacy among individuals with comorbid medical conditions supports recent clinical practice guidelines that recommend varenicline as a first-line pharmacotherapy for smoking cessation.
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Affiliation(s)
- Alana M Rojewski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Amanda M Palmer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston SC, USA
| | - Nathaniel L Baker
- Department of Public Health Sciences, Medical University of South Carolina, Charleston SC, USA
| | - Benjamin A Toll
- Department of Public Health Sciences, Medical University of South Carolina, Charleston SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
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Kale D, Tattan-Birch H, Brown J, Cox S, Dawkins L, Goniewicz ML, Morris K, Shahab L. Examining acute psychopharmacological effects of nicotine vaping versus heated tobacco products in a randomised crossover study of product naïve adult smokers. Sci Rep 2023; 13:22676. [PMID: 38114686 PMCID: PMC10730620 DOI: 10.1038/s41598-023-49602-3] [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: 04/03/2023] [Accepted: 12/10/2023] [Indexed: 12/21/2023] Open
Abstract
Nicotine vaping products (NVPs) and heated tobacco products (HTPs) are designed to replicate the sensory and behavioural aspects of smoking cigarettes while avoiding combustion. The success of these products as harm reduction tools will partially depend on their ability to satisfy smokers and alleviate nicotine-related withdrawal symptoms. This study aims to compare short-term effects of NVPs (Juul and Aspire PockeX) versus HTPs (IQOS) on smoking-related withdrawal relief, product satisfaction, intention to switch to NVP/HTP, perceptions and attitudes in UK adult cigarette smokers naïve to these products. In a randomized cross-over study, 45 participants visited the lab twice, at each visit trying one of the two products (NVP/HTP) and completing a questionnaire. Responses were normalized on a 0-100% scale and mean differences (MD) between NVP and HTP scores computed, with positive and negative MD values indicating greater endorsement for NVP and HTP, respectively. Cigarette cravings were reduced similarly (~ 20.0%) by both products (MD = 4.5%, 95%Confidence Interval (CI) - 4.8, 13.8). Direct positive effects (MD = - 3.5%, 95%CI - 7.2, 0.2) and adverse side effects (MD = 1.8%, 95%CI - 0.3, 3.8) were comparable after each product use, though marginally favouring HTPs. HTPs were perceived as more satisfying overall (MD = - 13.2%, 95%CI - 20.3 - 6.1) than NVPs but both were perceived as similarly addictive (MD = 3.6%, 95%CI - 4.6, 11.8), relative to cigarettes. Intention to switch to either product was comparable (MD = 4.0%, 95%CI - 5.7, 13.8). Comparison of acute use of NVP versus HTP in a sample of UK smokers naïve to these products suggests that HTPs are perceived as more satisfying than NVPs, though still less satisfying than cigarettes.Registration: The analysis plan was pre-registered, and it is available at https://osf.io/6ymdu.
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Affiliation(s)
- Dimitra Kale
- Department of Behavioural Science and Health, University College London, London, UK.
- SPECTRUM Consortium, London, UK.
| | - Harry Tattan-Birch
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, London, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, London, UK
| | - Sharon Cox
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, London, UK
| | - Lynne Dawkins
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, London, UK
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Kierra Morris
- Department of Behavioural Science and Health, University College London, London, UK
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, London, UK
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Sharma P, Tranby B, Kamath C, Brockman T, Roche A, Hammond C, Brewer LC, Sinicrope P, Lenhart N, Quade B, Abuan N, Halom M, Staples J, Patten C. A Christian Faith-Based Facebook Intervention for Smoking Cessation in Rural Communities (FAITH-CORE): Protocol for a Community Participatory Development Study. JMIR Res Protoc 2023; 12:e52398. [PMID: 38090799 PMCID: PMC10753420 DOI: 10.2196/52398] [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: 09/01/2023] [Revised: 11/02/2023] [Accepted: 11/28/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND Tobacco smoking remains the leading cause of preventable morbidity and mortality in the United States, with significant rural-urban disparities. Adults who live in rural areas of the United States have among the highest tobacco smoking rates in the nation and experience a higher prevalence of smoking-related deaths and deaths due to chronic diseases for which smoking is a causal risk factor. Barriers to accessing tobacco use cessation treatments are a major contributing factor to these disparities. Adults living in rural areas experience difficulty accessing tobacco cessation services due to geographical challenges, lack of insurance coverage, and lack of health care providers who treat tobacco use disorders. The use of digital technology could be a practical answer to these barriers. OBJECTIVE This report describes a protocol for a study whose main objectives are to develop and beta test an innovative intervention that uses a private, moderated Facebook group platform to deliver peer support and faith-based cessation messaging to enhance the reach and uptake of existing evidence-based smoking cessation treatment (EBCT) resources (eg, state quitline coaching programs) for rural adults who smoke. METHODS We will use the Integrated Theory of Health Behavior Change, surface or deep structure frameworks to guide intervention development, and the community-based participatory research (CBPR) approach to identify and engage with community stakeholders. The initial content library of moderator postings (videos and text or image postings) will be developed using existing EBCT material from the Centers for Disease Control and Prevention Tips from Former Smokers Campaign. The content library will feature topics related to quitting smoking, such as coping with cravings and withdrawal and using EBCTs with faith-based message integration (eg, Bible quotes). A community advisory board and a community engagement studio will provide feedback to refine the content library. We will also conduct a beta test of the intervention with 15 rural adults who smoke to assess the recruitment feasibility and preliminary intervention uptake such as engagement, ease of use, usefulness, and satisfaction to further refine the intervention based on participant feedback. RESULTS The result of this study will create an intervention prototype that will be used for a future randomized controlled trial. CONCLUSIONS Our CBPR project will create a prototype of a Facebook-delivered faith-based messaging and peer support intervention that may assist rural adults who smoke to use EBCT. This study is crucial in establishing a self-sufficient smoking cessation program for the rural community. The project is unique in using a moderated social media platform providing peer support and culturally relevant faith-based content to encourage adult people who smoke to seek treatment and quit smoking. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/52398.
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Affiliation(s)
- Pravesh Sharma
- Psychiatry and Psychology, Mayo Clinic Health System, Mayo Clinic, Eau Claire, WI, United States
| | - Brianna Tranby
- Behavioral Psychology, Mayo Clinic, Rochester, MN, United States
| | - Celia Kamath
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
| | - Tabetha Brockman
- Health Equity and Community Engagement in Research, Mayo Clinic, Rochester, MN, United States
| | - Anne Roche
- Psychology, Mayo Clinic, Rochester, MN, United States
| | | | | | - Pamela Sinicrope
- Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Ned Lenhart
- Living Water Church, Cameron, WI, United States
| | - Brian Quade
- Bethesda Lutheran Church, Eau Claire, WI, United States
| | - Nate Abuan
- Valleybrook Church, Eau Claire, WI, United States
| | - Martin Halom
- St John's Lutheran Church, Bloomer, WI, United States
| | | | - Christi Patten
- Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
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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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Collins BN, Lepore SJ, Egleston BL. Eliminating children's tobacco smoke exposure: a pathway to bioverified abstinence among low-income maternal smokers in the Babies Living Safe and Smokefree (BLiSS) trial. J Behav Med 2023; 46:1042-1048. [PMID: 37285107 PMCID: PMC10591859 DOI: 10.1007/s10865-023-00423-9] [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: 02/20/2023] [Accepted: 05/19/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Identifying behavioral pathways to smoking cessation in high-risk populations, such as low-income maternal smokers, could reduce tobacco disparities. The previous "BLiSS" multilevel intervention trial demonstrated efficacy of the BLiSS intervention in facilitating low-income maternal smokers' bioverified abstinence. This present study examined four putative pathways measured at 3-month end of treatment (Time 2) that could account for the observed intervention effect on smoking abstinence through 12 months (Time 2 - Time 3). METHODS Nutritionists in community clinics delivering safety net nutrition promotion programs across Philadelphia, Pennsylvania, USA, were trained by trial principal investigators to deliver a brief tobacco intervention informed by the American Academy of Pediatrics best practice guidelines ("Ask, Advise, Refer [AAR]"). After referral, 396 eligible participants were randomized to either a multimodal behavioral intervention (AAR + MBI) or a parallel attention control (AAR + control). Random effects regression analysis tested mediation. RESULTS Elimination of children's tobacco smoke exposure (TSE) at Time 2 was the only significant mediator of longitudinal smoking abstinence through Time 3. AAR + MBI mothers were more likely to eliminate their children's TSE by Time 2 (OR = 2.11, 95%CI 1.30, 3.42), which was significantly associated with Time 3 abstinence (OR = 6.72, CI 2.28, 19.80). Modeling showed a significant total effect of AAR + MBI on abstinence (OR = 6.21, CI 1.86, 20.71), a direct effect of AAR + MBI on abstinence (OR = 4.80, CI 1.45, 15.94) and an indirect effect through TSE elimination (OR = 1.29, CI 1.06, 1.57). CONCLUSIONS Integrating smoking cessation interventions with counseling prior to the quit attempt that is designed to facilitate adoption of smokefree home policies and efforts to eliminate children's TSE could enhance the likelihood of long-term abstinence in populations of smokers with elevated challenges quitting smoking.
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Affiliation(s)
- Bradley N Collins
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Ave, Ritter Annex 954, Philadelphia, PA, USA.
| | - Stephen J Lepore
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Ave, Ritter Annex 954, Philadelphia, PA, USA
| | - Brian L Egleston
- Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
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Baur F, Atila C, Lengsfeld S, Burkard T, Meienberg A, Bathelt C, Christ-Crain M, Winzeler B. Gender differences in weight gain during attempted and successful smoking cessation on dulaglutide treatment: a predefined secondary analysis of a randomised trial. BMJ Nutr Prev Health 2023; 6:301-309. [PMID: 38264360 PMCID: PMC10800263 DOI: 10.1136/bmjnph-2023-000781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/01/2023] [Indexed: 01/25/2024] Open
Abstract
Background Women seem to have more difficulty quitting smoking than men. This is particularly concerning as smoking puts women at a higher risk of developing smoking-associated diseases. Greater concerns about postcessation weight gain in women have been postulated as a possible explanation. Methods Predefined secondary analysis of a placebo-controlled, double-blind, parallel-group, superiority randomised trial including 255 adults who smoke daily (155 women, 100 men). Participants received weekly dulaglutide (1.5 mg) or placebo (0.9% sodium chloride) in addition to standardised smoking cessation care (varenicline 2 mg/day plus behavioural counselling) over 12 weeks. We aimed to investigate gender differences in weight change after dulaglutide-assisted smoking cessation. Weight change between baseline and week 12 was analysed as absolute and revative weight change and as substantial weight gain (defined as >6% increase). Results No gender differences were observed in absolute or relative weight change neither on dulaglutide nor placebo treatment. However, substantial weight gain (defined as >6% increase) in the placebo group was almost five times more frequent in females than males (24% vs 5%). Female patients were less likely to have substantial weight gain on dulaglutide compared with placebo (1% (n=1/83) vs 24% (n=17/72); p<0.001), while this dulaglutide effect was less pronounced in males (0% (n=0/44) vs 5% (n=3/56); p=0.333). Conclusion Dulaglutide reduced postcessation weight gain in both genders and was very effective in preventing substantial weight gain, which seems to be a specific observation in females. Trial registration number NCT03204396.
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Affiliation(s)
- Fabienne Baur
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Cihan Atila
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Sophia Lengsfeld
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Thilo Burkard
- Medical Outpatient Department, University Hospital Basel, Basel, Switzerland
| | - Andrea Meienberg
- Medical Outpatient Department, University Hospital Basel, Basel, Switzerland
| | - Cemile Bathelt
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Mirjam Christ-Crain
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Bettina Winzeler
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
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Das S, Jena PK, Satpathy N, Kishore J, Ak K, Epari V, Gadtia R. Performance of the Heaviness of Smoking Index in Indian Settings. Cureus 2023; 15:e50433. [PMID: 38222207 PMCID: PMC10785195 DOI: 10.7759/cureus.50433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 01/16/2024] Open
Abstract
Background and objective The heaviness of smoking index (HSI) is a popular tool to assess nicotine dependence in clinical and community settings. Low cigarette consumption and concurrent use of other tobacco products raise concerns about its validity in Indian settings. This study explores the performance of HSI in Indian settings. Methods This study analyzed daily manufactured cigarette smoker data from the cross-sectional Global Adult Tobacco Surveys (GATS) from its first (GAST-1, 2009) and second waves (GATS-2, 2016), both of which were available in the public domain. The HSI scores were calculated based on the number of cigarettes smoked per day (CPD) and time to first smoke (TTFS) after waking up among the current daily cigarette users. This study examined the utility of the HSI scale in Indian settings by estimating the predictability of low dependence on quit attempts and quit intentions using the likelihood ratio parameter. Results About nine in 10 cigarette users in India consumed less than 10 cigarettes per day, yielding a low score on the HSI scale for most of the daily cigarette users. The majority of daily cigarette smokers scored ≤ 1 (low dependence) on the HSI scale both in GATS-1 and GATS-2, irrespective of their exclusive cigarette use status. The absolute value and the 95% confidence limit of positive likelihood ratios (falling below and above one) suggest that the predictability of low dependence on quit attempts and quit intention in the Indian setting is limited. Conclusions The utility of the HSI scale in assessing nicotine dependence among cigarette users in India is limited. This may be attributed to low average cigarette consumption, concurrent use of various tobacco products, and the sociocultural milieu of Indian smokers. This highlights the need for a new rapid nicotine dependence scale tailored to the specific patterns of tobacco use behavior prevalent in the Indian context.
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Affiliation(s)
- Sagarika Das
- Nursing, Shri Jagdishprasad Jhabarmal Tibrewala (JJT) University, Jhunjhunu, IND
- Mental Health Nursing, Central Institute of Psychiatry, Ranchi, IND
| | - Pratap K Jena
- Health Care Management, Swiss School of Business and Management (SSBM) Geneva, Geneva, CHE
- Public Health, School of Public Health, Kalinga Institute of Industrial Technology (KIIT), Bhubaneswar, IND
| | - Nancy Satpathy
- Community Medicine, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan, Deemed to be University, Bhubaneswar, IND
| | - Jugal Kishore
- Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Kavitha Ak
- Public Health, Indian Medical Council of Medical Research (ICMR) Regional Medical Research Centre, Bhubaneswar, IND
| | - Venkatarao Epari
- Community Medicine, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan, Deemed to be University, Bhubaneswar, IND
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Anthenelli RM, McKenna BS, Giannini J, Attaluri SV, Rubin M, O'Crowley E, Miller S, Heffner JL. Combining varenicline preloading with Acceptance and Commitment Therapy (ACT) in persons with serious mental illness who smoke: The randomized ACTSLow pilot feasibility trial. Drug Alcohol Depend 2023; 253:111012. [PMID: 37931328 DOI: 10.1016/j.drugalcdep.2023.111012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/18/2023] [Accepted: 10/21/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND People with serious mental illness (SMI; bipolar [BD] or schizophrenia spectrum disorders [SSD]) who smoke have 30-60% lower odds of quitting and are more prone to experience neuropsychiatric adverse events (NPSAEs) when quitting than smokers without SMI. We pilot-tested the feasibility of combining two different dosing strategies of varenicline preloading with Acceptance and Commitment Therapy (ACT) in persons with SMI in an attempt to bolster quit rates without increasing NPSAEs. METHODS Twelve-week, single center, randomized, double-blind, pilot feasibility trial of low (0.5mg twice daily, slower titration) versus standard dose (1.0mg twice daily, standard titration) varenicline in persons with BD or SSD with a 12-week follow-up. All participants received up to 10 sessions of ACT for smoking cessation. Participants were asked to preload with varenicline while still smoking and set a flexible target quit day (TQD) by day 35. RESULTS Recruitment was hampered by shutdowns related to COVID-19 and the worldwide varenicline recall, respectively. Retention goals were met. Treatment satisfaction was high across both dosing and diagnostic groups. Most participants (92.9%) adhered to preloading instructions and the flexible TQD. Seven-day point prevalence abstinence at week 12 was highest in BD participants (37.5%) but lowest in SSD participants (16.7%) who received the standard dose. Medication was well tolerated. CONCLUSIONS Although recruitment was hindered by unanticipated world events, feasibility was demonstrated. Participants adhered to and were highly satisfied with the combination of pre-cessation varenicline plus ACT. Findings support testing this combined treatment approach in a fully powered trial of persons with BD who smoke.
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Affiliation(s)
- Robert M Anthenelli
- Pacific Treatment and Research Center, Department of Psychiatry, University of California, San Diego, 3252 Holiday Court, Suite 200, La Jolla, CA 92037, United States.
| | - Benjamin S McKenna
- Pacific Treatment and Research Center, Department of Psychiatry, University of California, San Diego, 3252 Holiday Court, Suite 200, La Jolla, CA 92037, United States; VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, United States
| | - Jillian Giannini
- Pacific Treatment and Research Center, Department of Psychiatry, University of California, San Diego, 3252 Holiday Court, Suite 200, La Jolla, CA 92037, United States
| | - Saisantosh V Attaluri
- Pacific Treatment and Research Center, Department of Psychiatry, University of California, San Diego, 3252 Holiday Court, Suite 200, La Jolla, CA 92037, United States
| | - Matine Rubin
- Pacific Treatment and Research Center, Department of Psychiatry, University of California, San Diego, 3252 Holiday Court, Suite 200, La Jolla, CA 92037, United States
| | - Erin O'Crowley
- Pacific Treatment and Research Center, Department of Psychiatry, University of California, San Diego, 3252 Holiday Court, Suite 200, La Jolla, CA 92037, United States
| | - Sierra Miller
- Pacific Treatment and Research Center, Department of Psychiatry, University of California, San Diego, 3252 Holiday Court, Suite 200, La Jolla, CA 92037, United States
| | - Jaimee L Heffner
- Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA 98109, United States
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Wanger TJ, de Moura FB, Ashare R, Loughead J, Lukas S, Lerman C, Janes AC. Brain and cortisol responses to smoking cues are linked in tobacco-smoking individuals. Addict Biol 2023; 28:e13338. [PMID: 38017638 DOI: 10.1111/adb.13338] [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: 02/01/2023] [Revised: 08/30/2023] [Accepted: 09/10/2023] [Indexed: 11/30/2023]
Abstract
Cues associated with smoking can induce relapse, which is likely driven by cue-induced neurobiological and physiological mechanisms. For instance, greater relapse vulnerability is associated with increases in cue-induced insula activation and heightened cortisol concentrations. Determining if there is a link between such cue-induced responses is critical given the need for biomarkers that can be easily measured in clinical settings and used to drive targeted treatment. Further, comprehensively characterising biological reactions to cues promises to aid in the development of therapies that address this specific relapse risk factor. To determine whether brain and cortisol responses to smoking cues are linked, this study recruited 27 nicotine-dependent tobacco-smoking individuals and acquired whole-brain functional activation during a cue reactivity task; salivary cortisol was measured before and after scanning. The results showed that increases in blood-oxygen-level-dependent activation in the right anterior insula and right dorsolateral prefrontal cortex (DLPFC) when viewing smoking versus neutral cues were positively correlated with a post-scan rise in salivary cortisol concentrations. These brain regions have been previously implicated in substance use disorders for their role in salience, interoception and executive processes. These findings show that those who have a rise in cortisol following smoking cue exposure also have a related rise in cue-induced brain reactivity, in brain regions previously linked with heightened relapse vulnerability. This is clinically relevant as measuring cue-induced cortisol responses is a more accessible proxy for assessing the engagement of cue-induced neurobiological processes associated with the maintenance of nicotine dependence.
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Affiliation(s)
- Timothy J Wanger
- McLean Imaging Center, McLean Hospital, Belmont, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Fernando B de Moura
- McLean Imaging Center, McLean Hospital, Belmont, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Rebecca Ashare
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Psychology, University at Buffalo, Buffalo, New York, USA
| | - James Loughead
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Scott Lukas
- McLean Imaging Center, McLean Hospital, Belmont, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Caryn Lerman
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Amy C Janes
- Neuroimaging Research Branch, National Institute on Drug Abuse (NIDA), Intramural Research Program, National Institutes of Health, Baltimore, Maryland, USA
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Freitas-Lemos R, Tegge AN, Tomlinson DC, Yeh YH, Stein JS, Michael Cummings K, Fong GT, Shields PG, Hatsukami DK, Bickel WK. Illegal product purchasing in the experimental tobacco marketplace: Effects of menthol cigarette and cigarette ventilation ban. Drug Alcohol Depend 2023; 253:111015. [PMID: 37951005 PMCID: PMC10885639 DOI: 10.1016/j.drugalcdep.2023.111015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/02/2023] [Accepted: 10/23/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND Tobacco regulations may increase demand for illegal cigarettes. We use the Experimental Tobacco Marketplace to estimate the impact of banning menthol cigarettes (Experiment 1) and decreasing allowable cigarette filter ventilation levels (Experiment 2). METHODS Crowdsourced participants were randomized into one of four groups (2×2 factorial design). Experiment 1 included menthol availability (yes/no) by purchasing option (legal only vs illegal available). Experiment 2 included filter-vented cigarettes availability (yes/no) by purchasing option (legal only vs illegal available). Participants were given an individualized budget to purchase tobacco. Percent budget spent was the outcome measure. RESULTS Experiment 1, with a legal marketplace only, non-menthol cigarette purchasing was lower (p=0.010) and electronic-cigarette purchasing was higher (p=0.016), when cigarettes were banned compared to when they were available. With an illegal marketplace, switching to legal non-menthol cigarettes was less likely (p<0.001) and purchasing illegal menthol cigarettes was higher (p<0.001), when cigarettes were banned compared to when they were available. Experiment 2, with a legal marketplace only, cigarette purchasing was lower (p=0.010), when the participant's filtered vented cigarettes were banned compared to when they were available. With an illegal marketplace, purchasing the legal low-ventilated cigarette option was lower (p<0.001) and significant differences in illegal filter-vented cigarette purchasing were not observed, when their filter-vented cigarettes were banned compared to when they were available legally. CONCLUSIONS Without an illegal option, both restrictions decreased cigarette purchasing, but the menthol ban increased e-cigarette purchasing. With an illegal option, a menthol ban increased illegal cigarette purchasing, but decreasing filter ventilation did not.
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Affiliation(s)
| | - Allison N Tegge
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA; Department of Statistics, Virginia Tech, Blacksburg, VA, USA
| | - Devin C Tomlinson
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA; Graduate Program in Translational Biology, Medicine, and Health, Virginia Tech, Blacksburg, VA, USA
| | - Yu-Hua Yeh
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
| | - Jeffrey S Stein
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Geoffrey T Fong
- Department of Psychology and School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada; Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Peter G Shields
- Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH, USA
| | - Dorothy K Hatsukami
- Masonic Cancer Center and Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Warren K Bickel
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA.
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Probst L, Monnerat S, Vogt DR, Lengsfeld S, Burkard T, Meienberg A, Bathelt C, Christ-Crain M, Winzeler B. Effects of dulaglutide on alcohol consumption during smoking cessation. JCI Insight 2023; 8:e170419. [PMID: 37991022 PMCID: PMC10721313 DOI: 10.1172/jci.insight.170419] [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: 03/28/2023] [Accepted: 10/04/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUNDAlcohol use disorder has a detrimental impact on global health and new treatment targets are needed. Preclinical studies show attenuating effects of glucagon-like peptide-1 (GLP-1) agonists on addiction-related behaviors in rodents and nonhuman primates. Some trials have shown an effect of GLP-1 agonism on reward processes in humans; however, results from clinical studies remain inconclusive.METHODSThis is a predefined secondary analysis of a double-blind, randomized, placebo-controlled trial evaluating the GLP-1 agonist dulaglutide as a therapy for smoking cessation. The main objective was to assess differences in alcohol consumption after 12 weeks of treatment with dulaglutide compared to placebo. The effect of dulaglutide on alcohol consumption was analyzed using a multivariable generalized linear model.RESULTSIn the primary analysis, participants out of the cohort (n = 255) who reported drinking alcohol at baseline and who completed 12 weeks of treatment (n = 151; placebo n = 75, dulaglutide n = 76) were included. The median age was 42 (IQR 33-53) with 61% (n = 92) females. At week 12, participants receiving dulaglutide drank 29% less (relative effect = 0.71, 95% CI 0.52-0.97, P = 0.04) than participants receiving placebo. Changes in alcohol consumption were not correlated with smoking status at week 12.CONCLUSIONThese results provide evidence that dulaglutide reduces alcohol intake in humans and contribute to the growing body of literature promoting the use of GLP-1 agonists in treatment of substance use disorders.TRIAL REGISTRATIONClinicalTrials.gov NCT03204396.FUNDINGSwiss National Foundation, Gottfried Julia Bangerter-Rhyner Foundation, Goldschmidt-Jacobson Foundation, Hemmi Foundation, University of Basel, University Hospital Basel, Swiss Academy of Medical Science.
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Affiliation(s)
- Leila Probst
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Sophie Monnerat
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Deborah R. Vogt
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Sophia Lengsfeld
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Thilo Burkard
- Department of Cardiology, and
- Medical Outpatient Department, University Hospital Basel, Basel, Switzerland
| | - Andrea Meienberg
- Department of Cardiology, and
- Medical Outpatient Department, University Hospital Basel, Basel, Switzerland
| | - Cemile Bathelt
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Mirjam Christ-Crain
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Bettina Winzeler
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
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Blondé J, Desrichard O, Falomir-Pichastor JM, Felder M, Folly L, Riedo G. Cohabitation with a smoker and efficacy of cessation programmes: the mediating role of the theory of planned behaviour. Psychol Health 2023; 38:1665-1682. [PMID: 35275033 DOI: 10.1080/08870446.2022.2041638] [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: 06/30/2021] [Revised: 12/31/2021] [Accepted: 02/09/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The present research sought to examine whether cohabitation with a smoker undermines smoking cessation among people engaged in a cessation programme and whether the components of the Theory of Planned Behaviour (TPB) act as mediating mechanisms. DESIGN A prospective longitudinal study with online questionnaires was conducted among smokers living in Switzerland who enrolled in a 6-months smoking cessation programme. MAIN OUTCOME MEASURES Cohabitation with a smoker and the TPB constructs were assessed 10 days after the start of the programme (T1; N = 820). Smoking abstinence was measured at T1, and at 3-months (T2; N = 624) and 6-months follow-ups (T3; N = 354). RESULTS Results showed that living with a smoker decreased the odds that smokers remained abstinent throughout the cessation programme. Furthermore, we found that cohabitation was negatively associated with subjective norm. Afterwards, subjective norm predicted intention to maintain smoking cessation, which, in turn, predicted smoking abstinence. Such mediation effects persisted at each time point. CONCLUSION The present research provided evidence that living with other smokers at home can lead to greater risks of relapsing among people engaged in a cessation programme. We discussed the role of smoking-related norms in the efficacy of cessation interventions. Supplemental data for this article is available online at https://doi.org/10.1080/08870446.2022.2041638 .
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Affiliation(s)
- Jérôme Blondé
- Faculty of Psychology and Education Sciences, University of Geneva, Geneve, Switzerland
| | - Olivier Desrichard
- Faculty of Psychology and Education Sciences, University of Geneva, Geneve, Switzerland
| | | | - Max Felder
- Behaviour Change Lab, Geneve, Switzerland
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Kimber C, Sideropoulos V, Cox S, Frings D, Naughton F, Brown J, McRobbie H, Dawkins L. E-cigarette support for smoking cessation: Identifying the effectiveness of intervention components in an on-line randomized optimization experiment. Addiction 2023; 118:2105-2117. [PMID: 37455014 PMCID: PMC10952247 DOI: 10.1111/add.16294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/06/2023] [Indexed: 07/18/2023]
Abstract
AIMS, DESIGN AND SETTING The aim of this study was to determine which combination(s) of five e-cigarette-orientated intervention components, delivered on-line, affect smoking cessation. An on-line (UK) balanced five-factor (2 × 2 × 2 × 2 × 2 = 32 intervention combinations) randomized factorial design guided by the multi-phase optimization strategy (MOST) was used. PARTICIPANTS A total of 1214 eligible participants (61% female; 97% white) were recruited via social media. INTERVENTIONS The five on-line intervention components designed to help smokers switch to exclusive e-cigarette use were: (1) tailored device selection advice; (2) tailored e-liquid nicotine strength advice; (3): tailored e-liquid flavour advice; (4) brief information on relative harms; and (5) text message (SMS) support. MEASUREMENTS The primary outcome was 4-week self-reported complete abstinence at 12 weeks post-randomization. Primary analyses were intention-to-treat (loss to follow-up recorded as smoking). Logistic regressions modelled the three- and two-way interactions and main effects, explored in that order. FINDINGS In the adjusted model the only significant interaction was a two-way interaction, advice on flavour combined with text message support, which increased the odds of abstinence (odds ratio = 1.55, 95% confidence interval = 1.13-2.14, P = 0.007, Bayes factor = 7.25). There were no main effects of the intervention components. CONCLUSIONS Text-message support with tailored advice on flavour is a promising intervention combination for smokers using an e-cigarette in a quit attempt.
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Affiliation(s)
| | | | - Sharon Cox
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | | | - Felix Naughton
- School of Health SciencesUniversity of East AngliaNorwichUK
| | - Jamie Brown
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Hayden McRobbie
- National Drug and Alcohol Research CentreUniversity of New South WalesSydneyNSWAustralia
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Pang RD, Tucker CJ, Guillot CR, Belcher B, Kirkpatrick MG. Associations of DHEA(S) with negative and positive affect in people who smoke daily with elevated and low depression symptoms: A pilot laboratory study. Addict Behav 2023; 146:107801. [PMID: 37423068 DOI: 10.1016/j.addbeh.2023.107801] [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: 04/18/2023] [Revised: 06/07/2023] [Accepted: 07/02/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Individuals with depression symptoms have a harder time quitting smoking. High negative affect and low positive affect are core depression symptoms and arise following cigarette abstinence. Investigating associations of biological markers with negative and positive affect may provide valuable information about factors relevant to smoking cessation in individuals with elevated depression symptoms. METHODS Depression symptoms were measured at a baseline session. Participants then completed two counterbalanced experimental sessions (non-abstinent, abstinent) and completed measures of positive and negative affect, and provided saliva samples. Saliva samples were assayed at the Salimetrics' SalivaLab (Carlsbad, CA) using the Salimetrics Salivary Dehydroepiandrosterone (DHEA) Assay Kit (Cat. No. 1-1202) and Dehydroepiandrosterone-sulfate (DHEA-S) Assay Kit (Cat. No. 1-1252). RESULTS There were no main or interactive associations of DHEA with negative affect. However, there were significant DHEAS × experimental session and DHEAS × experimental session × depression symptom level interactions with negative affect. In the high depression symptom group, DHEAS positively associated with negative affect during the non-abstinent experimental session, but DHEAS negatively associated with negative affect during the abstinent experimental session. There were no associations of DHEA or DHEAS with positive affect. CONCLUSION This study found that DHEAS negatively associated with negative affect during cigarette abstinence in individuals with elevated depression symptoms. This is important as high negative affect during cigarette abstinence may result in a return to smoking.
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Affiliation(s)
- Raina D Pang
- Department of Population and Public Health Sciences, University of Southern California, 1845 N. Soto Street, Suite 312E, Los Angeles, CA 90032, United States; Department of Psychology, University of Southern California, SGM 50, 3620 McClintock Ave, Los Angeles, CA 90089, United States.
| | - Chyna J Tucker
- Department of Population and Public Health Sciences, University of Southern California, 1845 N. Soto Street, Suite 312E, Los Angeles, CA 90032, United States.
| | - Casey R Guillot
- Department of Psychology, University of North Texas, Terrill Hall, Denton, TX 7620, United States.
| | - Britni Belcher
- Department of Population and Public Health Sciences, University of Southern California, 1845 N. Soto Street, Suite 312E, Los Angeles, CA 90032, United States.
| | - Matthew G Kirkpatrick
- Department of Population and Public Health Sciences, University of Southern California, 1845 N. Soto Street, Suite 312E, Los Angeles, CA 90032, United States; Department of Psychology, University of Southern California, SGM 50, 3620 McClintock Ave, Los Angeles, CA 90089, United States.
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48
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Fearon IM. Human abuse liability assessment of e-cigarettes: Why, what and how? Drug Test Anal 2023; 15:1211-1221. [PMID: 35302289 DOI: 10.1002/dta.3251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/04/2022] [Accepted: 02/08/2022] [Indexed: 11/12/2022]
Abstract
Cigarette smoking is the world's leading cause of preventable death and disease. Alternative nicotine products such as e-cigarettes have tobacco harm reduction potential, by providing smokers with an alternative form of nicotine delivery but with either the reduced presence or absence of the numerous harmful chemicals found in combustible cigarette smoke. One aspect of importance in determining the potential of e-cigarettes to provide a viable alternative to combustible cigarettes for smokers is their ability to cause dependence, also known as their abuse liability. E-cigarettes with little or no abuse liability would be unlikely to be used as a substitute for cigarettes, whereas at least some degree of abuse liability is acknowledged as supportive both to aiding cigarette substitution or complete cessation and to preventing relapse. Given this link between abuse liability and substitution efficacy, human studies assessing the abuse liability of e-cigarettes are important to determine their true harm reduction potential. In this review, the concept of tobacco product abuse liability is discussed, along with the primary elements-pharmacokinetics and pharmacodynamics (subjective effects)-that need to be assessed to determine abuse liability. The review also presents a number of human abuse liability study design considerations and discusses what existing studies in the literature tell us about the abuse liability and harm reduction potential of e-cigarettes.
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Fearon IM, Seltzer RGN, Houser TL, Tope A, Cahours X, Verron T, Malt L, Nahde T, O'Connell G, Nides M. Examination of the impact of myblu electronic nicotine delivery system e-liquid nicotine strength on self-reported measures of dependence. Drug Test Anal 2023; 15:1270-1280. [PMID: 35712897 DOI: 10.1002/dta.3335] [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: 04/13/2022] [Revised: 05/31/2022] [Accepted: 06/15/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Greater nicotine delivery is associated with higher nicotine concentrations in electronic nicotine delivery system (ENDS) liquids. However, there is a current debate as to whether this leads to increased dependence and mitigates ENDS public health potential. METHODS Self-reported dependence among users of myblu ENDS containing different nicotine concentrations was examined with data from a multiwave cross-sectional survey of US young adults and adults. Questions examined responses related to dependence measures and participants' most often used myblu ENDS nicotine concentration (low: 0%, 1% and 1.2%; medium: 2%, 2.4% and 2.5%; or high: 3.6% and 4%). RESULTS A global general linear model using nicotine concentration, age and days myblu that was used in the past 30 revealed a significant difference in PROMIS scores among nicotine concentration groups (F = 4.07, p = 0.02). However, pairwise comparisons to examine which specific groups differed significantly from others showed no significant differences. Logistic regression demonstrated that strong past 30-day cravings to use myblu among participants using high or medium nicotine concentrations were not significantly different from those using a low concentration (ORs 0.66 [0.42, 1.03], p = 0.07 and 0.95 [0.49, 1.82], p = 0.98, respectively). Time to daily first use for high or medium nicotine concentration users was not significantly different from those using a low concentration (ORs 0.89 [0.70, 1.14], p = 0.35 and 0.84 [0.57, 1.25], p = 0.40, respectively). CONCLUSIONS Use of myblu ENDS with different nicotine concentrations is not associated with differing levels of dependence. Our findings contradict the notion that high ENDS e-liquid nicotine levels generate increased dependence.
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Affiliation(s)
| | | | - Trisha L Houser
- Houser Clinical Research Writing and Consulting, LLC, Durham, North Carolina, USA
| | | | | | | | | | - Thomas Nahde
- Reemtsma Cigarettenfabriken GmbH, Hamburg, Germany
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50
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Walker N, Calder A, Barnes J, Laking G, Parag V, Bullen C. Effectiveness of nicotine salt vapes, cytisine, and a combination of these products, for smoking cessation in New Zealand: protocol for a three-arm, pragmatic, community-based randomised controlled trial. BMC Public Health 2023; 23:1760. [PMID: 37697327 PMCID: PMC10494376 DOI: 10.1186/s12889-023-16665-w] [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: 06/26/2023] [Accepted: 08/30/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Combining short-acting nicotine replacement therapy with varenicline increases smoking cessation rates compared with varenicline alone, but not all people tolerate these medications or find them helpful. We aim to investigate the therapeutic potential of an analogous combination, by evaluating the effectiveness, safety, and acceptability of combining nicotine salt e-cigarettes with cytisine, compared to nicotine salt e-cigarettes or cytisine only, on smoking abstinence at six months. METHODS A pragmatic, community-based, investigator-blinded, randomised superiority trial design will be utilised. Eligible participants will be people who smoke daily (N = 800, 90% power) from throughout New Zealand, who are: aged ≥ 18 years, motivated to quit in the next two weeks, able to provide online consent, willing to use e-cigarettes and/or cytisine, and have daily access to a mobile phone. Recruitment will utilise multi-media advertising. Participants will be randomised (3:3:2 ratio) to 12 weeks of: 1) e-cigarettes (closed pod system, 3% nicotine salt, tobacco flavour) plus cytisine; 2) e-cigarettes alone, or 3) cytisine alone. All groups will receive a six-month, text-message-based behavioural support programme. The primary outcome is self-reported, biochemically verified, continuous abstinence at six months post-quit date. Secondary outcomes, measured at quit date, then one, three, six, and 12 months post-quit date, include self-reported continuous abstinence, 7-day point prevalence abstinence, cigarettes smoked per day, withdrawal and urge to smoke, time to (re)lapse, treatment use and compliance, treatment crossover, dual-use, use of other cessation products, change in e-cigarette products, continuation of product use, acceptability, change in health state, health-related quality of life, change in body mass index, adverse events, and cost per quitter. DISCUSSION Pragmatic trials are of particular value as they reflect the 'real world' impact of interventions. The trial will provide some of the first evidence on the effectiveness of combining nicotine salt e-cigarettes with cytisine for smoking cessation, in a country with strong tobacco control policy. Findings will be incorporated into relevant systematic reviews, informing practice and policy. TRIAL REGISTRATION NCT05311085 ClinicalTrials.gov. Registered 5th April, 2022.
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Affiliation(s)
- Natalie Walker
- School of Population Health, National Institute for Health Innovation, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
| | - Amanda Calder
- School of Population Health, National Institute for Health Innovation, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Joanne Barnes
- School of Pharmacy, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - George Laking
- Department of Molecular Medicine and Pathology, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Varsha Parag
- School of Population Health, National Institute for Health Innovation, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Chris Bullen
- School of Population Health, National Institute for Health Innovation, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
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