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Vanderkam P, Pomes C, Dzeraviashka P, Castera P, Jaafari N, Lafay-Chebassier C. Insomnia and parasomnia induced by validated smoking cessation pharmacotherapies and electronic cigarettes: a network meta-analysis. CNS Spectr 2024; 29:96-108. [PMID: 38433577 DOI: 10.1017/s1092852924000087] [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: 03/05/2024]
Abstract
We aim to assess the relationship between validated smoking cessation pharmacotherapies and electronic cigarettes (e-cigarettes) and insomnia and parasomnia using a systematic review and a network meta-analysis. A systematic search was performed until August 2022 in the following databases: PUBMED, COCHRANE, CLINICALTRIAL. Randomized controlled studies against placebo or validated therapeutic smoking cessation methods and e-cigarettes in adult smokers without unstable or psychiatric comorbidity were included. The primary outcome was the presence of "insomnia" and "parasomnia." A total of 1261 studies were selected. Thirty-seven studies were included in the quantitative analysis (34 for insomnia and 23 for parasomnia). The reported interventions were varenicline (23 studies), nicotine replacement therapy (NRT, 10 studies), bupropion (15 studies). No studies on e-cigarettes were included. Bayesian analyses found that insomnia and parasomnia are more frequent with smoking cessation therapies than placebo except for bupropion. Insomnia was less frequent with nicotine substitutes but more frequent with bupropion than the over pharmacotherapies. Parasomnia are less frequent with bupropion but more frequent with varenicline than the over pharmacotherapies. Validated smoking cessation pharmacotherapies can induce sleep disturbances with different degrees of frequency. Our network meta-analysis shows a more favorable profile of nicotine substitutes for insomnia and bupropion for parasomnia. It seems essential to systematize the assessment of sleep disturbances in the initiation of smoking cessation treatment. This could help professionals to personalize the choice of treatment according to sleep parameters of each patient. Considering co-addictions, broadening the populations studied and standardizing the measurement are additional avenues for future research.
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Affiliation(s)
- Paul Vanderkam
- Université de Poitiers, INSERM, U-1084, Laboratoire de Neurosciences Expérimentales et Cliniques, Poitiers, France
- Unité de Recherche Clinique Intersectorielle en Psychiatrie, Centre Hospitalier Henri Laborit, Poitiers, France
- Department of General Practice, University of Bordeaux, Bordeaux, France
| | - Charlotte Pomes
- Department of General Practice, University of Poitiers, Poitiers, France
| | | | - Philippe Castera
- Department of General Practice, University of Bordeaux, Bordeaux, France
| | - Nematollah Jaafari
- Unité de Recherche Clinique Intersectorielle en Psychiatrie, Centre Hospitalier Henri Laborit, Poitiers, France
| | - Claire Lafay-Chebassier
- Université de Poitiers, INSERM, U-1084, Laboratoire de Neurosciences Expérimentales et Cliniques, Poitiers, France
- CHU de Poitiers, Service de Pharmacologie Clinique et Vigilances, Poitiers, France
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Dearfield CT, Choi K, Vivino A, Horn K, Ahluwalia JS, Crandell I, Bernat EM, Bernat DH. Are excluding e-cigarettes a loophole in the smokefree public housing rule? Prev Med Rep 2023; 31:102069. [PMID: 36483578 PMCID: PMC9722475 DOI: 10.1016/j.pmedr.2022.102069] [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: 07/27/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 12/04/2022] Open
Abstract
The U.S. Department of Housing and Urban Development (HUD) required all Public Housing Authorities to become smokefree in July 2018, following an 18-month implementation period that began February 2017. The HUD rule included all combustible tobacco products; e-cigarettes were not included. This purpose of this study is to characterize e-cigarette use overall and initiation after the implementation of the smokefree rule among tobacco users living in public housing. Data were collected from 396 adult (18+ years) current tobacco users at the time of rule implementation residing in the District of Columbia Housing Authority between July 2018 and November 2021. Measures include e-cigarette use, age of initiation, reasons for e-cigarette use, e-cigarette use susceptibility (among non-users), and sociodemographic characteristics. Descriptive and crosstab statistics were calculated to characterize e-cigarette use. Nearly-one-quarter of tobacco users reported lifetime use of e-cigarettes (24 %, n = 95) and 4.8 % (n = 19) indicated past 30-day e-cigarette use. Of the lifetime users, twenty-two (23.2 %) initiated their use after the smoke-free rule went into effect, with only two of those residents indicating they did so because of the rule. Of those who never used an e-cigarette, 23.5 % (n = 70) indicated being curious about e-cigarettes and 10.7 % (n = 40) said they may use e-cigarettes in the next year. Results indicate low use of e-cigarette products and low uptake due to the rule. Few tobacco users who never used e-cigarettes indicated intentions to use. Results suggest that omitting e-cigarettes from the HUD rule has not led to significant use of these products in this sample.
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Affiliation(s)
- Craig T. Dearfield
- The George Washington University Milken Institute School of Public Health, Department of Epidemiology, Washington, DC, United States
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, United States
| | - Anthony Vivino
- The George Washington University Milken Institute School of Public Health, Department of Epidemiology, Washington, DC, United States
| | - Kimberly Horn
- Virginia Tech-Carilion Fralin Biomedical Research Institute, Blacksburg, VA, United States
| | - Jasjit S. Ahluwalia
- Department of Behavioral and Social Sciences, Legorreta Cancer Center, Brown University, Providence, RI, United States
| | - Ian Crandell
- Virginia Tech-Center for Biostatistics and Health Data Sciences, Roanoke, VA, United States
| | | | - Debra H. Bernat
- The George Washington University Milken Institute School of Public Health, Department of Epidemiology, Washington, DC, United States
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Ablah E, Kellogg M, Rohleder M, Cagan R, Richter K. Institutional Tobacco Policy and Tobacco Use Among Kansas Sheriffs' Staff and Individuals Incarcerated in Jail. JOURNAL OF CORRECTIONAL HEALTH CARE 2022; 28:193-197. [PMID: 35353016 DOI: 10.1089/jchc.20.05.0035] [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] [Indexed: 11/12/2022]
Abstract
This article describes the factors that contribute to Kansas county jails' tobacco culture to identify reasons for high tobacco use and intervention opportunities. Kansas sheriffs' offices were asked to complete a novel 26-item survey from August through November 2019, and 40% responded. A few reported that tobacco cessation counseling was available to staff (31%) or incarcerated individuals (12%). Seventy-nine percent reported that staff were permitted to use tobacco in designated places outside, whereas 24% reported that tobacco use by incarcerated individuals was permitted in designated places outside. In the jails' commissaries, 5% reported selling nicotine gum or nicotine lozenges and 26% reported selling e-cigarettes. The lack of tobacco cessation counseling and nicotine replacement therapy, weak policies, and availability of tobacco all contribute to Kansas county jails' prevalent tobacco culture.
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Affiliation(s)
- Elizabeth Ablah
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, Kansas, USA
| | - Melinda Kellogg
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, Kansas, USA
| | - Mason Rohleder
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, Kansas, USA
| | - Rick Cagan
- National Alliance on Mental Illness-Kansas, Topeka, Kansas, USA
| | - Kimber Richter
- Department of Population Health, University of Kansas School of Medicine-Kansas City, Kansas City, Kansas, USA
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Covell NH, Foster F, Lipton N, Kingman E, Tse J, Aquila A, Williams JM. Self- Evaluation Tool to Support Implementation of Treatment for Tobacco Use Disorder in Behavioral Health Programs. Community Ment Health J 2022; 58:812-820. [PMID: 34518927 PMCID: PMC8437659 DOI: 10.1007/s10597-021-00890-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/28/2021] [Indexed: 11/28/2022]
Abstract
Tobacco use in people with behavioral health conditions remain two to three times higher than the general population causing premature death and impacting recovery negatively across several domains. Intermediary organizations can provide practical tools, training, and technical assistance to help programs improve capacity to treat tobacco use. This report describes the construction and application of the Tobacco Integration Self-Evaluation Tool (TiSET) for behavioral health programs, a 20-item scale inspired by the DDCMHT and additional content from the Facility Tobacco Policy and Treatment Practices Self-Evaluation tool that one of the study authors (JW) used previously with addiction treatment programs. Completing the TiSET is an important step for behavioral health programs to evaluate their ability to effectively treat people that use tobacco. An important next step is to use those results to facilitate a quality improvement process. We include large agency example illustrating how the TiSET can be applied in real-world practice.
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Affiliation(s)
- Nancy H Covell
- Columbia University Vagelos College of Physicians and Surgeons, Center for Practice Innovations, New York State Psychiatric Institute, New York, NY, USA.
| | - Forrest Foster
- Center for Practice Innovations, New York State Psychiatric Institute, New York, NY, USA
| | - Noah Lipton
- Center for Practice Innovations, New York State Psychiatric Institute, New York, NY, USA
| | - Emily Kingman
- The Institute for Community Living (ICL), Inc. New York, New York, NY, USA
| | - Jeanie Tse
- The Institute for Community Living (ICL), Inc. New York, New York, NY, USA.,New York University and Fountain House, New York, NY, USA
| | - Annie Aquila
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Jill M Williams
- Rutgers University-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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5
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Altowiher NSS, Bustami R, Alwadey AM, Alqahtani M. Tobacco Taxation Influences the Smoking Habits of Adult Smokers Attending Smoking Cessation Clinic in Saudi Arabia. Front Public Health 2022; 10:794237. [PMID: 35265571 PMCID: PMC8899034 DOI: 10.3389/fpubh.2022.794237] [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: 11/05/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To determine whether the increased tobacco price due to tax implementation on tobacco products (including cigarettes) has a significant effect on smoking cessation among Saudi Arabian adult smokers. Methods An interviewer-administered questionnaire was used to obtain data from adult Saudi smokers and recent quitters attending smoking cessation clinics between January 2018 and September 2019. The responses of the participants were summarized and analyzed. Results In total, 660 participants were interviewed, of which 98% were men who resided in the western region (33%). Taxation had no effect on smoking in 387 participants [58.6%; 95% confidence interval (CI): 54.9, 62.4], some effect in 220 participants (33.3%; 95% CI: 29.7, 36.9), and a substantial effect in 50 participants (7.6%; 95% CI: 5.6, 9.6). Strategies adopted to cope with the tax implementation included cutting down on the number of cigarettes smoked (302; 45.8%), changing to a cheaper brand of cigarette (151; 22.9%), purchasing in bulk (105; 15.9%), attempting to quit (453; 68.6%), and doing nothing (108; 16.4%). The rate of quitting smoking after attending the clinic was 20.7% (95% CI: 17.7, 23.9). Occupation (P = 0.003), education (P = 0.03), and current smoking habit (P = 0.07) were significantly associated with the impact of tobacco taxation. The strategies adopted in response to tax implementation on cigarettes were significantly associated with occupation (χ2 = 30, degrees of freedom = 12, P < 0.001). Conclusions Tobacco taxation influenced 40% of the participants. Their attempts to opt for alternatives should be recognized in evaluating policies to reduce adverse health impacts caused by tobacco abuse.
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Affiliation(s)
| | - Rami Bustami
- Department Biostatistics and Epidemiology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Ali M. Alwadey
- Tobacco Control Program, Ministry of Health (Saudi Arabia), Riyadh, Saudi Arabia
| | - Mansour Alqahtani
- Tobacco Control Program, Ministry of Health (Saudi Arabia), Riyadh, Saudi Arabia
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[The anesthetist's view on Jethro Tull's Aqualung]. Anaesthesist 2020; 70:237-246. [PMID: 33165627 PMCID: PMC7650578 DOI: 10.1007/s00101-020-00882-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Im Jahre 1971 veröffentlichte die britische Rockgruppe Jethro Tull ihr Meilensteinalbum Aqualung. Darauf ist ein Lied gleichen Titels zu hören, das die Geschichte eines Wohnungslosen namens „Aqualung“ erzählt, der einen kalten Tag auf einer Bank in einem Londoner Park verbringt. Es passiert nicht wirklich viel: Er schaut jungen Mädchen beim Spielen zu, bückt sich, um eine Zigarettenkippe aufzuheben, geht einen kurzen Weg zu einer öffentlichen Toilette, die Heilsarmee bietet ihm eine Tasse Tee an, er wird durch die junge Prostituierte „cross-eyed Mary“ erschreckt und flüchtet vor ihr und stirbt schließlich mit rasselnden letzten Atemzügen, die an Tiefseetauchergeräusche erinnern. Offensichtlich ist Aqualung schwer krank. Möglicherweise leidet er an einem Lungenödem, peripherer arterieller Verschlusskrankheit, posttraumatischer Belastungsstörung und vielleicht noch an weiteren der vielen, für Wohnungslose typischen Erkrankungen. Die Beschreibung seiner letzten Atemzüge mag den Anästhesisten an das Todesrasseln erinnern. Eine Möglichkeit, medizinisches Fachwissen an Ärzte zu vermitteln, besteht darin, Daten und Fakten über Erkrankungen mit Elementen der Popkultur zu verknüpfen. Dieser Essay möchte einen bis heute berühmten Rocksong als Vehikel nutzen, um Anästhesisten und Intensivmediziner für intensivmedizinisch relevante Erkrankungen von Wohnungslosen zu sensibilisieren und den Wissensstand zu verbessern.
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Hassett-Walker C, Shadden M. Examining Arrest and Cigarette Smoking in Emerging Adulthood. Tob Use Insights 2020; 13:1179173X20904350. [PMID: 32082049 PMCID: PMC7005980 DOI: 10.1177/1179173x20904350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 01/13/2020] [Indexed: 11/19/2022] Open
Abstract
Background: Despite prior studies, transitions in smoking patterns are not fully
understood. Getting arrested may alter an individual’s smoking pattern
through processes proscribed by the criminological labeling theory. This
study examined how arrest during emerging adulthood altered smoking behavior
during subsequent years and whether there were differential effects by
race/ethnicity and gender. Methods: We analyzed 15 waves of data from the National Longitudinal Survey of Youth
1997. Multinomial logistic regressions were performed using Stata software
version 14. Results: For both genders, arrested black men and women had the most distinct smoking
transitions (both increases and decreases) as compared with their
non-arrested counterparts. Among men, particularly black males, arrest in
early adulthood was associated with the men transitioning to both increased
and decreased smoking. Patterns in smoking transitions for women were less
clear, suggesting that women’s smoking may be influenced by factors not in
the models. Women had a low probability of starting to smoke or increasing
smoking if they were never arrested between 18 and 21 years of age. Conclusions: The results for transitioning into increased smoking offer some support for
labeling theory processes. Other findings suggest that arrest may lead to
some men reducing or quitting smoking. Early adulthood arrest may serve to
“shock the system” and contribute to males altering their prior smoking
behavior. Implications: Tobacco use over the life course, particularly across different racial and
ethnic groups, remains understudied. This study contributes to the
literature using a nationally representative sample to examine the effect of
getting arrested in emerging adulthood on cigarette use during subsequent
years. In conducting the study, investigators combined theories and
methodological approaches from 2 complementary disciplines: public health
and criminal justice. Because criminal justice policymakers tend to focus on
issues like ex-offender unemployment, public health officials can provide
guidance regarding the effect of justice system involvement on smoking,
particularly given the adverse health outcomes of using cigarettes.
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Dutra LM, Farrelly MC, Nonnemaker J, Bradfield B, Gaber J, Patel M, Hair EC. Differential Relationship between Tobacco Control Policies and U.S. Adult Current Smoking by Poverty. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214130. [PMID: 31717748 PMCID: PMC6862047 DOI: 10.3390/ijerph16214130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/14/2019] [Accepted: 10/23/2019] [Indexed: 12/29/2022]
Abstract
The study's purpose was to identify differences in the relationship between tobacco control policies and smoking by poverty. We matched state smoke-free air law coverage (SFALs), tobacco control funding (TCF), and cigarette taxes with individual current smoking and demographics from supplements to the Current Population Survey (1985-2015). We regressed (logistic) smoking on policy variables, poverty (<138% of poverty line versus ≥138% of poverty line), interactions of policy and poverty, and covariates, presenting beta coefficients instead of odds ratios because it is difficult to interpret interactions using odds ratios (they are ratios of odds ratios). We coded SFALs as (1) proportion of state covered by 100% workplace, restaurant and bar laws (SFAL-All) or (2) proportion of state covered by workplace laws (SFAL-WP) and proportion covered by restaurant or bar laws (SFAL-RB). In the SFAL-All model, SFAL-All (Beta coeff: -0.03, 95% CI: -0.06, -0.002), tax (Coeff: -0.06, 95% CI: -0.07, -0.05), and TCF (Coeff: -0.01, 95% CI: -0.01, -0.001) were associated with less smoking. In this model, the interaction of SFAL-All by poverty was significant (Coeff: 0.08, 95% CI: 0.02, 0.13). In the SFAL-WP/RB model, SFAL-RB (Coeff: -0.05, 95% CI: -0.08, -0.02), tax (Coeff: -0.05, 95% CI: -0.06, -0.04), and TCF (Coeff: -0.01, 95% CI: -0.01, -0.00) were significant. In the same model, SFAL-WP (Coeff: 0.09, 95% CI: 0.03, 0.15), SFAL-RB (Coeff: -0.14, 95% CI: -0.19, -0.09), and TCF (Coeff: 0.01, 95% CI: 0.00, 0.02) interacted with poverty. Tax by poverty was of borderline significance in this model (Coeff = 0.02, 95% CI: -0.00, 0.04, p = 0.050). Among adults, SFALs, TCF, and tax were associated with less current smoking, and SFALs and TCF had differential relationships with smoking by poverty.
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Affiliation(s)
- Lauren M. Dutra
- Center for Health Policy Science and Tobacco Research, RTI International, 3040 East Cornwallis Road, Durham, NC 27709, USA; (M.C.F.); (J.N.); (B.B.); (J.G.)
- Correspondence: ; Tel.: +1-510-665-8297
| | - Matthew C. Farrelly
- Center for Health Policy Science and Tobacco Research, RTI International, 3040 East Cornwallis Road, Durham, NC 27709, USA; (M.C.F.); (J.N.); (B.B.); (J.G.)
| | - James Nonnemaker
- Center for Health Policy Science and Tobacco Research, RTI International, 3040 East Cornwallis Road, Durham, NC 27709, USA; (M.C.F.); (J.N.); (B.B.); (J.G.)
| | - Brian Bradfield
- Center for Health Policy Science and Tobacco Research, RTI International, 3040 East Cornwallis Road, Durham, NC 27709, USA; (M.C.F.); (J.N.); (B.B.); (J.G.)
| | - Jennifer Gaber
- Center for Health Policy Science and Tobacco Research, RTI International, 3040 East Cornwallis Road, Durham, NC 27709, USA; (M.C.F.); (J.N.); (B.B.); (J.G.)
| | - Minal Patel
- Schroeder Institute, Truth Initiative, 900 G Street Northwest, Fourth Floor, Washington, DC 20001, USA; (M.P.); (E.C.H.)
| | - Elizabeth C. Hair
- Schroeder Institute, Truth Initiative, 900 G Street Northwest, Fourth Floor, Washington, DC 20001, USA; (M.P.); (E.C.H.)
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Petersen AB, Stewart HC, Walters J, Vijayaraghavan M. Smoking Policy Change Within Permanent Supportive Housing. J Community Health 2019; 43:312-320. [PMID: 28884243 DOI: 10.1007/s10900-017-0423-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Smoke-free policies effectively reduce secondhand smoke (SHS) exposure among non-smokers, and reduce consumption, encourage quit attempts, and minimize relapse to smoking among smokers. Such policies are uncommon in permanent supportive housing (PSH) for formerly homeless individuals. In this study, we collaborated with a PSH provider in San Diego, California to assess a smoke-free policy that restricted indoor smoking. Between August and November 2015, residents completed a pre-policy questionnaire on attitudes toward smoke-free policies and exposure to secondhand smoke, and then 7-9 months after policy implementation residents were re-surveyed. At follow-up, there was a 59.7% reduction in indoor smoking. The proportion of residents who identified as current smokers reduced by 13% (95% CI: -38, 10.2). The proportion of residents who reported never smelling SHS indoors (apartment 24.2%, 95% CI: 4.2, 44.1; shared areas 17.2%, 95% CI: 1.7, 32.7); in outdoor areas next to the living unit (porches or patio 56.7%, 95% CI: 40.7, 72.8); and in other outdoor areas (parking lot 28.6%, 95% CI: 8.3, 48.9) was lower post-policy compared with pre-policy. Overall, resident support increased by 18.7%; however, the greatest increase in support occurred among current smokers (from 14.8 to 37.5%). Fewer current smokers reported that the policy would enable cessation at post-policy compared to pre-policy. Our findings demonstrate the feasibility of implementing smoke-free policies in PSH for formerly homeless adults. However, policy alone appears insufficient to trigger change in smoking behavior, highlighting the need for additional cessation resources to facilitate quitting.
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Affiliation(s)
| | | | - Jon Walters
- Housing Innovation Partners, San Diego, CA, USA
| | - Maya Vijayaraghavan
- Division of General Internal Medicine/Zuckerberg San Francisco General Hospital, School of Medicine, University of California San Francisco, 1001 Potrero Ave, Box 1364, San Francisco, CA, 94110, USA.
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Lent AB, O’Connor PA, Reikowsky RC, Nair US, Bell ML. Quit outcomes among clients ineligible for cessation medication through the state quitline: a retrospective, observational study. BMC Public Health 2018; 18:1001. [PMID: 30097065 PMCID: PMC6086054 DOI: 10.1186/s12889-018-5923-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 08/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Distribution of tobacco cessation medications through state quitlines increases service utilization and quit outcomes. However, some state quitlines have moved to models in which callers are instructed to obtain quit medications through their health insurance pharmaceutical benefit. We aimed to investigate the impact of this policy on medication access and quit outcomes in the state quitline setting for clients who must obtain covered medications through the state Medicaid program. We hypothesized that clients with Medicaid who were referred by their healthcare provider would be more likely to report using quit medication and have higher quit rates compared to clients with Medicaid who engaged the quitline on their own. METHODS An observational, retrospective study was conducted using state quitline clients with Medicaid health insurance who were ineligible for quitline provided cessation medications. Clients were stratified by referral type: self-referred, passively referred, and proactively referred. Unadjusted and adjusted logistic regression was used to estimate the effect of referral type on both quit status and cessation medication use. RESULTS Proactively referred clients were less likely to use quit medication (53.6%) compared to self (56.9%) and passively referred clients (61.1%). Proactively referred clients had lower quit rates (31.4%), as compared to passively referred (36.0%) and self-referred (35.1%). In adjusted models, proactively referred clients were significantly less likely to be quit than passively referred clients (OR = 0.75, 95% CI: 0.56, 0.99). There were no statistically significant differences in medication use or number of coaching sessions among proactive, passive, and self-referred clients in adjusted models. CONCLUSIONS In adjusted models, medication use did not significantly differ by mode of entry in this population of Medicaid beneficiaries. Psychosocial factors such as intention to quit in the next 30 days, social support for quitting, education level, race, and ethnicity impacted quit status and differed by mode of entry. Quitlines should use tailored strategies to increase engagement and reduce barriers among proactively referred clients.
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Affiliation(s)
- Adrienne B. Lent
- Health Promotion Sciences, University of Arizona, Mel and Enid Zuckerman College of Public Health, 1295 N Martin Ave, Tucson, AZ 85724 USA
| | - Patrick A. O’Connor
- Biostatistics, University of Arizona, Mel and Enid Zuckerman College of Public Health, 1295 N Martin Ave, Tucson, AZ 85724 USA
| | - Ryan C. Reikowsky
- Health Promotion Sciences, University of Arizona, Mel and Enid Zuckerman College of Public Health, 1295 N Martin Ave, Tucson, AZ 85724 USA
| | - Uma S. Nair
- Health Promotion Sciences, University of Arizona, Mel and Enid Zuckerman College of Public Health, 1295 N Martin Ave, Tucson, AZ 85724 USA
| | - Melanie L. Bell
- Epidemiology and Biostatistics, University of Arizona, Mel and Enid Zuckerman College of Public Health, 1295 N Martin Ave, Tucson, AZ 85724 USA
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Kurti AN, Redner R, Lopez AA, Keith DR, Villanti AC, Stanton CA, Gaalema DE, Bunn JY, Doogan NJ, Cepeda-Benito A, Roberts ME, Phillips J, Higgins ST. Tobacco and nicotine delivery product use in a national sample of pregnant women. Prev Med 2017; 104:50-56. [PMID: 28789981 PMCID: PMC5734954 DOI: 10.1016/j.ypmed.2017.07.030] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 07/25/2017] [Accepted: 07/31/2017] [Indexed: 11/19/2022]
Abstract
Monitoring use of tobacco products among pregnant women is a public health priority, yet few studies in U.S. national samples have been reported on this topic. We examined prevalence and correlates of using cigarettes, e-cigarettes, and other tobacco/nicotine delivery products in a U.S. national sample of pregnant women. Data were obtained from all pregnant women (≥18 years) in the first wave of the Population Assessment of Tobacco and Health (PATH, 2013-2014) Study (N=388). Prevalence of current and prior use of tobacco/nicotine products was examined overall and among current cigarette smokers. Multiple logistic regression was used to examine correlates of use of cigarettes, e-cigarettes, hookah and cigars. Overall prevalence was highest for cigarettes (13.8%), followed by e-cigarettes (4.9%), hookah (2.5%) and cigars (2.3%), and below 1% for all other products. Prevalence of using other tobacco products is much higher among current smokers than the general population, with e-cigarettes (28.5%) most prevalent followed by cigars (14.0%), hookah (12.4%), smokeless (4.7%), snus (4.6%), and pipes (2.1%). Sociodemographic characteristics (poverty, low educational attainment, White race) and past-year externalizing psychiatric symptoms were correlated with current cigarette smoking. In turn, current cigarette smoking and past year illicit drug use were correlated with using e-cigarettes, hookah, and cigars. These results underscore that tobacco/nicotine use during pregnancy extends beyond cigarettes. The results also suggest that use of these other products should be included in routine clinical screening on tobacco use, and the need for more intensive tobacco control and regulatory strategies targeting pregnant women.
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Affiliation(s)
- Allison N Kurti
- University of Vermont Tobacco Center of Regulatory Science, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States.
| | - Ryan Redner
- University of Vermont Tobacco Center of Regulatory Science, University of Vermont, United States; Rehabilitation Institute, Southern Illinois University, United States
| | - Alexa A Lopez
- University of Vermont Tobacco Center of Regulatory Science, University of Vermont, United States
| | - Diana R Keith
- University of Vermont Tobacco Center of Regulatory Science, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States
| | - Andrea C Villanti
- University of Vermont Tobacco Center of Regulatory Science, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States
| | - Cassandra A Stanton
- Westat, Center for Evaluation and Coordination of Training and Research (CECTR) in Tobacco Regulatory Science, Department of Oncology, Georgetown University Medical Center, United States
| | - Diann E Gaalema
- University of Vermont Tobacco Center of Regulatory Science, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States
| | - Janice Y Bunn
- Department of Biostatistics, Obstetrics, Gynecology, University of Vermont, United States
| | | | - Antonio Cepeda-Benito
- University of Vermont Tobacco Center of Regulatory Science, University of Vermont, United States
| | | | - Julie Phillips
- University of Vermont Tobacco Center of Regulatory Science, University of Vermont, United States; Department of Reproductive Sciences, University of Vermont, United States
| | - Stephen T Higgins
- University of Vermont Tobacco Center of Regulatory Science, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States; Department of Psychological Science, University of Vermont, United States
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Facility-level, state, and financial factors associated with changes in the provision of smoking cessation services in US substance abuse treatment facilities: Results from the National Survey of Substance Abuse Treatment Services 2006 to 2012. J Subst Abuse Treat 2017; 77:107-114. [PMID: 28476262 DOI: 10.1016/j.jsat.2017.03.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 03/22/2017] [Accepted: 03/24/2017] [Indexed: 11/20/2022]
Abstract
Cigarette smoking is common among patients in substance abuse treatment. Tobacco control programs have advocated for integrated tobacco dependence treatment into behavioral healthcare, including within substance abuse treatment facilities (SATFs) to reduce the public health burden of tobacco use. This study used data from seven waves (2006 to 2012) of the National Survey of Substance Abuse Treatment Services (n=94,145) to examine state and annual changes in the provision of smoking cessation services within US SATFs and whether changes over time could be explained by facility-level (private vs public ownership, receipt of earmarks, facility admissions, acceptance of government insurance) and state-level factors (cigarette tax per pack, smoke free policies, and percent of CDC recommended tobacco prevention spending). Results showed that the prevalence of SATFs offering smoking cessation services increased over time, from 13% to 65%. The amount of tax per cigarette pack, accepting government insurance, government (vs private) ownership, facility admissions, and CDC recommended tobacco prevention spending (per state) were the strongest correlates of the provision of smoking cessation programs in SATFs. Facilities that received earmarks were less likely to provide cessation services. Adult smoking prevalence and state-level smoke free policies were not significant correlates of the provision of smoking cessation services over time. Policies aimed at increasing the distribution of tax revenues to cessation services in SATFs may offset tobacco-related burden among those with substance abuse problems.
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