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Cropsey KL, Wagner WP, Bontemps A, Hawes E, Pridgen B, Lahti AC, Hendricks PS, Azuero A, Carpenter MJ. Effects of in vivo NRT sampling on smoking abstinence and NRT adherence: A randomized clinical trial. Drug Alcohol Depend 2024; 264:112458. [PMID: 39357075 DOI: 10.1016/j.drugalcdep.2024.112458] [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: 05/03/2024] [Revised: 09/15/2024] [Accepted: 09/19/2024] [Indexed: 10/04/2024]
Abstract
BACKGROUND Nicotine replacement therapy (NRT) is an effective treatment but is associated with poor adherence during smoking cessation attempts. This study aimed to determine if In Vivo Sampling, an experiential intervention that includes sampling of NRT in-session, increases NRT adherence and smoking abstinence compared to standard smoking cessation behavioral counseling. METHODS Eligible participants were under community corrections supervision and smoked five or more cigarettes per day for the past year. Participants were randomly assigned to receive either In Vivo Sampling or standard smoking cessation behavioral counseling. Both interventions involved four 30-minute sessions and received 12 weeks of combination NRT. Self-reported NRT adherence, quit attempts, and carbon monoxide (CO)-verified smoking cessation were measured at one, three-, and six-months post-intervention. RESULTS From 2017-2022, 515 participants were enrolled and randomized. The In Vivo Sampling group had significantly greater mean adherence to patch and lozenge NRT regimens (71 % vs. 60 %, OR: 1.63, 95 % CI: 1.36-1.96, p<.001). The In Vivo group had a significantly higher likelihood of quit attempts across time (61 % vs. 53 %, OR: 1.4, 95 % CI: 1.05-1.87, p=.021). Groups did not significantly differ on the percent of participants who had quit smoking at 6 months post-intervention (17 % In Vivo Sampling vs. 13 % standard counseling, OR: 1.43, p=.24). CONCLUSION In Vivo Sampling demonstrated better NRT adherence and quit attempts but similar cessation rates to standard behavioral counseling. The In Vivo Sampling intervention represents a novel approach that increased behaviors typically associated with successful cessation over standard behavioral counseling.
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Affiliation(s)
- Karen L Cropsey
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham, USA.
| | - William P Wagner
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham, USA
| | - Andrew Bontemps
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham, USA
| | - Elizabeth Hawes
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham, USA
| | - Bailey Pridgen
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham, USA
| | - Adrienne C Lahti
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham, USA
| | - Peter S Hendricks
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham, USA
| | - Andres Azuero
- School of Nursing, University of Alabama, Birmingham, USA
| | - Matthew J Carpenter
- Department of Psychiatry, Hollings Cancer Center, Medical University of South Carolina, USA
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2
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Mao RMD, Williams TP, Klimberg VS, Radhakrishnan RS, DeAnda A, Perez A, Walker JP, Mileski WJ, Tyler DS. Quality of Surgical Care Within the Criminal Justice Health Care System. JAMA Surg 2024; 159:179-184. [PMID: 38055231 PMCID: PMC10701659 DOI: 10.1001/jamasurg.2023.6236] [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: 05/30/2023] [Accepted: 09/03/2023] [Indexed: 12/07/2023]
Abstract
Importance Individuals who are incarcerated represent a vulnerable group due to concerns about their ability to provide voluntary and informed consent, and there are considerable legal protections regarding their participation in medical research. Little is known about the quality of surgical care received by this population. Objective To evaluate perioperative surgical care provided to patients who are incarcerated within the Texas Department of Criminal Justice (TDCJ) and compare their outcomes with that of the general nonincarcerated population. Design, Setting, and Participants This cohort study analyzed data from patients who were incarcerated within the TDCJ and underwent general or vascular surgery at the University of Texas Medical Branch (UTMB) from 2012 to 2021. Case-specific outcomes for a subset of these patients and for patients in the general academic medical center population were obtained from the American College of Surgeons National Quality Improvement Program (ACS-NSQIP) and compared. Additional quality metrics (mortality index, length of stay index, and excess hospital days) from the Vizient Clinical Data Base were analyzed for patients in the incarcerated and nonincarcerated groups who underwent surgery at UTMB in 2020 and 2021 to provide additional recent data. Patient-specific demographics, including age, sex, and comorbidities were not available for analysis within this data set. Main Outcome and Measures Perioperative outcomes (30-day morbidity, mortality, and readmission rates) were compared between the incarcerated and nonincarcerated groups using the Fisher exact test. Results The sample included data from 6675 patients who were incarcerated and underwent general or vascular surgery at UTMB from 2012 to 2021. The ACS-NSQIP included data (2012-2021) for 2304 patients who were incarcerated and 602 patients who were not and showed that outcomes were comparable between the TDCJ population and that of the general population treated at the academic medical center with regard to 30-day readmission (6.60% vs 5.65%) and mortality (0.91% vs 1.16%). However, 30-day morbidity was significantly higher in the TDCJ population (8.25% vs 5.48%, P = .01). The 2020 and 2021 data from the Vizient Clinical Data Base included 629 patients who were incarcerated and 2614 who were not and showed that the incarcerated and nonincarcerated populations did not differ with regard to 30-day readmission (12.52% vs 11.30%) or morbidity (1.91% vs 2.60%). Although the unadjusted mortality rate was significantly lower in the TDCJ population (1.27% vs 2.68%, P = .04), mortality indexes, which account for case mix index, were similar between the 2 populations (1.17 vs 1.12). Conclusions and Relevance Findings of this cohort study suggest that patients who are incarcerated have equivalent rates of mortality and readmission compared with a general academic medical center population. Future studies that focus on elucidating the potential factors associated with perioperative morbidity and exploring long-term surgical outcomes in the incarcerated population are warranted.
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Affiliation(s)
- Rui-Min D. Mao
- Department of Surgery, The University of Texas Medical Branch, Galveston
| | - Taylor P. Williams
- Department of Surgery, The University of Texas Medical Branch, Galveston
| | | | | | - Abe DeAnda
- Department of Surgery, The University of Texas Medical Branch, Galveston
| | - Alexander Perez
- Department of Surgery, The University of Texas Medical Branch, Galveston
| | - John P. Walker
- Department of Surgery, The University of Texas Medical Branch, Galveston
| | - William J. Mileski
- Department of Surgery, The University of Texas Medical Branch, Galveston
| | - Douglas S. Tyler
- Department of Surgery, The University of Texas Medical Branch, Galveston
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Bonner SN, Curley R, Love K, Akande T, Akhtar A, Erhunmwunsee L. Structural Racism and Lung Cancer Risk: A Scoping Review. JAMA Oncol 2024; 10:122-128. [PMID: 38032677 DOI: 10.1001/jamaoncol.2023.4897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Importance Structural racism is associated with persistent inequities in health and health outcomes in the US for racial and ethnic minority groups. This review summarizes how structural racism contributes to differential population-level exposure to lung cancer risk factors and thus disparate lung cancer risk across different racial and ethnic groups. Observations A scoping review was conducted focusing on structural racism and lung cancer risk for racial and ethnic minority groups. The domains of structural racism evaluated included housing and built environment, occupation and employment, health care, economic and educational opportunity, private industry, perceived stress and discrimination, and criminal justice involvement. The PubMed, Embase, and MedNar databases were searched for English-language studies in the US from January 1, 2010, through June 30, 2022. The review demonstrated that racial and ethnic minority groups are more likely to have environmental exposures to air pollution and known carcinogens due to segregation of neighborhoods and poor housing quality. In addition, racial and ethnic minority groups were more likely to have exposures to pesticides, silica, and asbestos secondary to higher employment in manual labor occupations. Furthermore, targeted marketing and advertisement of tobacco products by private industry were more likely to occur in neighborhoods with more racial and ethnic minority groups. In addition, poor access to primary care services and inequities in insurance status were associated with elevated lung cancer risk among racial and ethnic minority groups. Lastly, inequities in tobacco use and cessation services among individuals with criminal justice involvement had important implications for tobacco use among Black and Hispanic populations. Conclusions and Relevance The findings suggest that structural racism must be considered as a fundamental contributor to the unequal distribution of lung cancer risk factors and thus disparate lung cancer risk across different racial and ethnic groups. Additional research is needed to better identify mechanisms contributing to inequitable lung cancer risk and tailor preventive interventions.
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Affiliation(s)
- Sidra N Bonner
- Department of Surgery, University of Michigan, Ann Arbor
- National Clinician Scholars Program, University of Michigan, Ann Arbor
| | - Richard Curley
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Kyra Love
- Library Services, City of Hope, Duarte, California
| | - Tola Akande
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Aamna Akhtar
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Loretta Erhunmwunsee
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California
- Department of Populations Sciences, City of Hope National Medical Center, Duarte, California
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Saloner B, Li W, Flores M, Progovac AM, Lê Cook B. A Widening Divide: Cigarette Smoking Trends Among People With Substance Use Disorder And Criminal Legal Involvement. Health Aff (Millwood) 2023; 42:187-196. [PMID: 36745833 PMCID: PMC10157835 DOI: 10.1377/hlthaff.2022.00901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
People with substance use disorder (SUD) smoke cigarettes at a rate more than twice that of the general population. Policies and programs have focused on promoting smoking cessation among people with SUD, yet it is unclear whether interventions have adequately reached the subgroup involved in the criminal legal system, who have among the highest smoking rates. Drawing on repeated cross-sections of the National Survey on Drug Use and Health, we found that smoking rates declined by 9.4 percentage points overall among people with SUD from 2010 to 2019, but rates remained virtually unchanged among the subgroup with criminal legal involvement. In regression analyses focused on people with SUD, three-quarters of the excess smoking burden for those with criminal legal involvement at baseline (2010-13) was accounted for by controlling for sociodemographics, substance use type, health insurance, and recent SUD treatment. However, even after we controlled for these same factors, the disparity in smoking prevalence among people with SUD between those with and without criminal legal involvement remained constant over time. These findings underscore the need for smoking cessation interventions focused on the criminal legal system, including correctional facilities and SUD treatment programs that serve people in this population.
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Affiliation(s)
- Brendan Saloner
- Brendan Saloner , Johns Hopkins University, Baltimore, Maryland
| | - Wenshu Li
- Wenshu Li, Foundation Medicine, Cambridge, Massachusetts
| | - Michael Flores
- Michael Flores, Cambridge Health Alliance and Harvard University, Cambridge, Massachusetts
| | - Ana M Progovac
- Ana M. Progovac, Cambridge Health Alliance and Harvard University
| | - Benjamin Lê Cook
- Benjamin Lê Cook, Cambridge Health Alliance and Harvard University
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Scholze AR, Dália Alves J, Berra TZ, Santos FLD, Ramos ACV, Lima de Freitas G, José Quina Galdino M, Meneguetti Pieri F, Augusto Moraes Arcoverde M, Cristina Pillon S, Monroe AA, Fronteira I, Gomes D, Alexandre Arcêncio R. The burden of alcohol, tobacco and others drugs among incarcerated population diagnosed with tuberculosis: time trends and spatial determinants in Southern Brazil. BMC Public Health 2022; 22:999. [PMID: 35581564 PMCID: PMC9112653 DOI: 10.1186/s12889-022-13408-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 05/12/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis and is a public health problem worldwide. It is estimated that 90% of the patients diagnosed with TB live in vulnerable environments with limited health resources, such as individuals living in correctional facilities. This study aimed to identify the consumption of alcohol, tobacco, and other drugs among prisoners diagnosed with TB and the spatial determinants and time trends of the phenomenon in southern Brazil. METHODS A cross-sectional study using data from the Brazilian Notifiable Diseases Information System was carried out. TB cases confirmed from 2014 to 2018 in prisons located in Paraná, Brazil, were selected. The Prais-Winsten procedure was performed to identify time trends by calculating monthly rates and the percentage of monthly variation. The Seasonal-Trend by Loess decomposition method was used to verify the time series and trends. The spatial association was verified with the Getis-Ord Gi* technique, and the risk areas were identified using spatial scan statistics. RESULTS A total of 1,099 TB cases were found in the studied population. The consumption of tobacco (n = 460; 41.9%), illegal drugs (n = 451; 41.0%), and alcohol (n = 179; 16.3%) stood out. An ascending trend was found for the consumption of alcohol (+ 19.4%/mo. (95%CI: 12.20-23.03)), tobacco (+ 20.2%/mo. (95%CI: 12.20-28.82)), and illegal drugs (+ 62.2%/mo. (95%CI: 44.54-81.97)). Spatial analysis revealed clusters for the use of alcohol, tobacco, and illegal drugs. CONCLUSIONS This study advances knowledge presenting the burden of drug use and its typology among individuals diagnosed with TB in the prison system. There is a growing trend among patients to use drugs, especially illegal drugs. The clusters show differences between the places where the prisons are located.
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Affiliation(s)
- Alessandro Rolim Scholze
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, São Paulo, Ribeirão Preto, Brazil.
| | - Josilene Dália Alves
- Institute of Biological Sciences and Health, Federal University of Mato Grosso, Barra do Garças, Mato Grosso, Brazil
| | - Thaís Zamboni Berra
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, São Paulo, Ribeirão Preto, Brazil
| | - Felipe Lima Dos Santos
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, São Paulo, Ribeirão Preto, Brazil
| | - Antônio Carlos Vieira Ramos
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, São Paulo, Ribeirão Preto, Brazil
| | - Giselle Lima de Freitas
- Department of Maternal-Infant and Public Health Nursing, College of Nursing, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | | | | - Sandra Cristina Pillon
- Department of Psychiatric Nursing and Human Sciences, Ribeirão Preto College of Nursing, University of São Paulo, São Paulo, Ribeirão Preto, Brazil
| | - Aline Aparecida Monroe
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, São Paulo, Ribeirão Preto, Brazil
| | - Inês Fronteira
- Global Health and Tropical Medicine, Instituto de Higiene E Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Dulce Gomes
- School of Science and Technology, Research Center in Mathematics and Application, University of Évora, Évora, Portugal
| | - Ricardo Alexandre Arcêncio
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, São Paulo, Ribeirão Preto, Brazil
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Nativity Status and Poly Tobacco Use among Young Adults in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031230. [PMID: 35162251 PMCID: PMC8835020 DOI: 10.3390/ijerph19031230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 02/01/2023]
Abstract
Young adults are the second largest segment of the immigrant population in the United States (US). Given recent trends in later age of initiation of tobacco use, we examined variation in use of tobacco products by nativity status for this population group. Methods: Our study included young adults 18–30 years of age sampled in the National Health Interview Survey (2015–2019), a nationally representative sample of the US population. We calculated prevalence of use of any and two or more tobacco products (cigarettes, cigars, pipes, e-cigarettes, and smokeless tobacco) for foreign-born (n = 3096) and US-born (n = 6811) young adults. Logistic regression models were adjusted for age, sex, race-ethnicity, education, and poverty, while accounting for the complex survey design. Results: Foreign-born young adults were significantly less likely to use any tobacco product (Cigarette = 7.3% vs. 10.7%; Cigar = 1.8% vs. 4.8%; E-cigarette = 2.3% vs. 4.5%, respectively; p < 0.01) or poly tobacco use (1.9% vs. 4.2%; p < 0.01) than US-born young adults. Adjusted regression models showed lower odds of poly tobacco use among the foreign-born than their US-born counterparts (Odds Ratio = 0.41, (95% Confidence Interval: 0.26–0.63)). Conclusions: The findings highlight the importance of targeted interventions by nativity status and further tobacco prevention efforts needed for the US-born.
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Holzer KJ, AbiNader MA, Vaughn MG, Salas-Wright CP, Oh S. Crime and Violence in Older Adults: Findings From the 2002 to 2017 National Survey on Drug Use and Health. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:764-781. [PMID: 32306830 DOI: 10.1177/0886260520913652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Studies on criminal behaviors largely focus on youth and younger adults. While criminal engagement declines with age, the aging population and significant costs associated with older offenders warrant their increased clinical and research attention. The present study utilizes data from the 2002 to 2017 National Survey on Drug Use and Health to estimate the prevalence and explore the sociodemographic and psychosocial correlates of criminal behavior in adults aged 50 years and older. The overall prevalence of older adults engaging in criminal behaviors during this time was approximately 1.20%. There was no significant difference in crime involvement between adults aged 50 to 64 years and 65 years and older. Older individuals who committed crimes were more likely to be male and Black and earning low income. Criminality was also associated with use of illicit substances and depression as well as receipt of mental health treatment.
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Affiliation(s)
| | | | - Michael G Vaughn
- Saint Louis University, MO, USA
- Yonsei University, Seoul, Republic of Korea
| | | | - Sehun Oh
- The Ohio State University, Columbus, USA
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Hawes ES, Mildrum Chana S, Faust A, Baker JC, Hendricks PS, Azuero A, Lahti AC, Carpenter MJ, Cropsey KL. In vivo Experience With NRT to Increase Adherence and Smoking Abstinence Among Individuals in the Criminal Legal System: Study Protocol for a Randomized Clinical Trial. Front Psychiatry 2022; 13:886680. [PMID: 35800020 PMCID: PMC9253399 DOI: 10.3389/fpsyt.2022.886680] [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: 02/28/2022] [Accepted: 05/26/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND While tobacco use among individuals involved in the criminal legal system remains 3-4 times higher than the general population, few interventions have been targeted for this population to aid in smoking cessation. Nicotine replacement therapy (NRT) is a relatively effective and accessible smoking cessation aid; however, individuals frequently stop use of NRT early due to side effects and misperceptions about the products. The present study aims to address low medication adherence by examining the efficacy of an "in vivo" NRT sampling experience in individuals under community criminal legal supervision. METHODS Following recruitment through community legal outlets, participants (N = 517) are randomized to either an "in vivo NRT sampling" group or a standard smoking cessation behavioral counseling group. The in vivo group uses NRT in session and discusses perceptions and experiences of using NRT in real time while the standard smoking cessation counseling group receives four sessions of standard behavioral smoking cessation counseling. Both groups receive four intervention sessions and 12 weeks of NRT following the intervention. The 6-month post-intervention primary outcome measures are smoking point-prevalence abstinence and medication adherence. CONCLUSION This is a novel smoking cessation intervention specifically aimed at increasing NRT adherence and smoking cessation among those involved in the criminal legal system, a group of individuals with high smoking rates and low rates of pharmacotherapy use. If proven effective, the present treatment could be a novel intervention to implement in criminal legal settings given the minimal requirement of resources and training.This trial is registered with www.clinicaltrials.gov-NCT02938403.
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Affiliation(s)
- Elizabeth S Hawes
- Department of Psychiatry and Behavioral Neurobiology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sofía Mildrum Chana
- Department of Psychiatry and Behavioral Neurobiology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Alexandra Faust
- Department of Psychiatry and Behavioral Neurobiology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Julianne C Baker
- Department of Psychiatry and Behavioral Neurobiology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Peter S Hendricks
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Andres Azuero
- Department of Nursing, Family, Community and Health Systems, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Adrienne C Lahti
- Department of Psychiatry and Behavioral Neurobiology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Karen L Cropsey
- Department of Psychiatry and Behavioral Neurobiology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
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Supportive and palliative care of adults with respiratory problems experiencing structural vulnerability from homelessness, prison or other criminal justice system involvement. Curr Opin Support Palliat Care 2021; 14:197-205. [PMID: 32701858 DOI: 10.1097/spc.0000000000000511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW This review seeks to identify the current prevalence of potentially life-limiting respiratory conditions among those who have experienced homelessness, incarceration or had criminal justice involvement, and current developments in, and barriers to, delivery of supportive and palliative respiratory care to these populations. These structurally vulnerable populations are known to be growing, their health behaviours more risky, and their morbidity and mortality higher, with evidence of accelerated ageing. RECENT FINDINGS Most studies identified investigated prevalence of respiratory conditions, which were found to be high. In contrast, only one study directly explored supportive and palliative care (in a prison population) and none considered or addressed palliative and end-of-life needs of these populations, or mechanisms to address them. There was an absence of qualitative work and studies of the impact on, or role of, family, friends or informal networks. SUMMARY There is a need for evidence-based interventions to reduce the risk of communicable respiratory conditions and a greater understanding of disease trajectories and management for these vulnerable populations, including provision of accessible appropriate supportive, palliative and end-of-life care.
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Winkelman TNA, Ford BR, Dunsiger S, Chrastek M, Cameron S, Strother E, Bock BC, Busch AM. Feasibility and Acceptability of a Smoking Cessation Program for Individuals Released From an Urban, Pretrial Jail: A Pilot Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2115687. [PMID: 34228127 PMCID: PMC8261607 DOI: 10.1001/jamanetworkopen.2021.15687] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
IMPORTANCE Tobacco use prevalence among individuals involved in the criminal-legal system is 125% higher than that of the general population and leads to high levels of smoking-related morbidity and mortality. OBJECTIVE To examine the acceptability, feasibility, and preliminary clinical outcomes of a smoking cessation intervention for individuals who are incarcerated. DESIGN, SETTING, AND PARTICIPANTS This pilot randomized clinical trial was conducted from January 2019 to May 2020. Participants were recruited in a pretrial county jail in a large Midwestern US city and were followed up after release. Participants were incarcerated, smoked daily before incarceration, desired to stay quit or reduce cigarette smoking upon release, and expected to be released to the community within 90 days of enrollment. Data analysis was performed from June to October 2020. INTERVENTIONS Participants randomized to the counseling plus nicotine replacement therapy (NRT) group received 1 hour of smoking cessation counseling in jail, a supply of nicotine lozenges upon release, and up to 4 telephone counseling sessions after release. Those randomized to brief health education (BHE) received 30 minutes of general health education in jail. MAIN OUTCOMES AND MEASURES The primary clinical outcome was biologically verified 7-day point prevalence abstinence (PPA) at 3 weeks after release. Secondary clinical outcomes included 7-day PPA at 12 weeks, changes in number of cigarettes per day, and time to smoking lapse and relapse. RESULTS A total of 46 participants (42 men [91%]; mean [SD] age, 38.2 [9.1] years) were enrolled and remained eligible at release; 23 were randomized to the counseling plus NRT group and 23 were randomized to the BHE group. Recruitment, enrollment, and retention of participants was feasible and acceptable. There were no significant differences in smoking abstinence between groups as determined by 7-day PPA at 3 weeks (adjusted 7-day PPA, 11.9% for counseling plus NRT vs 10.6% for BHE; odds ratio, 1.13; 95% CI, 0.14-9.07) and at 12 weeks (adjusted 7-day PPA, 11.1% for counseling plus NRT vs 14.3% for BHE; odds ratio, 0.75; 95% CI, 0.09-6.11). Cigarettes per day for the counseling plus NRT group decreased more compared with the BHE group at both 3 weeks (difference [SE], -4.58 [1.58] cigarettes per day; 95% CI, -7.67 to -1.48 cigarettes per day; P = .007) and 12 weeks (difference [SE], -3.26 [1.58] cigarettes per day; 95% CI, -5.20 to -0.20 cigarettes per day; P = .04) after release. CONCLUSIONS AND RELEVANCE Initiation of counseling plus NRT during incarceration and continuing after release is feasible and acceptable to participants and may be associated with reduced cigarette use after release. However, additional supports are needed to increase engagement in telephone counseling after release. A larger clinical trial is warranted to determine the effectiveness of counseling plus NRT. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03799315.
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Affiliation(s)
- Tyler N. A. Winkelman
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
- Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota
| | - Becky R. Ford
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
| | - Shira Dunsiger
- Center for Health Promotion and Health Equity, Department of Behavioral and Social Sciences, Brown University, School of Public Health, Providence, Rhode Island
| | - Michelle Chrastek
- Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
| | - Sarah Cameron
- Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
| | - Ella Strother
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
| | - Beth C. Bock
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Andrew M. Busch
- Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
- Division of Clinical Pharmacology, Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota
- Department of Medicine, University of Minnesota, Minneapolis
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11
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Leavens ELS, Ford BR, Ojo-Fati O, Winkelman TNA, Vickery KD, Japuntich SJ, Busch AM. Electronic cigarette use patterns and chronic health conditions among people experiencing homelessness in MN: a statewide survey. BMC Public Health 2020; 20:1889. [PMID: 33297999 PMCID: PMC7724886 DOI: 10.1186/s12889-020-09919-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/18/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Adults experiencing homelessness have higher rates of disease and premature morbidity compared to the general population. Tobacco use is a primary contributing factor to these disparities; however, less is known regarding e-cigarette use patterns among adults experiencing homelessness and whether e-cigarettes are used in a manner that is narrowing or widening health disparities. This study aimed to describe the 1) prevalence and trends in e-cigarette use, 2) correlates of e-cigarettes use, and 3) rates of chronic health conditions by product use pattern in a community-based sample of adults experiencing homelessness. METHODS Adults experiencing homelessness in Minnesota were surveyed by self-report in 2015 (n = 3672) and 2018 (n = 4181) regarding e-cigarette and combustible cigarette use, potential correlates of e-cigarette use, and self-reported chronic health conditions (i.e., asthma, hypertension, diabetes, and cancer). RESULTS Frequency of use increased from 2015 to 2018 for combustible cigarettes (66.9% vs. 72.3%), e-cigarettes (11.4% vs. 14.5%), and dual combustible/e-cigarette use (10.2% vs. 12.9%). The strongest bivariate correlates of past 30-day e-cigarette use were younger age, non-binary gender identification, non-heterosexual orientation, identification as White/Caucasian, greater frequency of lifetime homelessness, substance use, lack of regular place for medical care, mental health diagnosis, criminal justice involvement, and combustible cigarette smoking. Dual users had significantly higher rates of asthma and cancer than both those using combustible cigarettes and those using neither combustible nor e-cigarettes. CONCLUSIONS During a time when cigarette smoking, e-cigarette use, and dual use were decreasing in the general population in Minnesota, rates increased in the homeless population. We observed that the rates of dual use were more than five times greater among homeless adults compared to the general population in 2018. Correlates of e-cigarette use were identified and should be used to identify subpopulations for intervention targeting. Mechanisms of the relationship between dual use and increased risks of health conditions deserve further study.
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Affiliation(s)
- Eleanor L S Leavens
- Department of Population Health, University of Kansas School of Medicine, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA.
| | - Becky R Ford
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Olamide Ojo-Fati
- Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Tyler N A Winkelman
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
- General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Katherine Diaz Vickery
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
- General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Sandra J Japuntich
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Clinical Pharmacology, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | - Andrew M Busch
- Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Clinical Pharmacology, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
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12
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Czaplicki L, Simpson R, Zhou Y, Patel M, Cuccia AF, Vallone DM, Schillo BA. Public Support for E-Cigarette-related Policies among a Nationally Representative Sample of US Adults. Tob Use Insights 2020; 13:1179173X20959700. [PMID: 33100830 PMCID: PMC7549073 DOI: 10.1177/1179173x20959700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 08/21/2020] [Indexed: 12/28/2022] Open
Abstract
Background: The wide availability of flavored e-cigarettes and broad use of e-cigarettes
in public places may contribute to the rapidly increasing rates of use among
youth and young adults in the U.S. However, policies at the federal, state
and local levels can address these factors. Objective: Assess public support for 5 e-cigarette-related policies and evaluate
response patterns by demographics, tobacco use, e-cigarette harm
perceptions, geographic region, and strength of state-level clean indoor air
policies. Methods: Data were collected Oct-Dec 2018 from a nationally representative online
panel of U.S. adults (n = 3211). We measured support for 5 policies: (1) a
ban on the sale flavored e-cigarettes; (2) requiring tobacco products, like
e-cigarettes, be kept out of view in stores where adolescents shop; and
prohibiting e-cigarette use in (3) all public places; (4) restaurants; and
(5) bars. Weighted, adjusted logistic regressions modeled variation in
policy support. Results: A majority of respondents (63.3%) supported a flavor ban, with no differences
in support by smoking status. Most respondents supported keeping tobacco
products out of view (78.0%) and prohibiting e-cigarette use in indoor
public places (82.9%), restaurants (86.5%), and bars (76.1%). In the
adjusted models, current e-cigarette users had significantly lower odds of
policy support compared to never users. We observed no differences in
support by geographic region or strength of state-level clean indoor air
policies. Conclusion: Results suggest high levels of public support to regulate e-cigarette
flavors, marketing, and use in public places. Targeted messaging may be
needed to increase support among current e-cigarette users.
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Affiliation(s)
| | - Randall Simpson
- Schroeder Institute at Truth Initiative, Washington, DC, USA
| | - Yitong Zhou
- Schroeder Institute at Truth Initiative, Washington, DC, USA
| | - Minal Patel
- Schroeder Institute at Truth Initiative, Washington, DC, USA
| | - Alison F Cuccia
- Schroeder Institute at Truth Initiative, Washington, DC, USA
| | - Donna M Vallone
- Schroeder Institute at Truth Initiative, Washington, DC, USA.,College of Global Public Health, New York University, New York, NY, USA.,Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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13
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Abstract
Incarcerated men in the United States, an understudied population, have not been the focus of cancer prevention research. This pilot study explored the impact of Cancer 101 for imprisoned male smokers to increase cancer knowledge and promote cancer prevention activities in the prison population. Cancer 101 was pilot tested for adoption with representatives from the target audience in three prison facilities located in the northeastern region of the United States, and based on their feedback, modifications were implemented. Pretest and posttest surveys were used to assess knowledge of attitudes regarding the benefits of cancer prevention activities at baseline and immediately after completing Cancer 101. Furthermore, a paired t test procedure was used to determine whether cancer knowledge improved after participating in the Cancer 101 program. A total of 161 men completed all of the modules, participated in pre/post assessments, and qualitatively described their behavioral intentions to participate in activities that could reduce cancer risk. The mean cancer knowledge scores differed before and after completing Cancer 101, t(163) = -14.67, p < .001. Regarding age, the older the respondent, the higher their cancer knowledge score, r = .29, p < .001. This study showed improvements in cancer knowledge scores and behavioral intentions to participate in activities to reduce cancer. Cancer 101 provides opportunities for inmates to increase cancer knowledge, as well as promote action for cancer control during incarceration.
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Affiliation(s)
| | | | - Karen Cropsey
- University of Alabama at Birmingham School of Medicine
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14
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Finlay A, Binswanger I, Timko C. Introduction to the special issue. Addict Sci Clin Pract 2020; 15:5. [PMID: 32019590 PMCID: PMC7001374 DOI: 10.1186/s13722-020-0182-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 01/23/2020] [Indexed: 11/10/2022] Open
Abstract
This special issue of Addiction Science & Clinical Practice, "Addiction treatment access and utilization among criminal justice involved populations", presents a series of articles on substance use disorder treatment access and utilization by people who have contact with the criminal justice system (e.g., jails, prisons, and courts). Despite the high prevalence of substance use disorders among people who experience these settings, evidence-based treatment for substance use disorders may be unavailable and/or care may be fragmented during transitions between settings. Articles in this special issue address several gaps in the literature and present a conceptual model of opioid overdose risk, the results of a randomized controlled trial to increase treatment uptake and retention during and after incarceration, descriptions of barriers to treatment after release from incarceration, and data from nationally representative surveys of substance use disorders and treatment use among people who have been involved in the criminal justice system. Importantly, the voices of people with lived experience in the criminal justice system were incorporated in two manuscripts. Together these articles advance our understanding of how to improve care coordination and expansion of services across systems and organizations to prevent overdose, improve treatment utilization, and ultimately, improve health outcomes among criminal justice involved populations in the United States who have substance use disorders or use substances.
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Affiliation(s)
- Andrea Finlay
- Center for Innovation To Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA, 94025, USA.
- Department of Veterans Affairs, National Center on Homelessness Among Veterans, Menlo Park, CA, USA.
| | - Ingrid Binswanger
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA
- Colorado Permanente Medical Group, Denver, CO, USA
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Christine Timko
- Center for Innovation To Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA, 94025, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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