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McCuistian C, Lisha NE, Campbell B, Cheng C, Le J, Guydish J. Reducing tobacco use in substance use treatment: The California tobacco free initiative. Addict Behav 2024; 155:108025. [PMID: 38593596 DOI: 10.1016/j.addbeh.2024.108025] [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: 01/25/2024] [Revised: 03/12/2024] [Accepted: 03/29/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND People in substance use disorder (SUD) treatment have a smoking prevalence that is five times higher than the national average. California funded the Tobacco Free for Recovery Initiative, designed to support programs in implementing tobacco-free grounds and increasing smoking cessation services. In the first cohort of the initiative (2018-2020) client smoking prevalence decreased from 54.2% to 26.6%. The current study examined whether similar findings would be replicated with a later cohort of programs (2020-2022). METHOD Cross-sectional survey data were collected from clients in 11 residential SUD treatment programs at baseline (n = 185) and at post intervention (n = 227). Multivariate logistic regression assessed change over time in smoking prevalence, tobacco use behaviors, and receipt of cessation services across the two timepoints. RESULTS Client smoking prevalence decreased from 60.3 % to 40.5 % (Adjusted Odds Ratio [AOR] = 0.46, 95 % CI = 0.27, 0.78; p = 0.004). Current smokers and those who quit while in treatment reported an increase in nicotine replacement therapy (NRT)/pharmacotherapy from baseline to post intervention (31.9 % vs 45.6 %; AOR = 2.22, 95 % CI = 1.08, 4.58; p = 0.031). CONCLUSIONS Like the first cohort, the Tobacco Free for Recovery initiative was associated with decreased client smoking prevalence and an increase in NRT/pharmacotherapy. These findings strengthen the evidence that similar initiatives may be effective in reducing smoking prevalence among people in SUD treatment.
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Affiliation(s)
- Caravella McCuistian
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco 1001 Potrero Ave, San Francisco, CA 94110, United States.
| | - Nadra E Lisha
- Division of General Internal Medicine, School of Medicine University of California, San Francisco 530 Parnassus Ave, San Francisco, CA 94143, United States
| | - Barbara Campbell
- Division of General Internal Medicine & Geriatrics, Oregon Health and Science University 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, United States
| | - Christine Cheng
- Smoking Cessation Leadership Center, University of California, San Francisco 490 Illinois Street, 9216, San Francisco, CA 94158, United States
| | - Jennifer Le
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco 1001 Potrero Ave, San Francisco, CA 94110, United States
| | - Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St., Floor 7, San Francisco, CA 94158, United States
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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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Hoang THL, Nguyen VM, Adermark L, Alvarez GG, Shelley D, Ng N. Factors Influencing Tobacco Smoking and Cessation Among People Living with HIV: A Systematic Review and Meta-analysis. AIDS Behav 2024; 28:1858-1881. [PMID: 38478323 PMCID: PMC11161546 DOI: 10.1007/s10461-024-04279-1] [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] [Accepted: 01/25/2024] [Indexed: 06/10/2024]
Abstract
Tobacco smoking is highly prevalent among people living with HIV (PLWH), yet there is a lack of data on smoking behaviours and effective treatments in this population. Understanding factors influencing tobacco smoking and cessation is crucial to guide the design of effective interventions. This systematic review and meta-analysis of studies conducted in both high-income (HICs) and low- and middle-income countries (LMICs) synthesised existing evidence on associated factors of smoking and cessation behaviour among PLWH. Male gender, substance use, and loneliness were positively associated with current smoking and negatively associated with smoking abstinence. The association of depression with current smoking and lower abstinence rates were observed only in HICs. The review did not identify randomised controlled trials conducted in LMICs. Findings indicate the need to integrate smoking cessation interventions with mental health and substance use services, provide greater social support, and address other comorbid conditions as part of a comprehensive approach to treating tobacco use in this population. Consistent support from health providers trained to provide advice and treatment options is also an important component of treatment for PLWH engaged in care, especially in LMICs.
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Affiliation(s)
- Thanh H L Hoang
- School of Public Health and Community Medicine, Institute for Medicine, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 18A, 41390, Gothenburg, Sweden.
| | - Van M Nguyen
- School of Public Health and Community Medicine, Institute for Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Louise Adermark
- Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gloria G Alvarez
- School of Global Public Health, New York University, New York, USA
| | - Donna Shelley
- School of Global Public Health, New York University, New York, USA
| | - Nawi Ng
- School of Public Health and Community Medicine, Institute for Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Allen MI, Johnson BN, Kumar A, Su Y, Singh S, Deep G, Nader MA. Behavioral and neuronal extracellular vesicle biomarkers associated with nicotine's enhancement of the reinforcing strength of cocaine in female and male monkeys. ADDICTION NEUROSCIENCE 2024; 11:100151. [PMID: 38911873 PMCID: PMC11192513 DOI: 10.1016/j.addicn.2024.100151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
While the majority of people with cocaine use disorders (CUD) also co-use tobacco/nicotine, most preclinical cocaine research does not include nicotine. The present study examined nicotine and cocaine co-use under several conditions of intravenous drug self-administration in monkeys, as well as potential peripheral biomarkers associated with co-use. In Experiment 1, male rhesus monkeys (N = 3) self-administered cocaine (0.001-0.1 mg/kg/injection) alone and with nicotine (0.01-0.03 mg/kg/injection) under a progressive-ratio schedule of reinforcement. When nicotine was added to cocaine, there was a significant leftward/upward shift in the number of injections received. In Experiment 2, socially housed female and male cynomolgus monkeys (N = 14) self-administered cocaine under a concurrent drug-vs-food choice schedule of reinforcement. Adding nicotine to the cocaine solution shifted the cocaine dose-response curves to the left, with more robust shifts noted in the female animals. There was no evidence of social rank differences. To assess reinforcing strength, delays were added to the presentation of drug; the co-use of nicotine and cocaine required significantly longer delays to decrease drug choice, compared with cocaine alone. Blood samples obtained post-session were used to analyze concentrations of neuronally derived small extracellular vesicles (NDE); significant differences in NDE profile were observed for kappa-opioid receptors when nicotine and cocaine were co-used compared with each drug alone and controls. These results suggest that drug interactions involving the co-use of nicotine and cocaine are not simply changing potency, but rather resulting in changes in reinforcing strength that should be utilized to better understand the neuropharmacology of CUD and the evaluation of potential treatments.
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Affiliation(s)
- Mia I. Allen
- Department of Translational Neuroscience, Wake Forest University School of Medicine, Winston-Salem, NC, United States
- Center for Addiction Research, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Bernard N. Johnson
- Department of Translational Neuroscience, Wake Forest University School of Medicine, Winston-Salem, NC, United States
- Center for Addiction Research, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Ashish Kumar
- Department of Cancer Biology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Yixin Su
- Department of Cancer Biology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Sangeeta Singh
- Department of Cancer Biology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Gagan Deep
- Center for Addiction Research, Wake Forest University School of Medicine, Winston-Salem, NC, United States
- Department of Cancer Biology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
- J Paul Sticht Center for Healthy Aging and Alzheimer’s Prevention, School of Medicine, Wake Forest University, Winston-Salem, NC, United States
- Department of Cancer Biology, School of Medicine, Wake Forest University, Winston-Salem, NC, United States
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United States
| | - Michael A. Nader
- Department of Translational Neuroscience, Wake Forest University School of Medicine, Winston-Salem, NC, United States
- Center for Addiction Research, Wake Forest University School of Medicine, Winston-Salem, NC, United States
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
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Dunham CM, Huang GS, Chance EA, Hileman BM. Association of Cigarette Smoking History With Drug Abuse History and Arterial Carboxyhemoglobin in Trauma Activation Patients: A Retrospective Study. Cureus 2024; 16:e58606. [PMID: 38765416 PMCID: PMC11102803 DOI: 10.7759/cureus.58606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction The relationship between cigarette smoking and arterial carboxyhemoglobin (CoHb) in trauma activation patients has not been investigated. The aim was to determine if cigarette smoking is associated with drug abuse history and arterial CoHb levels. Methodology This is a retrospective review of level I trauma center activations aged 18-60 during 2018-2020. A medical record audit was performed to assess each patient's cigarette smoking and drug abuse history and admission arterial CoHb level. The CoHb levels and smoking history for each patient were used to construct a receiver operating characteristic curve. Results Of the 742 trauma activations aged 18-60, 737 (99.3%) had a documented cigarette smoking history. Smoking history was positive in 49.7% (366) and negative in 50.3% (371). The positive smoking proportion was greater in patients with a drug abuse history (63.9% (234/366)) than those with a negative history (31.0% (115/371); p<0.0001; odds ratio=4.0). In 717 patients with a CoHb value, the CoHb was higher in smokers (3.9±2.2%) than in non-smokers (0.5±0.4%; p<0.0001; Cohen d=2.2). A CoHb >1.5% was higher in smokers (93.3% (333/357)) than non-smokers (1.7% (6/360); p<0.0001; odds ratio=818.6). The receiver operating characteristic curve for the relationship between CoHb and cigarette smoking history showed an area under the curve of 0.980 (p<0.0001). Using an arterial CoHb level >1.5% to predict a positive smoking history and a CoHb level ≤1.5% to predict a non-smoking history, sensitivity was 93.3% (333/357), specificity was 98.3% (354/360), and accuracy was 95.8% (687/717). Conclusion Cigarette smoking in trauma activations aged 18-60 is associated with drug abuse history and increased arterial CoHb levels on trauma center arrival.
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Affiliation(s)
- C Michael Dunham
- Trauma, Critical Care, and General Surgery, St. Elizabeth Youngstown Hospital, Youngstown, USA
| | - Gregory S Huang
- Trauma, Critical Care, and General Surgery, St. Elizabeth Youngstown Hospital, Youngstown, USA
| | - Elisha A Chance
- Trauma and Neuroscience Research, St. Elizabeth Youngstown Hospital, Youngstown, USA
| | - Barbara M Hileman
- Trauma and Neuroscience Research, St. Elizabeth Youngstown Hospital, Youngstown, USA
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Zvolensky MJ, Shepherd JM, Clausen BK, Redmond BY, Correa-Fernández V, Ditre JW. Combustible cigarette smokers versus e-cigarette dual users among Latinx individuals: Differences in alcohol and drug use severity. Exp Clin Psychopharmacol 2024; 32:197-206. [PMID: 37470998 PMCID: PMC10799193 DOI: 10.1037/pha0000673] [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: 07/21/2023]
Abstract
The Latinx population in the United States (U.S.) experiences significant tobacco and other substance use-related health disparities. Yet, little is known about the couse of combustible cigarettes and e-cigarettes (dual use) in relation to substance use behavior among Latinx smokers. The present investigation compared English-speaking Latinx adults living in the United States who exclusively smoke combustible cigarettes versus dual users in terms of alcohol use and other drug use problem severity. Participants were 297 Hispanic/Latinx daily cigarette smokers (36.4% female, Mage = 35.9 years, SD = 8.87) recruited nationally across the United States using Qualtrics Panels to complete self-report measures of behavioral health outcomes. Five analysis of covariance models were conducted to evaluate differences in overall alcohol consumption, dependence, related problems, hazardous drinking, and drug use problem severity between exclusive combustible cigarette smokers (N = 205) and dual users (N = 92). Results indicated that dual users evinced greater levels of alcohol consumption, dependence, alcohol-related problems, and hazardous drinking compared to exclusive combustible cigarette smokers (ps < .001). Dual users also reported greater levels of drug use problems relative to exclusive combustible cigarette smokers (p < .001). The current findings are among the first to document that dual cigarette and e-cigarette use status (compared to exclusive combustible cigarette smoking) may serve as a clinically relevant risk indicator for a range of deleterious substance use problems among Latinx individuals. Future research is needed to corroborate these findings and examine dual-use status as a longitudinal predictor of alcohol and other substance-related problems. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Michael J. Zvolensky
- Department of Psychology, University of Houston
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center
- HEALTH Institute, University of Houston
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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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8
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Parker MA, Cruz-Cano R, Streck JM, Ballis E, Weinberger AH. Incidence of opioid misuse by cigarette smoking status in the United States. Addict Behav 2023; 147:107837. [PMID: 37659270 PMCID: PMC10529804 DOI: 10.1016/j.addbeh.2023.107837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND The combination of opioid misuse and cigarette smoking contributes to increased morbidity and mortality compared to each substance use alone. We estimated the incidence of opioid misuse for persons who currently or formerly smoked versus never smoked. METHODS Data came from the 2015-2020 National Surveys on Drug Use and Health cross-sectional surveys of US civilians aged 12+ (n = 315,661). Weighted opioid misuse incidence and average time between cigarette use initiation and opioid misuse initiation were calculated annually by smoking status. Logistic regression models tested time trends in incidence by smoking status. RESULTS Overall, 0.75% of persons initiated opioid misuse per year; opioid misuse incidence was 1.35% for those who currently smoked cigarettes, 0.54% for those who formerly smoked, and 0.67% for those who never smoked. For persons who currently smoked and misused opioids (1.50%), 95.08% smoked prior to opioid use. The average time between smoking followed by opioid misuse was 12.93 years and for opioid misuse followed by smoking was 4.36 years. Persons who currently smoked were more likely to initiate opioid misuse than those who had never smoked (AOR = 1.81, 95% CI: 1.60, 2.06). There was a decrease in the opioid misuse incidence over time (AOR = 0.90; 95% CI: 0.85, 0.92), which did not differ by smoking status. CONCLUSIONS Persons who currently smoked cigarettes, relative to those who never smoked, were more likely to initiate opioid misuse. As most individuals smoked before opioid misuse, it may be useful for primary prevention efforts to decrease opioid misuse initiation by focusing on smoking status.
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Affiliation(s)
- Maria A Parker
- Indiana University School of Public Health, Department of Epidemiology & Biostatistics, Bloomington, IN, USA.
| | - Raul Cruz-Cano
- Indiana University School of Public Health, Department of Epidemiology & Biostatistics, Bloomington, IN, USA
| | - Joanna M Streck
- Tobacco Research and Treatment Center, Division of General Internal Medicine Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Eleni Ballis
- Indiana University School of Public Health, Department of Epidemiology & Biostatistics, Bloomington, IN, USA
| | - Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA; Departments of Epidemiology & Population Health and Psychiatry & Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
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Zvolensky MJ, Shepherd JM, Clausen BK, Smit T, Redmond BY, Ditre JW. Alcohol use severity in relation to pain severity and interference among latinx adults with current pain who smoke cigarettes. J Behav Med 2023; 46:940-947. [PMID: 37316762 DOI: 10.1007/s10865-023-00428-4] [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: 04/04/2023] [Accepted: 06/02/2023] [Indexed: 06/16/2023]
Abstract
Limited research has focused expressly on dual tobacco-alcohol use among the Latinx population. Latinx individuals who smoke represent a tobacco health disparities group and evince elevated rates of pain problems and symptoms. Prior research has consistently linked pain problems and severity to smoking and alcohol prevalence, maintenance, and behavior. Accordingly, the current study sought to build from the limited work that exists among Latinx persons who smoke and evaluate the role of alcohol use severity in terms of pain severity and interference. The current sample consisted of 228 adult Latinx daily cigarette smokers (Mage = 34.95 years; SD = 8.58; 39.0% female) who endorsed current pain. Results indicated that elevated alcohol use problems were associated with greater levels of pain severity (R2 = 0.06) and interference (R2 = 0.06). The present findings suggest that there may be utility in clinical screening for alcohol use problems among Latinx persons who smoke to offset pain problems among this high-risk group.
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Affiliation(s)
- 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, USA.
- HEALTH Institute, University of Houston, Houston, USA.
| | - Justin M Shepherd
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
| | - Bryce K Clausen
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
| | - Tanya Smit
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
| | - Brooke Y Redmond
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
| | - Joseph W Ditre
- Department of Psychology, Syracuse University, Syracuse, NY, USA
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10
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Pagano A, Le T, Fong T, Reid R, Delucchi K, Guydish J. Gambling, tobacco use, and health among individuals in substance use disorder treatment. Am J Addict 2023; 32:563-573. [PMID: 37543853 DOI: 10.1111/ajad.13458] [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: 02/01/2023] [Revised: 05/23/2023] [Accepted: 07/25/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Gambling is highly comorbid with disordered use of tobacco and other drugs, and may increase relapse risk among substance use disorder (SUD) patients. We investigated associations between gambling and tobacco use behaviors among SUD patients to inform clinical care. METHODS Patients (N = 651, 170 female) from 25 residential SUD treatment programs in California completed surveys about tobacco use, health, and gambling. Using multivariate regression, we examined associations between gambling, tobacco use behaviors, and mental and physical health. RESULTS Past-year gamblers were more likely than non-gamblers to be current smokers (adjusted odds ratio [AOR] = 1.44, 95% confidence interval [CI] = 1.03, 2.01). Smokers who gambled had higher mean Heaviness of Smoking Index (HSI) scores (mean difference = +0.32, 95% CI = 0.04, 0.60), and more often reported smokeless tobacco use (AOR = 1.73, 95% CI = 1.16, 2.58), compared to non-gambling smokers. Past-year problem gamblers were more likely than all others (non-gamblers and non-problem gamblers) to be current smokers (AOR = 1.44, 95% CI = 1.08, 1.90) and to report high psychosocial stress (AOR = 1.87, 95% CI = 1.34, 2.61). Smokers with problem gambling also had higher HSI scores (mean difference = +0.54, 95% CI = 0.14, 0.95) compared to smokers without problem gambling. DISCUSSION AND CONCLUSIONS Gambling and problem gambling were associated with tobacco use and heavier smoking. SUD patients with gambling comorbidity may be heavier smokers and may need concurrent treatment for tobacco use and problem gambling. SCIENTIFIC SIGNIFICANCE This study provides novel data regarding gambling and tobacco use behaviors among SUD patients.
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Affiliation(s)
- Anna Pagano
- Institute for Health Policy Studies, University of California, San Francisco, California, USA
| | - Thao Le
- Institute for Health Policy Studies, University of California, San Francisco, California, USA
| | - Timothy Fong
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Rory Reid
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Kevin Delucchi
- UCSF Weill Institute for Neurosciences, University of California, San Francisco, California, USA
| | - Joseph Guydish
- Institute for Health Policy Studies, University of California, San Francisco, California, USA
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11
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Chelslín F, Lodefalk M, Kruse R. Smoking during pregnancy is associated with the placental proteome. Reprod Toxicol 2023; 119:108409. [PMID: 37209868 DOI: 10.1016/j.reprotox.2023.108409] [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: 02/22/2023] [Revised: 05/10/2023] [Accepted: 05/17/2023] [Indexed: 05/22/2023]
Abstract
Maternal smoking during pregnancy (MSDP) is a significant risk factor for the development of foetal, neonatal, and childhood morbidities. We hypothesized that infants exposed to MSDP have a distinct proteomic expression in their term placentas compared to infants without such an exposure. A total of 39 infants exposed (cord blood cotinine levels of >1 ng/mL) and 44 infants not exposed to MSDP were included in the study. Women with chronic disease, body mass index of > 30, or a history of uterine surgery were excluded. Total proteome abundance was analysed with quantitative mass spectrometry. For univariate analysis of differences in placental protein levels between groups, ANOVA with multiple testing corrections by the Benjamini-Hochberg method was used. For multivariate analysis, we used principal component analysis, partial least squares, lasso, random forest, and neural networks. The univariate analyses showed four differentially abundant proteins (PXDN, CYP1A1, GPR183, and KRT81) when heavy and moderate smoking groups were compared to non-smokers. With the help of machine learning, we found that an additional six proteins (SEPTIN3, CRAT, NAAA, CD248, CADM3, and ZNF648) were discriminants of MSDP. The placental abundance of these ten proteins together explained 74.1% of the variation in cord blood cotinine levels (p = 0.002). Infants exposed to MSDP showed differential abundance of proteins in term placentas. We report differential placental abundance of several proteins for the first time in the setting of MSDP. We believe that these findings supplement the current understanding of how MSDP affects the placental proteome.
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Affiliation(s)
- Felix Chelslín
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, SE-701 82 Örebro, Sweden.
| | - Maria Lodefalk
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, SE-701 82 Örebro, Sweden; Department of Paediatrics, Faculty of Medicine and Health, Örebro University, SE-701 82 Örebro, Sweden
| | - Robert Kruse
- Department of Clinical Research Laboratory, Faculty of Medicine and Health, Örebro University, SE-701 82 Örebro, Sweden; Inflammatory Response and Infection Susceptibility Centre (iRiSC) and X-HiDE Consortium, Faculty of Medicine and Health, Örebro University, SE-701 82 Örebro, Sweden
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Rao V, Lanni S, Yule AM, DiSalvo M, Stone M, Berger AF, Wilens TE. Diagnosing major depressive disorder and substance use disorder using the electronic health record: A preliminary validation study. JOURNAL OF MOOD AND ANXIETY DISORDERS 2023; 2:100007. [PMID: 37693103 PMCID: PMC10486184 DOI: 10.1016/j.xjmad.2023.100007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Background One mechanism to examine if major depressive disorder (MDD) is related to the development of substance use disorder (SUD) is by leveraging naturalistic data available in the electronic health record (EHR). Rules for data extraction and variable construction linked to psychometrics validating their use are needed to extract data accurately. Objective We propose and validate a methodologic framework for using EHR variables to identify patients with MDD and non-nicotine SUD. Methods Proxy diagnoses and index dates of MDD and/or SUD were established using billing codes, problem lists, patient-reported outcome measures, and prescriptions. Manual chart reviews were conducted for the 1-year period surrounding each index date to determine (1) if proxy diagnoses were supported by chart notes and (2) if the index dates accurately captured disorder onset. Results The results demonstrated 100% positive predictive value for proxy diagnoses of MDD. The proxy diagnoses for SUD exhibited strong agreement (Cohen's kappa of 0.84) compared to manual chart review and 92% sensitivity, specificity, positive predictive value, and negative predictive value. Sixteen percent of patients showed inaccurate SUD index dates generated by EHR extraction with discrepancies of over 6 months compared to SUD onset identified through chart review. Conclusions Our methodology was very effective in identifying patients with MDD with or without SUD and moderately effective in identifying SUD onset date. These findings support the use of EHR data to make proxy diagnoses of MDD with or without SUD.
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Affiliation(s)
- Vinod Rao
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Sylvia Lanni
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Amy M. Yule
- Department of Psychiatry, Boston Medical Center, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Maura DiSalvo
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Mira Stone
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Amy F. Berger
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Timothy E. Wilens
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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Sinclair DL, Sussman S, Savahl S, Florence M, Vanderplasschen W. Narcotics Anonymous attendees' perceptions and experiences of substitute behaviors in the Western Cape, South Africa. Subst Abuse Treat Prev Policy 2023; 18:40. [PMID: 37408038 DOI: 10.1186/s13011-023-00552-z] [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: 04/26/2023] [Accepted: 06/26/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Much remains unknown about the dynamics of substitute behaviors during addiction recovery among persons attending recovery support groups. Insight into the nature, motives for, and course of substitute behaviors could help to shape recovery support and harm reduction services. METHODS Twenty-three semi-structured in-depth interviews (n = 14 males and n = 9 females) were conducted with a convenience sample of Narcotics Anonymous attendees from a number of groups in the Western Cape, South Africa. Participants ranged in age from 22-55 years (M = 39.3, SD = 9.35). RESULTS Thematic analysis yielded four themes: (i) substance-to-substance substitution; (ii) substance-to-behavior substitution; (iii) substitute behaviors and harm (reduction) and (iv) support needs to manage and resolve substitute behaviors. According to the study, participants' substitute behaviors developed across recovery stages; were temporary or long-term replacements for substance use disorders and were engaged for distraction, isolation from others, calming, assuaging boredom, keeping occupied, filling a perceived experiential void, modifying mood and to self-medicate. While substitutes were utilized for harm reduction or relapse prevention, the potential for ostensibly healthy behaviors to threaten recovery and lead to relapse was also recognized. CONCLUSIONS Self-monitoring, ongoing vigilance, and awareness of when substitutes become genuine addictions are critical for timely, suitable interventions.
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Affiliation(s)
- Deborah Louise Sinclair
- Department of Psychology, University of the Western Cape, Cape Town, 7535, South Africa.
- Department of Special Needs Education, Ghent University, 9000, Ghent, Belgium.
| | - Steve Sussman
- Departments of Population and Public Health Sciences, and Psychology, and School of Social Work, University of Southern California, Los Angeles, CA, 90032-3628, USA
| | - Shazly Savahl
- Centre for Interdisciplinary Studies of Children, Families and Society, University of the Western Cape, South Africa, Cape Town, 7535, South Africa
| | - Maria Florence
- Department of Psychology, University of the Western Cape, Cape Town, 7535, South Africa
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14
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Pagano A, McCuistian C, Le T, Campbell BK, Delucchi K, Woodward-Lopez G, Guydish J. Smoking Behavior and Wellness among Individuals in Substance Use Disorder Treatment. J Psychoactive Drugs 2023; 55:330-341. [PMID: 35815722 PMCID: PMC9826798 DOI: 10.1080/02791072.2022.2095942] [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: 02/17/2022] [Revised: 06/02/2022] [Accepted: 06/05/2022] [Indexed: 01/11/2023]
Abstract
Tobacco-related morbidity and mortality disproportionately affect people with substance use disorders (SUD). Encouraging overall wellness may support tobacco use cessation. We investigated relationships between wellness (health status, physical activity, sugar-sweetened beverage (SSB) consumption), cigarette smoking, and smoking cessation among SUD treatment patients to inform clinical care. Cross-sectional surveys were conducted with 395 patients in 20 California residential SUD programs. Using multivariate regression, we examined associations between smoking status and wellness. Among smokers, we examined associations between lifetime smoking exposure, cessation behaviors and attitudes, and wellness. Compared to nonsmokers (n = 121), smokers (n = 274) reported more SSB consumption, poorer physical health, and more respiratory symptoms. Among smokers, SSB consumption and respiratory symptoms increased per ten pack-years of smoking. Smokers with respiratory symptoms reported higher motivation to quit and more use of nicotine replacement therapy (NRT). Smokers with more days of poor mental health reported lower motivation to quit. Overall, cigarette smoking was associated with other health-risk behaviors among SUD treatment patients. Respiratory symptoms may increase, and poor mental health may decrease, SUD patients' intent to quit smoking. To reduce chronic disease risk among SUD patients, treatment programs should consider promoting overall wellness concurrently with smoking cessation.
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Affiliation(s)
- Anna Pagano
- Institute for Health Policy Studies, University of California, San Francisco, 490 Illinois Street, Floor 7, San Francisco, CA 94158
| | - Caravella McCuistian
- Institute for Health Policy Studies, University of California, San Francisco, 490 Illinois Street, Floor 7, San Francisco, CA 94158
| | - Thao Le
- Institute for Health Policy Studies, University of California, San Francisco, 490 Illinois Street, Floor 7, San Francisco, CA 94158
| | - Barbara K. Campbell
- Division of General & Internal Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098
| | - Kevin Delucchi
- Department of Psychiatry & Behavioral Sciences, 401 Parnassus Ave, University of California, San Francisco, San Francisco, CA 94143
| | - Gail Woodward-Lopez
- University of California Nutrition Policy Institute, 1111 Franklin St, Fifth Floor, Oakland, CA 94607
| | - Joseph Guydish
- Institute for Health Policy Studies, University of California, San Francisco, 490 Illinois Street, Floor 7, San Francisco, CA 94158
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Guydish J, McCuistian C, Hosakote S, Le T, Masson CL, Campbell BK, Delucchi K. A cluster-randomized trial of a brief multi-component intervention to improve tobacco outcomes in substance use treatment. Subst Abuse Treat Prev Policy 2023; 18:34. [PMID: 37328775 PMCID: PMC10276468 DOI: 10.1186/s13011-023-00539-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: 11/16/2022] [Accepted: 05/07/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Smoking prevalence is high among people in substance use disorder (SUD) treatment, and program interventions to address smoking are often complex and lengthy. This cluster-randomized trial tested whether a brief multi-component intervention impacted tobacco outcomes among staff and clients. METHODS Seven SUD treatment programs were randomly assigned to the multi-component intervention or to waitlist control. The 6-month intervention included a leadership motivation assessment, program incentives, 4 staff training sessions and a leadership learning community session. Survey data were collected from staff and clients at pre- and post-intervention. Outcomes were first compared across condition (intervention vs waitlist control), and then examined pre- to post-intervention with condition collapsed. RESULTS Staff in the intervention (n = 48) and control conditions (n = 26) did not differ at post-intervention on smoking prevalence, self-efficacy to help clients quit, or practices used to help clients quit smoking. Intervention clients (n = 113) did not differ from controls (n = 61) in smoking prevalence or receipt of tobacco services. Pre-post comparisons collapsed across condition showed a decrease in client and staff smoking prevalence, which could not be attributed to the intervention, and a decrease in client receipt of cessation medication. CONCLUSION The brief multi-component intervention did not support changes in smoking prevalence or in tobacco-related services received by clients. Other intervention features are needed to reduce smoking among SUD clients. TRIAL REGISTRATION Randomization occurred at the program level and outcomes measured are program-level measures. Accordingly, the trial is not registered.
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Affiliation(s)
- Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St., Floor 7, San Francisco, CA 94158 USA
| | - Caravella McCuistian
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St., Floor 7, San Francisco, CA 94158 USA
| | - Sindhushree Hosakote
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St., Floor 7, San Francisco, CA 94158 USA
| | - Thao Le
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St., Floor 7, San Francisco, CA 94158 USA
| | - Carmen L. Masson
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, USA
| | - Barbara K. Campbell
- Division of General Internal Medicine & Geriatrics, Oregon Health and Sciences University, Portland, USA
| | - Kevin Delucchi
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, USA
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Fields L, Roberts W, Schwing I, McCoy M, Verplaetse T, Peltier M, Carretta R, Zakiniaeiz Y, Rosenheck R, McKee S. Examining the relationship of concurrent obesity and tobacco use disorder on the development of substance use disorders and psychiatric conditions: Findings from the NESARC-III. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 7:100162. [PMID: 37159814 PMCID: PMC10163607 DOI: 10.1016/j.dadr.2023.100162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/28/2023] [Accepted: 04/19/2023] [Indexed: 05/11/2023]
Abstract
Background Multimorbidity is linked to worse health outcomes than single health conditions. However, recent studies show that obesity may reduce the risk of developing substance use disorders (SUDs), particularly in vulnerable populations. We investigated how comorbid obesity and tobacco use disorder (TUD) relate to the risk of SUDs and psychiatric conditions. Methods Data was used from 36,309 individuals who completed the National Epidemiological Survey on Alcohol and Related Conditions - Wave III. Individuals who met the DSM-5 criteria for TUD in the last year were defined as the TUD group. Obesity was defined as having a body mass index (BMI) greater than 30 kg/m2. Using this information, individuals were grouped into categories, with people being identified as either having obesity, TUD, both obesity and TUD, or not having either obesity or TUD (comparison). Groups were compared against their comorbid diagnoses of either an additional SUD or psychiatric conditions. Results Controlling for demographic characteristics, we found that individuals with obesity including those individuals with TUD, had lower rates of comorbid SUD diagnosis than individuals with TUD alone. Additionally, individuals with combined TUD and obesity, and those with TUD alone, had the highest rates of comorbid psychiatric disorder diagnosis. Conclusions The current study aligns with previous research suggesting that obesity may reduce risk of substance use disorders, even in individuals who have other risk factors promoting harmful substance use (e.g., tobacco use). These findings may inform targeted intervention strategies for this clinically relevant subpopulation.
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Affiliation(s)
- L.J. Fields
- Department of Psychology, Arcadia University, 450 S Easton Rd, Glenside, PA 19038, United States
| | - W. Roberts
- Department of Psychiatry, Yale School of Medicine, 300 George St #901, New Haven, CT 06511, United States
| | - I. Schwing
- Department of Psychology, Arcadia University, 450 S Easton Rd, Glenside, PA 19038, United States
| | - M. McCoy
- Department of Psychology, Arcadia University, 450 S Easton Rd, Glenside, PA 19038, United States
| | - T.L. Verplaetse
- Department of Psychiatry, Yale School of Medicine, 300 George St #901, New Haven, CT 06511, United States
| | - M.R. Peltier
- Department of Psychiatry, Yale School of Medicine, 300 George St #901, New Haven, CT 06511, United States
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, United States
| | - R.F. Carretta
- Department of Psychiatry, Yale School of Medicine, 300 George St #901, New Haven, CT 06511, United States
| | - Y. Zakiniaeiz
- Department of Psychiatry, Yale School of Medicine, 300 George St #901, New Haven, CT 06511, United States
| | - R. Rosenheck
- Department of Psychiatry, Yale School of Medicine, 300 George St #901, New Haven, CT 06511, United States
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT 06516, United States
| | - S.A. McKee
- Department of Psychiatry, Yale School of Medicine, 300 George St #901, New Haven, CT 06511, United States
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Streck JM, Regan S, Werner M, Glynn A, Villanti AC, Park ER, Wakeman SE, Evins AE, Rigotti NA. Preliminary feasibility of integrating tobacco treatment into SUD peer recovery coaching: a mixed-methods study of peer recovery coaches. Addict Sci Clin Pract 2023; 18:25. [PMID: 37122035 PMCID: PMC10148997 DOI: 10.1186/s13722-023-00380-3] [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: 10/19/2022] [Accepted: 03/29/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Individuals with substance use disorder (SUD) have high prevalence of cigarette smoking and difficulty quitting. Peer recovery coaches (PRCs; individuals with lived SUD experience) facilitate SUD behavior change in recoverees but it is unknown if/how they address tobacco treatment in SUD recovery coaching. We assessed PRC's tobacco-related practices and attitudes about tobacco treatment in SUD recovery. METHODS The Tobacco use In Peer-recovery Study (TIPS) was a cross-sectional mixed-methods pilot survey (January-March 2022) of the 26 PRCs employed by a Massachusetts-based healthcare system's 12 SUD treatment clinics/programs. PRCs completed a quantitative survey (n = 23/26; 88%) and a telephone-based qualitative interview (n = 20/26; 77%). RESULTS One-third of PRCs reported current smoking, 50% reported former smoking, and 18% never smoked. Among PRCs, 61% reported accompanying recoverees outdoors to smoke, 26% smoked with recoverees, 17% had provided cigarettes to recoverees, 32% used smoking to help build peer-relationships, and 74% rated smoking as socially acceptable in SUD treatment. PRCs reported regularly talking to recoverees about tobacco treatment (65%), believed they should have a role in helping recoverees quit smoking (52%), and were interested in tobacco treatment training (65%). A majority of both nonsmoking and current smoking PRCs (73% vs. 57%) regularly talked to recoverees about quitting smoking. CONCLUSION PRCs' attitudes about integrating tobacco treatment into SUD recovery coaching were generally positive and PRCs reported they could have a role in helping recoverees with tobacco treatment. Barriers to integrating tobacco treatment into SUD recovery include use of cigarettes as a peer-recovery tool and high prevalence and social acceptability of smoking in SUD recovery.
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Affiliation(s)
- Joanna M Streck
- Department of Psychiatry, Massachusetts General Hospital (MGH), 100 Cambridge Street, 16th Floor, Boston, MA, 02114, USA.
- Harvard Medical School, Harvard University, Boston, MA, USA.
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, MGH, Boston, MA, USA.
| | - Susan Regan
- Harvard Medical School, Harvard University, Boston, MA, USA
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, MGH, Boston, MA, USA
| | - Michael Werner
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, MGH, Boston, MA, USA
| | - Alexia Glynn
- Department of Psychiatry, Massachusetts General Hospital (MGH), 100 Cambridge Street, 16th Floor, Boston, MA, 02114, USA
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, MGH, Boston, MA, USA
| | - Andrea C Villanti
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ, USA
| | - Elyse R Park
- Department of Psychiatry, Massachusetts General Hospital (MGH), 100 Cambridge Street, 16th Floor, Boston, MA, 02114, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, MGH, Boston, MA, USA
| | - Sarah E Wakeman
- Harvard Medical School, Harvard University, Boston, MA, USA
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, MGH, Boston, MA, USA
| | - A Eden Evins
- Department of Psychiatry, Massachusetts General Hospital (MGH), 100 Cambridge Street, 16th Floor, Boston, MA, 02114, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
| | - Nancy A Rigotti
- Harvard Medical School, Harvard University, Boston, MA, USA
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, MGH, Boston, MA, USA
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Jatana S, Verhoeff K, Mocanu V, Jogiat U, Birch DW, Karmali S, Switzer NJ. Substance abuse screening prior to bariatric surgery: an MBSAQIP cohort study evaluating frequency and factors associated with screening. Surg Endosc 2023:10.1007/s00464-023-10026-9. [PMID: 36991265 DOI: 10.1007/s00464-023-10026-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/12/2023] [Indexed: 03/30/2023]
Abstract
INTRODUCTION Patients undergoing bariatric surgery experience substantial risk of pre- and postoperative substance use. Identifying patients at risk for substance use using validated screening tools remains crucial to risk mitigation and operative planning. We aimed to evaluate proportion of bariatric surgery patients undergoing specific substance abuse screening, factors associated with screening and the relationship between screening and postoperative complications. METHODS The 2021 MBSAQIP database was analyzed. Bivariate analysis was performed to compare factors between groups who were screened for substance abuse versus non-screened, and to compare frequency of outcomes. Multivariate logistic regression analysis was performed to assess the independent effect of substance screening on serious complications and mortality, and to assess factors associated with substance abuse screening. RESULTS A total of 210, 804 patients were included, with 133,313 (63.2%) undergoing screening and 77,491 (36.8%) who did not. Those who underwent screening were more likely to be white, non-smoker, and have more comorbidities. The frequency of complications was not significant (e.g., reintervention, reoperation, leak) or similar (readmission rates 3.3% vs. 3.5%) between screened and not screened groups. On multivariate analysis, lower substance abuse screening was not associated with 30-day death or 30-day serious complication. Factors that significantly affected likelihood of being screened for substance abuse included being black (aOR 0.87, p < 0.001) or other race (aOR 0.82, p < 0.001) compared to white, being a smoker (aOR 0.93, p < 0.001), having a conversion or revision procedure (aOR 0.78, p < 0.001; aOR 0.64, p < 0.001, respectively), having more comorbidities and undergoing Roux-en-y gastric bypass (aOR 1.13, p < 0.001). CONCLUSION There remains significant inequities in substance abuse screening in bariatric surgery patients regarding demographic, clinical, and operative factors. These factors include race, smoking status, presence of preoperative comorbidities, and procedure type. Further awareness and initiatives highlighting the importance of identifying at risk patients is critical for ongoing outcome improvement.
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Britton M, Martinez Leal I, Jafry MZ, Chen TA, Rogova A, Kyburz B, Williams T, Reitzel LR. Influence of Provider and Leader Perspectives about Concurrent Tobacco-Use Care during Substance-Use Treatment on Their Tobacco Intervention Provision with Clients: A Mixed-Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5260. [PMID: 37047876 PMCID: PMC10094458 DOI: 10.3390/ijerph20075260] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 06/19/2023]
Abstract
People with substance-use disorders have elevated rates of tobacco use compared with the general population, yet rarely receive tobacco-dependence treatment within substance-use treatment settings (SUTS). One barrier to delivering evidence-based interventions in SUTS is providers' misconception that treating tobacco use and non-nicotine substance use concurrently jeopardizes clients' substance-use recovery, although research indicates that it enhances support for recovery and relapse prevention. A total of 86 treatment providers employed in SUTS (i.e., 9 Federally Qualified Health Centers, 16 Local Mental Health Authorities (LMHAs), 6 substance-use treatment programs in LMHAs, and 55 stand-alone substance-use treatment centers) in Texas, USA, answered survey questions about their (1) thoughts about treating tobacco during substance-use treatment, and (2) delivery of the 5A's tobacco-use intervention (Ask, Advise, Assess, Assist, Arrange). Twenty-six providers and leaders were interviewed about attitudes toward tobacco-free workplace policies and tobacco dependence and the relative importance of treating tobacco (vs. other substance-use disorders) at their center. Providers who did not believe tobacco use should be addressed as soon as clients begin treatment (i.e., endorsed responses of after 1 year, it depends on the client, or never) had lower odds of Asking clients about their tobacco use (OR = 0.195), Advising clients to quit smoking (OR = 0.176), and Assessing interest in quitting smoking (OR = 0.322). Qualitative results revealed barriers including beliefs that clients need to smoke to relieve the stress of substance-use recovery, are disinterested in quitting, fears that concurrent treatment would jeopardize substance use, and limited resources; additional training and education resources was the key facilitator theme. The results demonstrate a critical need to eliminate barriers to tobacco-treatment provision for clients in SUTS through education to correct misperceptions, specialized training to equip providers with knowledge and skills, and resources to build center capacity. Integrating evidence-based smoking interventions into routine care is key to support the recovery efforts of clients in SUTS.
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Affiliation(s)
- Maggie Britton
- Department of Health Disparities Research, The University of Texas at MD Anderson Cancer Center, 1400 Pressler Street, Unit 1440, Houston, TX 77030, USA
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Isabel Martinez Leal
- Department of Health Disparities Research, The University of Texas at MD Anderson Cancer Center, 1400 Pressler Street, Unit 1440, Houston, TX 77030, USA
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Midhat Z. Jafry
- Department of Health Disparities Research, The University of Texas at MD Anderson Cancer Center, 1400 Pressler Street, Unit 1440, Houston, TX 77030, USA
| | - Tzuan A. Chen
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Anastasia Rogova
- Department of Health Disparities Research, The University of Texas at MD Anderson Cancer Center, 1400 Pressler Street, Unit 1440, Houston, TX 77030, USA
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
| | - Bryce Kyburz
- Integral Care, 1430 Collier Street, Austin, TX 78704, USA
| | | | - Lorraine R. Reitzel
- Department of Health Disparities Research, The University of Texas at MD Anderson Cancer Center, 1400 Pressler Street, Unit 1440, Houston, TX 77030, USA
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
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Martínez C, Lisha N, McCuistian C, Strauss E, Deluchi K, Guydish J. Comparing client and staff reports on tobacco-related knowledge, attitudes, beliefs and services provided in substance use treatment. Tob Induc Dis 2023; 21:45. [PMID: 36969981 PMCID: PMC10037428 DOI: 10.18332/tid/160974] [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: 12/08/2022] [Revised: 02/04/2023] [Accepted: 02/06/2023] [Indexed: 03/26/2023] Open
Abstract
INTRODUCTION Smoking is highly prevalent in substance use disorder (SUD) programs, but few studies have explored the tobacco-related attitudes of staff and clients in the same program. The aim of this study was to compare staff and client reports on 10 tobacco-related items and associate them with tobacco measures implemented in the programs. METHODS A cross-sectional survey was conducted in 18 residential SUD programs from 2019 to 2020. Overall, 534 clients and 183 clinical staff self-reported their tobacco use, knowledge, attitudes, beliefs, and practices/services regarding smoking cessation. Ten comparable items were asked of both clients and staff. Differences in their responses were tested using bivariate analyses. We examine the association between selected tobacco-related items on making a quit attempt and planning to quit in the next 30 days. RESULTS In all, 63.7% of clients were current cigarette users versus 22.9% of staff. About half of clinicians (49.4%) said they had the skills to help patients quit smoking, while only 34.0% of clients thought their clinicians had these skills (p=0.003). About 28.4% of staff reported encouraging their patients to use nicotine replacement treatment (NRT), and 23.4% of patients said they had been encouraged to use these products. Client reports of planning a quit attempt were positively correlated with whether both staff and clients reported that the use of NRT was encouraged (clients: r=0.645 p=0.004; staff: r=0.524 p=0.025). CONCLUSIONS A low level of tobacco-related services was provided by staff and received by clients. In programs where smokers were encouraged to use NRT, a higher percentage of smokers planned a quit attempt. Tobacco-related training among staff, and communication about tobacco use with clients, should be improved to make tobacco services more visible and accessible in SUD treatment.
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Affiliation(s)
- Cristina Martínez
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d’Oncologia-ICO, Barcelona, Spain
- Cancer Control and Prevention Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
- Department of Public Health, Mental Health, and Maternal and Child Health Nursing, School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
- Institute for Health Policy Studies, University of California San Francisco, San Francisco, United States
| | - Nadra Lisha
- Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, United States
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, United States
| | - Caravella McCuistian
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, United States
| | - Elana Strauss
- Institute for Health Policy Studies, University of California San Francisco, San Francisco, United States
| | - Kevin Deluchi
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, United States
| | - Joseph Guydish
- Institute for Health Policy Studies, University of California San Francisco, San Francisco, United States
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Zvolensky MJ, Bakhshaie J, Garey L, Kauffman BY, Heggeness LF, Schmidt NB. Cumulative vulnerabilities and smoking abstinence: A test from a randomized clinical trial. Behav Res Ther 2023; 162:104272. [PMID: 36746057 DOI: 10.1016/j.brat.2023.104272] [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: 06/27/2022] [Revised: 01/17/2023] [Accepted: 01/31/2023] [Indexed: 02/04/2023]
Abstract
Smoking cessation is often associated with socioeconomic and intrapersonal vulnerabilities such as psychopathology. Yet, most research that focuses on predicting smoking cessation outcomes tends focus on a small number of possible vulnerabilities. In a secondary data analysis, we developed and empirically evaluated a comprehensive, cumulative vulnerability risk composite reflecting psychologically based transdiagnostic processes, social determinants of health, and psychopathology. Participants were adult smokers who responded to study advertisements (e.g., flyers, newspaper ads, radio announcements) for an in-person delivered 4-session smoking cessation trial (N = 267; 47% female; Mage = 39.4, SD = 13.8). Results indicated that the decline in point prevalence abstinence (PPA) from quit week to 6-month post-quit was statistically significant (p < .001). There were statistically significant effects of cumulative risk score on the intercept (p < .001) and slope (p = .01). These findings were evident in unadjusted and adjusted (controlling for sex, treatment condition, and nicotine dependence) models. The present results indicate smokers with greater cumulative vulnerability demonstrated poorer smoking cessation outcomes. There may be clinical advantages to better understanding cumulative vulnerability among treatment-seeking smokers and other smoking populations to enhance the impact of public health efforts to reduce smoking.
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Affiliation(s)
- Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; HEALTH Institute, University of Houston, Houston, TX, USA.
| | - Jafar Bakhshaie
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX, USA; HEALTH Institute, University of Houston, Houston, TX, USA
| | | | - Luke F Heggeness
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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22
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Hussaini KS, Yocher G. Adverse Maternal Experiences and Neonatal Abstinence Syndrome. Matern Child Health J 2023; 27:497-507. [PMID: 36592279 PMCID: PMC10949090 DOI: 10.1007/s10995-022-03577-1] [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] [Accepted: 12/20/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To propose a measure for adverse maternal experiences (AMEs) and examine if AMEs are independently associated with delivery of a neonatal abstinence syndrome (NAS) diagnosed infant. METHODS Using the Pregnancy Risk Assessment Monitoring System (PRAMS) stressful life events questions, we constructed a composite measure of AMEs. We conducted a retrospective analysis of linked Birth Certificate Data, Hospital Discharge Data and PRAMS data for 2012-2018 using the composite measure. Our analytic sample included 6358 singleton deliveries. We calculated prevalence of NAS and AMEs and prevalence odds ratio (POR) for delivery of an NAS-diagnosed infant adjusting for maternal sociodemographic characteristics, pre-pregnancy depression, prescription medicine 12 months prior to pregnancy, and smoking during pregnancy. RESULTS The overall prevalence of NAS in Delaware during 2012-2018 was 2.2% (95% CI 1.8-2.6); 9.5% (95% CI 8.7-10.2) of women reported AMEs. After adjustment, women with AMEs had 1.1 times greater odds (aPOR 2.1; 95% CI 1.3-3.3) to deliver a NAS-diagnosed infant as compared with women without AMEs. CONCLUSIONS Although the cross-sectional nature of the study limits drawing any causal inferences, there are co-occurring factors that support plausibility of an association between AMEs and delivering NAS-diagnosed infants. Addressing AMEs, mental health and substance use screening and treatment as part of preconception and prenatal care may mitigate risks.
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Affiliation(s)
- Khaleel S Hussaini
- Division of Reproductive Health, Field Support Branch, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA.
- Division of Public Health, Delaware Department of Health and Social Services, 1351 W. North Street, Dover, DE, 19904, USA.
| | - George Yocher
- Division of Public Health, Delaware Department of Health and Social Services, 1351 W. North Street, Dover, DE, 19904, USA
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23
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Service Providers’ Perceptions of Substitute Addictions in the Western Cape, South Africa. JOURNAL OF DRUG ISSUES 2023. [DOI: 10.1177/00220426231159550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Globally little is known regarding substance use service providers’ perceptions of substitute behaviours and this significant gap could hinder service provision and recovery outcomes. Semi-structured focus group discussions (including 22 service providers across five sites) were conducted in residential treatment facilities in the Western Cape, South Africa. Service providers recognised substances (e.g. cigarettes and caffeine) and behaviours (e.g. gambling, eating, love, sex, shopping, exercise, and gaming) as potential substitutes. Identified substitute motives included managing cravings; self-medication; filling the experiential void of the primary substance, and time-spending. Concurrent behaviours and addictions were believed to be a key mechanism underlying substitution however, service providers did not uniformly screen for co-occurring behavioural addictions. Substitute behaviours were primarily considered a pathway to relapse and service providers emphasised prevention, detection and family education. To suitably intervene, screening for co-occurring behaviours should be an integral part of the assessment of those presenting for substance use treatment.
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Dunham CM, Huang GS, Chance EA, Hileman BM, Han JS. Trauma activation patient preinjury toxicology-positive proportions and associated risk conditions: A retrospective study. Injury 2023; 54:1334-1341. [PMID: 36737270 DOI: 10.1016/j.injury.2023.01.048] [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: 09/05/2022] [Revised: 12/13/2022] [Accepted: 01/26/2023] [Indexed: 01/30/2023]
Abstract
BACKGROUND Unlike prior guidelines for a positive toxicology screen, the 2022 national trauma data bank dictionary requires the exclusion of postinjury drugs. We aimed to (1) investigate the proportion of drugs in the toxicology screen that were given postinjury; (2) determine preinjury toxicology-positive associations with smoking, psychiatric, and drug abuse histories in an activation patient (ACT-Pt) cohort; and (3) explore whether ACT-Pt varied toxicology testing rates would produce similar preinjury toxicology-positive results. METHODS In this retrospective study, the historic parent database included consecutive trauma center admissions where toxicology testing was discretionary. A supplementary electronic medical record audit of ACT-Pts age 18-60 years assessed smoking, psychiatric, and drug abuse histories. Subsequently, ACT-Pt age 18-100 years testing was encouraged by attending surgeons and, later routine testing was implemented. RESULTS Of 2,076 patients in the historic parent database, discretionary toxicology testing occurred in 23.9% (n = 496) and the positive proportion was 58.9% (n = 292). However, 23.6% (n = 69) of the positive screens had the drug given postinjury. The preinjury positive-toxicology proportion was 45.0% (223/496). Preinjury toxicology positivity was greater in ACT-Pts age 18-60 years (52.3%) than in other patients (activations >60 years of age or consultations) (33.7%; p < 0.0001; odds ratio [OR] = 2.2). Smoking, psychiatric, and drug abuse histories were more common in ACT-Pts age 18-60 years preinjury toxicology-positive patients (74.4%, 51.3%, and 98.7%) than in negative patients (36.6%, 25.2%, and 25.2%; p < 0.0001). In ACT-Pts age 18-100 years, when compared to historic discretionary testing (32.7%), testing was increased with encouraged testing (62.1%; p < 0.0001; OR = 3.4) and routine testing (73.1%; p < 0.0001; OR = 5.6). ACT-Pt preinjury toxicology positivity was similar for historic discretionary (47.9%), encouraged (57.6%), and routine (51.3%) (p = 0.3670) testing. The meta-analytic toxicology-positive proportion for the three testing strategies was 49.8%. CONCLUSIONS Substantial toxicology-positive findings are due to postinjury drug administration. Toxicology positivity is associated with ACT-Pts age 18-60 years and smoking, psychiatric, and drug abuse histories. ACT-Pt age 18-100 years preinjury toxicology positivity is 50% and does not vary with different testing proportions and strategies.
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Affiliation(s)
- C Michael Dunham
- Trauma, Critical Care, and General Surgery Services, St. Elizabeth Youngstown Hospital, 1044 Belmont Ave., St. Elizabeth Youngstown Hospital, Youngstown, OH 44501, United States.
| | - Gregory S Huang
- Trauma, Critical Care, and General Surgery Services, St. Elizabeth Youngstown Hospital, 1044 Belmont Ave., St. Elizabeth Youngstown Hospital, Youngstown, OH 44501, United States
| | - Elisha A Chance
- Trauma and Neuroscience Research Department, St. Elizabeth Youngstown Hospital, 1044 Belmont Ave., Youngstown, OH 44501, United States
| | - Barbara M Hileman
- Trauma and Neuroscience Research Department, St. Elizabeth Youngstown Hospital, 1044 Belmont Ave., Youngstown, OH 44501, United States
| | - Jane S Han
- Department of Surgery, St Elizabeth Youngstown Hospital, 1044 Belmont Ave., Youngstown, OH 44501, United States
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25
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Tobacco Dependence and Marginalized Populations: Key Considerations for Health Care Providers. Respir Med 2023. [DOI: 10.1007/978-3-031-24914-3_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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26
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Delile JM. Tabac et précarité : l’enjeu central de l’accès aux soins. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2023; 35:69-80. [PMID: 38423965 DOI: 10.3917/spub.pr1.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
The prevalence and severity of smoking are particularly high in populations in precarious situations and make smoking an essential determinant of social inequalities in health, due to its particularly catastrophic impact on the health of these populations. The general reduction in smoking, less significant in disadvantaged populations, contributes to further increasing these inequalities, and smoking tends to be concentrated in the most vulnerable populations. The relationships between tobacco and precariousness are examined by identifying, based on a review of the literature, the main common factors of vulnerability: stress and social adversity, self-stigma, a low feeling of self-efficacy, the social function of tobacco use, the ambivalence of demands, associated addictions, the severity of tobacco dependence, distance from support and care systems, etc. Specific attention is paid to certain particular conditions: mental health disorders, addictions (other than tobacco), inadequate housing, detention, migration. On this basis, courses of action are proposed to improve access to care and its effectiveness for the people concerned. Emphasis is placed on the mobilization of professionals who often tend to neglect issues of smoking in view of the immediate severity of the problems at the origin of the demands of the people received. A support offer for harm reduction (vaping in particular) seems particularly suited to often-ambivalent demands. The importance of networking and the involvement of CSAPAs/CAARUDs is also underlined. At the systemic level, all of this must be accompanied by political advocacy to reduce these inequalities and social determinants of health..
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27
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Yokoyama A, Kimura M, Yoshimura A, Matsushita S, Yoneda J, Maesato H, Komoto Y, Nakayama H, Sakuma H, Yumoto Y, Takimura T, Toyama T, Iwahara C, Mizukami T, Yokoyama T, Higuchi S. Nonsmoking after simultaneous alcohol abstinence and smoking cessation program was associated with better drinking status outcome in Japanese alcohol-dependent men: A prospective follow-up study. PLoS One 2023; 18:e0282992. [PMID: 36989266 PMCID: PMC10057780 DOI: 10.1371/journal.pone.0282992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/01/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Growing evidence suggests that intervention for smoking cessation enhances alcohol abstinence in treatment settings for alcohol dependence. However, research in this field is rare in Asians. METHOD We prospectively investigated the association of smoking status with drinking status using 9 surveys mailed during a 12-month period in 198 Japanese alcohol-dependent men (70 never/ex-smokers and 128 smokers) who admitted for the first time and completed a 3-month inpatient program for simultaneous alcohol abstinence and smoking cessation. RESULTS Nonsmoking during the first month after discharge and at the end of follow-up was reported in 28.9% and 25.0% of the baseline smokers, respectively. Kaplan-Meier estimates showed that a 12-month alcohol abstinence and heavy-drinking-free status were more frequent among never/ex-smokers (45.1% and 59.8%, respectively) and baseline smokers who quit smoking during the first month after discharge (59.0% and 60.8%, respectively), compared with sustained smokers (30.0% and 41.2%, respectively). Among the baseline smokers, the multivariate odds ratio (95% confidence interval) for smoking cessation during the first month were 2.77 (1.01-7.61) for alcohol abstinence during the period and 2.50 (1.00-6.25) for use of varenicline, a smoking cessation agent, during the inpatient program. After adjusting for age, drinking profile, lifestyle, family history of heavy or problem drinking, lifetime episodes of other major psychiatric disorders, and medications at discharge, the multivariate hazard ratios (HRs) for drinking lapse were 0.57 (0.37-0.89) for the never/ex-smoking and 0.41 (0.23-0.75) for new smoking cessation groups, respectively, compared with sustained smoking, while the corresponding HRs for heavy-drinking lapse were 0.55 (0.33-0.90) and 0.47 (0.25-0.88), respectively. The HR for drinking lapse was 0.63 (0.42-0.95) for the nonsmoking group (vs. smoking) during the observation period, while the HR for heavy-drinking lapse was 0.58 (0.37-0.91) for the nonsmoking group (vs. smoking) during the observation period. Other significant variables that worsened drinking outcomes were higher daily alcohol intake prior to hospitalization, family history of heavy or problem drinking and psychiatric medications at discharge. CONCLUSION Nonsmoking was associated with better outcomes on the drinking status of Japanese alcohol-dependent men, and a smoking cessation program may be recommended to be integrated into alcohol abstinence programs.
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Affiliation(s)
- Akira Yokoyama
- National Hospital Organization Kurihama Medical and Addiction Center, Yokosuka, Kanagawa, Japan
| | - Mitsuru Kimura
- National Hospital Organization Kurihama Medical and Addiction Center, Yokosuka, Kanagawa, Japan
| | - Atsushi Yoshimura
- Division of Psychiatry, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan
| | - Sachio Matsushita
- National Hospital Organization Kurihama Medical and Addiction Center, Yokosuka, Kanagawa, Japan
| | - Junichi Yoneda
- National Hospital Organization Kurihama Medical and Addiction Center, Yokosuka, Kanagawa, Japan
| | - Hitoshi Maesato
- National Hospital Organization Kurihama Medical and Addiction Center, Yokosuka, Kanagawa, Japan
| | - Yasunobu Komoto
- Department of Psychiatry, Yoshino Hospital, Machida, Tokyo, Japan
| | - Hideki Nakayama
- Department of Psychiatry, Asahiyama Hospital, Sapporo, Hokkaido, Japan
| | - Hiroshi Sakuma
- Department of Psychiatry, National Hospital Organization Saigata Medical Center, Joetsu, Niigata, Japan
| | - Yosuke Yumoto
- National Hospital Organization Kurihama Medical and Addiction Center, Yokosuka, Kanagawa, Japan
| | - Tsuyoshi Takimura
- National Hospital Organization Kurihama Medical and Addiction Center, Yokosuka, Kanagawa, Japan
| | - Tomomi Toyama
- National Hospital Organization Kurihama Medical and Addiction Center, Yokosuka, Kanagawa, Japan
| | - Chie Iwahara
- Department of Psychiatry, Hakuhou Clinic, Saitama, Saitama, Japan
| | - Takeshi Mizukami
- National Hospital Organization Kurihama Medical and Addiction Center, Yokosuka, Kanagawa, Japan
| | - Tetsuji Yokoyama
- Department of Health Promotion, National Institute of Public Health, Wako, Saitama, Japan
| | - Susumu Higuchi
- National Hospital Organization Kurihama Medical and Addiction Center, Yokosuka, Kanagawa, Japan
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Akram S, Ali M, Mutahir Z, Ibad N, Sarmad S, Mehboob S, Saleem M. Role of TNF-α -308G/A Polymorphism in Bipolar Disorder and its Relationship with Clinical and Demographic Variables. INNOVATIONS IN CLINICAL NEUROSCIENCE 2023; 20:60-71. [PMID: 37122575 PMCID: PMC10132278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Objective Gene-environment interactions might play a significant role in the development of bipolar disorder (BD). The objective of the current study was to investigate the association between tumor necrosis factor (TNF)-α -308 G/A polymorphism and BD and conduct a bioinformatics analysis of the protein-protein network of TNF-α. Gene-environment interactions and the relationship between stressful life events (SLEs) and substance abuse with TNF genotypes and other characteristics were analyzed. Methods The genomic deoxyribonucleic acid (DNA) of 400 patients with BD and 200 control subjects were extracted and genotyped for TNF-α -308 G/A polymorphism. SLEs and substance abuse were evaluated using the Life Event and Difficulty Schedule (LEDS) and a self-designed substance abuse questionnaire for the events six months prior to the onset of the disease, respectively. Gene-environment interactions were assessed by multiple statistical tools. Bioinformatics analysis of the TNF-α network and its interacting proteins was carried out using STRING and Cytoscape softwares. Results Genotyping analysis revealed a significant association between TNF-α -308 G/A polymorphism and BD (p<0.009). Furthermore, analysis of gene-environment interaction revealed a significant association between TNF-α -308 G/A and SLEs (p=0.001) and TNF-α -308 G/A and substance abuse (p=0.001). Three distinct proteins, RELA, RIPK1, and BIRC3, were identified through hub analysis of the protein network. Conclusion TNF-α -308 G/A polymorphism is positively associated with BD. SLEs and substance abuse might trigger the early onset of BD. Proteins identified through bioinformatics analysis might contribute to the TNF-α mediated pathophysiology of BD and can be the potential therapeutic targets.
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Affiliation(s)
- Shama Akram
- Ms. Akram and Drs. Ali, Mutahir, and Saleem are with School of Biochemistry and Biotechnology, University of the Punjab in Lahore, Pakistan
| | - Moazzam Ali
- Ms. Akram and Drs. Ali, Mutahir, and Saleem are with School of Biochemistry and Biotechnology, University of the Punjab in Lahore, Pakistan
| | - Zeeshan Mutahir
- Ms. Akram and Drs. Ali, Mutahir, and Saleem are with School of Biochemistry and Biotechnology, University of the Punjab in Lahore, Pakistan
| | - Nabeel Ibad
- Dr. Ibad is with Shaikh Zayed Hospital in Lahore, Pakistan
| | - Sana Sarmad
- Dr. Sarmad is with Rashid Latif Medical College in Lahore, Pakistan
| | - Sumaira Mehboob
- Dr. Mehboob is with School of Biochemistry, Minhaj University Lahore in Lahore, Pakistan
| | - Mahjabeen Saleem
- Ms. Akram and Drs. Ali, Mutahir, and Saleem are with School of Biochemistry and Biotechnology, University of the Punjab in Lahore, Pakistan
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29
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Wiss DA, Prelip ML, Upchurch DM, von Ehrenstein OS, Tomiyama AJ, Shoptaw SJ. Perceived social support moderates the association between household dysfunction adverse childhood experiences (ACEs) and self-reported drug use among men who have sex with men in Los Angeles, California. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 110:103899. [PMID: 36334318 DOI: 10.1016/j.drugpo.2022.103899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) have been shown to be associated with drug use in adulthood. The single ACE of household substance use history (part of the household dysfunction category) has frequently been associated with drug use. Resilience factors such as perceived social support appear to buffer the association between ACEs and drug use and may be particularly relevant for urban men who have sex with men (MSM). The current study of low-income mostly Black and Latino MSM aims to investigate whether the cumulative ACE score predicts self-reported drug use in a dose-response manner and whether this potential association differs by perceived social support. METHODS Data was utilized from a longitudinal study of MSM (mean age=34; SD=7.1) with varied substance use behaviors (n = 321) collected between August 2014 and April 2022. Cumulative, household dysfunction ACEs, and the single ACE of household substance use history were investigated as predictors of self-reported drug use (methamphetamine, ecstasy, cocaine/crack, heroin/fentanyl, party drugs [GHB, special K, mushrooms, LSD/acid], other drugs [bath salts, PCP]) during the past six months in mixed-effects logistic regression models, with moderation analyses by perceived social support (measured by the Multidimensional Scale of Perceived Social Support) across all models using stratified analysis and one model of multiplicative interaction. RESULTS There was no suggestion of a dose-response relationship between the number of ACEs and the predicted probability of self-reported drug use. Cumulative ACEs did not predict the outcome overall (aOR=1.99; 95% CI: 0.86-4.59), however, a positive association was estimated for individuals reporting lower levels of perceived social support (aOR=2.80; 95% CI: 0.97-8.06). The dimension of household dysfunction had a positive association with drug use (aOR=1.32; 95% CI: 1.00-1.74) whereas the dimension of childhood maltreatment did not. The association between household dysfunction and drug use was moderated by the perception of social support, with those reporting lower levels having greater odds of reporting drug use (aOR=2.94; 95% CI: 1.04-8.31). The association between household substance use history and self-reported drug use was similarly moderated by perceived social support in a multiplicative interaction model (p = .02). CONCLUSION Perceived social support emerged as a potential buffering factor for any reported drug use, particularly for the single ACE of household substance use history. Given that the association between ACEs and drug use was weak among those with higher levels of perceived social support, promotion of social ties in the community may help reduce the burden of substance use among MSM exposed to ACEs.
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Affiliation(s)
- David A Wiss
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, 650 Young Drive South, Los Angeles, CA 90095, USA.
| | - Michael L Prelip
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, 650 Young Drive South, Los Angeles, CA 90095, USA
| | - Dawn M Upchurch
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, 650 Young Drive South, Los Angeles, CA 90095, USA
| | - Ondine S von Ehrenstein
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, 650 Young Drive South, Los Angeles, CA 90095, USA; Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, 650 Young Drive South, Los Angeles, CA 90095, USA
| | - A Janet Tomiyama
- Department of Psychology, University of California Los Angeles, 502 Portola Plaza, Los Angeles, CA 90095, USA
| | - Steven J Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California Los Angeles, 10880 Wilshire Blvd., Los Angeles, CA 90024, USA
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30
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Parker MA, Byers JE, Villanti AC. Effect of brief nicotine corrective messaging on nicotine beliefs in persons who use opioids. Exp Clin Psychopharmacol 2022; 30:1008-1015. [PMID: 34291993 PMCID: PMC8782917 DOI: 10.1037/pha0000497] [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: 12/24/2022]
Abstract
This pilot study tested the effect of a brief nicotine education messaging exposure on beliefs about nicotine, nicotine-replacement therapy (NRT), and e-cigarettes. Participants ages 18 and older were recruited via Amazon Mechanical Turk to complete a 20-min online survey in April/May 2020 to assess relationships between opioid use, smoking, and other behaviors. Participants with past-month extra-medical opioid use completed questions on background characteristics and literacy and then were randomized in a 2:1 ratio of two conditions: nicotine education (n = 362) or no message control (n = 181). Beliefs about nicotine, NRT, and e-cigarettes were asked of all participants; this occurred after message exposure for the nicotine education condition. Bivariate and multivariable analyses examined differences in beliefs by study condition. Brief nicotine messaging increased the probability of a correct response to "Nicotine is a cause of cancer" (false, 63% vs. 36%) and reduced the probability of a don't know response (9% vs. 17%) compared to the no message control condition. Nicotine education also reduced false beliefs about harms of long-term NRT use compared to cigarettes (p < .05). In adjusted models, participants in the nicotine education group had lower mean false beliefs about nicotine (p < .001) and to a lesser extent NRT (p = .053) compared with the control group; there was no difference in mean false beliefs about e-cigarettes (p = .547) between groups. A brief education intervention produced similar changes in nicotine beliefs in adults with past-month extra-medical opioid use as in a general adult sample. Findings support the potential for impact of nicotine public education messaging in vulnerable populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Maria A. Parker
- Indiana University School of Public Health, Department of Epidemiology & Biostatistics, Bloomington, IN, United States
| | - Jodi E. Byers
- Indiana University School of Public Health, Department of Applied Health Science, Bloomington, IN, United States
| | - Andrea C. Villanti
- Vermont Center on Behavior & Health, University of Vermont, Burlington, VT, United States
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31
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Przybyla S, Ashare RL, Cioffi L, Plotnik I, Shuter J, Seng EK, Weinberger AH. Substance Use and Adherence to Antiretroviral Therapy among People Living with HIV in the United States. Trop Med Infect Dis 2022; 7:tropicalmed7110349. [PMID: 36355891 PMCID: PMC9697670 DOI: 10.3390/tropicalmed7110349] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
People with HIV (PWH) report substance use at higher rates than HIV-uninfected individuals. The potential negative impact of single and polysubstance use on HIV treatment among diverse samples of PWH is underexplored. PWH were recruited from the Center for Positive Living at the Montefiore Medical Center (Bronx, NY, USA) from May 2017-April 2018 and completed a cross-sectional survey with measures of substance use, antiretroviral therapy (ART) use, and ART adherence. The overall sample included 237 PWH (54.1% Black, 42.2% female, median age 53 years). Approximately half of the sample reported any current substance use with 23.1% reporting single substance use and 21.4% reporting polysubstance use. Polysubstance use was more prevalent among those with current cigarette smoking relative to those with no current smoking and among females relative to males. Alcohol and cannabis were the most commonly reported polysubstance combination; however, a sizeable proportion of PWH reported other two, three, and four-substance groupings. Single and polysubstance use were associated with lower ART adherence. A thorough understanding of substance use patterns and related adherence challenges may aid with targeted public health interventions to improve HIV care cascade goals, including the integration of substance use prevention into HIV treatment and care settings.
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Affiliation(s)
- Sarahmona Przybyla
- Department of Community Health and Health Behavior, State University of New York, Buffalo, NY 14214, USA
- Correspondence: ; Tel.: +1-716-829-6750
| | - Rebecca L. Ashare
- Department of Psychology, State University of New York, Buffalo, NY 14214, USA
| | - Loriann Cioffi
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY 10461, USA
| | - Isabella Plotnik
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY 10461, USA
| | - Jonathan Shuter
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- AIDS Center and Division of Infectious Diseases, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Elizabeth K. Seng
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY 10461, USA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- AIDS Center and Division of Infectious Diseases, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Andrea H. Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY 10461, USA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- AIDS Center and Division of Infectious Diseases, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY 10461, USA
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Kolodner G, DiClemente CC, Miller MM. Nicotine Addiction: A Burning Issue in Addiction Psychiatry. Psychiatr Clin North Am 2022; 45:451-465. [PMID: 36055732 DOI: 10.1016/j.psc.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Addressing nicotine addiction has been given a low priority, compared with other substance use disorders (SUDs), by the addiction treatment field. Persons with nicotine addiction are reluctant to attempt to stop using nicotine products-despite recognizing it to be a problem-because they are feeling discouraged by multiple past unsuccessful attempts at quitting. By understanding that discouragement is a frequent reason that these people are in Precontemplation and by using traditional clinical interventions applied to other SUDs, clinicians could achieve better overall treatment outcomes.
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Affiliation(s)
- George Kolodner
- Georgetown University School of Medicine, Washington, DC, USA.
| | | | - Michael M Miller
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Medical College of Wisconsin, Wauwatosa, WI, USA
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Kathuria H, Shankar D, Cobb V, Newman J, Bulekova K, Werntz S, Borrelli B. Integrating Social Determinants of Health With Tobacco Treatment for Individuals With Opioid Use Disorder: Feasibility and Acceptability Study of Delivery Through Text Messaging. JMIR Form Res 2022; 6:e36919. [PMID: 36048509 PMCID: PMC9478816 DOI: 10.2196/36919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 07/17/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Individuals with opioid use disorder (OUD) have a high prevalence of smoking and frequently experience unmet social determinants of health (SDOH), which may be barriers to smoking cessation. Hospitalization is an opportunity to encourage smoking cessation. Unfortunately, many clinicians do not provide tobacco treatment to support the maintenance of cessation achieved during hospitalization. Interventions are required to support these high-risk individuals after hospital discharge. Objective This study aimed to test the feasibility and acceptability of a 28-day SMS text messaging program tailored to individuals with OUD, which provides smoking cessation support and addresses unmet SDOH needs. Methods From July to December 2019, we enrolled 25 individuals who were hospitalized with tobacco dependence and OUD at our large safety net hospital. The SMS text messaging program was initiated during hospitalization and continued for 28 days. Participants were enrolled in either the ready to quit within 30 days or the not ready to quit within 30 days program based on their readiness to quit. Automated SMS text messages were sent twice daily for 4 weeks. The topics included health and cost benefits of quitting, both general and opioid specific (16 messages); managing mood and stress (8 messages); motivation, coping strategies, and encouragement (18 messages); addressing medication misconceptions (5 messages); links to resources to address substance use (2 messages providing links to the Massachusetts Substance Use Helpline and Boston Medical Center resources), tobacco dependence (1 message providing a link to the Massachusetts Quitline), and unmet SDOH needs (6 messages assessing SDOH needs with links to resources if unmet SDOH needs were identified). Questionnaires and interviews were conducted at baseline and at 2 and 4 weeks after enrollment. Results The participants were 56% (14/25) female, 36% (9/25) African American, 92% (23/25) unemployed, and 96% (24/25) Medicaid insured. Approximately 84% (21/25) activated the program, and none of the participants unsubscribed. Approximately 57% (12/21) completed either the 2- or 4-week questionnaires. Program satisfaction was high (overall mean 6.7, SD 0.8, range 1-7). Many perceived that the SMS text messaging program provided social support, companionship, and motivation to stop smoking. Messages about the health benefits of quitting were well received, whereas messages on how quitting cigarettes may prevent relapse from other substances had mixed views, highlighting the importance of tailoring interventions to patient preferences. Conclusions SMS text messaging to promote smoking cessation and address SDOH needs may be an effective tool for improving quit rates and health outcomes in individuals with tobacco dependence and OUD. Our study adds to the growing body of evidence that SMS text messaging approaches are feasible and acceptable for providing tobacco treatment to all individuals who smoke, even among low-income populations who have OUD and are not ready to quit.
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Affiliation(s)
- Hasmeena Kathuria
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, United States
| | - Divya Shankar
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, United States
| | - Vinson Cobb
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, United States
| | - Julia Newman
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, United States
| | | | | | - Belinda Borrelli
- Henry M Goldman School of Dental Medicine, Boston University, Boston, MA, United States
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Min JY, Levin J, Weinberger AH. Associations of tobacco cigarette use and dependence with substance use disorder treatment completion by sex/gender and race/ethnicity. J Subst Abuse Treat 2022; 140:108834. [PMID: 35803029 DOI: 10.1016/j.jsat.2022.108834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/29/2022] [Accepted: 06/28/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Individuals with substance use disorders (SUD) are approximately five times more likely to smoke cigarettes than the general population. Individuals who smoke cigarettes have greater odds of SUD relapse compared to individuals who do not smoke cigarettes, but we know little about how cigarette use is related to SUD treatment completion overall by sex/gender or race/ethnicity. METHODS This study examined 2855 adults (71.98 % male; >70 % racial/ethnic minority) in outpatient and residential SUD treatment at a New York-based treatment agency over a six-month period in 2018. RESULTS Overall, approximately three-fourths of SUD treatment-seeking participants smoked cigarettes, with high rates across sex/gender and racial/ethnic groups. Nicotine dependence did not differ by sex/gender, and White Non-Hispanic adults had the highest levels of nicotine dependence across racial/ethnic groups. Those who smoked cigarettes were significantly less likely to complete treatment compared to those who did not smoke cigarettes (OR = 0.69; 95 % CI: 0.58, 0.82). The study found no overall differences in SUD treatment completion and length of stay by sex/gender or race/ethnicity. CONCLUSIONS Given the high prevalence of cigarette smoking and lower odds of completing SUD treatment, the current system of care for SUD treatment may be enhanced by addressing cigarette smoking from onset of treatment.
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Affiliation(s)
- Jung-Yun Min
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.
| | - Jacob Levin
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.
| | - Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
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Secades-Villa R, Aonso-Diego G, González-Roz A. A randomized controlled trial of contingency management for smoking cessation in substance use treatment patients. Int J Clin Health Psychol 2022; 22:100314. [PMID: 35662791 PMCID: PMC9157212 DOI: 10.1016/j.ijchp.2022.100314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/03/2022] [Indexed: 12/04/2022] Open
Abstract
Background/Objective Contingency management (CM) is one of the most effective interventions for smokers with substance use disorder (SUD), and no empirical assessment of its long-term efficacy has been conducted so far in a real-world context. The objectives were: (1) examine the additive effectiveness of CM on cognitive-behavioral treatment (CBT) for smoking cessation, and (2) examine the relationship between smoking cessation and substance use abstinence. Method A total of 80 participants (75.8% males; Mage = 45.31; SD = 9.64) were assigned to two smoking cessation treatments: CBT or CBT+CM. A set of generalized estimating equations were conducted to examine the effect of treatment condition on smoking outcomes, as well as the effect of smoking status on substance abstinence. Results Adding CM to CBT for smoking cessation improved tobacco abstinence rates at the end-of-treatment (p = .049). Tobacco abstinence rates declined over time (p = .012), but no significant effects of treatment condition were observed across follow-ups (p = .260). Smoking cessation was not significantly related to substance abstinence (p ≥ .488). Conclusions CM facilitates early abstinence in smokers with SUD, although effects subside after treatment termination. The lack of association between smoking abstinence and substance use suggests no jeopardizing effects as a result of quitting smoking.
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Affiliation(s)
- Roberto Secades-Villa
- Addictive Behaviors Research Group, Faculty of Psychology, University of Oviedo, Plaza Feijoo s/n, 33003 Oviedo, Spain
| | - Gema Aonso-Diego
- Addictive Behaviors Research Group, Faculty of Psychology, University of Oviedo, Plaza Feijoo s/n, 33003 Oviedo, Spain
- Corresponding author.
| | - Alba González-Roz
- Addictive Behaviors Research Group, Faculty of Psychology, University of Oviedo, Plaza Feijoo s/n, 33003 Oviedo, Spain
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Alodhayani AA, Almutairi KM, Vinluan JM, Alonazi WB, Alzahrani HG, Batais MA, Kaki FM, Almigbal TH, Alsaad S. A retrospective analysis of substance use among female psychiatric patients in Saudi Arabia. Front Psychol 2022; 13:843785. [PMID: 36072054 PMCID: PMC9443957 DOI: 10.3389/fpsyg.2022.843785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 06/29/2022] [Indexed: 11/25/2022] Open
Abstract
Objective This study investigated the prevalence of substance use (SU), and its risk factors, among women attending psychiatric outpatients center in Saudi Arabia. Design A retrospective cross-sectional design. Materials and methods We reviewed outpatients' records of 200 female patients with a history of SU from a psychiatric unit in Jeddah, Saudi Arabia from December 2018 to February 2019. The researchers developed the pro forma, and 2 psychiatrists and a family medicine physician validated the form. Results The most common and widely used were psychoactive substances (58%), followed by central nervous system (CNS) depressants (22%), and finally cannabinols (9.5%). Overall, the highest substance use was the amphetamine-cannabis-nicotine (ACN) representing nearly half of the illicit items (46.6%), followed by heroine-alcohol-benzodiazepine (16.4%), and with the lowest being benzodiazepine-nicotine (1.7%). There was a significant difference between the single substance and multiple substance use in terms of age (p = 0.001), smoking behavior (p = 0.001), patients past history (p = 0.005), and age of the patient at the start of drug use (p = 0.005). Conclusion Although the prevalence of substance use among women is low in Saudi Arabia, screening of substance use disorders risks and building a rehabilitation program to control drug dependence are needed.
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Affiliation(s)
- Abdulaziz A. Alodhayani
- Department of Family Medicine and Community, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Khalid M. Almutairi
- Department of Family Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Jason M. Vinluan
- Department of Family Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Wadi B. Alonazi
- College of Business Administration, King Saud University, Riyadh, Saudi Arabia
| | | | - Mohammed Ali Batais
- Department of Family Medicine and Community, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Turky H. Almigbal
- Department of Family Medicine and Community, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Saad Alsaad
- Department of Family Medicine and Community, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Goodwin RD, Davidson L. Prevalence of Cigarette Smoking Among US Adults With Major Depression or Substance Use Disorders. JAMA 2022; 328:585. [PMID: 35943476 DOI: 10.1001/jama.2022.10852] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Renee D Goodwin
- Department of Epidemiology and Biostatistics, The City University of New York, New York, New York
- Columbia University, New York, New York
| | - Larry Davidson
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
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Patient experiences with tobacco use during substance use disorder treatment and early recovery: a mixed method analysis of phone interview responses. J Addict Dis 2022:1-7. [PMID: 35930400 DOI: 10.1080/10550887.2022.2103352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Tobacco use and related mortality remain disproportionately high among individuals with substance use disorders (SUDs). Though engagement in tobacco cessation interventions is associated with improved long-term recovery, many individuals in SUD treatment do not participate. The goal of the present study was to better understand patient views regarding tobacco use/cessation during residential SUD treatment, in order to decrease barriers for this vulnerable population. This study utilized a cross-sectional design and mixed methods analysis. Following discharge from residential SUD treatment, individuals who reported any use of tobacco were invited to participate in a brief phone interview. Forty-one of the 60 who were reached (68%) agreed to participate. Responses were quantified for analysis when appropriate, and descriptive statistics were calculated for quantitative data. Thematic analysis was used to analyze qualitative responses. Most respondents (83%) reported that tobacco cessation was an important goal and were open to tobacco cessation treatment. The vast majority (85%) did not think tobacco use interfered with their recovery from other SUDs. Respondents noted the socially-reinforcing nature of tobacco use in treatment, and indicated a desire for increased access to cessation services. Results suggest increased patient education and changes to treatment center tobacco policies may assist individuals recovering from SUD with tobacco cessation.
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Meng Z, Li Q, Ma Y, Liu C. Transcranial direct current stimulation of the frontal-parietal-temporal brain areas reduces cigarette consumption in abstinent heroin users. J Psychiatr Res 2022; 152:321-325. [PMID: 35785574 DOI: 10.1016/j.jpsychires.2022.06.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 06/10/2022] [Accepted: 06/24/2022] [Indexed: 11/28/2022]
Abstract
Transcranial direct current stimulation (tDCS) has been demonstrated to modulate neural activity and related brain functions. In clinical studies, tDCS has been shown to reduce craving in various substance use disorders including cocaine, heroin and nicotine. Our previous report suggested that cathodal tDCS on the frontal-parietal-temporal (FPT) brain areas reduced cigarette consumption in moderate smokers. However, whether it is effective in smokers with history of drug use is unknown. This study investigated the effects of bilateral FPT areas cathodal tDCS on smokers with history of heroin use. 22 abstinent heroin users were recruited and randomly assigned to sham group and tDCS group. The sham group received 30 s tDCS treatment and tDCS group received normal tDCS (one trial of 20 min, 1 mA, cathodal electrodes were placed bilaterally on the FPT areas). The average of daily cigarettes consumption was recorded for the week before the tDCS and the following day after tDCS. In addition, pupil light reflex was measured right before and after tDCS treatment. One trial of tDCS stimulation significantly reduced daily cigarette consumption in smokers who had heroin use history. This reducing effect was also observed in heavy smokers. In addition, this effect on cigarette consumption lasted at least 48 h after the stimulation. Furthermore, it has been shown that opiates decrease pupillary size in humans, we found detectable changes of the dynamic pupil light reflex after bilateral tDCS stimulation. These findings suggest that FPT cathodal tDCS may be an effective approach to reduce cigarette craving in heroin users.
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Affiliation(s)
- Zhiqiang Meng
- Shenzhen Key Laboratory of Drug Addiction, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518000, China; CAS Key Laboratory of Brain Connectome and Manipulation, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China; Shenzhen-Hong Kong Institute of Brain Sciences-Shenzhen Fundamental Research, Institutions, Shenzhen, 518000, China.
| | - Qing Li
- Shenzhen Key Laboratory of Drug Addiction, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518000, China; Medical School, Kunming University of Science and Technology, Kunming, China
| | - Yuanye Ma
- Medical School, Kunming University of Science and Technology, Kunming, China; Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, China
| | - Chang Liu
- Shenzhen Key Laboratory of Viral Vectors for Biomedicine, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518000, China; CAS Key Laboratory of Brain Connectome and Manipulation, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China; Shenzhen-Hong Kong Institute of Brain Sciences-Shenzhen Fundamental Research, Institutions, Shenzhen, 518000, China.
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Regan C, Fehily C, Campbell E, Bowman J, Faulkner J, Oldmeadow C, Bartlem K. Clustering of chronic disease risks among people accessing community mental health services. Prev Med Rep 2022; 28:101870. [PMID: 35813396 PMCID: PMC9256721 DOI: 10.1016/j.pmedr.2022.101870] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 06/19/2022] [Accepted: 06/24/2022] [Indexed: 10/26/2022] Open
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Swithenbank Z, Harrison R, Porcellato L. Service user perceptions of smoking cessation in residential substance use treatment. PLoS One 2022; 17:e0270045. [PMID: 35731791 PMCID: PMC9216544 DOI: 10.1371/journal.pone.0270045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 06/02/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
Prevalence of tobacco smoking among adults in substance misuse treatment is much higher than the wider population, yet limited research is available, and residential treatment services have been overlooked as a potential setting for cessation interventions. Exploring the perceptions of service users about smoking cessation in residential rehabilitation is important to gain better understanding of this issue and identify ways to inform future intervention development.
Methods
Ten semi-structured interviews were conducted in the Northwest of England in 2017 with adults (7 male, 3 female) who were currently or had previously been in residential treatment for substance misuse. Five participants were current smokers, three had never smoked, and two were former smokers. Participants were asked about their smoking behaviours, factors relating to smoking and smoking cessation and the relationship between smoking and substance use. All interviews were transcribed and data was analysed thematically.
Results
Study findings highlighted a general consensus amongst participants that residential treatment services offered an ideal opportunity for cessation but there were concerns that doing so might jeopardise recovery. Smoking in substance use treatment services is still the norm and factors such as perceived social and psychological benefits, normative behaviours and lack of perceived risk or prioritisation pose challenges for implementing smoking cessation within this setting, although facilitators such as motivation to change and appropriateness of the setting were also identified.
Conclusions
This study suggests that service users perceive residential treatment services as suitable environments to introduce smoking cessation. To address the needs of adults who smoke and are in recovery from substance use, further research and cooperation from treatment organisations is needed to integrate substance misuse and smoking cessation services. More conclusive evidence on the effectiveness of tackling both issues at the same time is also required.
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Affiliation(s)
- Zoe Swithenbank
- Public Health Institute, Liverpool John Moores University, Liverpool, United Kingdom
- * E-mail:
| | - Rebecca Harrison
- Public Health Institute, Liverpool John Moores University, Liverpool, United Kingdom
| | - Lorna Porcellato
- Public Health Institute, Liverpool John Moores University, Liverpool, United Kingdom
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Chung JH, Mierke A, Ramos O, Kagabo W, Boling W, Cheng W, Danisa O. Preoperative opiate use leads to increased postoperative opiate use and readmissions after anterior cervical discectomy and fusion. JOURNAL OF SPINE SURGERY (HONG KONG) 2022; 8:214-223. [PMID: 35875623 PMCID: PMC9263740 DOI: 10.21037/jss-21-126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 04/02/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Determine effects of pre-operative opiate use on anterior cervical discectomy and fusion (ACDF) surgery outcomes. METHODS The study design was a single center retrospective cohort study. Patient records were reviewed from 2013 and 2018 for elective 1 to 2 level ACDF surgeries. Patients were classified as: opiate naive (ON: no history of opiate) use, acute opiate (AO: <6 months preoperatively) use, and chronic opiate (CO: 6-12 months preoperatively) use based on prescription history before surgery. Opiate use was quantified by milligram morphine equivalents (MME) at 6-12 months preop, 0-6 months preop, 0-6 months postop, and 6-12 months postop. Charts were reviewed for American Society of Anesthesiologists (ASA) physical status classification and smoking history. RESULTS Readmission rates were 9.8% for ON, 9.1% for AO, and 30% for CO (P value <0.05). Average opiate use measured in MME 6-12 months post-surgery was 5.76 for ON, 18.44 for AO, and 39.92 for CO (P value <0.05). Readmission rate between nonsmokers, former smokers, and active smokers was 4.4%, 0%, and 10.8% (P value <0.05) at 30-90 days post-surgery, and 1.1%, 14.5%, and 2.5% (P value <0.05) in the 91 days to 1-year post-surgery. CONCLUSIONS There is statistically significant relationship between CO and higher readmission rates after ACDF. Preoperative opiate use is also associated with increased opiate use 6-12 months after surgery. Smoking history is also associated with increased readmission rates.
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Affiliation(s)
- Jun Ho Chung
- Department of Orthopedic Surgery, Loma Linda University Health, Loma Linda, California, USA
| | - Alex Mierke
- Department of Orthopedic Surgery, Loma Linda University Health, Loma Linda, California, USA
| | - Omar Ramos
- Department of Orthopedic Surgery, Loma Linda University Health, Loma Linda, California, USA
| | - Whitney Kagabo
- Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Warren Boling
- Department of Neurosurgery, Loma Linda University Health, Loma Linda, California, USA
| | - Wayne Cheng
- Veterans Affairs Loma Linda Health Care, Loma Linda, California, USA
| | - Olumide Danisa
- Department of Orthopedic Surgery, Loma Linda University Health, Loma Linda, California, USA
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van Amsterdam J, van den Brink W. Smoking As an Outcome Moderator In the Treatment of Alcohol Use Disorders. Alcohol Alcohol 2022; 57:664-673. [PMID: 35589093 DOI: 10.1093/alcalc/agac027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 11/15/2022] Open
Abstract
AIMS To clarify whether smoking interferes with successful treatment of alcohol use disorder (AUD). METHODS The current systematic review investigates the potential moderating effect of smoking on behavioural and pharmacological treatment of AUD. In addition, this review summarizes the results of randomized controlled trials investigating the effect of smoking cessation treatments in subjects with AUD on drinking outcomes. RESULTS Overall, the results show that 16 out of the 31 pharmacological and psychotherapeutic alcohol treatment studies showed that being a non-smoker or decreased tobacco consumption during AUD treatment is associated with beneficial drinking outcomes, including reduced drinking, later relapse and prolonged alcohol abstinence. As such, smoking predicts poorer drinking outcomes in alcohol treatments. In the stop-smoking studies in patients with AUD, reduced smoking had virtually no effect on drinking behaviours. The inverse association between smoking and drinking outcome observed here indicates that non-smokers may be more successful to attain alcohol abstinence than smokers do. However, this association does not imply per se that smoking triggers alcohol consumption, since it can also mean that alcohol consumption promotes smoking. CONCLUSIONS It is concluded that (continued) tobacco smoking may have a negative moderating effect on the treatment outcome of AUD treatments. To optimize treatment outcome of AUD one may consider informing and counselling patients with AUD about the risks of smoking for treatment outcomes and offering support for smoking cessation.
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Affiliation(s)
- Jan van Amsterdam
- Department of Psychiatry, Academic Medical Center University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Academic Medical Center University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
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Valencia MLC, Peters B. The early onset of nicotine dependence, severity of substance use disorder, and relapse: an inpatient study. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2069610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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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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McCuistian C, Kapiteni K, Le T, Safier J, Delucchi K, Guydish J. Reducing tobacco use in substance use treatment: An intervention to promote tobacco-free grounds. J Subst Abuse Treat 2022; 135:108640. [PMID: 34743925 PMCID: PMC8903046 DOI: 10.1016/j.jsat.2021.108640] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/10/2021] [Accepted: 10/13/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND People in substance use disorder (SUD) treatment experience disproportionate rates of tobacco use. California has prioritized smoking cessation among these individuals through the Tobacco-Free for Recovery Initiative, which includes an intervention aimed at supporting programs in implementing tobacco-free grounds. The current study examined changes in client smoking prevalence, tobacco use behaviors, and receipt of cessation services among the first seven programs participating in the initiative. METHODS Residential treatment program clients completed cross-sectional surveys at the start of the intervention (baseline: n = 249), at an interim timepoint post-baseline (interim: n = 275), and at the end of the intervention 15 months later (post-intervention: n = 219). All participants reported smoking status. Current smokers reported tobacco use behaviors, and both current smokers and those who quit in treatment reported receipt of cessation services. Univariate analyses explored differences across the three timepoints and multivariate logistic regression assessed change from baseline to interim and baseline to post-intervention. RESULTS Client smoking prevalence decreased from 54.2% at pre- to 26.6% at post-intervention (Adjusted Odds Ratio [AOR] = 0.25, 95% CI = 0.13, 0.45). Current smokers and those who quit while in treatment reported an increase in NRT/pharmacotherapy (11.9% vs. 25.2%; AOR = 3.02, CI = 1.24, 7.35). When comparing baseline to the interim timepoint (a timepoint before the COVID-19 pandemic), data analyses also demonstrated a significant decrease in smoking prevalence (54.2% vs. 41.8%; AOR = 0.62, CI = 0.42, 0.92) and increase in NRT/pharmacotherapy (11.9% vs. 24.5%; AOR = 3.68, CI = 1.11, 12.19). CONCLUSION An intervention to promote tobacco-free grounds implemented in residential SUD treatment programs was associated with a significant reduction in client smoking and an increase in NRT/pharmacotherapy. These associations were observed both before the COVID-19 pandemic and in the early stages of the pandemic, suggesting that they may be due to the intervention rather than to the pandemic.
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Affiliation(s)
- Caravella McCuistian
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St., Floor 7 San Francisco, CA 94158, United States of America.
| | - Kwinoja Kapiteni
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St., Floor 7 San Francisco, CA 94158, United States of America
| | - Thao Le
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St., Floor 7 San Francisco, CA 94158, United States of America.
| | - Jessica Safier
- Smoking Cessation Leadership Center, University of California San Francisco, 3333 California Street, Ste. 430, San Francisco, CA 94143, United States of America.
| | - Kevin Delucchi
- Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, United States of America.
| | - Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St., Floor 7 San Francisco, CA 94158, United States of America.
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Davis JP, Rao P, Dilkina B, Prindle J, Eddie D, Christie NC, DiGuiseppi G, Saba S, Ring C, Dennis M. Identifying individual and environmental predictors of opioid and psychostimulant use among adolescents and young adults following outpatient treatment. Drug Alcohol Depend 2022; 233:109359. [PMID: 35219997 DOI: 10.1016/j.drugalcdep.2022.109359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 02/10/2022] [Accepted: 02/13/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND The United States (US) continues to grapple with a drug overdose crisis. While opioids remain the main driver of overdose deaths, deaths involving psychostimulants such as methamphetamine are increasing with and without opioid involvement. Recent treatment admission data reflect overdose fatality trends suggesting greater psychostimulant use, both alone and in combination with opioids. Adolescents and young adults are particularly vulnerable with generational trends showing that these populations have particularly high relapse rates following treatment. METHODS We assessed demographic, psychosocial, psychological comorbidity, and environmental factors (percent below the poverty line, percent unemployed, neighborhood homicide rate, population density) that confer risk for opioid and/or psychostimulant use following substance use disorder treatment using two complementary machine learning approaches-random forest and least absolute shrinkage and selection operator (LASSO) modelling-with latency to opioid and/or psychostimulant as the outcome variable. RESULTS Individual level predictors varied by substance use disorder severity, with age, tobacco use, criminal justice involvement, race/ethnicity, and mental health diagnoses emerging at top predictors. Environmental variabels including US region, neighborhood poverty, population, and homicide rate around patients' treatment facility emerged as either protective or risk factors for latency to opioid and/or psychostimulant use. CONCLUSIONS Environmental variables emerged as one of the top predictors of latency to use across all levels of substance use disorder severity. Results highlight the need for tailored treatments based on severity, and implicate environmental variables as important factors influencing treatment outcomes.
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Affiliation(s)
- Jordan P Davis
- Suzanne Dworak-Peck School of Social Work, University of Southern California, USA.
| | - Prathik Rao
- Viterbi School of Engineering, Computer Science, University of Southern California, USA
| | - Bistra Dilkina
- Viterbi School of Engineering, Computer Science, University of Southern California, USA
| | - John Prindle
- Suzanne Dworak-Peck School of Social Work, University of Southern California, USA
| | - David Eddie
- Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, Harvard Medical School, USA
| | - Nina C Christie
- Department of Psychology, University of Sothern California & Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, USA
| | - Graham DiGuiseppi
- Suzanne Dworak-Peck School of Social Work; USC Center for Artificial Intelligence in Society, USC Center for Mindfulness Science, USC Institute for Addiction Science, University of Southern California, USA
| | - Shaddy Saba
- Suzanne Dworak-Peck School of Social Work, University of Southern California, USA
| | - Colin Ring
- Department of Psychology, Loma Linda University, USA
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48
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Alghamdi AA, Gartner C, Najman J, Smirnov A. Co-administering cannabis with tobacco and persistent tobacco smoking after 4½ years in young adults who use stimulants: A prospective population-based study. J Psychoactive Drugs 2022; 54:119-128. [PMID: 34254884 DOI: 10.1080/02791072.2021.1947546] [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: 12/08/2020] [Revised: 04/22/2021] [Accepted: 05/13/2021] [Indexed: 10/20/2022]
Abstract
Tobacco smoking remains highly prevalent in high-risk groups, including young adults who use cannabis and a variety of other drugs. We examine whether co-administering cannabis with tobacco is associated with heavier and more persistent tobacco smoking compared to separate use of these substances among young adults who use drugs recreationally. Data are from a prospective population-based study of young adults residing in Queensland, Australia, who recurrently used ecstasy or methamphetamine. The mean age was 20.8 years at baseline, and 47% were female. An ordinal regression model was developed (n = 277) with levels of tobacco smoking at 4½ years as the outcome. At baseline, just under half the sample (44.6%) had not co-administered cannabis with tobacco in the last month, 9.5% rarely co-administered, 7.7% sometimes co-administered, and 38.2% always co-administered. Always co-administering cannabis with tobacco was associated with more frequent and persistent tobacco smoking at 4½ years (Odds Ratio (OR): 1.98, 95% Confidence Interval (CI): 1.02, 3.83), independently of factors including baseline frequency of cannabis and tobacco use. Young adults who use cannabis should be advised not to co-administrate cannabis with tobacco, and comprise an important target group for tobacco smoking cessation interventions.
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Affiliation(s)
- Abdullah Ahmed Alghamdi
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Faculty of Public Health and Health Informatics, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Coral Gartner
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Jake Najman
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Andrew Smirnov
- Senior Lecturer and Director of Research Training, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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49
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Lin SC, Gathua N, Thompson C, Sripipatana A, Makaroff L. Disparities in smoking prevalence and associations with mental health and substance use disorders in underserved communities across the United States. Cancer 2022; 128:1826-1831. [PMID: 35253202 DOI: 10.1002/cncr.34132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Smoking contributes to the top 3 deadliest cancers, cancers of the lung, colon, and pancreas, which account for nearly 40% of all cancer-related deaths in the United States. Despite historicly low smoking rates, substantial disparities remain among people with mental health conditions and substance use disorders (SUDs). METHODS The study examined the prevalence of smoking among adults from underserved communities who are served at federally qualified health centers through an analysis of the 2014 Health Center Patient Survey. Furthermore, the study assessed associations of smoking with co-occurring mental health conditions and SUDs among adult smokers (n = 1735). RESULTS The prevalence of smoking among health center patients was 28.1%. Among current smokers, 59.1% had depression and 45.4% had generalized anxiety. Non-Hispanic Black smokers had more than 2 times the odds of reporting SUDs (adjusted odds ratio [aOR], 2.13; 95% confidence interval [CI], 1.06-4.30). Individuals at or below 100% of the federal poverty level had more than 2 times the odds of having mental health conditions (aOR, 2.55; 95% CI, 1.58-4.11), and those who were unemployed had more than 3 times the odds for SUDs (aOR, 3.21; 95% CI, 1.27-8.10). CONCLUSIONS The prevalence of smoking in underserved communities is nearly double the national prevalence. In addition, the study underscores important socioeconomic determinants of health in smoking cessation behavior and the marked disparities among individuals with mental health conditions and SUDs. Finally, the findings illuminate the unique need for tailored treatments supporting cancer prevention care to address challenges confronted by vulnerable populations.
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Affiliation(s)
- Sue C Lin
- Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland
| | - Naomie Gathua
- Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland
| | - Cheryl Thompson
- Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland
| | - Alek Sripipatana
- Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland
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50
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Stevens ER, Sherman SE. A targeted approach to using e-cigarettes for harm reduction in adults. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2022; 48:128-132. [PMID: 35130449 DOI: 10.1080/00952990.2021.2007938] [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] [Received: 10/08/2021] [Revised: 11/12/2021] [Accepted: 11/14/2021] [Indexed: 06/14/2023]
Abstract
Smoking remains the leading preventable cause of death and disease in the US. While e-cigarettes (EC) are undeniably harmful when used by adolescents and nonsmokers, the perpetuation of the increasing negative perceptions of EC and widespread false belief that EC are equal or more harmful than combustible cigarettes (CC) represents a significant missed public health opportunity. EC have great potential to serve as a mechanism for smoking harm reduction among hard-to-treat populations of smokers who have failed to quit with currently available treatments. In this paper, we outline why we need to overcome the hostile EC research environment to explore the potential use of EC as a harm-reduction strategy in hard-to-treat populations.
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Affiliation(s)
- Elizabeth R Stevens
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Scott E Sherman
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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