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Reitzel LR, Nguyen N, Eischen S, Thomas J, Okuyemi KS. Is smoking cessation associated with worse comorbid substance use outcomes among homeless adults? Addiction 2014; 109:2098-104. [PMID: 25041459 PMCID: PMC4229393 DOI: 10.1111/add.12688] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 03/20/2014] [Accepted: 07/10/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Smoking prevalence among homeless adults is exceedingly high, and high rates of comorbid substance use are among the barriers to abstinence experienced by this group. The extent to which smoking cessation might engender an escalation in comorbid substance use could be a concern prohibiting treatment provision and engagement. This study examined whether smoking abstinence status was associated with alcohol and substance use at 26 weeks post-randomization among homeless smokers in a smoking cessation trial. DESIGN The current study was a secondary analysis of randomized smoking cessation intervention trial data. SETTING The parent study was conducted in the Minneapolis/St Paul area of Minnesota, USA. PARTICIPANTS Participants were 427 homeless adult smokers interested in quitting smoking. MEASUREMENTS Covariates collected at baseline included alcohol, cocaine, marijuana/hashish, heroin and 'any' drug use, age, sex, race/ethnicity, education, tobacco dependence, length of time homeless and treatment group. Biochemically verified smoking abstinence and self-reported alcohol and substance use were collected at 26 weeks post-randomization. FINDINGS Smoking abstinence was associated with fewer drinking days (P = 0.03), fewer drinks consumed on drinking days (P = 0.01), and lower odds of heavy drinking (P = 0.05), but not with differences in the number of days of cocaine, marijuana/hashish, heroin or any drug use. CONCLUSIONS In homeless smokers, achieving smoking abstinence may be associated with a reduction in alcohol consumption but appears not to be associated with a substantial change in other drug use.
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Affiliation(s)
- Lorraine R. Reitzel
- College of Education, Department of Educational Psychology, University of Houston, Houston, TX, USA
| | - Nga Nguyen
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sara Eischen
- Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Janet Thomas
- General Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Kolawole S. Okuyemi
- Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
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Richards CM, Sharif F, Eischen S, Thomas J, Wang Q, Guo H, Luo X, Okuyemi K. Retention of Homeless Smokers in the Power to Quit Study. Nicotine Tob Res 2014; 17:1104-11. [PMID: 25301816 DOI: 10.1093/ntr/ntu210] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 09/26/2014] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Concerns about retention are a major barrier to conducting studies enrolling homeless individuals. Since smoking is a major problem in homeless communities and research on effective methods of promoting smoking cessation is needed, we describe strategies used to increase retention and participant characteristics associated with retention in smoking cessation study enrolling homeless adults. METHODS The parent study was a 2-group randomized controlled trial with 26-week follow-up enrolling 430 homeless smokers from emergency shelters and transitional housing units in Minneapolis/Saint Paul, MN, USA. Multiple strategies were used to increase retention, including conducting visits at convenient locations for participants, collecting several forms of contact information from participants, using a schedule that was flexible and included frequent low-intensity visits, and providing incentives. Participant demographics as well as characteristics related to tobacco and drug use and health status were analyzed for associations with retention using univariate and multivariate analysis. RESULTS Overall retention was 75% at 26 weeks. Factors associated with increased retention included greater age; having healthcare coverage; history of multiple homeless episodes, lower stress level; and higher PHQ-9 (Patient Health Questionnaire-9) score. A history of excessive drinking and drug use were associated with decreased retention. CONCLUSIONS It is possible to successfully retain homeless individuals in a smoking cessation study if the study is designed with participants' needs in mind.
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Affiliation(s)
- Christina M Richards
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN; Program in Health Disparities Research, University of Minnesota, Minneapolis, MN
| | - Faduma Sharif
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN; Program in Health Disparities Research, University of Minnesota, Minneapolis, MN
| | - Sara Eischen
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN; Program in Health Disparities Research, University of Minnesota, Minneapolis, MN
| | | | - Qi Wang
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN
| | - Hongfei Guo
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Xianghua Luo
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Kolawole Okuyemi
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN; Program in Health Disparities Research, University of Minnesota, Minneapolis, MN; Center for Health Equity, University of Minnesota, Minneapolis, MN; Masonic Cancer Center, University of Minnesota, Minneapolis, MN;
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Warner C, Sewali B, Olayinka A, Eischen S, Wang Q, Guo H, Ahluwalia JS, Okuyemi KS. Smoking cessation in homeless populations: who participates and who does not. Nicotine Tob Res 2013; 16:369-72. [PMID: 24158227 DOI: 10.1093/ntr/ntt169] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Although homeless individuals smoke at an alarmingly high rate, few smoking cessation clinical trials have focused on this vulnerable population. Little is known about recruitment efforts and suitable eligibility criteria for tobacco control research in homeless populations. METHODS The aim of this article is to describe the recruitment, eligibility, and enrollment of homeless smokers who participated in the Power to Quit smoking study, a randomized smoking cessation clinical trial funded by the National Institutes of Health. The study compared motivational interviewing and standard counseling while participants received an 8-week treatment of the nicotine patch. RESULTS Working with local emergency shelters, a total of 839 adult smokers were screened for study eligibility, 580 of whom (69.1%) met eligibility criteria. Of those eligible, 430 (74.1%) returned for randomization. Those who returned for randomization were older and more likely to have a phone number compared with eligible participants not enrolled. The most common reasons for exclusion included exhaled carbon monoxide levels less than or equal to 5 parts per million (indicating nonsmoking status), use of smoking cessation aid during the past 30 days, and not meeting the study definition of homelessness. CONCLUSION Knowledge of these factors may help researchers tailor criteria that accurately identify and include homeless smokers in future research.
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Affiliation(s)
- Carolyn Warner
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN
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Okuyemi KS, Goldade K, Whembolua GL, Thomas JL, Eischen S, Sewali B, Guo H, Connett JE, Grant J, Ahluwalia JS, Resnicow K, Owen G, Gelberg L, Jarlais DD. Motivational interviewing to enhance nicotine patch treatment for smoking cessation among homeless smokers: a randomized controlled trial. Addiction 2013; 108:1136-44. [PMID: 23510102 PMCID: PMC3651796 DOI: 10.1111/add.12140] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 09/06/2012] [Accepted: 01/29/2013] [Indexed: 11/29/2022]
Abstract
AIMS To assess the effects of adding motivational interviewing (MI) counseling to nicotine patch for smoking cessation among homeless smokers. DESIGN Two-group randomized controlled trial with 26-week follow-up. PARTICIPANTS AND SETTING A total of 430 homeless smokers from emergency shelters and transitional housing units in Minneapolis/St Paul, Minnesota, USA. INTERVENTION AND MEASUREMENTS All participants received 8-week treatment of 21-mg nicotine patch. In addition, participants in the intervention group received six individual sessions of MI counseling which aimed to increase adherence to nicotine patches and to motivate cessation. Participants in the standard care control group received one session of brief advice to quit smoking. Primary outcome was 7-day abstinence from cigarette smoking at 26 weeks, as validated by exhaled carbon monoxide and salivary cotinine. FINDINGS Using intention-to-treat analysis, verified 7-day abstinence rate at week 26 for the intervention group was non-significantly higher than for the control group (9.3% versus 5.6%, P = 0.15). Among participants who did not quit smoking, reduction in number of cigarettes from baseline to week 26 was equally high in both study groups (-13.7 ± 11.9 for MI versus -13.5 ± 16.2 for standard care). CONCLUSIONS Adding motivational interviewing counseling to nicotine patch did not increase smoking rate significantly at 26-week follow-up for homeless smokers.
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Affiliation(s)
- Kolawole S. Okuyemi
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN,Program in Health Disparities Research, University Of Minnesota, Minneapolis, MN,Center for Health Equity, University Of Minnesota, Minneapolis, MN,Masonic Cancer Center, University Of Minnesota, Minneapolis, MN
| | - Kate Goldade
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN,Program in Health Disparities Research, University Of Minnesota, Minneapolis, MN
| | - Guy-Lucien Whembolua
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN,Program in Health Disparities Research, University Of Minnesota, Minneapolis, MN,Center for Health Equity, University Of Minnesota, Minneapolis, MN
| | - Janet L. Thomas
- Program in Health Disparities Research, University Of Minnesota, Minneapolis, MN,Center for Health Equity, University Of Minnesota, Minneapolis, MN,Masonic Cancer Center, University Of Minnesota, Minneapolis, MN,Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Sara Eischen
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN,Program in Health Disparities Research, University Of Minnesota, Minneapolis, MN
| | - Barrett Sewali
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN,Program in Health Disparities Research, University Of Minnesota, Minneapolis, MN
| | - Hongfei Guo
- Division of Biostatistics, School of Public Health, and Clinical and Translational Institute, University of Minnesota, Minneapolis, MN
| | - John E. Connett
- Division of Biostatistics, School of Public Health, and Clinical and Translational Institute, University of Minnesota, Minneapolis, MN
| | - Jon Grant
- Department of Psychiatry, University of Minnesota, Minneapolis, MN
| | - Jasjit S. Ahluwalia
- Program in Health Disparities Research, University Of Minnesota, Minneapolis, MN,Center for Health Equity, University Of Minnesota, Minneapolis, MN,Masonic Cancer Center, University Of Minnesota, Minneapolis, MN,Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Ken Resnicow
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI
| | | | - Lillian Gelberg
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Don Des Jarlais
- Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, Albert Einstein College of Medicine, New York, NY
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Okuyemi KS, Goldade K, Whembolua GL, Thomas JL, Eischen S, Guo H, Connett JE, Grant J, Ahluwalia JS, Resnicow K, Owen G, Gelberg L, Jarlais DD. Smoking characteristics and comorbidities in the power to quit randomized clinical trial for homeless smokers. Nicotine Tob Res 2012; 15:22-8. [PMID: 22589422 DOI: 10.1093/ntr/nts030] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Smoking prevalence in homeless populations is strikingly high (∼70%); yet, little is known about effective smoking cessation interventions for this population. We conducted a community-based clinical trial, Power To Quit (PTQ), to assess the effects of motivational interviewing (MI) and nicotine patch (nicotine replacement therapy [NRT]) on smoking cessation among homeless smokers. This paper describes the smoking characteristics and comorbidities of smokers in the study. METHODS Four hundred and thirty homeless adult smokers were randomized to either the intervention arm (NRT + MI) or the control arm (NRT + Brief Advice). Baseline assessment included demographic information, shelter status, smoking history, motivation to quit smoking, alcohol/other substance abuse, and psychiatric comorbidities. RESULTS Of the 849 individuals who completed the eligibility survey, 578 (68.1%) were eligible and 430 (74.4% of eligibles) were enrolled. Participants were predominantly Black, male, and had mean age of 44.4 years (S D = 9.9), and the majority were unemployed (90.5%). Most participants reported sleeping in emergency shelters; nearly half had been homeless for more than a year. Nearly all the participants were daily smokers who smoked an average of 20 cigarettes/day. Nearly 40% had patient health questionnaire-9 depression scores in the moderate or worse range, and more than 80% screened positive for lifetime history of drug abuse or dependence. CONCLUSIONS This study demonstrates the feasibility of enrolling a diverse sample of homeless smokers into a smoking cessation clinical trial. The uniqueness of the study sample enables investigators to examine the influence of nicotine dependence as well as psychiatric and substance abuse comorbidities on smoking cessation outcomes.
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Affiliation(s)
- Kolawole S Okuyemi
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN 55414, USA.
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Goldade K, Whembolua GL, Thomas J, Eischen S, Guo H, Connett J, Des Jarlais D, Resnicow K, Gelberg L, Owen G, Grant J, Ahluwalia JS, Okuyemi KS. Designing a smoking cessation intervention for the unique needs of homeless persons: a community-based randomized clinical trial. Clin Trials 2012; 8:744-54. [PMID: 22167112 DOI: 10.1177/1740774511423947] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although smoking prevalence remains strikingly high in homeless populations (~70% and three times the US national average), smoking cessation studies usually exclude homeless persons. Novel evidence-based interventions are needed for this high-risk subpopulation of smokers. PURPOSE To describe the aims and design of a first-ever smoking cessation clinical trial in the homeless population. The study was a two-group randomized community-based trial that enrolled participants (n = 430) residing across eight homeless shelters and transitional housing units in Minnesota. The study objective was to test the efficacy of motivational interviewing (MI) for enhancing adherence to nicotine replacement therapy (NRT; nicotine patch) and smoking cessation outcomes. METHODS Participants were randomized to one of the two groups: active (8 weeks of NRT + 6 sessions of MI) or control (NRT + standard care). Participants attended six in-person assessment sessions and eight retention visits at a location of their choice over 6 months. Nicotine patch in 2-week doses was administered at four visits over the first 8 weeks of the 26-week trial. The primary outcome was cotinine-verified 7-day point-prevalence abstinence at 6 months. Secondary outcomes included adherence to nicotine patch assessed through direct observation and patch counts. Other outcomes included the mediating and/or moderating effects of comorbid psychiatric and substance abuse disorders. RESULTS Lessons learned from the community-based cessation randomized trial for improving recruitment and retention in a mobile and vulnerable population included: (1) the importance of engaging the perspectives of shelter leadership by forming and convening a Community Advisory Board; (2) locating the study at the shelters for more visibility and easier access for participants; (3) minimizing exclusion criteria to allow enrollment of participants with stable psychiatric comorbid conditions; (4) delaying the baseline visit from the eligibility visit by a week to protect against attrition; and (5) regular and persistent calls to remind participants of upcoming appointments using cell phones and shelter-specific channels of communication. LIMITATIONS The study's limitations include generalizability due to the sample drawn from a single Midwestern city in the United States. Since inclusion criteria encompassed willingness to use NRT patch, all participants were motivated and were ready to quit smoking at the time of enrollment in the study. Findings from the self-select group will be generalizable only to those motivated and ready to quit smoking. High incentives may limit the degree to which the intervention is replicable. CONCLUSIONS Lessons learned reflect the need to engage communities in the design and implementation of community-based clinical trials with vulnerable populations.
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Affiliation(s)
- Kate Goldade
- Department of Family Medicine and Community Health, University of Minnesota, Medical School, Minneapolis, MN 55116, USA.
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