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Harfmann RF, Heil SH, Bunn JY, Snell LM, Tidey JW, Sigmon SC, Gaalema DE, Lee DC, Streck JM, Bergeria CL, Davis DR, Plucinski S, Higgins ST. Changes in weight among individuals with psychiatric conditions or socioeconomic disadvantage assigned to smoke very low nicotine content cigarettes. Exp Clin Psychopharmacol 2024; 32:181-188. [PMID: 38236223 DOI: 10.1037/pha0000700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Nicotine abstinence leads to weight gain, which could be an unintended consequence of a nicotine reduction policy. This secondary analysis used weekly assessments of weight and ratings of "increased appetite/hunger/weight gain" collected in three 12-week, randomized controlled trials evaluating the effects of cigarettes differing in nicotine dose (15.8, 2.4, or 0.4 mg/g) among individuals with affective disorders, opioid use disorder (OUD), and socioeconomically disadvantaged women. Linear mixed models tested differences by dose and time. Analyses first collapsed across populations and then separated out individuals with OUD because biomarkers suggested they used substantially more noncombusted nicotine. Across populations, weight increased significantly over time, averaging 1.03 kg (p < .001), but did not vary by dose nor was there any interaction of dose/time. "Increased appetite/hunger/weight gain" ratings increased significantly as a function of dose, with differences between low and high doses (1.95 and 1.73, respectively, p = .01), but not by time nor any interaction. In the combined group of individuals with affective disorders and socioeconomically disadvantaged women, weight and "increased appetite/hunger/weight gain" ratings increased significantly by dose, with differences between low and high doses (1.43 vs. 0.73 kg, p = .003 and 2.00 vs. 1.76, p = .02, respectively). Among individuals with OUD, there were no significant effects of any kind on either outcome. Individuals with affective disorders and socioeconomically disadvantaged women gained weight and reported more subjective appetite/weight gain when given 0.4, but not 2.4 mg/g cigarettes, despite comparable decreases in nicotine exposure. However, neither change was clinically significant, suggesting minimal short-term adverse consequences of a nicotine reduction policy. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Roxanne F Harfmann
- Department of Psychiatry, Vermont Center on Behavior and Health, University of Vermont
| | - Sarah H Heil
- Department of Psychiatry, Vermont Center on Behavior and Health, University of Vermont
| | - Janice Y Bunn
- Department of Psychiatry, Vermont Center on Behavior and Health, University of Vermont
| | - L Morgan Snell
- Department of Behavioral and Social Sciences, Brown University
| | | | - Stacey C Sigmon
- Department of Psychiatry, Vermont Center on Behavior and Health, University of Vermont
| | - Diann E Gaalema
- Department of Psychiatry, Vermont Center on Behavior and Health, University of Vermont
| | - Dustin C Lee
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University
| | | | - Cecilia L Bergeria
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University
| | | | - Shirley Plucinski
- Department of Psychiatry, Vermont Center on Behavior and Health, University of Vermont
| | - Stephen T Higgins
- Department of Psychiatry, Vermont Center on Behavior and Health, University of Vermont
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Harfmann RF, Heil SH, Cannon LM, Dalton VK, Kusunoki Y, Kock LS, MacAfee LK. Reasons for past abortions among women in treatment for opioid use disorder. Psychol Addict Behav 2024; 38:193-196. [PMID: 37707466 PMCID: PMC10932847 DOI: 10.1037/adb0000959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
OBJECTIVE The main reasons women in the general population seek abortion are financial, timing, and partner-related reasons. While women with opioid use disorder (OUD) appear to use abortion services more than women in the general population, reasons for abortion in this group have not been examined to our knowledge. METHOD Female patients aged 18-50 years in OUD treatment at 22 randomly selected facilities in Michigan were surveyed. The survey included items assessing reproductive health history. Women who reported having one or more abortions were asked to think back to that time and their reasons for choosing abortion. Twenty potential reasons and a write-in option were offered; women could endorse as many as applied. RESULTS Of 260 women surveyed, 84 reported having an abortion. Of these, most (77.4%) reported multiple reasons for having an abortion. The most common reasons for having an abortion were not having money to take care of a baby (54.8%), feeling too young to have a child and not feeling ready to be a mother (both 42.9%), not loving the father and other partner-related concerns (25.0%-32.1%), and having concerns about the effects of their drug use (28.6%). No combination of reasons for abortion emerged as more prevalent than any other. CONCLUSIONS Like women in the general population, women in treatment for OUD had not only abortions because of financial, timing, and partner-related reasons but also concerns about the effects of their drug use. These results underscore the multiple and often interrelated reasons that lead women to seek abortion. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Roxanne F. Harfmann
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
| | - Sarah H. Heil
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
| | | | - Vanessa K. Dalton
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | | | - Loren S. Kock
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
| | - Lauren K. MacAfee
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont, Burlington, VT
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Kock L, Melbostad HS, Heil SH. Prevalence of psychosocial issues among pregnant women who do and do not use illicit substances. Psychol Addict Behav 2024; 38:205-210. [PMID: 37616097 PMCID: PMC10891299 DOI: 10.1037/adb0000952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
OBJECTIVE The American College of Obstetricians and Gynecologists (ACOG) recommends providers screen their prenatal patients for 11 psychosocial issues because they affect patient mental and physical well-being. The prevalence and co-occurrence of these issues have rarely been compared among pregnant women who do and do not report recent illicit substance use. METHOD Seven psychosocial issues identified by ACOG were operationalized using National Survey on Drug Use and Health variables. We report weighted prevalence and adjusted risk ratios (ARR) for these issues in pregnant women who did versus did not report past-month illicit substance use. RESULTS Pregnant women (n = 3,657) who reported past-month illicit substance use (6.3%; 95% CI [5.4-7.3]) had significantly higher prevalence of almost all psychosocial issues examined, including past-month cigarette smoking (44.9% versus 9.5%; ARR = 2.84, 95% CI [2.21-3.65]); past-month alcohol use, 36.1% versus 7.9%; ARR = 4.71 (3.59-6.18); serious past-month distress, 23.0% versus 5.0%; ARR = 3.51 (2.39-5.15); no health insurance, 11.7% versus 6.2%; ARR = 1.71 (1.07-2.74); and receipt of food stamps, 45.0% versus 24.0%; ARR = 1.40 (1.18-1.67). Moving 3 + times in the past year followed a similar pattern, but results were compatible with there being no difference, 10.6% versus 5.5%; ARR = 1.39 (0.86-2.25). The majority of pregnant women reporting illicit substance use endorsed experiencing ≥ 2 psychosocial issues while the majority of those who did not report illicit substance use did not endorse any. CONCLUSIONS Pregnant women who use illicit substances experience higher prevalence and greater co-occurrence of psychosocial issues compared to those who do not, reinforcing recommendations for multidisciplinary approaches to care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Loren Kock
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 S Prospect Street, Burlington, 05401, USA
| | - Heidi S. Melbostad
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 S Prospect Street, Burlington, 05401, USA
- Howard Center Chittenden Clinic, 75 San Remo Dr, S Burlington 05403, USA
| | - Sarah H. Heil
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 S Prospect Street, Burlington, 05401, USA
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Nowak SA, Harder VS, Villanti AC, Heil SH, Sigmon SC. Statewide Trends in Buprenorphine Prescribing in Rural and Nonrural Vermont: Analysis of Population-based Patient Pharmacy Claims. J Addict Med 2023; 17:714-716. [PMID: 37934542 DOI: 10.1097/adm.0000000000001208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
IMPORTANCE Opioid-related mortality rates have risen dramatically over the past decade, and office-based opioid treatment using buprenorphine offers hope for combatting this trend. Vermont's policymakers, health care systems, and treatment providers have worked to expand access to treatment throughout the rural state. OBJECTIVE The objective of the current study was to characterize the trends in the number of buprenorphine prescribers and the number of patients per prescriber in Vermont over the past decade (2010-2020). METHODS We used Vermont's all-payer claims database to identify patients with buprenorphine claims between 2010 and 2020 and their prescribers. We conducted analyses of trends in the number of prescribers treating different numbers of patients, the number of patients treated by prescribers in those categories, and the number of rural (vs nonrural) patients filling buprenorphine prescriptions. We used Z tests to determine if there were statistical differences between trends. RESULTS The number of buprenorphine prescribers treating 10+ patients grew more rapidly than other prescriber groups ( P < 0.001). Nearly half of Vermont patients in 2020 were treated by 33 high-volume prescribers who treated 100 or more patients with buprenorphine. The number of patients filling buprenorphine prescriptions in Vermont increased by 98% between 2010 and 2020, with greater increases seen among rural than nonrural residents (107% vs 72%; P = 0.008). CONCLUSIONS AND RELEVANCE Since 2010, Vermont has increased utilization of its office-based opioid treatment capacity, particularly in rural counties.
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Affiliation(s)
- Sarah A Nowak
- From the Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT (SAN); Department of Pediatrics, Larner College of Medicine at the University of Vermont, Burlington, VT (VSH); Department of Psychiatry, Larner College of Medicine at the University of Vermont, Burlington, VT (VSH); Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Burlington, VT (ACV); Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT (SHH); and Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT (SCS)
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Andraka-Christou B, Williams M, Buksbaum S, Karkkainen J, Stein BD, Batchelder SR, Peck K, Heil SH, Rawson R, Sigmon SC. US state laws relevant to incentives for health behavior: A qualitative analysis. Prev Med 2023; 176:107645. [PMID: 37494973 PMCID: PMC10805957 DOI: 10.1016/j.ypmed.2023.107645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/19/2023] [Accepted: 07/23/2023] [Indexed: 07/28/2023]
Abstract
Contingency management (CM) involves provision of incentives for positive health behaviors via a well-defined protocol and is among the most effective treatments for patients with substance use disorders (SUDs). An understanding of laws affecting incentives for health behaviors and outcomes, including contexts in which incentives are already permitted, could inform efforts to disseminate CM. We conducted a systematic NexisUni legal database review of state statutes and regulations effective during 2022 to identify (a) laws that explicitly permit or prohibit delivery of incentives to patients, employees, or insurance beneficiaries for SUD-specific behaviors or outcomes, and (b) laws that explicitly permit delivery of incentives for any health behaviors or outcomes. We identified 27 laws across 17 jurisdictions that explicitly permit delivery of incentives for SUD-related behaviors or outcomes, with most occurring in the context of wellness programs. No state laws were identified that explicitly prohibit SUD-specific incentives. More broadly, we identified 57 laws across 29 jurisdictions permitting incentives for any health outcomes (both SUD- and non-SUD-related). These laws occurred in the contexts of wellness programs, K-12/early childhood education, government public health promotion, and SUD treatment provider licensing. Considering the urgent need to expand evidence-based SUD treatment in rural and underserved areas throughout the US, these findings could inform efforts to develop laws explicitly permitting provision of incentives in SUD care and enhance efforts to disseminate CM more broadly.
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Affiliation(s)
| | - Michelle Williams
- University of Central Florida, 525 W Livingston Ave, Suite 401, Orlando, FL 32801, USA
| | - Scott Buksbaum
- University of Central Florida, 525 W Livingston Ave, Suite 401, Orlando, FL 32801, USA
| | - Josie Karkkainen
- University of Central Florida, 525 W Livingston Ave, Suite 401, Orlando, FL 32801, USA
| | - Bradley D Stein
- RAND Corporation, 4570 Fifth Avenue, Pittsburgh, PA 15238, USA
| | - Sydney R Batchelder
- The Vermont Center on Behavior and Health, University of Vermont, 1 South Prospect St, Burlington, VT 05401, USA
| | - Kelly Peck
- The Vermont Center on Behavior and Health, University of Vermont, 1 South Prospect St, Burlington, VT 05401, USA
| | - Sarah H Heil
- The Vermont Center on Behavior and Health, University of Vermont, 1 South Prospect St, Burlington, VT 05401, USA
| | - Richard Rawson
- The Vermont Center on Behavior and Health, University of Vermont, 1 South Prospect St, Burlington, VT 05401, USA
| | - Stacey C Sigmon
- The Vermont Center on Behavior and Health, University of Vermont, 1 South Prospect St, Burlington, VT 05401, USA
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Kock LS, Erath TG, Coleman SRM, Higgins ST, Heil SH. Contingency management interventions for abstinence from cigarette smoking in pregnancy and postpartum: A systematic review and meta-analysis. Prev Med 2023; 176:107654. [PMID: 37532032 PMCID: PMC10828115 DOI: 10.1016/j.ypmed.2023.107654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/24/2023] [Accepted: 07/29/2023] [Indexed: 08/04/2023]
Abstract
Contingency management is one of the most effective treatments for substance use disorders in not-pregnant people. The most recent quantitative review of its efficacy among pregnant and postpartum women who smoke cigarettes concluded with moderate certainty that those receiving contingent financial incentives were twice as likely to be abstinent compared with controls. We aimed to update and extend previous reviews. Five databases were systematically searched for randomized controlled trials (RCTs) published before December 2022 that assessed the effectiveness of incentives for abstinence from substance use. Data from trials of smoking abstinence were pooled using a random-effects meta-analysis model (restricted maximum likelihood). Results are reported as risk-ratios (RRs) with 95% confidence intervals (CIs). This study is registered with PROSPERO, CRD42022372291. Twelve RCTs (3136) pregnant women) were included. There was high certainty evidence that women receiving incentives were more likely to be abstinent than controls at the last antepartum assessment (12 RCTs; RR = 2.43, 95% CI 2.04-2.91, n = 2941, I2 = 0.0%) and moderate certainty evidence at the longest postpartum assessment while incentives were still available (five RCTs; RR = 2.72, 1.47-5.02, n = 659, I2 = 44.5%), and at the longest postpartum follow-up after incentives were discontinued (six RCTs; RR = 1.93, 1.08-3.46, n = 1753, I2 = 51.8%). Pregnant women receiving incentives are twice as likely to achieve smoking abstinence during pregnancy suggesting this intervention should be standard care for pregnant women who smoke. The results also demonstrate that abstinence continues into the postpartum period, including after incentives are discontinued, but more trials measuring outcomes in the postpartum period are needed to strengthen this conclusion.
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Affiliation(s)
- Loren S Kock
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 South Prospect St, Burlington, VT 05401, United States.
| | - Tyler G Erath
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 South Prospect St, Burlington, VT 05401, United States
| | - Sulamunn R M Coleman
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 South Prospect St, Burlington, VT 05401, United States
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 South Prospect St, Burlington, VT 05401, United States
| | - Sarah H Heil
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 South Prospect St, Burlington, VT 05401, United States
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Sigmon SC, Peck KR, Batchelder SR, Badger GJ, Heil SH, Higgins ST. Technology-Assisted Buprenorphine Treatment in Rural and Nonrural Settings: Two Randomized Clinical Trials. JAMA Netw Open 2023; 6:e2331910. [PMID: 37755833 PMCID: PMC10534272 DOI: 10.1001/jamanetworkopen.2023.31910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/27/2023] [Indexed: 09/28/2023] Open
Abstract
Importance Expansion of opioid use disorder treatment is needed, particularly in rural communities. Objective To evaluate technology-assisted buprenorphine (TAB) efficacy (1) over a longer period than previously examined, (2) with the addition of overdose education, and (3) among individuals residing in rural communities. Design, Setting, and Participants Two parallel, 24-week randomized clinical trials were conducted at the University of Vermont between February 1, 2018, and June 30, 2022. Participants were adults with untreated opioid use disorder from nonrural (trial 1) or rural (trial 2) communities. These trials are part of a programmatic effort to develop TAB protocols to improve treatment availability in underserved areas. Interventions Within each trial, 50 participants were randomized to TAB or control conditions. Participants in the TAB group completed bimonthly visits to ingest medication and receive take-home doses via a computerized device. They received nightly calls via an interactive voice response (IVR) system, IVR-generated random call-backs, and iPad-delivered HIV, hepatitis C virus (HCV), and overdose education. Control participants received community resource guides and assistance with contacting resources. All participants received harm reduction supplies and completed monthly assessments. Main Outcomes and Measures The primary outcome was biochemically verified illicit opioid abstinence across monthly assessments. Secondary outcomes included self-reported opioid use in both groups and abstinence at bimonthly and random call-back visits, treatment adherence, satisfaction, and changes in HIV, HCV, and overdose knowledge among TAB participants. Results Fifty individuals (mean [SD] age, 40.6 [13.1] years; 28 [56.0%] male) participated in trial 1, and 50 (mean [SD] age, 40.3 [10.8] years; 30 [60.0%] male) participated in trial 2. Participants in the TAB group achieved significantly greater illicit opioid abstinence vs controls at all time points in both trial 1 (85.3% [128 of 150]; 95% CI, 70.7%-93.3%; vs 24.0% [36 of 150]; 95% CI, 13.6%-38.8%) and trial 2 (88.0% [132 of 150]; 95% CI, 72.1%-95.4%; vs 21.3% [32 of 150]; 95% CI, 11.4%-36.5%). High abstinence rates were also observed at TAB participants' bimonthly dosing visits (83.0% [95% CI, 67.0%-92.0%] for trial 1 and 88.0% [95% CI, 71.0%-95.0%] for trial 2). Treatment adherence was favorable and similar between trials (with rates of approximately 99% for buprenorphine administration, 93% for daily IVR calls, and 92% for random call-backs), and 183 of 187 urine samples (97.9%) tested negative for illicit opioids at random call-backs. iPad-delivered education was associated with significant and sustained increases in HIV, HCV, and overdose knowledge. Conclusions and Relevance In these randomized clinical trials of TAB treatment, demonstration of efficacy was extended to a longer duration than previously examined and to patients residing in rural communities. Trial Registration ClinicalTrials.gov Identifier: NCT03420313.
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Affiliation(s)
- Stacey C. Sigmon
- Vermont Center on Behavior and Health, University of Vermont, Burlington
- Department of Psychiatry, University of Vermont, Burlington
- Department of Psychological Science, University of Vermont, Burlington
| | - Kelly R. Peck
- Vermont Center on Behavior and Health, University of Vermont, Burlington
- Department of Psychiatry, University of Vermont, Burlington
- Department of Psychological Science, University of Vermont, Burlington
| | - Sydney R. Batchelder
- Vermont Center on Behavior and Health, University of Vermont, Burlington
- Department of Psychiatry, University of Vermont, Burlington
| | - Gary J. Badger
- Department of Medical Biostatistics, University of Vermont, Burlington
| | - Sarah H. Heil
- Vermont Center on Behavior and Health, University of Vermont, Burlington
- Department of Psychiatry, University of Vermont, Burlington
- Department of Psychological Science, University of Vermont, Burlington
| | - Stephen T. Higgins
- Vermont Center on Behavior and Health, University of Vermont, Burlington
- Department of Psychiatry, University of Vermont, Burlington
- Department of Psychological Science, University of Vermont, Burlington
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Kock LS, Melbostad HS, Heil SH. Prevalence of Psychosocial Issues Among Pregnant Women Who Do and Do Not Use Illicit Substances. Res Sq 2023:rs.3.rs-2845911. [PMID: 37163000 PMCID: PMC10168477 DOI: 10.21203/rs.3.rs-2845911/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Objective It is often believed that pregnant women who use illicit substances are more likely to experience psychosocial issues like smoking, depression, and inadequate health care compared to pregnant women who do not. However, the prevalence of these psychosocial issues has rarely been calculated and compared using nationally representative data. Methods Important psychosocial issues identified by the American College of Obstetricians and Gynecologists were operationalized using variables in the National Survey on Drug Use and Health. We report weighted prevalence and age-adjusted odds ratios for these issues in pregnant women who did vs. did not report past-month illicit substance use. Results Pregnant women (n = 3,657) who reported past-month illicit substance use (6.3%; 95% CI 5.4-7.0) had significantly higher rates of almost all psychosocial issues examined, including past-month cigarette smoking (44.9% vs. 6.5%; age-adjusted odds ratio (AOR) = 7.14 (95% CI 4.98-10.20)); past-month alcohol use (36.1% vs. 7.8%; AOR = 6.80 (4.69, 9.86)); serious past-month distress (23.0% vs. 5.0%; AOR = 4.99 (3.07-8.11)); no health insurance (11.7% vs. 6.2%; AOR = 1.79 (1.07-2.99)); and receipt of food stamps (45.0% vs. 24.0%; AOR = 2.26 (1.55-3.29)). Moving 3 + times in the past year followed a similar pattern, but results were compatible with there being no difference between groups (10.6% vs. 5.5%; AOR = 1.59 (0.95-2.66)). In contrast to other issues examined, English language proficiency was higher among those who reported illicit substance use (4.7% vs. 0.4%; AOR = 0.08 (0.01-0.63)). Conclusions Pregnant women who use illicit substances experience higher rates of most psychosocial issues compared to those who do not, reinforcing recommendations for multidisciplinary approaches to care.
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Higgins ST, Nighbor TD, Kurti AN, Heil SH, Slade EP, Shepard DS, Solomon LJ, Lynch ME, Johnson HK, Markesich C, Rippberger PL, Skelly JM, DeSarno M, Bunn J, Hammond JB, Roemhildt ML, Williams RK, O'Reilly DM, Bernstein IM. Randomized Controlled Trial Examining the Efficacy of Adding Financial Incentives to Best practices for Smoking Cessation Among pregnant and Newly postpartum Women. Prev Med 2022; 165:107012. [PMID: 35248683 PMCID: PMC9440164 DOI: 10.1016/j.ypmed.2022.107012] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/21/2022] [Accepted: 02/26/2022] [Indexed: 11/21/2022]
Abstract
We report results from a single-blinded randomized controlled trial examining financial incentives for smoking cessation among 249 pregnant and newly postpartum women. Participants included 169 women assigned to best practices (BP) or BP plus financial incentives (BP + FI) for smoking cessation available through 12-weeks postpartum. A third condition included 80 never-smokers (NS) sociodemographically-matched to women who smoked. Trial setting was Burlington, Vermont, USA, January, 2014 through January, 2020. Outcomes included 7-day point-prevalence abstinence antepartum and postpartum, and birth and other infant outcomes during 1st year of life. Reliability and external validity of results were assessed using pooled results from the current and four prior controlled trials coupled with data on maternal-smoking status and birth outcomes for all 2019 singleton live births in Vermont. Compared to BP, BP + FI significantly increased abstinence early- (AOR = 9.97; 95%CI, 3.32-29.93) and late-pregnancy (primary outcome, AOR = 5.61; 95%CI, 2.37-13.28) and through 12-weeks postpartum (AOR = 2.46; CI,1.05-5.75) although not 24- (AOR = 1.31; CI,0.54-3.17) or 48-weeks postpartum (AOR = 1.33; CI,0.55-3.25). There was a significant effect of trial condition on small-for-gestational-age (SGA) deliveries (χ2 [2] = 9.01, P = .01), with percent SGA deliveries (+SEM) greatest in BP, intermediate in BP + FI, and lowest in NS (17.65 + 4.13, 10.81 + 3.61, and 2.53 + 1.77, respectively). Reliability analyses supported the efficacy of financial incentives for increasing abstinence antepartum and postpartum and decreasing SGA deliveries; external-validity analyses supported relationships between antepartum cessation and SGA risk. Adding financial incentives to Best Practice increases smoking cessation among antepartum and postpartum women and improves other maternal-infant outcomes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02210832.
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Affiliation(s)
- Stephen T Higgins
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America.
| | - Tyler D Nighbor
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America
| | - Allison N Kurti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America
| | - Sarah H Heil
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America
| | - Eric P Slade
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America; Johns Hopkins University School of Nursing, United States of America
| | - Donald S Shepard
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America; Heller School for Social Policy and Management, Brandeis University, United States of America
| | - Laura J Solomon
- Department of Family Medicine, Psychology Emerita, University of Vermont, United States of America
| | - Mary Ellen Lynch
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America
| | - Harley K Johnson
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America
| | - Catherine Markesich
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America
| | - Peter L Rippberger
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America
| | - Joan M Skelly
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America; Department of Medical Biostatistics, University of Vermont, United States of America
| | - Michael DeSarno
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America; Department of Medical Biostatistics, University of Vermont, United States of America
| | - Janice Bunn
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America; Department of Medical Biostatistics, University of Vermont, United States of America
| | | | | | | | - Deirdre M O'Reilly
- Department of Pediatrics, University of Vermont, United States of America
| | - Ira M Bernstein
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America; Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, United States of America
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Gaalema DE, Snell LM, Tidey JW, Sigmon SC, Heil SH, Lee DC, Bunn JY, Park C, Hughes JR, Higgins ST. Potential effects of nicotine content in cigarettes on use of other substances. Prev Med 2022; 165:107290. [PMID: 36208817 PMCID: PMC10275576 DOI: 10.1016/j.ypmed.2022.107290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 09/26/2022] [Accepted: 10/02/2022] [Indexed: 11/07/2022]
Abstract
A national nicotine reduction policy has the potential to reduce cigarette smoking and associated adverse health impacts among vulnerable populations. However, possible unanticipated adverse effects of reducing nicotine content in cigarettes, such as increasing the use of alcohol or other abused substances, must be examined. The purpose of this study was to evaluate the effects of exposure to varying doses of nicotine in cigarettes on use of other substances. This was a secondary analysis (n = 753) of three simultaneous, multisite, double-blind, randomized-controlled trials examining 12 weeks of exposure to study cigarettes varying in nicotine content (0.4, 2.4, 15.8 mg nicotine/g tobacco) among daily smokers from three vulnerable populations: individuals with affective disorders (n = 251), individuals with opioid use disorder (n = 256), and socioeconomically-disadvantaged women of reproductive age (n = 246). Effect of study cigarette assignment on urine toxicology screens (performed weekly) and responses to drug and alcohol use questionnaires (completed at study weeks 6 and 12) were examined using negative binomial regression, logistic regression, or repeated measures analysis of variance, controlling for sex, age, and menthol status. The most common substances identified using urine toxicology included tetrahydrocannabinol (THC; 44.8%), cocaine (9.2%), benzodiazepine (8.6%), and amphetamines (8.0%), with 57.2% of participants testing positive at least once for substance use (27.3% if excluding THC). No significant main effects of nicotine dose were found on any of the examined outcomes. These results suggest that reducing nicotine content does not systematically increase use of other substances, even among individuals at increased risk of substance use. ClinicalTrials.gov Identifiers: NCT02232737, NCT2250664, NCT2250534.
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Affiliation(s)
- Diann E Gaalema
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington, VT, United States of America.
| | - L Morgan Snell
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States of America
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States of America
| | - Stacey C Sigmon
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington, VT, United States of America
| | - Sarah H Heil
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington, VT, United States of America
| | - Dustin C Lee
- Behavioral Pharmacology Research Unit, Johns Hopkins University, Baltimore, MD, United States of America
| | - Janice Y Bunn
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington, VT, United States of America
| | - Claire Park
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington, VT, United States of America
| | - John R Hughes
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington, VT, United States of America
| | - Stephen T Higgins
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington, VT, United States of America
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11
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Higgins ST, Erath TG, DeSarno M, Reed DD, Gaalema DE, Sigmon SC, Heil SH, Tidey JW. Leveraging the cigarette purchase task to understand relationships between cumulative vulnerabilities, the relative reinforcing effects of smoking, and response to reduced nicotine content cigarettes. Prev Med 2022; 165:107206. [PMID: 35995102 DOI: 10.1016/j.ypmed.2022.107206] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 03/03/2022] [Revised: 07/30/2022] [Accepted: 08/14/2022] [Indexed: 02/03/2023]
Abstract
We examined if the relative-reinforcing effects of smoking increase with greater cumulative vulnerability and whether cumulative vulnerability moderates response to reduced nicotine content cigarettes. Participants were 775 adults from randomized clinical trials evaluating research cigarettes differing in nicotine content (0.4, 2.4, 15.8 mg/g). Participants were categorized as having low (0-1), moderate (2-3), or high (≥4) cumulative vulnerability. Vulnerabilities included rural residence, opioid use disorder, affective disorder, low educational attainment, poverty, unemployment, and physical disability. We used the cigarette purchase task (CPT) to assess the relative-reinforcing effects of participants' usual-brand cigarettes at baseline and study cigarettes during the 12-week trial. The CPT is a behavioral-economic task wherein participants estimate likely smoking (demand) over 24 h under escalating cigarette price. Demand is characterized by two factors: Amplitude (demand volume at zero/minimal price) and Persistence (demand sensitivity to price). Greater cumulative vulnerability was associated with greater demand Amplitude (F[2709] = 16.04,p < .0001) and Persistence (F[2709] = 8.35,p = .0003) for usual-brand cigarettes. Demand Amplitude for study cigarettes increased with increasing cumulative vulnerability (F[2619] = 19.59, p < .001) and decreased with decreasing nicotine content ([4879] = 5.45, p < .001). The only evidence of moderation was on demand Persistence (F[8867] = 2.00,p = .04), with larger reductions at the 0.4 mg/g compared to 15.8 mg/g doses among participants with low compared to moderate or high cumulative vulnerability. The relative-reinforcing effects of smoking clearly increase with greater cumulative vulnerability. Reducing nicotine content would likely reduce demand Amplitude across cumulative-vulnerability levels but reductions in demand Persistence may be more limited among those with greater cumulative vulnerability.
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Affiliation(s)
- Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America.
| | - Tyler G Erath
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America
| | - Michael DeSarno
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America
| | - Derek D Reed
- Department of Applied Behavioral Science, University of Kansas, Lawrence, KS, United States of America
| | - Diann E Gaalema
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America
| | - Stacey C Sigmon
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America
| | - Sarah H Heil
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States of America
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Browning KO, DeSarno MJ, Davis DR, Streck JM, Bergeria CL, Harfmann RF, Parker MA, Heil SH, Sigmon SC, Gaalema DE, Tidey JW, Lee DC, Tetreault HJ, Higgins ST. Relating individual differences in the reinforcing value of smoking and dependence severity to nicotine exposure levels in vulnerable populations. Prev Med 2022; 165:107312. [PMID: 36272516 PMCID: PMC9986960 DOI: 10.1016/j.ypmed.2022.107312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 10/02/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022]
Abstract
Cigarette smoking is overrepresented in populations with psychiatric conditions and socioeconomic disadvantage. Greater understanding of the role of reinforcement and nicotine dependence in smoking among vulnerable populations may facilitate development of better targeted interventions to reduce smoking. Prior research demonstrated that individual differences in the reinforcing value of smoking and nicotine-dependence severity predicted total nicotine-exposure in vulnerable populations. The present study uses multivariate regression to address two aims: (1) Quantify the degree to which the reinforcing value of smoking, assessed using the Cigarette Purchase Task (CPT), and dependence severity assessed using the Fagerström Test of Nicotine Dependence and Brief Wisconsin Inventory of Smoking Dependence Motives (B-WISDM) each account for individual differences in cotinine-plus-3'-hydroxycotinine (COT+3HC) levels. (2) Explore whether there is overlap in the variance accounted for by the CTP, FTND, and B-WISDM. Participants were 628 adults with co-morbid psychiatric conditions or socioeconomic disadvantage who smoked daily. The CPT, FTND, and B-WISDM models accounted for 23.76%, 32.45%, and 29.61% of the variance in COT+3HC levels, respectively. Adding CPT to the FTND model failed to increase the variance accounted for and adding it to the B-WISDM model did so by only 1.2% demonstrating considerable overlap in the variance in nicotine exposure levels accounted for by these three instruments. These results provide new knowledge on the relationship between individual differences in the reinforcing value of smoking and nicotine-exposure levels and suggest differences in reinforcing value may underpin a considerable portion of the variance in nicotine exposure accounted for by dependence severity.
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Affiliation(s)
- Kaitlyn O Browning
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America
| | - Michael J DeSarno
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America
| | - Danielle R Davis
- Yale University Tobacco Center of Regulatory Science, Yale University School of Medicine, New Haven, CT, United States of America
| | - Joanna M Streck
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Cecilia L Bergeria
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Roxanne F Harfmann
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America
| | - Maria A Parker
- School of Public Health, Indiana University, Bloomington, IN, United States of America
| | - Sarah H Heil
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America
| | - Stacey C Sigmon
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America
| | - Diann E Gaalema
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States of America
| | - Dustin C Lee
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Haley J Tetreault
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States of America.
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13
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Morgan SL, Reed GL, Tidey J, Bunn JY, Harfmann RF, Heil SH, Sigmon SC, Gaalema D, Higgins ST. Predictors of Adherence Among Vulnerable Populations of Adults Assigned to Smoke Very Low Nicotine Content Cigarettes. Nicotine Tob Res 2022; 24:1959-1967. [PMID: 35704338 PMCID: PMC9653083 DOI: 10.1093/ntr/ntac145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 05/19/2022] [Accepted: 06/13/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Regulators are considering reducing the nicotine content in cigarettes to a minimally addictive level. This could particularly benefit smokers from populations vulnerable to heavy smoking and difficulties quitting. We assessed predictors of adherence among adults from vulnerable populations assigned to use very low nicotine content cigarettes (VLNCs) in randomized clinical trials, to identify characteristics of those who require additional assistance if a nicotine reduction policy were implemented. AIMS AND METHODS Data came from three populations of vulnerable adult smokers assigned to use VLNC cigarettes (0.4 mg/g nicotine) during 12-week randomized controlled trials (n = 286): Socioeconomically disadvantaged women of reproductive age, opioid-maintained adults, and adults with affective disorders. Logistic and linear regressions modeled predictors of adherence based on changes in cotinine at week-6 and week-12 assessments relative to baseline, and as a 90% reduction in cotinine relative to baseline (full adherence: yes/no). Predictors included satisfaction with study cigarettes, craving, nicotine dependence severity, withdrawal, population membership, baseline affective-disorder symptoms, and sociodemographic characteristics. RESULTS Dependence severity was negatively associated with both adherence measures at week 6 (p < .01), whereas increased satisfaction with study cigarettes and age were positively associated with both measures at weeks 6 and 12 (p < .01). Opioid-maintained adults exhibited reduced adherence and were less likely to reach full adherence at week 12 compared to disadvantaged women (p = .02). CONCLUSIONS Factors associated with VLNC adherence in vulnerable populations are similar to those in the general population of smokers. Furthermore, studies are indicated investigating nicotine supplements (e.g., e-cigarettes, NRT) to support highly dependent adults faced with using VLNCs. IMPLICATIONS This study identified factors predicting difficulty maintaining adherence to a regimen of very low nicotine content cigarettes (VLNC) among adults from vulnerable populations. Findings suggested that factors predicting difficulty maintaining adherence (greater nicotine dependence and low satisfaction with study-provided VLNC) were common across vulnerable smokers and the general population of adults who smoke. Furthermore, research should investigate alternatives to support highly dependent adults, such as pairing VLNC with supplemental, noncombusted nicotine. Some vulnerable populations (e.g., opioid-maintained adults) may be especially in need of supplemental, noncombusted nicotine.
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Affiliation(s)
- Snell L Morgan
- Corresponding Author: L Morgan Snell, Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI 02912, USA. Telephone: 401-863-2402; Fax: 401-863-6697; E-mail:
| | - G L Reed
- Brown University, Providence, RI, USA
| | - J Tidey
- Brown University, Providence, RI, USA
| | - J Y Bunn
- University of Vermont, Burlington, VT, USA
| | | | - S H Heil
- University of Vermont, Burlington, VT, USA
| | - S C Sigmon
- University of Vermont, Burlington, VT, USA
| | - D Gaalema
- University of Vermont, Burlington, VT, USA
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14
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Wiley RC, Oliver AC, Snow MB, Bunn JY, Barrows AJ, Tidey JW, Lee DC, Sigmon SC, Gaalema DE, Heil SH, Markesich C, Villanti AC, Higgins ST. The Impact of the Covid-19 Pandemic on Smoking Among Vulnerable Populations. Nicotine Tob Res 2022; 25:282-290. [PMID: 35605264 PMCID: PMC9384158 DOI: 10.1093/ntr/ntac135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 05/17/2022] [Accepted: 05/21/2022] [Indexed: 01/12/2023]
Abstract
AIM While accumulating evidence suggests that people modified their smoking during the ongoing COVID-19 pandemic, it remains unclear whether those most at risk for tobacco-related health disparities did so. The current study examined changes in smoking among several vulnerable smoker populations during the COVID-19 pandemic. METHODS A web-based survey was distributed in 2020 to 709 adults with socioeconomic disadvantage, affective disorders, or opioid use disorder who participated in a previous study investigating the effects of very low nicotine content (VLNC) cigarettes on smoking. Current smoking status and rate, and adoption of protective health behaviors in response to the pandemic (eg social distancing, mask wearing) were examined. RESULTS Among 332 survey respondents (46.8% response rate), 84.6% were current smokers. Repeated measures ANOVA showed that current cigarettes/day (CPD) was higher during COVID than pre-COVID (12.9 ± 1.0 versus 11.6 ± 1.0; p < .001). Most respondents had adopted protective health behaviors to prevent infection (>79% for all behaviors). More than half indicated that they were still leaving their homes specifically to buy cigarettes (64.6%) and were buying more packs per visit to the store (54.5%) than pre-COVID. Individuals unemployed at the time of the survey experienced greater increases in CPD (from 11.4 ± 1.4 to 13.3 ± 1.4, p = .024) as did those with higher levels of anxiety (from 11.5 ± 1.1 to 13.6 ± 1.1, p < .001). CONCLUSIONS Smoking increased during the COVID-19 pandemic in this sample of adults from vulnerable populations, even while most adopted protective health measures to prevent infection. Unemployment and anxiety might identify those at greatest risk for increases in tobacco use. IMPLICATIONS Individuals from populations especially vulnerable to smoking might be at risk for greater harm from cigarette smoking during times of pandemic-related stress. Public health interventions are warranted to ameliorate increases in smoking among these populations. Special attention should be paid to those experiencing unemployment and high anxiety.
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Affiliation(s)
- Rhiannon C Wiley
- Corresponding author: Rhiannon C. Wiley, Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, University Health Center, 1 S. Prospect Street, Burlington, VT 05401, USA. Telephone: 802-656-1982;
| | - Anthony C Oliver
- Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT,Department of Psychiatry, Larner College of Medicine, University of Vermont, Burlington, VT
| | - Miranda B Snow
- Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT,Department of Psychiatry, Larner College of Medicine, University of Vermont, Burlington, VT
| | - Janice Y Bunn
- Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT,Department of Medical Biostatistics, Larner College of Medicine, University of Vermont, Burlington, VT
| | - Anthony J Barrows
- Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT,Department of Psychiatry, Larner College of Medicine, University of Vermont, Burlington, VT
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI
| | - Dustin C Lee
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stacey C Sigmon
- Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT,Department of Psychological Science, University of Vermont, Burlington, VT,Department of Psychiatry, Larner College of Medicine, University of Vermont, Burlington, VT
| | - Diann E Gaalema
- Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT,Department of Psychological Science, University of Vermont, Burlington, VT,Department of Psychiatry, Larner College of Medicine, University of Vermont, Burlington, VT
| | - Sarah H Heil
- Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT,Department of Psychological Science, University of Vermont, Burlington, VT,Department of Psychiatry, Larner College of Medicine, University of Vermont, Burlington, VT
| | - Catherine Markesich
- Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT,Department of Psychological Science, University of Vermont, Burlington, VT
| | - Andrea C Villanti
- Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT,Department of Psychological Science, University of Vermont, Burlington, VT,Department of Psychiatry, Larner College of Medicine, University of Vermont, Burlington, VT
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT,Department of Psychological Science, University of Vermont, Burlington, VT,Department of Psychiatry, Larner College of Medicine, University of Vermont, Burlington, VT
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15
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Melbostad HS, Wachtel DS, Lipke KA, Badger GJ, Matusiewicz AK, Rey CN, MacAfee LK, Dougherty AK, Heil SH. Preliminary Side Effect Profile, Safety, and Tolerability of Hormonal Contraception Among Women Receiving Opioid-Agonist Therapy. Contraception 2022; 110:16-20. [DOI: 10.1016/j.contraception.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 02/26/2022] [Accepted: 02/28/2022] [Indexed: 11/03/2022]
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16
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Oliver AC, DeSarno M, Irvin CG, Kaminsky D, Tidey JW, Sigmon SC, Heil SH, Gaalema DE, Lee D, Bunn JY, Davis DR, Streck JM, Gallagher T, Higgins ST. Effects of Reduced Nicotine Content Cigarettes on Fractional Exhaled Nitric Oxide and Self-Reported Respiratory Health Outcomes Among Smokers With Psychiatric Conditions or Socioeconomic Disadvantage. Nicotine Tob Res 2022; 24:135-140. [PMID: 34255068 PMCID: PMC8826384 DOI: 10.1093/ntr/ntab145] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 07/12/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION This study examined whether exposure to reduced-nicotine-content cigarettes (RNCCs) for 12 weeks alters respiratory health using Fractional Exhaled Nitric Oxide (FeNO), a validated biomarker of respiratory epithelial health, and the Respiratory Health Questionnaire (RHQ), a subject-rated questionnaire on respiratory symptoms. Participants were 747 adult daily smokers enrolled in three double-blind, randomized clinical trials evaluating effects of cigarette nicotine content (0.4, 2.4, 15.8 mg nicotine/g tobacco) in people with affective disorders, opioid use disorder (OUD), or socioeconomic disadvantage. AIMS AND METHODS FeNO levels and RHQ ratings were collected at baseline and Weeks 6 and 12 following randomization. Multiple regression was used to assess associations of FeNO and RHQ with smoking characteristics. Mixed-model repeated-measures ANOVA was used to evaluate the effects of nicotine content on FeNO and RHQ outcomes over the 12-week study period. RESULTS FeNO levels but not RHQ ratings varied inversely with smoking characteristics at baseline (Ps < 0.0001) in smokers with affective disorders and socioeconomic disadvantage but less so in those with OUD. Participants with affective disorders and socioeconomic disadvantage, but not those with OUD, who were assigned to RNCCs had higher FeNO levels at Week 12 than those assigned to the 15.8 mg/g dose [F(2,423) = 4.51, p = .01, Cohen's d = 0.21]. No significant dose-related changes in RHQ scores were identified. CONCLUSIONS Use of RNCCs across a 12-week period attenuates smoking-related reductions in FeNO levels in smokers with affective disorders and socioeconomic disadvantage although not those with OUD. FeNO changes were not accompanied by changes in respiratory-health ratings. TRIAL REGISTRATION Inclusion and exclusion criteria for the sample and experimental manipulation of the nicotine content of assigned cigarettes are registered: NCT02232737, NCT02250664, NCT02250534. The FeNO measure reported in this manuscript is an exploratory outcome that was not registered. IMPLICATIONS Should a reduced nicotine content standard be implemented; these results suggest that reduced nicotine content in cigarettes will not exacerbate and instead may attenuate smoking-related decreases in FeNO. This is significant as NO is an important component in maintaining a healthy respiratory system and necessary to defend against infection. Furthermore, the results of the current study demonstrate that the adoption of the reduced nicotine content standard may result in beneficial impacts on respiratory epithelial health among vulnerable populations that are disproportionally affected by the adverse health outcomes precipitated by combustible tobacco use.
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Affiliation(s)
- Anthony C Oliver
- Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT, USA
- Department of Psychiatry, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Michael DeSarno
- Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT, USA
- Department of Medical Biostatistics, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Charles G Irvin
- Vermont Lung Center, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - David Kaminsky
- Vermont Lung Center, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - Stacey C Sigmon
- Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT, USA
- Department of Psychiatry, Larner College of Medicine, University of Vermont, Burlington, VT, USA
- Department of Psychological Science, University of Vermont, Burlington, VT, USA
| | - Sarah H Heil
- Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT, USA
- Department of Psychiatry, Larner College of Medicine, University of Vermont, Burlington, VT, USA
- Department of Psychological Science, University of Vermont, Burlington, VT, USA
| | - Diann E Gaalema
- Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT, USA
- Department of Psychiatry, Larner College of Medicine, University of Vermont, Burlington, VT, USA
- Department of Psychological Science, University of Vermont, Burlington, VT, USA
| | - Dustin Lee
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Janice Y Bunn
- Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT, USA
- Department of Medical Biostatistics, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Danielle R Davis
- Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Joanna M Streck
- Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas Gallagher
- Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT, USA
- Department of Psychiatry, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT, USA
- Department of Psychiatry, Larner College of Medicine, University of Vermont, Burlington, VT, USA
- Department of Psychological Science, University of Vermont, Burlington, VT, USA
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17
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Harder VS, Villanti AC, Heil SH, Smith ML, Gaalema DE, Meyer MC, Schafrick NH, Sigmon SC. Opioid use disorder treatment in rural settings: The primary care perspective. Prev Med 2021; 152:106765. [PMID: 34411588 PMCID: PMC8591995 DOI: 10.1016/j.ypmed.2021.106765] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/07/2021] [Accepted: 08/14/2021] [Indexed: 12/13/2022]
Abstract
Despite the efficacy of medications for treating opioid use disorder (OUD), they are underutilized, especially in rural areas. Our objectives were to determine the association between primary care practitioners (PCPs) rurality and concerns for patient substance use, and to identify factors associated with PCP comfort treating OUD, focusing on barriers to treatment. We developed a web-based survey completed by 116 adult-serving PCPs located in Vermont's rural and non-rural counties between April-August 2020. The instrument included PCP-identified concerns for substance use among patients, barriers to treating patients with OUD, and current level of comfort treating patients with OUD. On a scale from 0 to 10, rural PCPs reported higher concern for heroin (mean difference; Mdiff = 1.38, 95% CI: 0.13 to 2.63), fentanyl (Mdiff = 1.52, 95% CI: 0.29 to 2.74), and methamphetamine (Mdiff = 1.61, 95% CI: 0.33 to 2.90) use among patients compared to non-rural PCPs, and practitioners in both settings expressed high concern regarding their patients' use of tobacco (7.6 out of 10) and alcohol (7.0 out of 10). There was no difference in reported comfort in treating patients with OUD among rural vs. non-rural PCPs (Mdiff = 0.65, 95%CI: 0.17 to 1.46; P = 0.119), controlling for higher comfort among male PCPs and those waivered to prescribe buprenorphine (Ps < 0.05). Lack of training/experience and medication diversion were PCP-identified barriers associated with less comfort treating OUD patients, while time constraints was associated with more comfort (Ps < 0.05). Taken together, these data highlight important areas for dissemination of evidence-based training, support, and resources to expand OUD treatment capacity in rural communities.
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Affiliation(s)
- Valerie S Harder
- Center on Rural Addiction, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Psychiatry, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Pediatrics, Robert Larner, M.D. College of Medicine, University of Vermont, S-253 Given Courtyard, 89 Beaumont Avenue, Burlington, VT 05401, USA.
| | - Andrea C Villanti
- Center on Rural Addiction, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Psychiatry, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Vermont Center on Behavior and Health, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA
| | - Sarah H Heil
- Center on Rural Addiction, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Psychiatry, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Vermont Center on Behavior and Health, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Psychological Science, University of Vermont, 2 Colchester Ave., Burlington, VT 05401, USA
| | - M Lindsey Smith
- Center on Rural Addiction, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Cutler Institute for Health and Social Policy, Muskie School of Public Service, University of Southern Maine, 34 Bedford St., Portland, ME 04104, USA
| | - Diann E Gaalema
- Center on Rural Addiction, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Psychiatry, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Vermont Center on Behavior and Health, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Psychological Science, University of Vermont, 2 Colchester Ave., Burlington, VT 05401, USA
| | - Marjorie C Meyer
- Center on Rural Addiction, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, Robert Larner, M.D. College of Medicine, University of Vermont, 111 Colchester Ave, Main Campus, East Pavilion, Level 4, Burlington, VT 05401, USA
| | - Nathaniel H Schafrick
- Center on Rural Addiction, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA
| | - Stacey C Sigmon
- Center on Rural Addiction, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Psychiatry, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Vermont Center on Behavior and Health, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Psychological Science, University of Vermont, 2 Colchester Ave., Burlington, VT 05401, USA
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18
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Higgins ST, DeSarno M, Bunn JY, Gaalema DE, Leventhal AM, Davis DR, Streck JM, Harfmann RF, Markesich C, Orr E, Sigmon SC, Heil SH, Tidey JW, Lee D, Hughes JR. Cumulative vulnerabilities as a potential moderator of response to reduced nicotine content cigarettes. Prev Med 2021; 152:106714. [PMID: 34242666 PMCID: PMC8906391 DOI: 10.1016/j.ypmed.2021.106714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/10/2021] [Revised: 06/04/2021] [Accepted: 07/03/2021] [Indexed: 12/29/2022]
Abstract
Risk for smoking increases in a summative manner corresponding to the number of co-occurring vulnerabilities present (cumulative vulnerability). We examined whether cumulative vulnerabilities moderate response to reduced nicotine content cigarettes in a secondary analysis of results from 775 participants in three 12-week randomized clinical trials examining research cigarettes varying in nicotine content (0.4, 2.4, 15.8 mg nicotine/g tobacco). Participants were categorized as having 0-1, 2-3, or ≥ 4 cumulative vulnerabilities. Vulnerabilities included: rural residence, current substance use disorder, current affective disorder, low educational attainment, poverty, unemployment, physical disability. The primary outcome was total cigarettes per day (CPD) during Week 12; secondary outcomes included CPD across weeks, toxin exposure, dependence severity, craving/withdrawal (17 dependent measures). Results were analyzed using repeated measures analysis of covariance and growth-curve modeling. Total CPD during Week 12 increased as cumulative-vulnerability increased (P = 0.004), and decreased as nicotine content decreased (P < 0.001), with no significant interaction of cumulative vulnerability and dose (P = 0.67). Effects on other outcomes generally followed that same pattern. The only exception across the other outcomes was on Questionnaire-on-Smoking-Urges Factor-2 ratings for usual-brand cigarettes where cumulative vulnerability, dose, and time interacted (P = 0.007), with craving at the 0.4 and 2.4 mg/g doses decreasing over time, but inconsistently across vulnerability categories. Overall, we saw little evidence that cumulative vulnerabilities moderate response to reduced nicotine content cigarettes suggesting that a policy reducing nicotine content in cigarettes to minimally addictive levels could benefit even highly vulnerable smokers including those residing in rural or other regions with overrepresentation of co-occurring vulnerabilities. Clinicaltrials.gov identifiers: NCT02232737, NCT02250664, NCT02250534.
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Affiliation(s)
- Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA.
| | - Michael DeSarno
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
| | - Janice Y Bunn
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
| | - Diann E Gaalema
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
| | - Adam M Leventhal
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Danielle R Davis
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
| | - Joanna M Streck
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
| | - Roxanne F Harfmann
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
| | - Catherine Markesich
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
| | - Eva Orr
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
| | - Stacey C Sigmon
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
| | - Sarah H Heil
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
| | - Jennifer W Tidey
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - Dustin Lee
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John R Hughes
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
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19
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Heil SH, Melbostad HS, Matusiewicz AK, Rey CN, Badger GJ, Shepard DS, Sigmon SC, MacAfee LK, Higgins ST. Efficacy and Cost-Benefit of Onsite Contraceptive Services With and Without Incentives Among Women With Opioid Use Disorder at High Risk for Unintended Pregnancy: A Randomized Clinical Trial. JAMA Psychiatry 2021; 78:1071-1078. [PMID: 34259798 PMCID: PMC8280955 DOI: 10.1001/jamapsychiatry.2021.1715] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Rates of in utero opioid exposure continue to increase in the US. Nearly all of these pregnancies are unintended but there has been little intervention research addressing this growing and costly public health problem. OBJECTIVE To test the efficacy and cost-benefit of onsite contraceptive services with and without incentives to increase prescription contraceptive use among women with opioid use disorder (OUD) at high risk for unintended pregnancy compared with usual care. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial of 138 women ages 20 to 44 years receiving medication for OUD who were at high risk for an unintended pregnancy at trial enrollment between May 2015 and September 2018. The final assessment was completed in September 2019. Data were analyzed from October 2019 to March 2021. Participants received contraceptive services at a clinic colocated with an opioid treatment program. INTERVENTIONS Participants were randomly assigned to receive 1 of 3 conditions: (1) usual care (ie, information about contraceptive methods and community health care facilities) (n = 48); (2) onsite contraceptive services adapted from the World Health Organization including 6 months of follow-up visits to assess method satisfaction (n = 48); or (3) those same onsite contraceptive services plus financial incentives for attending follow-up visits (n = 42). MAIN OUTCOMES AND MEASURES Verified prescription contraceptive use at 6 months with a cost-benefit analysis conducted from a societal perspective. RESULTS In this randomized clinical trial of 138 women (median age, 31 years [range, 20-44 years]), graded increases in verified prescription contraceptive use were seen in participants assigned to usual care (10.4%; 95% CI, 3.5%-22.7%) vs contraceptive services (29.2%; 95% CI, 17.0%-44.1%) vs contraceptive services plus incentives (54.8%; 95% CI, 38.7%-70.2%) at the 6-month end-of-treatment assessment (P < .001 for all comparisons). Those effects were sustained at the 12-month final assessment (usual care: 6.3%; 95% CI, 1.3%-17.2%; contraceptive services: 25.0%; 95% CI, 13.6%-39.6%; and contraceptive services plus incentives: 42.9%; 95% CI, 27.7%-59.0%; P < .001) and were associated with graded reductions in unintended pregnancy rates across the 12-month trial (usual care: 22.2%; 95% CI, 11.2%-37.1%; contraceptive services: 16.7%; 95% CI, 7.0%-31.4%; contraceptive services plus incentives: 4.9%; 95% CI, 0.6%-15.5%; P = .03). Each dollar invested yielded an estimated $5.59 (95% CI, $2.73-$7.91) in societal cost-benefits for contraceptive services vs usual care, $6.14 (95% CI, $3.57-$7.08) for contraceptive services plus incentives vs usual care and $6.96 (95% CI, $0.62-$10.09) for combining incentives with contraceptive services vs contraceptive services alone. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, outcomes with both onsite contraceptive service interventions exceeded those with usual care, but the most efficacious, cost-beneficial outcomes were achieved by combining contraceptive services with incentives. Colocating contraceptive services with opioid treatment programs offers an innovative, cost-effective strategy for preventing unintended pregnancy. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02411357.
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Affiliation(s)
- Sarah H. Heil
- Department of Psychiatry, University of Vermont, Burlington,Department of Psychological Science, University of Vermont, Burlington
| | | | | | - Catalina N. Rey
- Department of Psychiatry, University of Vermont, Burlington,University of Nebraska Medical Center, Omaha
| | - Gary J. Badger
- Department of Medical Biostatistics, University of Vermont, Burlington
| | | | - Stacey C. Sigmon
- Department of Psychiatry, University of Vermont, Burlington,Department of Psychological Science, University of Vermont, Burlington
| | - Lauren K. MacAfee
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont, Burlington
| | - Stephen T. Higgins
- Department of Psychiatry, University of Vermont, Burlington,Department of Psychological Science, University of Vermont, Burlington
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20
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Kohlasch KL, Cioffredi LA, Lenninger C, Stewart E, Vatalaro T, Garavan H, Graham A, Heil SH, Krans EE, Robakis T, Rommel A, Sullivan EL, Thomason M, Potter A. Factors associated with parent views about participation in infant MRI research provide guidance for the design of the Healthy Brain and Child Development (HBCD) study. Dev Cogn Neurosci 2021; 50:100986. [PMID: 34242880 PMCID: PMC8267558 DOI: 10.1016/j.dcn.2021.100986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/04/2021] [Accepted: 07/01/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The National Institutes of Health announced the Healthy Brain and Child Development (HBCD) study to further understanding of infant brain development. This study examined perceptions and knowledge about research among the demographic groups to be studied in HBCD. METHOD 1164 participants (n = 548 pregnant people and 616 mothers of infants < 12 months) completed anonymous, on-line surveys. Domains included research literacy, MRI knowledge, and attitudes about research incentives and biospecimen collection. Logistic regression was used to examine factors related to outcome variables. RESULTS Knowledge of MRI safety was low and research literacy was high across participants. Likelihood of participation given various incentives differed between participants. Those with lower education were less likely to rate any items as increasing likelihood of participation. Substance use during pregnancy improved the model fit only for items about alternate visit structures (home and telephone visits) and confidentiality. CONCLUSION Overall results support the feasibility of infant imaging studies, such as HBCD with respondents having high research literacy and interest in learning about their baby's development. Educating potential participants about MRI safety and providing flexible incentives for participation will improve the success of infant MRI studies.
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Affiliation(s)
- Kaelyn L Kohlasch
- The University of Vermont, Department of Psychiatry, 1 South Prospect Street, Arnold 6, Burlington, VT 05401, United States.
| | - Leigh-Anne Cioffredi
- The University of Vermont, Department of Psychiatry, 1 South Prospect Street, Arnold 6, Burlington, VT 05401, United States.
| | - Carly Lenninger
- New York University Langone Health, One Park Avenue, New York, NY 10016, United States.
| | - Ellen Stewart
- Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA 15213, United States.
| | - Tessa Vatalaro
- New York University Langone Health, One Park Avenue, New York, NY 10016, United States.
| | - Hugh Garavan
- The University of Vermont, Department of Psychiatry, 1 South Prospect Street, Arnold 6, Burlington, VT 05401, United States.
| | - Alice Graham
- Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States.
| | - Sarah H Heil
- Vermont Center on Behavior and Health, Departments of Psychiatry and Psychological Science, UHC MS #482, 1 South Prospect Street, Burlington, VT 05401, United States.
| | - Elizabeth E Krans
- Magee-Womens Research Institute, 204 Craft Avenue, Pittsburgh, PA 15213, United States; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA 15213, United States.
| | - Thalia Robakis
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai School, 1 Gustave L. Levy Pl, New York, NY 10029, United States.
| | - Anna Rommel
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai School, 1 Gustave L. Levy Pl, New York, NY 10029, United States.
| | - Elinor L Sullivan
- Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States; Department of Behavioral Neuroscience, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States; Division of Neuroscience, Oregon National Primate Research Center, 505 N W 185th Avenue, Beaverton, OR 97006, United States.
| | - Moriah Thomason
- New York University Langone Health, One Park Avenue, New York, NY 10016, United States.
| | - Alexandra Potter
- The University of Vermont, Department of Psychiatry, 1 South Prospect Street, Arnold 6, Burlington, VT 05401, United States; Vermont Center on Behavior and Health, Departments of Psychiatry and Psychological Science, UHC MS #482, 1 South Prospect Street, Burlington, VT 05401, United States.
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21
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Streck JM, Sigmon SC, Priest J, Bergeria CL, Davis DR, Hughes JR, Villanti AC, Tidey JW, Heil SH, Gaalema DE, Stitzer ML, Higgins ST. Investigating tobacco withdrawal in response to reduced nicotine cigarettes among smokers with opioid use disorder and other vulnerabilities. Exp Clin Psychopharmacol 2020; 28:714-723. [PMID: 32027158 PMCID: PMC7415473 DOI: 10.1037/pha0000350] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Individuals with opioid use disorder (OUD) have high prevalence of smoking and poor cessation outcomes. Data suggest that smokers with OUD may experience heightened nicotine reinforcement and more severe tobacco withdrawal compared to smokers without OUD. The Food and Drug Administration is currently considering reducing the nicotine content of cigarettes to reduce smoking prevalence and smoking-related disease. It is critical to understand the effects of reduced nicotine content cigarettes (RNCCs) on tobacco withdrawal in this subgroup. In this secondary analysis, we investigated the ability of RNCCs to attenuate acute tobacco withdrawal and craving severity in smokers with OUD versus those without substance use disorders (SUDs). Smokers maintained on methadone or buprenorphine (opioid-maintained [OM]; n = 65) versus without other SUDs (i.e., non-SUD; n = 135) completed 5 laboratory sessions wherein they smoked their usual brand (UB) or a research cigarette varying in nicotine content (0.4, 2.4, 5.2, 15.8 mg/g of tobacco) under double-blind, acute abstinence conditions. Participants completed the Minnesota Tobacco Withdrawal Scale, including a desire to smoke (craving) item, before and every 15 min for 1 hr following smoking each cigarette. Tobacco withdrawal and craving did not differ significantly by OM status in response to UB or RNCCs. In addition to the Dose × Time interaction, greater depression and cigarette dependence consistently predicted withdrawal and craving (ps < .05). Across all cigarettes, tobacco withdrawal and craving did not significantly differ by OM status, suggesting that smokers receiving opioid agonist treatment may respond favorably to RNCCs. Additional studies with larger and more diverse samples are needed to address this question more definitively. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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22
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Heil SH, Bergeria CL, Lee DC, Bunn JY, Harfmann RF, Hughes JR, Tetreault HJ, Higgins ST. Abuse liability of cigarettes with very low nicotine content in pregnant cigarette smokers. Prev Med 2020; 140:106227. [PMID: 32768512 PMCID: PMC7680290 DOI: 10.1016/j.ypmed.2020.106227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 03/18/2020] [Revised: 07/03/2020] [Accepted: 08/02/2020] [Indexed: 01/01/2023]
Abstract
The U.S. Food and Drug Administration has proposed reducing the nicotine content of cigarettes to a minimally-addictive level. To our knowledge, this study is the first to examine how pregnant smokers respond to very low nicotine content (VLNC) cigarettes. In Phase 1, participants blindly sampled two VLNC cigarettes (0.4 and 2.4 mg/g of tobacco) and their usual brand (UB) cigarette in separate sessions, then completed a behavioral economic simulation task and measures of subjective effects, craving/withdrawal, and smoking topography. Phase 2 directly compared the relative reinforcing effects of the cigarettes using concurrent choice testing. All possible dose-pair combinations were tested in separate sessions where puffs were earned ad libitum by clicking the code associated with their preferred cigarette 10 times. Phase 3 tested the 0.4 mg/g-UB dose-pair where UB puffs could be earned with a progressively incremented number of clicks (maximum 8400). Ten pregnant smokers in Burlington, VT and Baltimore, MD participated in 2017-2018. Regarding abuse liability, participants chose the 0.4-mg/g dose less than UB (22% vs. 78%) during concurrent choice testing and the 0.4-mg/g dose sustained less demand than the 2.4-mg/g and UB doses on the simulation task. Positive subjective effects were also lower for both VLNC cigarettes vs. UB. Each cigarette reduced nicotine craving/withdrawal and no significant changes indicative of compensatory smoking were noted. Reducing the nicotine content of cigarettes may decrease their abuse liability in pregnant smokers without causing untoward craving/withdrawal or compensatory smoking. Studies of extended exposure to VLNCs in pregnant women are warranted.
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Affiliation(s)
- Sarah H Heil
- Vermont Center on Behavior and Health, University of Vermont, UHC MS #482, 1 South Prospect St., Burlington, VT 05401, United States of America.
| | - Cecilia L Bergeria
- Vermont Center on Behavior and Health, University of Vermont, UHC MS #482, 1 South Prospect St., Burlington, VT 05401, United States of America.
| | - Dustin C Lee
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224-6823, United States of America.
| | - Janice Y Bunn
- Vermont Center on Behavior and Health, University of Vermont, UHC MS #482, 1 South Prospect St., Burlington, VT 05401, United States of America.
| | - Roxanne F Harfmann
- Vermont Center on Behavior and Health, University of Vermont, UHC MS #482, 1 South Prospect St., Burlington, VT 05401, United States of America.
| | - John R Hughes
- Vermont Center on Behavior and Health, University of Vermont, UHC MS #482, 1 South Prospect St., Burlington, VT 05401, United States of America.
| | - Haley J Tetreault
- Vermont Center on Behavior and Health, University of Vermont, UHC MS #482, 1 South Prospect St., Burlington, VT 05401, United States of America.
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, UHC MS #482, 1 South Prospect St., Burlington, VT 05401, United States of America.
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23
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Melbostad HS, Badger GJ, Rey CN, MacAfee LK, Dougherty AK, Sigmon SC, Heil SH. Contraceptive Knowledge among Females and Males Receiving Medication Treatment for Opioid Use Disorder Compared to Those Seeking Primary Care. Subst Use Misuse 2020; 55:2403-2408. [PMID: 33019893 PMCID: PMC7712494 DOI: 10.1080/10826084.2020.1823418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Rates of unintended pregnancy among women receiving medication treatment for opioid use disorder (mOUD) are high, likely due in part to low rates of contraceptive use. Lack of knowledge about contraception may be contributing to inadequate contraceptive use. Objectives: To compare contraceptive knowledge among women and men receiving mOUD relative to a comparison group seeking primary care. Methods: We surveyed 332 reproductive-age women and men receiving mOUD or primary care with the recently validated 25-item Contraceptive Knowledge Assessment. We examined overall differences between patient groups and between females and males using two-way analyses of variance; individual item differences were tested using logistic regression. Results: The mean percent of total correct responses was lower among individuals receiving mOUD (n = 167) relative to the comparison group (n = 165), 47.7% vs. 53.8%, respectively (p < .001), and higher among females (n = 169) relative to males (n = 163), 56.1% vs. 45.2%, respectively (p < .001). Individual item analyses revealed patient group and sex differences primarily in the areas of contraceptive efficacy, attributes of contraceptive methods, and fertility awareness. Conclusion: While there were modest differences between patient groups and sexes, the results suggest a deficit in contraceptive knowledge across all groups. Substance use disorder treatment clinics could be an opportunistic setting in which to provide accurate information about contraception to patients with OUD and other substance use disorders.
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Affiliation(s)
- Heidi S. Melbostad
- Vermont Center on Behavior and Health, 1 South Prospect Street, UHC - OH3 MS 482, Burlington, VT, United States, 05401
- University of Vermont, Department of Psychological Science, 2 Colchester Avenue, John Dewey Hall, Room 248, Burlington, VT, United States, 05405
| | - Gary J. Badger
- Vermont Center on Behavior and Health, 1 South Prospect Street, UHC - OH3 MS 482, Burlington, VT, United States, 05401
| | - Catalina N. Rey
- Vermont Center on Behavior and Health, 1 South Prospect Street, UHC - OH3 MS 482, Burlington, VT, United States, 05401
- University of Vermont, Department of Psychiatry. 1 South Prospect Street, MS 446AR6, Burlington, VT, United States 05401
| | - Lauren K. MacAfee
- University of Vermont, Department of Obstetrics, Gynecology, and Reproductive Sciences, 111 Colchester Avenue, Smith 410, Burlington, VT, United States 05401
| | - Anne K. Dougherty
- University of Vermont, Department of Obstetrics, Gynecology, and Reproductive Sciences, 111 Colchester Avenue, Smith 410, Burlington, VT, United States 05401
| | - Stacey C. Sigmon
- Vermont Center on Behavior and Health, 1 South Prospect Street, UHC - OH3 MS 482, Burlington, VT, United States, 05401
- University of Vermont, Department of Psychological Science, 2 Colchester Avenue, John Dewey Hall, Room 248, Burlington, VT, United States, 05405
- University of Vermont, Department of Psychiatry. 1 South Prospect Street, MS 446AR6, Burlington, VT, United States 05401
| | - Sarah H. Heil
- Vermont Center on Behavior and Health, 1 South Prospect Street, UHC - OH3 MS 482, Burlington, VT, United States, 05401
- University of Vermont, Department of Psychological Science, 2 Colchester Avenue, John Dewey Hall, Room 248, Burlington, VT, United States, 05405
- University of Vermont, Department of Psychiatry. 1 South Prospect Street, MS 446AR6, Burlington, VT, United States 05401
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24
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Higgins ST, Tidey JW, Sigmon SC, Heil SH, Gaalema DE, Lee D, Hughes JR, Villanti AC, Bunn JY, Davis DR, Bergeria CL, Streck JM, Parker MA, Miller ME, DeSarno M, Priest JS, Cioe P, MacLeod D, Barrows A, Markesich C, Harfmann RF. Changes in Cigarette Consumption With Reduced Nicotine Content Cigarettes Among Smokers With Psychiatric Conditions or Socioeconomic Disadvantage: 3 Randomized Clinical Trials. JAMA Netw Open 2020; 3:e2019311. [PMID: 33079196 PMCID: PMC7576411 DOI: 10.1001/jamanetworkopen.2020.19311] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE This study is part of a programmatic effort evaluating the effects of reducing nicotine content of cigarettes to minimally addictive levels. OBJECTIVE To examine whether very low-nicotine-content (VLNC) cigarettes decrease smoking rates and dependence severity among smokers with psychiatric disorders or socioeconomic disadvantage. DESIGN, SETTING, AND PARTICIPANTS These 3 randomized clinical trials were performed at the University of Vermont, Brown University, and Johns Hopkins University between October 2016 and September 2019. Participants received 12 weeks of exposure to study cigarettes with nicotine content ranging from levels representative of commercial cigarettes (15.8 mg nicotine/g tobacco) to less than a hypothesized addiction threshold (2.4 mg/g and 0.4 mg/g). Daily smokers from 3 at-risk populations participated: individuals with affective disorders, exemplifying smokers with mental illness; individuals with opioid use disorder, exemplifying smokers with substance use disorders; and women with high school educations or less, exemplifying smokers with socioeconomic disadvantage. Data were analyzed from September 2019 to July 2020. INTERVENTIONS Random assignment to 1 of 3 study cigarettes provided weekly at no cost for 12 weeks. MAIN OUTCOMES AND MEASURES The primary outcome was between-group differences in mean total cigarettes smoked daily (CPD) during week 12; secondary outcomes included CPD for study and nonstudy cigarettes and dependence severity across weeks analyzed using analysis of covariance, random coefficients growth modeling, or repeated measures analysis of variance. RESULTS A total of 775 participants were included (mean [SD] age, 35.59 [11.05] years; 551 [71.10%] women [owing to 1 population being exclusively women]); participants smoked a mean (SD) of 17.79 (9.18) CPD at study intake. A total of 286 participants were randomized to 0.4 mg/g, 235 participants were randomized to 2.4 mg/g, and 254 participants were randomized to 15.8 mg/g. Participants randomized to VLNC cigarettes had decreased mean [SEM] total CPD during week 12 across populations (Cohen d = 0.61; P < .001). At week 12, mean (SEM) CPD decreased to 17.96 (0.98) CPD in the 0.4 mg/g group and to 19.53 (1.07) CPD in the 2.4 mg/g group, both of which were significantly different from the 15.8 mg/g group (25.08 [1.08] CPD at week 12) but not each other (0.4 mg/g adjusted mean difference: -7.54 [95%CI, -9.51 to -5.57]; 2.4 mg/g adjusted mean difference: -5.34 [95% CI, 7.41 to -3.26]). Several secondary outcomes differed across populations randomized to VLNCs, including mean total CPD across weeks, with linear trends lower in participants receiving 0.4 mg/g (-0.28 [95%CI, -0.39 to -0.18]; P < .001) and 2.4 mg/g (-0.13 [95%CI, -0.25 to -0.01]; P < .001) doses compared with those receiving the 15.8 mg/g dose (0.30 [95% CI, 0.19 to 0.41]). Fagerström Test of Nicotine Dependence mean total scores were significantly lower in participants who received VLNCs (Cohen d = 0.12; P < .001), with those who received the 0.4 mg/g dose (mean [SD] score, 3.99 [0.06]; P < .001 vs 15.8 mg/g) or 2.4 mg/g dose (mean [SD] score, 4.07 [0.06]; P = .01 vs 15.8 mg/g) differing from those who received the 15.8 mg/g dose (mean [SD] score, 4.31 [0.06]) but not from each other. CONCLUSIONS AND RELEVANCE These findings demonstrate that decreasing the nicotine content of cigarettes to very low levels reduced smoking rate and nicotine-dependence severity in these high-risk populations, effects that may facilitate successful cessation. TRIAL REGISTRATION ClinicalTrials.gov Identifiers: NCT02232737, NCT02250664, NCT02250534.
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Affiliation(s)
- Stephen T. Higgins
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Jennifer W. Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
| | - Stacey C. Sigmon
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Sarah H. Heil
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Diann E. Gaalema
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Dustin Lee
- Yale University Tobacco Center of Regulatory Science, Yale University School of Medicine, New Haven, Connecticut
| | - John R. Hughes
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Andrea C. Villanti
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Janice Y. Bunn
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Danielle R. Davis
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
- Yale University Tobacco Center of Regulatory Science, Yale University School of Medicine, New Haven, Connecticut
| | - Cecilia L. Bergeria
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joanna M. Streck
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Maria A. Parker
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
- School of Public Health, Indiana University, Bloomington
| | - Mollie E. Miller
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
| | - Michael DeSarno
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Jeff S. Priest
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Patricia Cioe
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
| | - Douglas MacLeod
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Anthony Barrows
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
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Streck JM, Davis DR, Pang RD, Sigmon SC, Bunn JY, Bergeria CL, Tidey JW, Heil SH, Gaalema DE, Hughes JR, Stitzer ML, Reed E, Higgins ST. Potential Moderating Effects of Sex/Gender on the Acute Relative Reinforcing and Subjective Effects of Reduced Nicotine Content Cigarettes in Vulnerable Populations. Nicotine Tob Res 2020; 22:878-884. [PMID: 31225625 PMCID: PMC7395666 DOI: 10.1093/ntr/ntz098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 06/18/2019] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Reports in relatively healthy smokers suggest men are more sensitive than women to the subjective effects of reduced nicotine content cigarettes (RNCCs). We know of no reports examining sex differences in the relative reinforcing effects of RNCCs, an important outcome in assessing smoking's addiction potential. The aim of the present study is to address this gap by examining sex/gender differences on reinforcing effects while examining whether sex differences in subjective effects are discernible in vulnerable populations. METHODS Secondary analysis of a within-subject, double-blinded experiment examining acute effects of cigarettes varying in nicotine content (0.4, 2.4, 5.2, 15.8 mg/g) among 169 adult smokers with psychiatric conditions or socioeconomic disadvantage. Effects of dose, sex, and their interaction were examined on reinforcing (concurrent-choice and Cigarette Purchase Task [CPT] testing), and subjective effects (Cigarette Evaluation Questionnaire [CEQ] and craving/withdrawal ratings). RESULTS Reducing nicotine content decreased the relative reinforcing effects of smoking in concurrent-choice and CPT testing (p's < .05) with no significant effects of sex nor dose × sex/gender interactions. Reducing nicotine content decreased CEQ ratings with only a single significant effect of sex (higher Psychological Reward scores among women than men, p = .02) and no significant dose × sex/gender interactions. Results on craving/withdrawal paralleled those on the CEQ. CONCLUSIONS Reducing nicotine content decreases the addiction potential of smoking independent of sex in populations highly vulnerable to smoking and addiction, with no indication that women are less sensitive to subjective effects of RNCCs or would benefit less from a policy reducing the nicotine content of cigarettes. IMPLICATIONS A policy reducing the nicotine content of cigarettes has the potential to reduce the addiction potential of smoking across men and women who are especially vulnerable to smoking, addiction, and tobacco-related adverse health impacts.
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Affiliation(s)
- Joanna M Streck
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont,Burlington, VT
| | - Danielle R Davis
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont,Burlington, VT
| | - Raina D Pang
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Stacey C Sigmon
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont,Burlington, VT
| | - Janice Y Bunn
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont,Burlington, VT
| | - Cecilia L Bergeria
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI
| | - Sarah H Heil
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont,Burlington, VT
| | - Diann E Gaalema
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont,Burlington, VT
| | - John R Hughes
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont,Burlington, VT
| | - Maxine L Stitzer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ellaina Reed
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont,Burlington, VT
| | - Stephen T Higgins
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont,Burlington, VT
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Gaalema DE, Tidey JW, Davis DR, Sigmon SC, Heil SH, Stitzer ML, Desarno MJ, Diaz V, Hughes JR, Higgins ST. Potential Moderating Effects of Psychiatric Diagnosis and Symptom Severity on Subjective and Behavioral Responses to Reduced Nicotine Content Cigarettes. Nicotine Tob Res 2020; 21:S29-S37. [PMID: 31867653 PMCID: PMC6939752 DOI: 10.1093/ntr/ntz139] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/05/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Given FDA's authority to implement a cigarette nicotine reduction policy, possible outcomes of this regulation must be examined, especially among those who may be most affected, such as those with comorbid psychiatric disorders. METHODS In this secondary analysis of a multisite, randomized, clinical laboratory study, we used analyses of variance to examine the effects of nicotine dose (0.4, 2.4, 5.2, and 15.8 mg/g of tobacco), depressive and anxiety diagnoses (depression only, anxiety only, both, or neither), and depressive and anxiety symptom severity on cigarette choice, smoke exposure, craving, and withdrawal across three vulnerable populations: socioeconomically disadvantaged women of reproductive age, opioid-dependent individuals, and those with affective disorders (n = 169). RESULTS Diagnosis and symptom severity largely had no effects on smoking choice, total puff volume, or CO boost. Significant main effects on craving and withdrawal were observed, with higher scores in those with both anxiety and depression diagnoses compared with depression alone or no diagnosis, and in those with more severe depressive symptoms (p's < .001). These factors did not interact with nicotine dose. Cigarettes with <15.8 mg/g nicotine were less reinforcing, decreased total puff volume, and produced significant but lower magnitude and shorter duration reductions in craving and withdrawal than higher doses (p's < .01). CONCLUSIONS Reducing nicotine dose reduced measures of cigarette addiction potential, with little evidence of moderation by either psychiatric diagnosis or symptom severity, providing evidence that those with comorbid psychiatric disorders would respond to a nicotine reduction policy similarly to other smokers. IMPLICATIONS Thus far, controlled studies in healthy populations of smokers have demonstrated that use of very low nicotine content cigarettes reduces cigarette use and dependence without resulting in compensatory smoking. These analyses extend those findings to a vulnerable population of interest, those with comorbid psychiatric disorders. Cigarettes with very low nicotine content were less reinforcing, decreased total puff volume, and produced significant but lower magnitude and shorter duration reductions in craving and withdrawal than higher doses. These nicotine dose effects did not interact with psychiatric diagnosis or mood symptom severity suggesting that smokers in this vulnerable population would respond to a nicotine reduction strategy similarly to other smokers.
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Affiliation(s)
- Diann E Gaalema
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI
| | - Danielle R Davis
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT
| | - Stacey C Sigmon
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT
| | - Sarah H Heil
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT
| | - Maxine L Stitzer
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael J Desarno
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT
| | - Valeria Diaz
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT
| | - John R Hughes
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT
| | - Stephen T Higgins
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT
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Davis DR, Parker MA, Villanti AC, Streck JM, Priest JS, Tidey JW, Gaalema DE, Sigmon SC, Heil SH, Higgins ST. Examining Age as a Potential Moderator of Response to Reduced Nicotine Content Cigarettes in Vulnerable Populations. Nicotine Tob Res 2020; 21:S49-S55. [PMID: 31867655 PMCID: PMC6939764 DOI: 10.1093/ntr/ntz134] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 07/30/2019] [Indexed: 01/13/2023]
Abstract
Introduction Young adults (aged 18–24 years) have a higher smoking prevalence than younger and older age groups and young adulthood is an important developmental period during which long-term behavior patterns like cigarette smoking are established. The aim of the current study was to examine how young adult smokers with additional vulnerabilities to smoking respond to reduced nicotine content cigarettes. Methods This is a secondary analysis of a double-blind, within-subject experiment conducted with 169 cigarette smokers recruited from populations with comorbid psychiatric conditions or socioeconomic disadvantage assessing acute effects of research cigarettes varying in nicotine content (0.4, 2.4, 5.2, 15.8 mg/g). Participants were dichotomized by chronological age (18–24 vs. ≥25 years). Across 14 laboratory sessions effects of nicotine content were examined on measures of relative reinforcing efficacy (Cigarette Purchase Task [CPT] and Concurrent Choice testing), subjective effects, craving/withdrawal, and smoking topography. Repeated measures analysis of variances were used to examine potential moderating effects of age. Results Young adults exhibited lower demand for reduced nicotine content cigarettes than older adults across three of five CPT indices (ps < .05). No differences by age were observed on other measures of reinforcing efficacy, subjective effects, craving/withdrawal, or smoking topography where effects generally decreased as an orderly function of decreasing nicotine content (ps <.05). Conclusion Overall, these findings suggest that reducing the nicotine content of cigarettes would decrease the addiction potential of cigarette smoking in young adult smokers as much or perhaps more than older adult smokers from populations at increased vulnerability to smoking, addiction, and smoking-related health consequences. Implications Reducing the nicotine content in cigarettes to lower addiction potential of smoking has been proposed as a means to improve overall population health. It is imperative to examine how young adults may respond to a nicotine reduction policy. We saw minimal evidence that age moderates acute response and where there was evidence it was in the direction of reduced nicotine content cigarettes having less addictive potential among young versus older adults (eg, steeper decreases in demand for very low nicotine content cigarettes among young versus older adults). Overall, a nicotine reduction policy has the potential to reduce smoking across age groups.
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Affiliation(s)
- Danielle R Davis
- Department of Psychiatry, Yale School of Medicine, New Haven, CT.,Department of Epidemiology and Biostatistics, Indiana University, Bloomington, IN
| | - Maria A Parker
- Department of Epidemiology and Biostatistics, Indiana University, Bloomington, IN
| | - Andrea C Villanti
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT
| | - Joanna M Streck
- Harvard Medical School/Massachusetts General Hospital, Department of Psychiatry, Boston, MA
| | - Jeff S Priest
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI
| | - Diann E Gaalema
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT
| | - Stacey C Sigmon
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT
| | - Sarah H Heil
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT
| | - Stephen T Higgins
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT
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Rey CN, Badger GJ, Melbostad HS, Wachtel D, Sigmon SC, MacAfee LK, Dougherty AK, Heil SH. Perceptions of long-acting reversible contraception among women receiving medication for opioid use disorder in Vermont. Contraception 2020; 101:333-337. [PMID: 32014521 PMCID: PMC7510935 DOI: 10.1016/j.contraception.2020.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 12/23/2019] [Accepted: 01/20/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To evaluate perceptions of long-acting reversible contraceptives (LARC) among women receiving medication for opioid use disorder. STUDY DESIGN Cross-sectional survey of 200 women receiving medication for opioid use disorder in Vermont. RESULTS A considerable proportion of women receiving medication for opioid use disorder in Vermont reported previous use of an IUD (40%) and/or a subdermal contraceptive implant (16%); the majority of prior LARC users were satisfied with their IUD (68%) or their implant (74%). Of the 38% of participants who had never considered IUD use, 85% percent (64/75) said that they knew nothing or only a little about IUDs. Of the 61% of participants who had never considered an implant, 81% percent (98/121) said that they knew nothing or only a little about the contraceptive method. The most commonly reported reasons for a lack of interest in the IUD and/or implant were concerns about side effects and preference for a woman-controlled method. CONCLUSIONS Gaps in LARC knowledge are common among those who have not used LARCs and concerns about side effects and preferences for a woman-controlled method limit some women's interest in these contraceptives. Additionally, reasons for dissatisfaction among past users are generally similar for IUD and implant and include irregular bleeding and having a bad experience with the method. IMPLICATIONS Efforts to increase awareness of LARC methods among women receiving medication for opioid use disorder should address concerns about side effects and reproductive autonomy and encourage satisfied LARC users to share their experiences with their social networks.
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Affiliation(s)
- Catalina N Rey
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Gary J Badger
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Department of Medical Biostatistics, University of Vermont, Burlington, VT, USA
| | - Heidi S Melbostad
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Department of Psychological Science, University of Vermont, Burlington, VT, USA
| | - Deborah Wachtel
- Department of Nursing, University of Vermont, Burlington, VT, USA
| | - Stacey C Sigmon
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Department of Psychiatry, University of Vermont, Burlington, VT, USA; Department of Medical Biostatistics, University of Vermont, Burlington, VT, USA
| | - Lauren K MacAfee
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont, Burlington, VT, USA
| | - Anne K Dougherty
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont, Burlington, VT, USA
| | - Sarah H Heil
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Department of Psychiatry, University of Vermont, Burlington, VT, USA; Department of Medical Biostatistics, University of Vermont, Burlington, VT, USA.
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Arger CA, Taghavi T, Heil SH, Skelly J, Tyndale RF, Higgins ST. Pregnancy-Induced Increases in the Nicotine Metabolite Ratio: Examining Changes During Antepartum and Postpartum. Nicotine Tob Res 2020; 21:1706-1710. [PMID: 30165458 DOI: 10.1093/ntr/nty172] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 08/21/2018] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Pregnancy-induced increases in nicotine metabolism may contribute to difficulties in quitting smoking during pregnancy. However, the time course of changes in nicotine metabolism during early and late pregnancy is unclear. This study investigated how pregnancy alters the nicotine metabolite ratio (NMR), a common biomarker of nicotine metabolism among nonpregnant smokers. METHODS Urinary NMR (trans-3'-hydroxycotinine [3HC]/cotinine [COT]) was assessed using total (free + glucuronide) and free compounds among women (N = 47) from a randomized controlled trial for smoking cessation who self-reported smoking and provided a urine sample during early pregnancy (M ± SD = 12.5 ± 4.5 weeks' gestation), late pregnancy (28.9 ± 2.0 weeks' gestation), and 6 months postpartum (24.7 ± 1.2 weeks since childbirth). Urine samples were analyzed using liquid chromatography-tandem mass spectrometry and NMR were calculated as Total 3HC/Free COT, Free 3HC/Free COT, and Total 3HC/Total COT. RESULTS NMR was significantly higher during early and late pregnancy compared to postpartum and significantly increased from early to late pregnancy as measured by Total 3HC/Free COT (0.76, 0.89, 0.60; all p's < .05) and Free 3HC/Free COT (0.68, 0.80, 0.51; all p's < .05). Total 3HC/Total COT did not vary over time (p = .81). CONCLUSIONS Total 3HC/Free COT and Free 3HC/Free COT increased in the first trimester and continued to increase throughout pregnancy, suggesting a considerable increase in nicotine metabolism over gestation. Future analyses are needed to interpret the changes in NMR in the context of nicotine pharmacokinetics, as well as its impact on changes in smoking behavior and cessation outcomes. IMPLICATIONS We observed that the NMR was significantly higher as early as 12 weeks' gestation and increased further as a function of gestational age. Among nonpregnant smokers, elevated NMR is associated with smoking phenotypes such as smoking more cigarettes per day and poorer response to nicotine patch; therefore, pregnancy-induced increases in the NMR may contribute to smoking during the first trimester of pregnancy and reducing or quitting smoking may become more challenging as the rate of nicotine metabolism accelerates over the course of pregnancy.
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Affiliation(s)
- Christopher A Arger
- Tobacco Center on Regulatory Science, Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT.,Department of Psychological Science, College of Arts and Science, University of Vermont, Burlington, VT.,Department of Psychiatry, Larner College of Medicine, University of Vermont, Burlington, VT
| | - Taraneh Taghavi
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON
| | - Sarah H Heil
- Tobacco Center on Regulatory Science, Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT.,Department of Psychological Science, College of Arts and Science, University of Vermont, Burlington, VT.,Department of Psychiatry, Larner College of Medicine, University of Vermont, Burlington, VT
| | - Joan Skelly
- Tobacco Center on Regulatory Science, Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT
| | - Rachel F Tyndale
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON.,Department of Psychiatry, University of Toronto, Toronto, ON.,Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, ON
| | - Stephen T Higgins
- Tobacco Center on Regulatory Science, Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT.,Department of Psychological Science, College of Arts and Science, University of Vermont, Burlington, VT.,Department of Psychiatry, Larner College of Medicine, University of Vermont, Burlington, VT
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Rey CN, Kurti AN, Badger GJ, Cohen AH, Heil SH. Stigma, Discrimination, Treatment Effectiveness, and Policy Support: Comparing Behavior Analysts' Views on Drug Addiction and Mental Illness. Behav Anal Pract 2019; 12:758-766. [PMID: 31976287 PMCID: PMC6834810 DOI: 10.1007/s40617-019-00345-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Individuals with substance use disorders (SUDs) often face discrimination. A recent study found that people in the general population hold significantly more negative views toward persons with drug addiction than those with other mental illnesses (Barry et al. in Psychiatric Services, 65(10), 1269-1272, 2014). It is possible that these negative attitudes stem from the historical view of addiction as a moral shortcoming or lack of willpower. Behavior analysts' approach to behavior is guided by the underlying philosophy of behaviorism, which proposes that behavior is determined by genetic and environmental factors, as opposed to the free will of an individual. Because behavior analysts view behavior as determined and do not assign responsibility to an individual for his or her behavior, one would hypothesize that behavior analysts would not view individuals with SUDs more negatively than those with other mental disorders. This study surveyed 288 behavior analysts regarding their views on SUDs and mental disorders. Results showed that behavior analysts have significantly more negative attitudes toward people with SUDs than toward people with other mental disorders. Respondents reported a greater desire for social distance and greater acceptability of discrimination for people with SUDs than for people with mental disorders. They also reported less potential for recovery and lower support for policies to improve equity in insurance coverage and were less supportive of using government funding to improve treatment, housing, and job support for people with SUDs.
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Affiliation(s)
- Catalina N. Rey
- Vermont Center on Behavioral Health, University of Vermont, 1 South Prospect St., MS 482, Burlington, VT 05401 USA
| | - Allison N. Kurti
- Vermont Center on Behavioral Health, University of Vermont, 1 South Prospect St., MS 482, Burlington, VT 05401 USA
| | - Gary J. Badger
- Vermont Center on Behavioral Health, University of Vermont, 1 South Prospect St., MS 482, Burlington, VT 05401 USA
| | - Alex H. Cohen
- Vermont Center on Behavioral Health, University of Vermont, 1 South Prospect St., MS 482, Burlington, VT 05401 USA
| | - Sarah H. Heil
- Vermont Center on Behavioral Health, University of Vermont, 1 South Prospect St., MS 482, Burlington, VT 05401 USA
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Davis DR, DeSarno MJ, Bergeria CL, Streck JM, Tidey JW, Sigmon SC, Heil SH, Gaalema DE, Stitzer ML, Higgins ST. Examining effects of unit price on preference for reduced nicotine content cigarettes and smoking rate. Prev Med 2019; 128:105823. [PMID: 31470023 PMCID: PMC6879848 DOI: 10.1016/j.ypmed.2019.105823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 05/30/2019] [Revised: 08/04/2019] [Accepted: 08/26/2019] [Indexed: 01/16/2023]
Abstract
Cigarette preference increases as a function of greater nicotine content, but manipulating cost can shift preference. The aims of the present study are to model whether (1) the behavioral-economic metric unit price (cost/reinforcer magnitude) accounts for preference shifts and (2) whether preference shifts toward reduced nicotine content are associated with smoking reductions. In a multisite study between 2015 and 2016, 169 daily smokers from vulnerable populations completed two concurrent-choice conditions examining preference for smoking normal (15.8 mg/g) and reduced (0.4 mg/g) nicotine content cigarettes. In Condition 1, both products were available at 10 responses/choice. In Condition 2, availability of the 0.4 mg/g dose remained at 10 responses/choice while the 15.8 mg/g dose was available on a progressive-ratio (PR) schedule wherein response cost increased following each choice. Unit prices were calculated by dividing dose by response requirement. Results were analyzed using ANOVA and binomial tests (p < .05). Participants preferred the 15.8 over 0.4 mg/g dose in Condition 1, but shifted preference to the 0.4 mg/g dose in Condition 2 (p < .001) immediately before the point in the PR progression where unit price for 15.8 dose exceeded unit price for the 0.4 dose (p < .001). This shift was associated with a reduction in smoking (p < .001). The unit price of nicotine appears to underpin cigarette product preference and may provide a metric for predicting preference and potentially impacting it through tobacco regulations. These results also demonstrate that reduced compared to normal nicotine content cigarettes sustain lower smoking rates discernible even under acute laboratory conditions and in vulnerable populations.
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Affiliation(s)
| | - Michael J DeSarno
- Department of Psychiatry, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Department Psychological Science, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
| | - Cecilia L Bergeria
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - Stacey C Sigmon
- Department of Psychiatry, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Department Psychological Science, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
| | - Sarah H Heil
- Department of Psychiatry, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Department Psychological Science, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
| | - Diann E Gaalema
- Department of Psychiatry, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Department Psychological Science, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
| | - Maxine L Stitzer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephen T Higgins
- Department of Psychiatry, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Department Psychological Science, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
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Heil SH, Melbostad HS, Rey CN. Innovative approaches to reduce unintended pregnancy and improve access to contraception among women who use opioids. Prev Med 2019; 128:105794. [PMID: 31398412 PMCID: PMC6879827 DOI: 10.1016/j.ypmed.2019.105794] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/03/2019] [Accepted: 08/06/2019] [Indexed: 12/24/2022]
Abstract
Dramatic increases in the rate of opioid use disorder (OUD) during pregnancy have been paralleled by substantial increases in the number of neonates diagnosed with neonatal abstinence syndrome (NAS). Women with OUD have reliably reported high rates of unintended pregnancy and a number of studies also indicate they desire easier access to contraception. Recent statements from the Centers for Disease Control and Prevention and the American Academy of Pediatrics/American College of Obstetricians and Gynecologists have drawn increased attention to efforts to prevent unintended pregnancy and improve access to contraception among women with OUD. We briefly review a number of innovative clinical approaches in these areas, including efforts to integrate family planning services into substance use disorder (SUD) treatment and other settings that serve people with OUD and interventions that aim to make family planning a higher priority among women with OUD. Results suggest many of these approaches have led to increases in contraceptive use and may aid in efforts to reduce unintended pregnancy and improve access to contraception among women with OUD now and in the future.
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Affiliation(s)
- Sarah H Heil
- Vermont Center on Behavior and Health, University of Vermont, United States of America; Department of Psychological Sciences, University of Vermont, United States of America; Department of Psychiatry, University of Vermont, United States of America.
| | - Heidi S Melbostad
- Vermont Center on Behavior and Health, University of Vermont, United States of America; Department of Psychological Sciences, University of Vermont, United States of America
| | - Catalina N Rey
- Vermont Center on Behavior and Health, University of Vermont, United States of America; Department of Psychiatry, University of Vermont, United States of America
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Bergeria CL, Heil SH, Davis DR, Streck JM, Sigmon SC, Bunn JY, Tidey JW, Arger CA, Reed DD, Gallagher T, Hughes JR, Gaalema DE, Stitzer ML, Higgins ST. Evaluating the utility of the modified cigarette evaluation questionnaire and cigarette purchase task for predicting acute relative reinforcing efficacy of cigarettes varying in nicotine content. Drug Alcohol Depend 2019; 197:56-64. [PMID: 30776572 PMCID: PMC6440849 DOI: 10.1016/j.drugalcdep.2019.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/03/2019] [Accepted: 01/05/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Nicotine is the addictive component in cigarettes that maintain cigarette smoking that subsequently leads to morbidity and mortality. Methods for assessing the abuse liability of cigarettes are essential to inform new tobacco product standards. This secondary analysis evaluated the utility of one subjective effects measure, the modified Cigarette Evaluation Questionnaire (mCEQ), and one behavioral economic task, the Cigarette Purchase Task (CPT), for predicting acute relative reinforcing efficacy measured by concurrent choice Self-Administration (SA). METHODS Smokers (N = 169) belonging to one of three vulnerable populations participated in a multi-site, double-blind study evaluating research cigarettes with varying levels of nicotine (0.4, 2.4, 5.2, 15.8 mg/g). Participants sampled cigarettes and completed the mCEQ and CPT. In subsequent sessions, cigarette preference was assessed using a concurrent choice SA procedure. Mixed-model repeated measures analysis of variance tests were used to evaluate the utility of the mCEQ subscales and CPT indices for predicting preference for the higher compared to lower nicotine content cigarettes. In addition, stepwise regressions were used to determine which subscales and indices independently predicted concurrent choice SA. RESULTS Greater increases on the Satisfaction and Enjoyment of Respiratory Tract Sensations mCEQ subscales independently predicted higher dose preference in concurrent choice testing. Elasticity was the only CPT index that predicted choice. However, its predictive utility differed by dose among opioid-maintained individuals. CONCLUSION The mCEQ and CPT predict behavioral measures of relative reinforcing efficacy as assessed in concurrent choice SA, with the mCEQ Satisfaction and Enjoyment of Respiratory Tract Sensations subscales being the strongest independent predictors.
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Affiliation(s)
- Cecilia L Bergeria
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sarah H Heil
- Departments of Psychiatry and Psychological Science, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA.
| | - Danielle R Davis
- Departments of Psychiatry and Psychological Science, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
| | - Joanna M Streck
- Departments of Psychiatry and Psychological Science, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
| | - Stacey C Sigmon
- Departments of Psychiatry and Psychological Science, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
| | - Janice Y Bunn
- Departments of Psychiatry and Psychological Science, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - Chris A Arger
- Departments of Psychiatry and Psychological Science, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
| | - Derek D Reed
- Department of Applied Behavioral Science, Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, Lawrence, KS, USA
| | - Thomas Gallagher
- Departments of Psychiatry and Psychological Science, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
| | - John R Hughes
- Departments of Psychiatry and Psychological Science, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
| | - Diann E Gaalema
- Departments of Psychiatry and Psychological Science, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
| | - Maxine L Stitzer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephen T Higgins
- Departments of Psychiatry and Psychological Science, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
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Higgins ST, Bergeria CL, Davis DR, Streck JM, Villanti AC, Hughes JR, Sigmon SC, Tidey JW, Heil SH, Gaalema DE, Stitzer ML, Priest JS, Skelly JM, Reed DD, Bunn JY, Tromblee MA, Arger CA, Miller ME. Response to reduced nicotine content cigarettes among smokers differing in tobacco dependence severity. Prev Med 2018; 117:15-23. [PMID: 29626557 PMCID: PMC6748869 DOI: 10.1016/j.ypmed.2018.04.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/01/2018] [Accepted: 04/03/2018] [Indexed: 11/18/2022]
Abstract
This study examines whether tobacco dependence severity moderates the acute effects of reducing nicotine content in cigarettes on the addiction potential of smoking, craving/withdrawal, or smoking topography. Participants (N = 169) were daily smokers with mild, moderate, or high tobacco-dependence severity using the Heaviness of Smoking Index. Following brief abstinence, participants smoked research cigarettes varying in nicotine content (0.4, 2.4, 5.2, 15.8 mg nicotine/g tobacco) in a within-subject design. Results were analyzed using repeated measures analysis of co-variance. No main effects of dependence severity or interactions with nicotine dose were noted in relative reinforcing effects in concurrent choice testing or subjective effects on the modified Cigarette Evaluation Questionnaire. Demand for smoking in the Cigarette Purchase Task was greater among more dependent smokers, but reducing nicotine content decreased demand independent of dependence severity. Dependence severity did not significantly alter response to reduced nicotine content cigarettes on the Minnesota Tobacco Withdrawal Scale nor Questionnaire of Smoking Urges-brief (QSU) Factor-2 scale; dependence severity and dose interacted significantly on the QSU-brief Factor-1 scale, with reductions dependent on dose among highly but not mildly or moderately dependent smokers. Dependence severity and dose interacted significantly on only one of six measures of smoking topography (i.e., maximum flow rate), which increased as dose increased among mildly and moderately but not highly dependent smokers. These results suggest that dependence severity has no moderating influence on the ability of reduced nicotine content cigarettes to lower the addiction potential of smoking, and minimal effects on relief from craving/withdrawal or smoking topography.
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Affiliation(s)
- Stephen T Higgins
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States.
| | - Cecilia L Bergeria
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States
| | - Danielle R Davis
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States
| | - Joanna M Streck
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States
| | - Andrea C Villanti
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States
| | - John R Hughes
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States
| | - Stacey C Sigmon
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States
| | - Sarah H Heil
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States
| | - Diann E Gaalema
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States
| | - Maxine L Stitzer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jeff S Priest
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States
| | - Joan M Skelly
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States
| | - Derek D Reed
- Department of Applied Behavioral Science, University of Kansas, Lawrence, KS, United States
| | - Janice Y Bunn
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States
| | - Morgan A Tromblee
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States
| | - Christopher A Arger
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States
| | - Mollie E Miller
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States
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Dougherty A, Kayongo A, Deans S, Mundaka J, Nassali F, Sewanyana J, Migadde E, Kiyemba R, Katali E, Holcombe SJ, Heil SH, Kalyesubula R. Knowledge and use of family planning among men in rural Uganda. BMC Public Health 2018; 18:1294. [PMID: 30477477 PMCID: PMC6258500 DOI: 10.1186/s12889-018-6173-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 10/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unmet need for family planning exceeds 33% in Uganda. One approach to decreasing unmet need is promoting male involvement in family planning. Male disapproval of use of family planning by their female partners and misconceptions about side effects are barriers to family planning globally and in Uganda in particular. Researchers have conducted a number of qualitative studies in recent years to examine different aspects of family planning among Ugandan men. The present study aimed to quantify men's knowledge of family planning in rural Uganda to understand how better to involve men in couples' contraceptive decision-making, particularly in low-resource settings. METHODS Data were derived from in-person, researcher-administered surveys of men in a rural agrarian district in Uganda (N = 178). Participant demographics and knowledge of family planning methods, side effects, and use were queried. Descriptive statistics were used for analysis. RESULTS Men were 34 years of age on average (range 18-71) and about half (56%) had a primary school education or less. Ninety-eight percent reported any knowledge of family planning, with 73% of men reporting obtaining information via radio and only 43% from health workers. The most common method known by men was the male condom (72%), but more than half also knew of injections (54%) and pills (52%). Relatively few men reported knowing about the most effective reversible contraceptive methods, intrauterine devices and implants (both 16%). Men identified many common contraceptive side-effects, such as vaginal bleeding (31%), and misconceptions about side effects, such as increased risk of infertility and birth defects, were relatively uncommon (both < 10%). About half of all men reported ever using a family planning method (53%), and 40% reported current use. CONCLUSIONS This study's quantitative results build on those of recent qualitative studies and provide information about the types of family planning information men are lacking and avenues for getting this information to them.
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Affiliation(s)
- Anne Dougherty
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Vermont, Burlington, VT, USA
| | - Alex Kayongo
- Department of Medicine, Makerere College of Health Sciences, Kampala, Uganda.,African Community Center for Social Sustainability (ACCESS), Nakaseke, Uganda
| | - Samantha Deans
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Vermont, Burlington, VT, USA
| | - John Mundaka
- African Community Center for Social Sustainability (ACCESS), Nakaseke, Uganda.,Department of Obstetrics and Gynecology, Makerere College of Health Sciences, Kampala, Uganda
| | - Faith Nassali
- African Community Center for Social Sustainability (ACCESS), Nakaseke, Uganda
| | - James Sewanyana
- African Community Center for Social Sustainability (ACCESS), Nakaseke, Uganda
| | - Eric Migadde
- African Community Center for Social Sustainability (ACCESS), Nakaseke, Uganda
| | - Ronald Kiyemba
- African Community Center for Social Sustainability (ACCESS), Nakaseke, Uganda
| | - Estherloy Katali
- African Community Center for Social Sustainability (ACCESS), Nakaseke, Uganda.,Makerere University Business School, Kampala, Uganda
| | - Sarah Jane Holcombe
- Bixby Center for Population, Health, and Sustainability, University of California, Berkeley, USA
| | - Sarah H Heil
- Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, USA
| | - Robert Kalyesubula
- African Community Center for Social Sustainability (ACCESS), Nakaseke, Uganda. .,Departments of Medicine and Physiology, Makerere College of Health Sciences, P.O Box 7072, Kampala, Uganda.
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Taghavi T, Arger CA, Heil SH, Higgins ST, Tyndale RF. Cigarette consumption and biomarkers of nicotine exposure during pregnancy and postpartum. Addiction 2018; 113:2087-2096. [PMID: 29920836 PMCID: PMC6175668 DOI: 10.1111/add.14367] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 01/18/2018] [Revised: 04/05/2018] [Accepted: 06/11/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND AIMS Smokers can regulate their nicotine intake by altering the number of cigarettes smoked per day (CPD) and their smoking intensity. The current study aimed to compare the utility of self-reported CPD, total nicotine equivalents (TNE) and urinary cotinine to estimate nicotine intake during pregnancy. DESIGN Longitudinal smoking behavior and biomarker data were collected at early pregnancy, late pregnancy and at postpartum as part of a smoking cessation trial to examine voucher-based incentives for decreasing smoking. SETTING Obstetric practices in Burlington, Vermont, United States. PARTICIPANTS A subset of participants (n = 47) from the parent trial, recruited between December 2006 and June 2012, who provided a urine sample at each assessment during early pregnancy, late pregnancy and postpartum. MEASUREMENTS Smoking was assessed using self-reported CPD, TNE, TNE/CPD and urinary cotinine. FINDINGS Pregnant smokers reported smoking 10.4 CPD at early pregnancy, 7.2 CPD at late pregnancy (a 31% reduction at late pregnancy, P = 0.001) and 8.6 CPD at postpartum (a 19% increase from late pregnancy, P = 0.08). TNE exposure was 41% (P = 0.07) and 48% (P = 0.03) lower at early and late pregnancy, respectively, compared to postpartum. TNE/CPD was on average 167% higher at late pregnancy compared to early pregnancy (P = 0.01) and remained high at postpartum, where it was 111% higher compared to early pregnancy (P = 0.007). Uriniary cotinine underestimated nicotine intake by 55% during early pregnancy and by 65% during late pregnancy compared to postpartum (Pinteraction < 0.001); the underestimation was greater in slower (Pinteraction < 0.001) versus faster (Pinteraction = 0.04) nicotine metabolizers. CONCLUSIONS Neither cigarettes smoked per day (CPD) nor cotinine provides an accurate estimate of nicotine exposure during pregnancy. CPD underestimates nicotine intake substantially due to under-reporting and/or higher intensity of smoking, while cotinine underestimates nicotine intake markedly due to accelerated nicotine (and cotinine) metabolism during pregnancy.
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Affiliation(s)
- Taraneh Taghavi
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Christopher A. Arger
- University of Vermont Center on Tobacco Regulatory Science, Burlington, VT, USA; Department of Psychiatry, University of Vermont, Burlington, VT, USA,Department of Psychological Science, University of Vermont, Burlington, VT, USA
| | - Sarah H. Heil
- University of Vermont Center on Tobacco Regulatory Science, Burlington, VT, USA; Department of Psychiatry, University of Vermont, Burlington, VT, USA,Department of Psychological Science, University of Vermont, Burlington, VT, USA
| | - Stephen T. Higgins
- University of Vermont Center on Tobacco Regulatory Science, Burlington, VT, USA; Department of Psychiatry, University of Vermont, Burlington, VT, USA,Department of Psychological Science, University of Vermont, Burlington, VT, USA
| | - Rachel F. Tyndale
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Streck JM, Bergeria CL, Parker MA, Davis DR, DeSarno M, Sigmon SC, Hughes JR, Gaalema DE, Heil SH, Tidey JW, Stitzer ML, Rothman M, Higgins ST. Response to reduced nicotine content cigarettes among smokers with chronic health conditions. Prev Med Rep 2018; 12:321-329. [PMID: 30416951 PMCID: PMC6224320 DOI: 10.1016/j.pmedr.2018.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 09/30/2018] [Accepted: 10/13/2018] [Indexed: 12/15/2022] Open
Abstract
Individuals with chronic health conditions persist in smoking despite the presence of smoking-related illness. The aim of this study was to examine whether chronic health conditions moderate response to reduced nicotine content cigarettes (0.4, 2.4, 5.2, 15.8 mg/g of tobacco). This is a secondary analysis of a controlled clinical laboratory study that examined the acute effects of cigarettes varying in nicotine content among individuals especially vulnerable to smoking and tobacco dependence. Participants in the present study were categorized as having 0, 1–2, or ≥3 smoking-related chronic health conditions (i.e., chronic condition severity, CCS). Repeated-measures analysis of variance was used to examine whether CCS moderated response to cigarettes across measures of addiction potential (i.e., concurrent choice testing between nicotine dose pairs, Cigarette Purchase Task (CPT) performance, positive subjective effects), tobacco withdrawal, cigarette craving, and smoking topography. No main effects of CCS or interactions of CCS and nicotine dose were observed for concurrent choice testing, positive subjective effects, tobacco withdrawal, or smoking topography. Main effects of CCS were noted on the CPT with greater CCS being associated with less persistent demand. There was an interaction of CCS and nicotine dose on Factor 1 of the Questionnaire on Smoking Urges with the effects of dose significant only among those with 1–2 chronic conditions. Overall, we see minimal evidence that chronic condition severity affects response to reduced nicotine content cigarettes. A policy that reduces the nicotine content of cigarettes to minimally addictive levels may benefit smokers already experiencing smoking-related chronic conditions.
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Affiliation(s)
- Joanna M Streck
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Cecilia L Bergeria
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Maria A Parker
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Danielle R Davis
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Michael DeSarno
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Stacey C Sigmon
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - John R Hughes
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Diann E Gaalema
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Sarah H Heil
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States of America
| | - Maxine L Stitzer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Matthew Rothman
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
| | - Stephen T Higgins
- Vermont Center on Tobacco Regulatory Science, Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, United States of America
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Bergeria CL, Heil SH, Bunn JY, Sigmon SC, Higgins ST. Comparing Smoking Topography and Subjective Measures of Usual Brand Cigarettes Between Pregnant and Non-Pregnant Smokers. Nicotine Tob Res 2018; 20:1243-1249. [PMID: 28658941 PMCID: PMC6121910 DOI: 10.1093/ntr/ntx148] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 06/23/2017] [Indexed: 11/13/2022]
Abstract
Introduction Most pregnant smokers report abruptly reducing their cigarettes per day (CPD) by ~50% after learning of pregnancy and making further smaller reductions over the remainder of their pregnancy. Laboratory and naturalistic studies with non-pregnant smokers have found that these types of reductions often lead to changes in smoking topography (i.e., changes in smoking intensity to maintain a desired blood-nicotine level). If pregnant women smoke more intensely, they may expose themselves and their offspring to similar levels of toxicants despite reporting reductions in CPD. Methods Pregnant and non-pregnant female smokers (n = 20 and 89, respectively) participated. At the experimental session, after biochemical confirmation of acute abstinence, participants smoked one usual brand cigarette ad lib through a Borgwaldt CReSS Desktop Smoking Topography device. Carbon monoxide (CO) and measures of nicotine withdrawal, craving, and reinforcement derived from smoking were also collected. Results The two groups did not differ on demographic or smoking characteristics at screening, except nicotine metabolism rate, which as expected, was faster in pregnant smokers. Analyses suggest that none of the smoking topography parameters differed between pregnant and non-pregnant smokers, although pregnant smokers had a significantly smaller CO boost. Both groups reported similar levels of relief of withdrawal and craving after smoking, but other subjective effects suggest that pregnant smokers find smoking less reinforcing than non-pregnant smokers. Conclusions Pregnant smokers do not smoke cigarettes differently than non-pregnant women, but appear to find smoking comparatively less pleasurable. Implications This is the first study to assess smoking topography in pregnant women. Pregnant women appear to be at increased risk for smoking cigarettes with more intensity because of (1) their tendency to make significant abrupt reductions in the number of cigarettes they smoke each day after learning of pregnancy and (2) an increase in nicotine metabolism induced by pregnancy. Despite these changes, the present results suggest that pregnant women do not smoke cigarettes more intensely or in a way that causes more toxicant exposure, perhaps due to a reportedly less pleasurable smoking experience.
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Affiliation(s)
- Cecilia L Bergeria
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
- Department of Psychiatry, University of Vermont, Burlington, VT
- Department of Psychological Science, University of Vermont, Burlington, VT
| | - Sarah H Heil
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
- Department of Psychiatry, University of Vermont, Burlington, VT
- Department of Psychological Science, University of Vermont, Burlington, VT
| | - Janice Y Bunn
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
- Department of Mathematics and Statistics, University of Vermont, Joseph E. Hills Agricultural Science Building, Burlington, VT
| | - Stacey C Sigmon
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
- Department of Psychiatry, University of Vermont, Burlington, VT
- Department of Psychological Science, University of Vermont, Burlington, VT
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
- Department of Psychiatry, University of Vermont, Burlington, VT
- Department of Psychological Science, University of Vermont, Burlington, VT
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Ochalek TA, Heil SH, Higgins ST, Badger GJ, Sigmon SC. A novel mHealth application for improving HIV and Hepatitis C knowledge in individuals with opioid use disorder: A pilot study. Drug Alcohol Depend 2018; 190:224-228. [PMID: 30056321 PMCID: PMC6446902 DOI: 10.1016/j.drugalcdep.2018.05.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 02/12/2018] [Revised: 05/04/2018] [Accepted: 05/06/2018] [Indexed: 12/11/2022]
Abstract
AIMS There is a critical need to reduce infectious disease transmission among individuals with opioid use disorder (OUD). Here we examine the ability of a novel, automated educational intervention, delivered via iPad in a single visit, to improve human immunodeficiency virus (HIV) and Hepatitis C (HCV) knowledge among adults with OUD. METHODS Participants were 25 adults enrolled in a 12-week trial evaluating the efficacy of an Interim Buprenorphine Treatment for reducing illicit opioid use and other risk behaviors during delays to opioid treatment. Participants completed baseline HIV and HCV knowledge assessments with corrective feedback. They then completed an interactive HIV flipbook and HCV video followed by a second administration of the knowledge assessments. The knowledge assessments were repeated at post-intake Weeks 4 and 12. RESULTS At baseline, participants answered 69% and 65% of items correctly on the HIV and HCV assessments, respectively. The educational intervention was associated with significant increases in knowledge (86% and 86% correct on the HIV and HCV assessments, respectively; p's<.001). These improvements persisted throughout the study, with scores at Week 4 and 12 significantly greater than baseline (p's<.001). CONCLUSION This HIV+Hepatitis Education intervention was associated with significant and sustained improvements in knowledge of HIV + HCV transmission and risk behaviors in this vulnerable group of individuals with OUD. Given the continuing opioid epidemic, efforts are urgently needed to reduce HIV and HCV contraction and transmission among individuals with OUD. Mobile health educational interventions may offer a time- and cost-effective approach for addressing these risks.
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Affiliation(s)
- Taylor A. Ochalek
- Vermont Center on Behavior and Health, University of Vermont, Rm 1415 UHC, 1 S. Prospect St., Burlington VT 05401, USA,Department of Psychology, University of Vermont, Rm 1415 UHC, 1 S. Prospect St., Burlington VT 05401, USA,Corresponding author at: Department of Psychology, University of Vermont UHC-SATC Room 1415, 1 South Prospect Street, Burlington, VT, 05401, USA. (T.A. Ochalek)
| | - Sarah H. Heil
- Vermont Center on Behavior and Health, University of Vermont, Rm 1415 UHC, 1 S. Prospect St., Burlington VT 05401, USA,Department of Psychology, University of Vermont, Rm 1415 UHC, 1 S. Prospect St., Burlington VT 05401, USA,Department of Psychiatry, University of Vermont, Rm 1415 UHC, 1 S. Prospect St., Burlington VT 05401, USA
| | - Stephen T. Higgins
- Vermont Center on Behavior and Health, University of Vermont, Rm 1415 UHC, 1 S. Prospect St., Burlington VT 05401, USA,Department of Psychology, University of Vermont, Rm 1415 UHC, 1 S. Prospect St., Burlington VT 05401, USA,Department of Psychiatry, University of Vermont, Rm 1415 UHC, 1 S. Prospect St., Burlington VT 05401, USA
| | - Gary J. Badger
- Department of Biostatistics, University of Vermont, Biostatistics Unit, 27 Hills Building, Rm 25D, Burlington, VT 05401, USA
| | - Stacey C. Sigmon
- Vermont Center on Behavior and Health, University of Vermont, Rm 1415 UHC, 1 S. Prospect St., Burlington VT 05401, USA,Department of Psychology, University of Vermont, Rm 1415 UHC, 1 S. Prospect St., Burlington VT 05401, USA,Department of Psychiatry, University of Vermont, Rm 1415 UHC, 1 S. Prospect St., Burlington VT 05401, USA
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Abstract
Prevalence of cigarette smoking among opioid-dependent individuals is 6-fold that of the general U.S. adult population and their quit rates are notoriously poor. One possible reason for the modest cessation outcomes in opioid-dependent smokers may be that they experience more severe tobacco withdrawal upon quitting. In this secondary analysis, we evaluated tobacco withdrawal in opioid-dependent (OD) smokers versus smokers without co-occurring substance use disorders (SUDs). Participants were 47 methadone- or buprenorphine-maintained smokers and 25 non-SUD smokers who completed 1 of several 2-week studies involving daily visits for biochemical monitoring, delivery of financial incentives contingent on smoking abstinence, and assessment of withdrawal via the Minnesota Nicotine Withdrawal Scale (MNWS). Prior to quitting smoking, OD smokers presented with higher baseline withdrawal scores than non-SUD smokers (1.7 ± 0.2 vs. 0.7 ± 0.2, respectively; F[1, 63] = 7.31, p < .001). Withdrawal scores in both groups decreased over the subsequent 2-week period with no group differences, F(1, 910) = 0.50, p = .48. A similar pattern was observed on craving (i.e., Desire to Smoke item of MNWS), although the trajectory of decrease over time on this item was also moderated by gender. Overall, there was no difference in withdrawal during biochemically verified smoking abstinence between OD and non-SUD smokers, suggesting that elevated withdrawal severity following quitting may not be a major factor contributing to the poor cessation outcomes consistently observed among OD smokers. Further scientific efforts are needed to improve our understanding of the high smoking rates and modest cessation outcomes in this challenging population. (PsycINFO Database Record
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Affiliation(s)
- Joanna M. Streck
- Vermont Center on Behavior and Health, University of Vermont
- Department of Psychological Science, University of Vermont
| | - Sarah H. Heil
- Vermont Center on Behavior and Health, University of Vermont
- Department of Psychological Science, University of Vermont
- Department of Psychiatry, University of Vermont
| | - Stephen T. Higgins
- Vermont Center on Behavior and Health, University of Vermont
- Department of Psychological Science, University of Vermont
- Department of Psychiatry, University of Vermont
| | | | - Stacey C. Sigmon
- Vermont Center on Behavior and Health, University of Vermont
- Department of Psychological Science, University of Vermont
- Department of Psychiatry, University of Vermont
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Cooper KM, Bernstein IM, Skelly JM, Heil SH, Higgins ST. The Independent Contribution of Uterine Blood Flow to Birth Weight and Body Composition in Smoking Mothers. Am J Perinatol 2018; 35:521-526. [PMID: 29183095 DOI: 10.1055/s-0037-1608810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study aims to evaluate the relationship of maternal smoking to uterine artery hemodynamics and examine independent contributions to birth weight and fetal body composition. STUDY DESIGN Women were enrolled in a prospective randomized controlled study targeting smoking abstinence. Uterine artery Doppler ultrasound was performed and volumetric blood flow was calculated. Third trimester ultrasound estimates of fetal body composition were performed and birth weight was recorded. RESULTS Uterine artery volumetric flow and resistance index (RI) were significantly correlated with birth weight adjusted for gestational age (R = 0.35, p = 0.002; R = - 0.27, p = 0.02). Volumetric flow was significantly associated with fetal fat mass (R = 0.30, p = 0.018). Smoking status did not have significant effects on lean body mass (t [61] = 0.60, p = 0.55), fat mass (t [61] = 1.67, p = 0.10), or volumetric flow (t = 0.86, df = 87, p = 0.39). Stepwise regression identified volumetric flow (β = 0.81, 95% confidence interval [CI]: 0.35-1.27, p < 0.001), maternal prepregnancy body mass index (β = 16.04, 95% CI: 2.57-29.50, p = 0.02), and fetal sex (β = 346.28, 95% CI: -532.64 to 159.91, p < 0.001, where male = 0 and female = 1) as independent contributors to birth weight adjusted for gestational age. CONCLUSION No direct relationship of smoking to uterine artery hemodynamics was demonstrated. Volumetric flow was an independent contributor to birth weight and was associated with fetal fat deposition, while smoking was not independently associated with either outcome.
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Affiliation(s)
- Kylie M Cooper
- Department of Maternal Fetal Medicine, University of Vermont Medical Center, Burlington, Vermont
| | - Ira M Bernstein
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont Medical Center, Burlington, Vermont
| | - Joan M Skelly
- Department of Biostatistician, Medical Biostatistics, University of Vermont, Burlington, Vermont
| | - Sarah H Heil
- Department of Psychiatry and Psychological Science, Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont
| | - Stephen T Higgins
- Department of Psychiatry, University of Vermont, Burlington, Vermont
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Kaltenbach K, O'Grady KE, Heil SH, Salisbury AL, Coyle MG, Fischer G, Martin PR, Stine S, Jones HE. Prenatal exposure to methadone or buprenorphine: Early childhood developmental outcomes. Drug Alcohol Depend 2018; 185:40-49. [PMID: 29413437 PMCID: PMC5906792 DOI: 10.1016/j.drugalcdep.2017.11.030] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 11/17/2017] [Accepted: 11/24/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Methadone and buprenorphine are recommended to treat opioid use disorders during pregnancy. However, the literature on the relationship between longer-term effects of prenatal exposure to these medications and childhood development is both spare and inconsistent. METHODS Participants were 96 children and their mothers who participated in MOTHER, a randomized controlled trial of opioid-agonist pharmacotherapy during pregnancy. The present study examined child growth parameters, cognition, language abilities, sensory processing, and temperament from 0 to 36 months of the child's life. Maternal perceptions of parenting stress, home environment, and addiction severity were also examined. RESULTS Tests of mean differences between children prenatally exposed to methadone vs. buprenorphine over the three-year period yielded 2/37 significant findings for children. Similarly, tests of mean differences between children treated for NAS relative to those not treated for NAS yielded 1/37 significant finding. Changes over time occurred for 27/37 child outcomes including expected child increases in weight, head and height, and overall gains in cognitive development, language abilities, sensory processing, and temperament. For mothers, significant changes over time in parenting stress (9/17 scales) suggested increasing difficulties with their children, notably seen in increasing parenting stress, but also an increasingly enriched home environment (4/7 scales) CONCLUSIONS: Findings strongly suggest no deleterious effects of buprenorphine relative to methadone or of treatment for NAS severity relative to not-treated for NAS on growth, cognitive development, language abilities, sensory processing, and temperament. Moreover, findings suggest that prenatal opioid agonist exposure is not deleterious to normal physical and mental development.
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Affiliation(s)
- Karol Kaltenbach
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.
| | - Kevin E O'Grady
- Department of Psychology, University of Maryland, College Park, College Park, MD 20742, USA.
| | - Sarah H Heil
- Departments of Psychiatry and Psychology, University of Vermont, Burlington, VT, USA.
| | - Amy L Salisbury
- Brown Center for the Study of Children at Risk, Women and Infants' Hospital, Providence, RI, USA; Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Mara G Coyle
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Gabriele Fischer
- Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria.
| | - Peter R Martin
- Department of Psychiatry, Vanderbilt University, Nashville, TN, USA.
| | - Susan Stine
- Emeritus Professor of Psychiatry and Behavior Neurosciences, Wayne State University, Detroit, MI, USA.
| | - Hendrée E Jones
- UNC Horizons and Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA; Departments of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, School of Medicine, Johns Hopkins University, Baltimore, MD 21224, USA.
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Taghavi T, Arger CA, Heil SH, Higgins ST, Tyndale RF. Changes in nicotine metabolic pathways across pregnancy: A longitudinal study. Drug Metab Pharmacokinet 2018. [DOI: 10.1016/j.dmpk.2017.11.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Arger CA, Heil SH, Sigmon SC, Tidey JW, Stitzer ML, Gaalema DE, Durand HJ, Bunn JY, Ruggieri EK, Higgins ST. Preliminary validity of the modified Cigarette Evaluation Questionnaire in predicting the reinforcing effects of cigarettes that vary in nicotine content. Exp Clin Psychopharmacol 2017; 25:473-478. [PMID: 29251976 PMCID: PMC5737747 DOI: 10.1037/pha0000145] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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] [Indexed: 12/29/2022]
Abstract
Validity studies evaluating self-report measures in relation to behavioral preference of cigarettes varying in nicotine content are needed. The current study examined the relationship between ratings on the modified Cigarette Evaluation Questionnaire (mCEQ) and the relative reinforcing effects of Spectrum research cigarettes (15.8, 5.2, 2.4, 0.4 mg per gram of tobacco). Data for this secondary analysis were obtained from a double-blind study (Higgins et al., 2017) evaluating the subjective and reinforcing effects of Spectrum cigarettes under acute smoking abstinence. Current smokers (N = 26) were recruited from three vulnerable smoking populations (economically disadvantaged women of reproductive age, opioid-maintained individuals, individuals with affective disorders). In Phase 1 (five sessions), the mCEQ (Satisfaction, Psychological Reward, Enjoyment of Respiratory Tract Sensations, Craving Reduction, Aversion subscales) was administered following ad lib smoking of Spectrum cigarettes and subscale differences scores were calculated by subtracting ratings of the 15.8 mg/g cigarette from ratings of the reduced nicotine content cigarettes. In Phase 2 (six sessions), participants completed six 2-dose concurrent choice tests. The relationship between mCEQ subscale difference scores from Phase 1 and nicotine dose choice from Phase 2 was examined using mixed-model repeated-measures analyses of variance. Higher Satisfaction and lower Aversion subscale difference scores were associated with choosing the 15.8 mg/g cigarette more than the 5.2, 2.4, and 0.4 mg/g cigarettes. Scores on the other mCEQ subscales were not associated with nicotine choice. These results provide support for validity of the mCEQ Satisfaction and Aversion subscales predicting the relative reinforcing effects and abuse liability of varying nicotine content cigarettes. (PsycINFO Database Record
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Affiliation(s)
- Christopher A. Arger
- University of Vermont, Center on Tobacco Regulatory Science, Department of Psychology and Psychiatry, Burlington, VT
| | - Sarah H. Heil
- University of Vermont, Center on Tobacco Regulatory Science, Department of Psychology and Psychiatry, Burlington, VT
| | - Stacey C. Sigmon
- University of Vermont, Center on Tobacco Regulatory Science, Department of Psychology and Psychiatry, Burlington, VT
| | - Jennifer W. Tidey
- Brown University, Center for Alcohol and Addiction Studies, Providence, RI
| | | | - Diann E. Gaalema
- University of Vermont, Center on Tobacco Regulatory Science, Department of Psychology and Psychiatry, Burlington, VT
| | - Hanna J. Durand
- University of Vermont, Center on Tobacco Regulatory Science, Department of Psychology and Psychiatry, Burlington, VT
| | - Janice Y. Bunn
- University of Vermont, Center on Tobacco Regulatory Science, Department of Psychology and Psychiatry, Burlington, VT
| | - Elizabeth K. Ruggieri
- University of Vermont, Center on Tobacco Regulatory Science, Department of Psychology and Psychiatry, Burlington, VT
| | - Stephen T. Higgins
- University of Vermont, Center on Tobacco Regulatory Science, Department of Psychology and Psychiatry, Burlington, VT
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Taghavi T, Arger CA, Heil SH, Higgins ST, Tyndale RF. Longitudinal Influence of Pregnancy on Nicotine Metabolic Pathways. J Pharmacol Exp Ther 2017; 364:238-245. [PMID: 29158210 DOI: 10.1124/jpet.117.245126] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 11/15/2017] [Indexed: 11/22/2022] Open
Abstract
Nicotine metabolism increases in pregnancy, which may contribute to the difficulties that pregnant women have in quitting smoking. We aimed to determine the extent and timing of changes in nicotine metabolic pathways, including C-oxidation, N-glucuronidation, and the pregnancy-induced influences on the activity of enzymes mediating these pathways (CYP2A6 and UGT2B10, respectively). Current smoking pregnant women (n = 47) provided a urine sample during early pregnancy (12.5 weeks), late pregnancy (28.9 weeks), and 6 months postpartum. Concentrations of urinary nicotine and metabolites were analyzed using liquid chromatography tandem mass spectrometry and compared using general linear repeated measures analyses. Nicotine C-oxidation was 1.07-fold (P = 0.12) and 1.11-fold (P < 0.001) higher at early and late pregnancy, respectively, compared with postpartum. Nicotine N-glucuronidation was 1.33-fold (P = 0.06) and 1.67-fold (P = 0.003) higher at early and late pregnancy, respectively, compared with postpartum. The CYP2A6 phenotype ratio (total 3'-hydroxycotinine/cotinine) was significantly higher at early and late pregnancy compared with postpartum (all P < 0.05) and correlated with nicotine C-oxidation (all P < 0.001), suggesting CYP2A6 activity is induced during pregnancy. The UGT2B10 phenotype ratio (nicotine glucuronide/nicotine) was higher at early and late pregnancy compared with postpartum (P = 0.07 and P < 0.05, respectively) and correlated with a second UGT2B10 phenotype ratio (cotinine glucuronide/cotinine) (all P < 0.001), suggesting UGT2B10 activity is induced during pregnancy. In conclusion, pregnancy-induced increases in nicotine metabolism start by 12 weeks gestation and continue as pregnancy progresses most likely due to induction of CYP2A6 and UGT2B10, resulting in potential reductions in the effectiveness of nicotine replacement therapies and an increase in metabolism of other CYP2A6 and UGT2B10 substrates during pregnancy.
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Affiliation(s)
- Taraneh Taghavi
- Departments of Pharmacology and Toxicology (T.T., R.F.T.) and Psychiatry (R.F.T.), University of Toronto, Toronto, Ontario, Canada; University of Vermont Center on Tobacco Regulatory Science, Burlington, Vermont (C.A.A., S.H.H., S.T.H.); Departments of Psychiatry (C.A.A., S.H.H., S.T.H.) and Psychological Science (S.H.H., S.T.H.), University of Vermont, Burlington, Vermont; and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada (R.F.T.)
| | - Christopher A Arger
- Departments of Pharmacology and Toxicology (T.T., R.F.T.) and Psychiatry (R.F.T.), University of Toronto, Toronto, Ontario, Canada; University of Vermont Center on Tobacco Regulatory Science, Burlington, Vermont (C.A.A., S.H.H., S.T.H.); Departments of Psychiatry (C.A.A., S.H.H., S.T.H.) and Psychological Science (S.H.H., S.T.H.), University of Vermont, Burlington, Vermont; and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada (R.F.T.)
| | - Sarah H Heil
- Departments of Pharmacology and Toxicology (T.T., R.F.T.) and Psychiatry (R.F.T.), University of Toronto, Toronto, Ontario, Canada; University of Vermont Center on Tobacco Regulatory Science, Burlington, Vermont (C.A.A., S.H.H., S.T.H.); Departments of Psychiatry (C.A.A., S.H.H., S.T.H.) and Psychological Science (S.H.H., S.T.H.), University of Vermont, Burlington, Vermont; and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada (R.F.T.)
| | - Stephen T Higgins
- Departments of Pharmacology and Toxicology (T.T., R.F.T.) and Psychiatry (R.F.T.), University of Toronto, Toronto, Ontario, Canada; University of Vermont Center on Tobacco Regulatory Science, Burlington, Vermont (C.A.A., S.H.H., S.T.H.); Departments of Psychiatry (C.A.A., S.H.H., S.T.H.) and Psychological Science (S.H.H., S.T.H.), University of Vermont, Burlington, Vermont; and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada (R.F.T.)
| | - Rachel F Tyndale
- Departments of Pharmacology and Toxicology (T.T., R.F.T.) and Psychiatry (R.F.T.), University of Toronto, Toronto, Ontario, Canada; University of Vermont Center on Tobacco Regulatory Science, Burlington, Vermont (C.A.A., S.H.H., S.T.H.); Departments of Psychiatry (C.A.A., S.H.H., S.T.H.) and Psychological Science (S.H.H., S.T.H.), University of Vermont, Burlington, Vermont; and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada (R.F.T.)
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Higgins ST, Heil SH, Sigmon SC, Tidey JW, Gaalema DE, Hughes JR, Stitzer ML, Durand H, Bunn JY, Priest JS, Arger CA, Miller ME, Bergeria CL, Davis DR, Streck JM, Reed DD, Skelly JM, Tursi L. Addiction Potential of Cigarettes With Reduced Nicotine Content in Populations With Psychiatric Disorders and Other Vulnerabilities to Tobacco Addiction. JAMA Psychiatry 2017; 74:1056-1064. [PMID: 28832876 PMCID: PMC5710465 DOI: 10.1001/jamapsychiatry.2017.2355] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [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] [Indexed: 12/24/2022]
Abstract
IMPORTANCE A national policy is under consideration to reduce the nicotine content of cigarettes to lower nicotine addiction potential in the United States. OBJECTIVE To examine how smokers with psychiatric disorders and other vulnerabilities to tobacco addiction respond to cigarettes with reduced nicotine content. DESIGN, SETTING, AND PARTICIPANTS A multisite, double-blind, within-participant assessment of acute response to research cigarettes with nicotine content ranging from levels below a hypothesized addiction threshold to those representative of commercial cigarettes (0.4, 2.3, 5.2, and 15.8 mg/g of tobacco) at 3 academic sites included 169 daily smokers from the following 3 vulnerable populations: individuals with affective disorders (n = 56) or opioid dependence (n = 60) and socioeconomically disadvantaged women (n = 53). Data were collected from March 23, 2015, through April 25, 2016. INTERVENTIONS After a brief smoking abstinence, participants were exposed to the cigarettes with varying nicotine doses across fourteen 2- to 4-hour outpatient sessions. MAIN OUTCOMES AND MEASURES Addiction potential of the cigarettes was assessed using concurrent choice testing, the Cigarette Purchase Task (CPT), and validated measures of subjective effects, such as the Minnesota Nicotine Withdrawal Scale. RESULTS Among the 169 daily smokers included in the analysis (120 women [71.0%] and 49 men [29.0%]; mean [SD] age, 35.6 [11.4] years), reducing the nicotine content of cigarettes decreased the relative reinforcing effects of smoking in all 3 populations. Across populations, the 0.4-mg/g dose was chosen significantly less than the 15.8-mg/g dose in concurrent choice testing (mean [SEM] 30% [0.04%] vs 70% [0.04%]; Cohen d = 0.40; P < .001) and generated lower demand in the CPT (α = .027 [95% CI, 0.023-0.031] vs α = .019 [95% CI, 0.016-0.022]; Cohen d = 1.17; P < .001). Preference for higher over lower nicotine content cigarettes could be reversed by increasing the response cost necessary to obtain the higher dose (mean [SEM], 61% [0.02%] vs 39% [0.02%]; Cohen d = 0.40; P < .001). All doses reduced Minnesota Nicotine Withdrawal Scale total scores (range of mean decreases, 0.10-0.50; Cohen d range, 0.21-1.05; P < .001 for all), although duration of withdrawal symptoms was greater at higher doses (η2 = 0.008; dose-by-time interaction, P = .002). CONCLUSIONS AND RELEVANCE Reducing the nicotine content of cigarettes may decrease their addiction potential in populations that are highly vulnerable to tobacco addiction. Smokers with psychiatric conditions and socioeconomic disadvantage are more addicted and less likely to quit and experience greater adverse health impacts. Policies to reduce these disparities are needed; reducing the nicotine content in cigarettes should be a policy focus.
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Affiliation(s)
- Stephen T. Higgins
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Sarah H. Heil
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Stacey C. Sigmon
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Jennifer W. Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
| | - Diann E. Gaalema
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - John R. Hughes
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Maxine L. Stitzer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hanna Durand
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Janice Y. Bunn
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Jeff S. Priest
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Christopher A. Arger
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Mollie E. Miller
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
| | - Cecilia L. Bergeria
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Danielle R. Davis
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Joanna M. Streck
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Derek D. Reed
- Department of Applied Behavioral Science, University of Kansas, Lawrence
| | - Joan M. Skelly
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
| | - Lauren Tursi
- University of Vermont Tobacco Center of Regulatory Science, Departments of Psychiatry and Psychological Science, Burlington
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Higgins TM, Dougherty AK, Badger GJ, Heil SH. Comparing long-acting reversible contraception insertion rates in women with Medicaid vs. private insurance in a clinic with a two-visit protocol. Contraception 2017; 97:76-78. [PMID: 28887052 DOI: 10.1016/j.contraception.2017.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 08/28/2017] [Accepted: 08/29/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study examined whether women with Medicaid are less likely to receive long-acting reversible contraception (LARC) in a clinic requiring two visits for insertion. STUDY DESIGN LARC insertion and pregnancy rates were compared among women with Medicaid vs. private insurance, along with other predictors, in a retrospective chart review (N=447). RESULTS Univariately, fewer women with Medicaid vs. private insurance received LARC (66% vs. 79%, p<.01) and more become pregnant (18% vs. 6%, p<.001). Significant multivariate predictors of not receiving LARC were being unmarried and postpartum, both of which were associated with having Medicaid. CONCLUSION Women with Medicaid are less likely than women with private insurance to have a requested LARC device inserted when a clinic requires two visits for insertion.
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Affiliation(s)
- Tara M Higgins
- The University of Vermont College of Medicine, University of Vermont, Burlington, VT, USA
| | - Anne K Dougherty
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, Burlington, VT, USA
| | - Gary J Badger
- Department of Medical Biostatistics, University of Vermont, Burlington, VT, USA
| | - Sarah H Heil
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Department of Psychiatry, University of Vermont, Burlington, VT, USA; Department of Psychological Science, University of Vermont, Burlington, VT, USA.
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Matusiewicz AK, Melbostad HS, Heil SH. Knowledge of and concerns about long-acting reversible contraception among women in medication-assisted treatment for opioid use disorder. Contraception 2017; 96:365-369. [PMID: 28778423 DOI: 10.1016/j.contraception.2017.07.167] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 07/24/2017] [Accepted: 07/25/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To assess interest in, concerns about and knowledge of long-acting reversible contraceptives (LARC) among women in medication-assisted treatment (MAT) for opioid use disorder who were at risk for unintended pregnancy. STUDY DESIGN Women in MAT completed a survey on contraceptive use, attitudes and knowledge, including LARC methods, as part of eligibility screening for an ongoing trial evaluating family planning interventions for this population. RESULTS Eighty-three women at risk for unintended pregnancy completed the survey, and a subset of 51 completed supplemental questions about implants. All participants had heard of IUDs and 75/83 (90%) had heard of implants, but only 34/83 (41%) and 14/51 (27%) reported being likely to use IUDs and implants, respectively. Thirty-five women reported they were unlikely to use IUDs, with 29/35 (83%) citing unspecified "other reasons" for this position and 24/35 (69%) endorsing concerns about side effects. Seventeen women reported they were unlikely to use implants, with 8/17 (47%) citing "other reasons" and 9/17 (53%) and 10/17 (59%) reporting concerns about insertion and removal, respectively. Participants reported they knew "a little" about LARCs, but only their knowledge of implants was limited. Only 50/83 (60%) participants were aware of the superior effectiveness of IUDs and 26/51 (51%) were aware of the superior effectiveness of implants relative to other reversible methods. CONCLUSIONS Participants reported relatively low interest in LARCs. Many women had unspecified reasons for not using LARCs. Participants also lacked information about LARC safety and effectiveness, especially with regard to implants. IMPLICATIONS Women in medication-assisted treatment for opioid use disorder are at high risk of unintended pregnancy, yet contraceptive use is low and use of less effective methods is common. Women in MAT may benefit from efforts to increase knowledge about implants and assuage concerns about their insertion and removal as well as more general efforts to improve knowledge about the relative efficacy of LARCs. Many women in MAT endorsed unspecified "other reasons" for not using LARCs, which should be explored further.
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Affiliation(s)
- Alexis K Matusiewicz
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Heidi S Melbostad
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Department of Psychological Science, University of Vermont, Burlington, VT, USA
| | - Sarah H Heil
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Department of Psychiatry, University of Vermont, Burlington, VT, USA; Department of Psychological Science, University of Vermont, Burlington, VT, USA.
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Herrmann ES, Matusiewicz AK, Stitzer ML, Higgins ST, Sigmon SC, Heil SH. Contingency Management Interventions for HIV, Tuberculosis, and Hepatitis Control Among Individuals With Substance Use Disorders: A Systematized Review. J Subst Abuse Treat 2017; 72:117-125. [PMID: 27394070 PMCID: PMC5386179 DOI: 10.1016/j.jsat.2016.06.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/14/2016] [Accepted: 06/17/2016] [Indexed: 12/12/2022]
Abstract
Hepatitis, HIV and tuberculosis are significant and costly public health problems that disproportionately affect individuals with substance use disorders (SUDs). Incentive-based treatment approaches (i.e., contingency management; CM) are highly effective at reducing drug use. The primary aim of this report is to review the extant literature that examines the efficacy of CM interventions for the prevention, diagnosis and treatment of hepatitis, HIV and tuberculosis among individuals with SUDs. A literature search identified 23 controlled studies on this topic. In approximately 85% of the studies, CM produced significantly better adherence to prevention, diagnosis and treatment-related medical services, with adherence rates averaging almost 35% higher among patients receiving incentives vs. control condition participants. Findings from these studies parallel the results of a meta-analysis of CM interventions for the treatment of SUDs. The results also suggest that the principles that underlie the efficacy of CM generalize across infectious disease and substance abuse treatment behaviors. The application of additional principles from the literature on CM for treatment of SUDs to interventions targeting infectious disease control would be beneficial. Further development and dissemination of these interventions has the potential to greatly impact public health.
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Affiliation(s)
- Evan S Herrmann
- Department of Psychology, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401.
| | - Alexis K Matusiewicz
- Department of Psychiatry, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401; Vermont Center on Behavior and Health, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401
| | - Maxine L Stitzer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224
| | - Stephen T Higgins
- Department of Psychology, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401; Department of Psychiatry, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401; Vermont Center on Behavior and Health, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401
| | - Stacey C Sigmon
- Department of Psychology, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401; Department of Psychiatry, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401; Vermont Center on Behavior and Health, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401
| | - Sarah H Heil
- Department of Psychology, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401; Department of Psychiatry, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401; Vermont Center on Behavior and Health, University of Vermont, Room 1415 UHC, 1 S. Prospect Street, Burlington, VT 05401
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Higgins ST, Heil SH, Sigmon SC, Tidey JW, Gaalema DE, Stitzer ML, Durand H, Bunn JY, Priest JS, Arger CA, Miller ME, Bergeria CL, Davis DR, Streck JM, Zvorsky I, Redner R, Vandrey R, Pacek LR. Response to varying the nicotine content of cigarettes in vulnerable populations: an initial experimental examination of acute effects. Psychopharmacology (Berl) 2017; 234:89-98. [PMID: 27714427 PMCID: PMC5203959 DOI: 10.1007/s00213-016-4438-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 06/28/2016] [Accepted: 09/14/2016] [Indexed: 12/24/2022]
Abstract
RATIONALE The purpose of this study was to begin researching the effects of very low nicotine content cigarettes in smokers especially vulnerable to dependence to assess their potential as a less dependence-producing alternative to current commercial cigarettes. METHODS Participants were 26 adult, daily cigarette smokers from one of three populations: economically disadvantaged women of reproductive age (n = 9), opioid-dependent individuals (n = 11), and individuals with affective disorders (n = 6). Participants completed fourteen 2-4-h experimental sessions in a within-subjects research design. Sessions were conducted following brief smoking abstinence. Four research cigarettes varying in nicotine content (0.4, 2.4, 5.2, and 15.8 mg/g) were studied under double-blind conditions, assessing smoking topography, subjective effects, and relative reinforcing effects of varying doses in concurrent choice tests. Results were collapsed across vulnerable populations and analyzed using repeated measures ANOVA. RESULTS No significant differences between doses were discernible in smoking topography. All doses were equi-effective at reducing nicotine withdrawal. Ratings of satisfaction from smoking were lower at the 0.4 compared to 15.8 mg/g dose. Participants preferred the 15.8 mg/g dose over the 0.4 and 2.4 but not the 5.2 mg/g doses in concurrent choice testing; no differences between the two lowest doses were noted. CONCLUSIONS All cigarettes effectively reduced nicotine withdrawal with no differences in smoking topography, suggesting minimal compensatory smoking. Dependence potential was lowest at the 0.4 mg/g dose. These initial results are promising regarding the feasibility of lowering nicotine content in cigarettes to very low levels in vulnerable populations without untoward effects.
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Affiliation(s)
| | - Sarah H. Heil
- University of Vermont Center on Tobacco Regulatory Science
| | | | | | | | | | - Hanna Durand
- University of Vermont Center on Tobacco Regulatory Science
| | - Janice Y. Bunn
- University of Vermont Center on Tobacco Regulatory Science
| | - Jeff S. Priest
- University of Vermont Center on Tobacco Regulatory Science
| | | | | | | | | | | | - Ivori Zvorsky
- University of Vermont Center on Tobacco Regulatory Science
| | - Ryan Redner
- University of Vermont Center on Tobacco Regulatory Science,Southern Illinois University
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