1
|
Lopez AA, Luebke JM, Redner R, Abusbaitan H, Tarima S. Substance Use Overdose Deaths Among Black and Indigenous Women in Wisconsin: A Review of Death Certificate Data From 2018 to 2020. J Addict Med 2024; 18:153-159. [PMID: 38180867 PMCID: PMC10939923 DOI: 10.1097/adm.0000000000001260] [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: 01/07/2024]
Abstract
OBJECTIVES We are in the midst of an overdose epidemic that has grown during the concurrent COVID-19 pandemic. In Wisconsin, overdose deaths increased 11-fold from 2000 to 2020, with over 1200 deaths in 2020. Because of disparities in substance use initiation, relapse, and treatment success among racially minoritized women, this study's purpose was to investigate overdose death rates among Black and Indigenous women in Wisconsin from 2018 to 2020. METHODS Overdose death rates were examined under the following parameters: sex, race (Black, Indigenous, White), age, year, and manner of death. Logistic regression analysis was also conducted looking at death count data, with race, age, and year as potential predictor variables. RESULTS Death rates (per 100,000) in 2018 were 14.1 (12.6-15.5) for White women, 20.8 (14.7-26.9) for Black women, and 26.5 (10.0-42.9) for Indigenous women; these rates increased in 2020 to 16.4 (14.8-17.9), 32.5 (25.0-40.0), and 59.9 (35.8-84.0) for White, Black, and Indigenous women, respectively. Regression findings illustrated that being Black or Indigenous and aged 15 to 44 or 45 to 64 years were significantly more likely to die from most causes of death (any drug, any opioid, prescription opioid, heroin, synthetic opioids, and cocaine; adjusted odds ratios > 1.25, P s < 0.001). CONCLUSIONS This study confirms that deaths in Wisconsin are disproportionately higher in female minoritized populations. Understanding the complex intricacies between the impacts of the COVID-19 pandemic coupled with barriers to treatment access or acceptability in these populations is urgently needed. It will take a multipronged approach to address the overdose epidemic and better serve these marginalized, vulnerable populations.
Collapse
Affiliation(s)
- Alexa A. Lopez
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | | | - Ryan Redner
- Behavior Analysis and Therapy, Southern Illinois University, Carbondale, IL, USA
| | - Hanan Abusbaitan
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Sergey Tarima
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| |
Collapse
|
2
|
Lopez AA, Dressel A, Luebke J, Williams J, Campbell J, Miller J, Kibicho J, Schadewald D, Abusbaitan H, Pirsch A, Gondwe KW, Schubert E, Ruiz A, Kako P, Mkandawire-Valhmu L, Egede LE. Intimate partner violence in the lives of Indigenous and Black women in the upper Midwest of the United States during the COVID-19 pandemic: A mixed-methods protocol examining help-seeking behaviours and experiences. Int J Ment Health Nurs 2024. [PMID: 38323681 DOI: 10.1111/inm.13294] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 12/29/2023] [Accepted: 01/09/2024] [Indexed: 02/08/2024]
Abstract
Violent behaviour perpetrated against women has long-lasting negative physical and mental health consequences for women, their children, their families, and their communities. Intimate partner violence (IPV) is associated with many adverse physical, psychological, and emotional consequences. Structural racism and historical trauma affect women's trust and further hinder the ability of Indigenous and Black women to seek help after experiencing IPV. The availability of IPV support services, which can include shelter, food, group therapy, legal assistance, and advocacy, can be inaccessible to women due to the inability to access often limited resources in urban environments and reasons compounded by potential geographic distance if living in rural areas or living in community. Understanding the unique reasons why Indigenous and Black women do not seek help, and the barriers they experience when seeking help after IPV, is critical. Pandemics have the potential to create further complexities on how IPV is experienced. Black and Indigenous women experiencing IPV were therefore at even greater risk for IPV-related harm because of state and local "stay at home" measures put in place to minimise the spread COVID-19. The purpose of this manuscript is to explicate the methods for a large R01 study in the Upper Midwest.
Collapse
Affiliation(s)
- Alexa A Lopez
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Anne Dressel
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Jeneile Luebke
- School of Nursing, University of Wisconsin, Madison, Wisconsin, USA
| | - Joni Williams
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jennifer Campbell
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jessica Miller
- School of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jennifer Kibicho
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Diane Schadewald
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Hanan Abusbaitan
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Anna Pirsch
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kaboni W Gondwe
- School of Nursing, University of Washington, Seattle, Washington, USA
| | - Erin Schubert
- Sojourner Family Peace Center, Milwaukee, Wisconsin, USA
| | - Ashley Ruiz
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Peninnah Kako
- University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | | | - Leonard E Egede
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| |
Collapse
|
3
|
Graf MDC, McMahon Bullis M, Lopez AA, Snethen J, Silvestre E, Mkandawire-Valhmu L. A Qualitative Analysis of Latina Migrant Farmworkers' Perception of Mental Health: Voices From Wisconsin. J Transcult Nurs 2024; 35:11-20. [PMID: 37902599 DOI: 10.1177/10436596231207490] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
INTRODUCTION Despite evidence showing Latinos' high prevalence of mental health, little is known about Latina migrant farmworkers' mental health experiences, especially those working in Midwestern states. Considering the multiple vulnerabilities observed among Latina migrant farmworkers, it is necessary to gain insight from own accounts and perceptions of mental health and mental health-seeking experiences. METHOD A qualitative descriptive approach, using in-depth semi-structured interviews with open-ended questions, served to retrieve data from 34 Latina migrant farmworkers. This study was informed by Chicana, postcolonial, and Black feminist epistemologies. RESULTS Thematic analysis identified themes within the data. These findings pertained to the conceptualization of mental health within the contexts of family, capacities, stigma, denial, and faith. DISCUSSION Our results demonstrate the need for health care providers to consider Latina migrant farmworkers' perceptions about mental health and apply those in designing and implementing culturally informed policy and practice.
Collapse
|
4
|
Lopez AA, Dressel AE, Deal E, Krueger E, Graf M, Pittman B, Schmitt M, Kako P, Ochoa-Nordstrum B, Mkandawire-Valhmu L. Substance Misuse Themes Among Women Living in Transitional Housing: Effects on Children, Intimate Partner Relationships, and Social Relationships. J Addict Nurs 2023; 34:121-130. [PMID: 37276201 DOI: 10.1097/jan.0000000000000524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
ABSTRACT Traditional substance misuse treatments have not always taken women or marginalized populations into consideration. A holistic approach that addresses how drugs may be used to cope with trauma caused by violence, poverty, and neglect as well as employment of engagement strategies that connect populations with culturally relevant support systems are key, especially in treating African American women. As substance misuse rates rise among African American women, characterizing how this may influence or be influenced by relationships (such as with children, intimate partners, and social relations) is especially important in the context of effective treatment. The purpose of this qualitative study was to examine the themes surrounding substance misuse and close relationships among women previously enrolled in a transitional housing treatment program grounded in social support. Many women discussed how the program itself was an impetus in addressing not only their own substance use but also intergenerational substance use within their families. Women also noted how relationships with their children were vastly different pretreatment compared with during and after treatment, specifically emphasizing a positive improvement. Regarding intimate relationships, African American women learned to establish assertiveness and navigate healthier social relationships, all while sustaining drug abstinence. It is important to acknowledge the role of the healthcare professional in ensuring effective and culturally relevant treatment for African American women; nursing curricula should include evidence-based practice education and training on mental health and substance misuse specific to marginalized communities to more deeply understand the complex intersections of substance misuse, poverty, and social relationships in the lives of women.
Collapse
|
5
|
Yingst J, Wang X, Lopez AA, Breland A, Soule E, Barnes A, Cohen J, Underwood M, Crabtree M, Foulds J. Changes in Nicotine Dependence Among Smokers Using Electronic Cigarettes to Reduce Cigarette Smoking in a Randomized Controlled Trial. Nicotine Tob Res 2023; 25:372-378. [PMID: 35752091 PMCID: PMC9910150 DOI: 10.1093/ntr/ntac153] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 12/03/2021] [Revised: 05/09/2022] [Accepted: 06/23/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION How nicotine dependence will be affected when current smokers initiate electronic cigarette (e-cigarette) use to reduce cigarette smoking is unknown. This study evaluated cigarette, e-cigarette, and total nicotine dependence more than 6 months among smokers reducing cigarette consumption by replacing with e-cigarettes. AIMS AND METHODS Adult cigarette smokers were randomized to one of four conditions (36 mg/ml e-cigarette, 8 mg/ml e-cigarette, 0 mg/ml e-cigarette, or cigarette-substitute [CS] [provided at no cost]) and instructed to reduce their cigarette smoking by 75% at 1 month. Participants completed follow-up at 1, 3, and 6 months. The Penn State Nicotine Dependence Index (PSNDI) measured dependence on cigarettes (PSCDI) and e-cigarettes (PSECDI). Urine cotinine measured total nicotine exposure. Linear mixed effects models for each outcome were conducted and included interaction terms between visit and condition. RESULTS Participants (n = 520) were 58.8% female, 67.3% White, and 48.0 years old. At baseline, the median number of cigarettes smoked per day was 17.3 and the mean PSCDI score was 13.4, with no significant differences between conditions. Participants in the e-cigarette conditions reported significantly lower PSCDI scores, compared with baseline, and with the CS condition at all follow-up visits. Those in the 36 mg/ml e-cigarette condition reported greater PSECDI scores at 6 months, compared with baseline and the 0 mg/ml and 8 mg/ml conditions. At all follow-up visits, there were no differences in total nicotine exposure compared to baseline, nor between any conditions. CONCLUSIONS E-cigarette use was associated with reduced cigarette dependence, compared to the CS, without significant increases in total nicotine exposure. IMPLICATIONS Initiation of electronic cigarette use while continuing to smoke could potentially increase nicotine dependence. In this randomized trial aimed at helping smokers to reduce their cigarette intake, we found that use of an e-cigarette was associated with a reduction in cigarette dependence and an increase in e-cigarette dependence (in the condition with the highest nicotine concentration only), with no long term increase in total nicotine dependence or nicotine exposure.
Collapse
Affiliation(s)
- Jessica Yingst
- Department of Public Health Sciences, Penn State College of Medicine, Center for Research on Tobacco and Health, Hershey, PA 17033, USA
| | - Xi Wang
- Department of Public Health Sciences, Penn State College of Medicine, Center for Research on Tobacco and Health, Hershey, PA 17033, USA
| | - Alexa A Lopez
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA
| | - Alison Breland
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Eric Soule
- Department of Health Education and Promotion, College of Health and Human Performance East Carolina University, Greenville, NC 27858, USA
| | - Andrew Barnes
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA 23219, USA
| | - Joanna Cohen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Megan Underwood
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Melanie Crabtree
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Jonathan Foulds
- Department of Public Health Sciences, Penn State College of Medicine, Center for Research on Tobacco and Health, Hershey, PA 17033, USA
| |
Collapse
|
6
|
Krueger E, Deal E, Lopez AA, Dressel AE, Graf MDC, Schmitt M, Hawkins M, Pittman B, Kako P, Mkandawire-Valhmu L. Successful substance use disorder recovery in transitional housing: Perspectives from African American women. Exp Clin Psychopharmacol 2022; 30:714-724. [PMID: 35201825 DOI: 10.1037/pha0000527] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Through the lens of Black Feminist Thought, the intersectionality of poverty, racism, and sexism in the lives of urban dwelling African American women was explored. Reflections on recovery among women previously enrolled in a transitional housing treatment program were gathered via semistructured interviews, using an instrumental case study design. Four major themes surrounding the context of recovery were identified and analyzed: Knowledge and awareness of addiction, importance of social support and support groups, peace of mind that resulted from a new lifestyle, and women's desire to maintain their recovery status. Many women did not realize that their drug use constituted an addiction prior to their enrollment in the program. Social support and support groups such as AA, NA, and AODA helped the women to maintain their recovery, and this newfound recovery resulted in additional stress relief. Finally, many women felt empowered to maintain their recovery, not only for themselves but also their children. Paradigm shifts in treatment and recovery processes are needed to better serve minority populations, specifically focusing on women and African Americans. Recovery services must shift from previously male centered, hegemonic, pathology-oriented treatment modalities to serve populations more efficiently and equitably. Furthermore, to create effective social change in recovery, programs must address the social determinants of substance misuse, addictive behaviors, and underlying structural inequalities resulting from the intersection of racism, sexism, and classism. Deeper understandings of complex social issues must be disseminated, particularly for women battling substance misuse who are homeless, racially discriminated against and marginalized. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Collapse
Affiliation(s)
| | - Emily Deal
- Joseph J. Zilber School of Public Health
| | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Deal E, Hawkins M, Del Carmen Graf M, Dressel A, Ruiz A, Pittman B, Schmitt M, Krueger E, Lopez AA, Mkandawire-Valhmu L, Kako P. Centering Our Voices: Experiences of Violence Among Homeless African American Women. Violence Against Women 2022:10778012221117599. [PMID: 36017557 DOI: 10.1177/10778012221117599] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Women experiencing homelessness who are also survivors of violence require uniquely tailored programs to accommodate complex needs. To understand how violence shaped the lives of formerly homeless African American women, an instrumental case study design and community-based participatory research approach was utilized in this qualitative study. Focus group interviews with graduates (N = 40) from a long-term transitional housing program were conducted. Using thematic analysis, identified themes included: cycles of violence, violence in the community, relationships with children, and coping with violence. These themes illustrated survivors' growth through supportive programming and highlighted services dedicated to empowering women who have experienced violence.
Collapse
Affiliation(s)
- Emily Deal
- Joseph J. Zilber School of Public Health, 14751University of Wisconsin Milwaukee, Milwaukee, WI, USA
| | - Maren Hawkins
- Joseph J. Zilber School of Public Health, 14751University of Wisconsin Milwaukee, Milwaukee, WI, USA
| | | | - Anne Dressel
- College of Nursing, 14751University of Wisconsin Milwaukee, Milwaukee, WI, USA
| | - Ashley Ruiz
- College of Nursing, 14751University of Wisconsin Milwaukee, Milwaukee, WI, USA
| | | | - Marin Schmitt
- Joseph J. Zilber School of Public Health, 14751University of Wisconsin Milwaukee, Milwaukee, WI, USA
| | - Emma Krueger
- Joseph J. Zilber School of Public Health, 14751University of Wisconsin Milwaukee, Milwaukee, WI, USA
| | - Alexa A Lopez
- College of Nursing, 14751University of Wisconsin Milwaukee, Milwaukee, WI, USA
| | | | - Peninnah Kako
- College of Nursing, 14751University of Wisconsin Milwaukee, Milwaukee, WI, USA
| |
Collapse
|
8
|
Hawkins MM, Lopez AA, Schmitt ME, Tamkin VL, Dressel AE, Kako P, Mkandawire-Valhmu L, Weinhardt LS. A qualitative analysis of perceptions of and reactions to COVID-19. Public Health Nurs 2022; 39:719-727. [PMID: 35122660 PMCID: PMC9115521 DOI: 10.1111/phn.13052] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/20/2021] [Accepted: 01/02/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To understand communities' perceptions, beliefs, and health-related behavior choices related to COVID-19 in order to guide public health nursing communication and interaction with patients and the community. DESIGN A qualitative study, guided by the Health Belief Model (HBM), strove to comprehend the perceptions and reactions to COVID-19 among Wisconsinites. SAMPLE Twenty-five diverse Wisconsin residents aged 18 or older. MEASUREMENTS Semi-structured interviews provided information about individuals' attitudes, perceptions, and reactions to COVID-19. Interviews were audio-recorded, transcribed, and thematic analysis was conducted to identify themes. RESULTS We identified three major themes: (1) "health care starts way before you ever enter the doors of a healthcare facility"; (2) "to live in a society is to help each other"; and (3) mental health as impacted by COVID-19. CONCLUSIONS This study demonstrated the need for greater public health support, as well as the role of Social Determinants of Health. Understanding perceptions and reactions to COVID-19 can help public health nurses understand and better respond to future pandemics.
Collapse
Affiliation(s)
- Maren M Hawkins
- University of Wisconsin-Milwaukee Joseph J. Zilber School of Public Health, Milwaukee, Wisconsin, USA
| | - Alexa A Lopez
- University of Wisconsin-Milwaukee, College of Nursing, Milwaukee, Wisconsin, USA
| | - Marin E Schmitt
- University of Wisconsin-Milwaukee Joseph J. Zilber School of Public Health, Milwaukee, Wisconsin, USA
| | - Vivian L Tamkin
- University of Wisconsin-Madison, School of Medicine and Public Health, Wisconsin, USA
| | - Anne E Dressel
- University of Wisconsin-Milwaukee, College of Nursing, Milwaukee, Wisconsin, USA
| | - Peninnah Kako
- University of Wisconsin-Milwaukee, College of Nursing, Milwaukee, Wisconsin, USA
| | | | - Lance S Weinhardt
- University of Wisconsin-Milwaukee Joseph J. Zilber School of Public Health, Milwaukee, Wisconsin, USA
| |
Collapse
|
9
|
Foulds J, Cobb CO, Yen MS, Veldheer S, Brosnan P, Yingst J, Hrabovsky S, Lopez AA, Allen SI, Bullen C, Wang X, Sciamanna C, Hammett E, Hummer BL, Lester C, Richie JP, Chowdhury N, Graham JT, Kang L, Sun S, Eissenberg T. Effect of Electronic Nicotine Delivery Systems on Cigarette Abstinence in Smokers with no Plans to Quit: Exploratory Analysis of a Randomized Placebo-Controlled Trial. Nicotine Tob Res 2021; 24:955-961. [PMID: 34850164 DOI: 10.1093/ntr/ntab247] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 06/25/2021] [Revised: 10/18/2021] [Accepted: 11/23/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The extent to which use of electronic nicotine delivery systems (ENDS) for smoking reduction leads to cigarette abstinence in smokers with no plans to quit smoking is unclear. This exploratory analysis examined the effects of ENDS delivering different amounts of nicotine on cigarette abstinence up to 24-week follow-up, in comparison to placebo or a behavioral substitute. METHODS This four-arm parallel-group, randomized, placebo-controlled trial took place at two academic medical centers in USA (Penn State Hershey and Virginia Commonwealth University). Participants were current adult smokers (N=520) interested in reducing but not planning to quit. They received brief advice and were randomized to one of four 24-week conditions, receiving either an eGo-style ENDS paired with 0, 8 or 36 mg/ml nicotine liquid (double-blind) or a cigarette-shaped tube, as a cigarette substitute (CS). Self-reported daily cigarette consumption and exhaled carbon monoxide (CO) were measured at all study visits. Outcomes included intent-to-treat, self-reported 7-day cigarette abstinence, biochemically confirmed by exhaled CO at 24 weeks after randomization. RESULTS At 24 weeks, significantly more participants in the 36 mg/ml condition (14/130, 10.8%) than in the 0 mg/ml condition (1/130, 0.8%) and the CS condition (4/130, 3.1%) were abstinent (relative risk = 14 [95% CI=1.9-104.9] and 3.5 [95% CI=1.2-10.4], respectively). The abstinence rate in the 8 mg/ml condition was 4.6% (6/130). CONCLUSIONS When smokers seeking to reduce smoking tried ENDS, few quit smoking in the short term. However, if smokers continued to use an ENDS with cigarette-like nicotine delivery, a greater proportion completely switched to ENDS, as compared with placebo or a cigarette substitute. IMPLICATIONS The extent to which use of electronic nicotine delivery systems (ENDS) for smoking reduction leads to cigarette abstinence in smokers with no plans to quit smoking was unclear. This randomized trial found that ENDS with nicotine delivery approaching that of a cigarette are more effective in helping ambivalent smokers to quit cigarette smoking.
Collapse
Affiliation(s)
- Jonathan Foulds
- Center for Research on Tobacco & Health, Penn State College of Medicine, Hershey, PA
| | - Caroline O Cobb
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA.,Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Miao-Shan Yen
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA.,Department of Biostatistics, Virginia Commonwealth University, Richmond, VA
| | - Susan Veldheer
- Center for Research on Tobacco & Health, Penn State College of Medicine, Hershey, PA
| | - Phoebe Brosnan
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA.,Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Jessica Yingst
- Center for Research on Tobacco & Health, Penn State College of Medicine, Hershey, PA
| | - Shari Hrabovsky
- Center for Research on Tobacco & Health, Penn State College of Medicine, Hershey, PA
| | - Alexa A Lopez
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI
| | - Sophia I Allen
- Center for Research on Tobacco & Health, Penn State College of Medicine, Hershey, PA
| | - Christopher Bullen
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Xi Wang
- Center for Research on Tobacco & Health, Penn State College of Medicine, Hershey, PA
| | - Chris Sciamanna
- Center for Research on Tobacco & Health, Penn State College of Medicine, Hershey, PA
| | - Erin Hammett
- Center for Research on Tobacco & Health, Penn State College of Medicine, Hershey, PA
| | - Breianna L Hummer
- Center for Research on Tobacco & Health, Penn State College of Medicine, Hershey, PA
| | - Courtney Lester
- Center for Research on Tobacco & Health, Penn State College of Medicine, Hershey, PA
| | - John P Richie
- Center for Research on Tobacco & Health, Penn State College of Medicine, Hershey, PA
| | - Nadia Chowdhury
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA
| | - Jacob T Graham
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA
| | - Le Kang
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA
| | - Shumei Sun
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA
| | - Thomas Eissenberg
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA.,Department of Psychology, Virginia Commonwealth University, Richmond, VA
| |
Collapse
|
10
|
Schmitt M, Dressel A, Del Carmen Graf M, Pittman B, Deal E, Krueger E, Lopez AA, Kako P, Mkandawire-Valhmu L. Adverse childhood experiences among previously homeless African American women. Public Health Nurs 2021; 39:446-455. [PMID: 34537971 DOI: 10.1111/phn.12970] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 08/20/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To learn how adverse childhood experiences (ACEs) impacted the life course trajectory of formerly homeless and at-risk African American women. DESIGN Intersectionality and life course theory informed this qualitative pilot study, based on an instrumental case study design. SAMPLE Forty previously homeless and at-risk African American women, who were graduates from a long-term transitional living facility in Milwaukee, Wisconsin. MEASUREMENTS Focus group interviews and one individual interview provided data about participants' life experiences prior to, during, and following their time at the transitional living facility, which provided supportive wrap-around services. Interviews were audiotaped, transcribed, and line-by-line thematic analysis was conducted to identify themes. Fifteen focus group participants also completed ACE questionnaires. RESULTS Participants reported a high prevalence of multiple ACEs, and three themes were identified: childhood experiences with family conflict, childhood experiences of abuse, and negative coping mechanisms. One-hundred percent of women had experienced at least one ACE, based on ACE questionnaire responses. CONCLUSIONS ACEs affect various parts of patient's lives as adults. For nurses and other healthcare professionals, connecting with community resources provides the opportunity to strategically approach health improvement with wrap-around resources to improve health outcomes.
Collapse
Affiliation(s)
- Marin Schmitt
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Anne Dressel
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | | | | | - Emily Deal
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Emma Krueger
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Alexa A Lopez
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Peninnah Kako
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | | |
Collapse
|
11
|
Cobb CO, Foulds J, Yen MS, Veldheer S, Lopez AA, Yingst JM, Bullen C, Kang L, Eissenberg T. Effect of an electronic nicotine delivery system with 0, 8, or 36 mg/mL liquid nicotine versus a cigarette substitute on tobacco-related toxicant exposure: a four-arm, parallel-group, randomised, controlled trial. Lancet Respir Med 2021; 9:840-850. [PMID: 33857436 DOI: 10.1016/s2213-2600(21)00022-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Electronic nicotine delivery systems (ENDSs) are used by some smokers to reduce cigarette consumption, but their effectiveness is uncertain. We aimed to examine the extent to which ENDSs or a non-nicotine cigarette substitute influence tobacco-related toxicant exposure and cigarette consumption in smokers interested in smoking reduction. METHODS We did a four-arm, parallel-group, randomised controlled trial at two sites in the USA (Penn State University, Hershey, PA, and Virginia Commonwealth University, Richmond, VA). We enrolled adults aged 21-65 years who smoked more than nine cigarettes per day (for at least the past year), with exhaled CO of more than 9 parts per million at screening, who were not currently using an ENDS, and who were interested in reducing smoking but not quitting. Participants were randomised (site-specific with allocation concealment; 1:1:1:1) to receive either a cartomiser-based, pen-style ENDS (eGo-style) paired with 0, 8, or 36 mg/mL liquid nicotine (participants and researchers masked to concentration) or a non-ENDS cigarette-shaped plastic tube that delivered no nicotine or aerosol (cigarette substitute; unmasked) for 24 weeks. Conditions were chosen to reflect a range of nicotine delivery including none (cigarette substitute and 0 mg/mL ENDS), low (8 mg/mL), and cigarette-like (36 mg/mL), and all conditions were paired with smoking reduction instructions. The primary outcome was concentration of the tobacco-specific carcinogen metabolite 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL; urinary total) collected at randomisation and at 4, 12, and 24 weeks. Multiple imputation with and without covariate adjustment was used in addition to sensitivity analyses. This trial is registered with ClinicalTrials.gov, NCT02342795. FINDINGS Between July 22, 2015, and Nov 16, 2017, 684 individuals were screened and 520 (76%) were enrolled and randomised. 188 (36%) of 520 participants were lost to follow-up by week 24; attrition did not differ by study group (39 [30%] of 130 in the cigarette substitute group, 56 [43%] of 130 in the ENDS with 0 mg/mL nicotine group, 49 [38%] of 130 in the ENDS 8 mg/mL group, and 44 [34%] of 130 in the ENDS 36 mg/mL group). Urinary total NNAL at 24 weeks in the ENDS with 36 mg/mL nicotine group was 210·80 pg/mg creatinine (95% CI 163·03-274·42) compared with 346·09 pg/mg creatinine (265·00-455·32) in the cigarette substitute group (p=0·0061). No other significant differences between groups were observed for any time point for urinary total NNAL. Serious adverse event frequency was similar across groups (12 events in 12 participants [9%] in the ENDS with 36 mg/mL nicotine group, seven events in six participants [5%] in the 8 mg/mL group, 11 events in ten participants [8%] in the 0 mg/mL group, and 13 events in 13 participants [10%] in the cigarette substitute group), and all of these were deemed unrelated or unlikely to be related to study product use. There was one death between randomisation and 24 weeks (suicide; in the ENDS with 0 mg/mL nicotine group). INTERPRETATION Use of an ENDS with cigarette-like nicotine delivery can reduce exposure to a major pulmonary carcinogen, NNAL, even with concurrent smoking. Future ENDS trials should involve products with well characterised nicotine delivery, including those with nicotine delivery approaching that of a cigarette. FUNDING National Institutes of Health, US Food and Drug Administration.
Collapse
Affiliation(s)
- Caroline O Cobb
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA; Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA.
| | - Jonathan Foulds
- Center for Research on Tobacco and Health, Penn State University College of Medicine, Hershey, PA, USA; Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA, USA
| | - Miao-Shan Yen
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA; Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
| | - Susan Veldheer
- Center for Research on Tobacco and Health, Penn State University College of Medicine, Hershey, PA, USA; Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA, USA; Department of Family and Community Medicine, Penn State University College of Medicine, Hershey, PA, USA
| | - Alexa A Lopez
- University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Jessica M Yingst
- Center for Research on Tobacco and Health, Penn State University College of Medicine, Hershey, PA, USA; Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA, USA
| | | | - Le Kang
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Thomas Eissenberg
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA; Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
| | | |
Collapse
|
12
|
Dressel A, Hawkins M, Lopez AA, Pittman-McGee B, Kako P, Gakii D, Mkandawire-Valhmu L. Nia Imani Model of Care's Impact on Homeless African-American Women. West J Nurs Res 2020; 42:1059-1067. [PMID: 32419671 DOI: 10.1177/0193945920922497] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This qualitative study assessed the impact of the Nia Imani model of care on homeless African-American women, many of whom abused drugs, experienced interpersonal violence, and faced other challenges when seeking to improve their lives and health. Nia Imani Family, Inc., is Milwaukee, Wisconsin's, only long-term transitional living facility. Grounded in Black feminist thought, our study included focus group interviews with 39 women who had lived at Nia Imani, and successfully completed its programs; and one individual interview with the founder, who had also experienced homelessness (N=40). Themes were identified through thematic analysis, and included the following: crucial social support, learning self-worth, stability and structure, appreciation for strict rules, and importance of parenting and financial literacy classes. To ensure effective interventions, there is a need for nurses to understand how community-based and community-led programs, like Nia Imani, impact the health and well-being of African-American women, who have experienced homelessness.
Collapse
Affiliation(s)
- Anne Dressel
- College of Nursing University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Maren Hawkins
- Joseph J. Zilber School of Public Health University of Wisconsin-Milwaukee, Milwaukee, USA
| | - Alexa A Lopez
- College of Nursing University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | | | - Peninnah Kako
- College of Nursing University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Dorothy Gakii
- College of Nursing University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | | |
Collapse
|
13
|
Cobb CO, Lopez AA, Soule EK, Yen MS, Rumsey H, Lester-Schotles R, Rudy AK, Lipato T, Guy M, Eissenberg T. Influence of electronic cigarette liquid flavors and nicotine concentration on subjective measures of abuse liability in young adult cigarette smokers. Drug Alcohol Depend 2019; 203:27-34. [PMID: 31401532 PMCID: PMC9307062 DOI: 10.1016/j.drugalcdep.2019.05.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 05/17/2019] [Accepted: 05/21/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND A rapidly evolving tobacco marketplace highlights the timeliness of the FDA's authority to regulate tobacco, specifically the role that flavorings in nicotine-containing electronic cigarette (ECIG) liquids have on public health. This study aimed to evaluate the extent to which ECIG liquid flavor and nicotine concentration influenced subjective measures of abuse liability among young adult cigarette (cig) smokers. METHODS Young adult (18-21 y.o.) smokers (M = 10.1 cig/day, no regular ECIG use history) completed 7 Latin-square ordered conditions each preceded by 12 h. nicotine/tobacco abstinence. Conditions were own brand cig (OB) and eGo-style ECIG paired with three liquid flavors (cream, tropical fruit, tobacco/menthol) varying in nicotine concentration (0 or 36 mg/ml). Products were administered in two 10-puff bouts in each condition. Heart rate/blood pressure (HR/BP) and tobacco/nicotine abstinence symptoms, nicotine/general drug effects, and acceptability measures were assessed repeatedly throughout sessions. Mixed linear models were followed-up with Tukey's HSD t-tests. RESULTS HR/BP indicated nicotine exposure during nicotine-containing conditions. OB and tobacco/menthol 36 mg/ml conditions produced significant decreases in ratings of cig smoking urges. Nicotine/drug effects were elevated significantly for OB and 36 mg/ml ECIG conditions with one exception noted for the tobacco/menthol 0 mg/ml condition. OB had the highest acceptability ratings, and ECIG condition results varied by acceptability item. CONCLUSIONS Among young adult smokers, ECIG conditions containing nicotine were positively associated with several subjective measures of abuse liability but not all. Flavors did not consistently mask/enhance effects observed. Results reinforce continued examination of ECIG-delivered nicotine and liquid flavors in relationship to abuse liability.
Collapse
Affiliation(s)
- Caroline O. Cobb
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA,Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA,Correspondence: Caroline O. Cobb, Virginia Commonwealth University, 808 W Franklin, Room 304, P.O. Box 842018, Richmond, VA 23284-2018 Phone: 804-828-8687
| | - Alexa A. Lopez
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA,Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Eric K. Soule
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA,Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Miao-Shan Yen
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA,Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Hannah Rumsey
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA,Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Rebecca Lester-Schotles
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA,Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Alyssa K. Rudy
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA,Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Thokozeni Lipato
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA,Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Mignonne Guy
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA,Department of African American Studies, Virginia Commonwealth University, Richmond, VA, USA
| | - Thomas Eissenberg
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA,Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
14
|
Sipos ML, Lopez AA, Nyland J, Taylor MR, McDonald J, LoPresti ML, Cabrera OA, Adler AB. U.S. Soldiers and Foreign Language School: Stressors and Health. Mil Med 2019; 184:e344-e352. [PMID: 30690460 DOI: 10.1093/milmed/usy359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/30/2018] [Accepted: 11/08/2018] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION While previous studies have examined the stress of the military training environment, studies have not systematically examined the stress associated with attending the Defense Language Institute Foreign Language Center (DLIFLC). Service members assigned to DLIFLC endure intense academic pressure to succeed while meeting military requirements. Thus, not only are traditional academic stressors likely to be of concern but there are other academic and military-related stressors that have to managed by students. The goal of the present study was to characterize the stressors facing military students, document their mental health status and well-being, and identify mitigating factors such as coping, social support, time management, and the classroom environment. MATERIALS AND METHODS Data were obtained from a cross-sectional survey administered in March of 2016. Study participants were 759 active-duty U.S. soldiers enrolled in DLIFLC, with a consent rate of 87.7%. Surveys were administered in classroom settings. Survey topics included demographics, student experience (e.g., classroom hours, stressors), mental health (e.g., depression, anxiety, hazardous alcohol use) and burnout, and mitigating factors (e.g., coping, social support, time management, classroom environment). Multiple logistic regressions were used to identify which variables in the predictor set were significantly associated with each of the five outcomes while controlling for the presence of all other variables. RESULTS In terms of behavioral health, 7.2% met screening criteria for depression, 9.4% for anxiety, and 17.1% for hazardous alcohol use; 43.4% reported high/very high levels of burnout. About one-third of the sample who had taken a test failed at least one (32.2%). In terms of common stressors more than half reported high or very high-stress levels from meeting academic expectations, not getting enough sleep, and pressure to succeed from civilian language instructors. For depression and anxiety, regression results found that denial coping was a risk factor whereas positive social interaction and classroom climate were protective factors. For hazardous alcohol use, denial coping and higher rank were risk factors and acceptance and time management were protective factors. In terms of academic burnout, in-class and military work hours were risk factors, whereas time management and classroom climate were protective. Finally, lower educational attainment, time spent in the classroom and times spent on military duties predicted exam failure. CONCLUSION Individual coping, social connection, and classroom climate are each associated with better DLIFLC student adjustment. Denial coping appears to impede individuals from assembling the personal resources needed to study a foreign language. In contrast, acceptance appears to support healthier adjustment, perhaps freeing individuals to focus on the task at hand rather than expend valuable energy resisting the demands being placed on them. Positive social interaction also appears to provide an important resource for students, and positive classroom climate is also associated with better mental health. These findings suggest that there are measures that individuals and the school can take to improve the DLIFLC experience and support students as they manage a myriad of stressors given the significance of their success to individual students and to the larger organization.
Collapse
Affiliation(s)
- Maurice L Sipos
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD
| | - Alexa A Lopez
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, Tacoma, WA
| | - Jennifer Nyland
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, Tacoma, WA
| | - Maura R Taylor
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, Tacoma, WA
| | - Jennifer McDonald
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, Tacoma, WA
| | - Matthew L LoPresti
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, Tacoma, WA
| | - Oscar A Cabrera
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, Tacoma, WA
| | - Amy B Adler
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD
| |
Collapse
|
15
|
Gaalema DE, Pericot-Valverde I, Bunn JY, Villanti AC, Cepeda-Benito A, Doogan NJ, Keith DR, Kurti AN, Lopez AA, Nighbor T, Parker MA, Quisenberry AJ, Redner R, Roberts ME, Stanton CA, Ades PA, Higgins ST. Tobacco use in cardiac patients: Perceptions, use, and changes after a recent myocardial infarction among US adults in the PATH study (2013-2015). Prev Med 2018; 117:76-82. [PMID: 29746974 PMCID: PMC6195824 DOI: 10.1016/j.ypmed.2018.05.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 01/29/2018] [Revised: 04/30/2018] [Accepted: 05/05/2018] [Indexed: 11/29/2022]
Abstract
Smoking status following cardiac events strongly predicts future morbidity and mortality. Using a nationally representative sample of United States adults, aims of this study were (1) to estimate use of, and attitudes towards, tobacco products as a function of level of cardiac risk, and (2) to explore changes in attitudes and tobacco use among adults experiencing a recent myocardial infarction (MI). Data were obtained from the first and second waves of the Population Assessment of Tobacco and Health (PATH) study. Use and attitudes towards tobacco products were examined at Wave 1 among adults with no chronic health condition (n = 18,026), those with risk factors for heart disease (n = 4593), and those who reported ever having had an MI (n = 643). Changes in perceived risk of tobacco and use between the two waves and having an MI in the last 12 months (n = 240) were also examined. Those who reported lifetime MI were more likely to believe that smoking/using tobacco was causing/worsening a health problem. Having had a recent MI event increased perceived tobacco-related risk and attempts at reduction/quitting, but did not significantly impact combusted tobacco cessation/reduction or uptake of non-combusted tobacco products. Sociodemographic characteristics and use of other tobacco products were associated with change in use of tobacco products. Those who have an MI are sensitized to the harm of continued smoking. Nonetheless, having an MI does not predict quitting combusted tobacco use or switching to potentially reduced harm products. Intense intervention is necessary to reduce combusted use in this high-risk population.
Collapse
Affiliation(s)
- Diann E Gaalema
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Departments of Psychiatry, University of Vermont, Burlington, VT, USA; Psychological Science, University of Vermont, Burlington, VT, USA.
| | - Irene Pericot-Valverde
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Departments of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Janice Y Bunn
- Medical Biostatistics, University of Vermont, Burlington, VT, USA
| | - Andrea C Villanti
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Departments of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Antonio Cepeda-Benito
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Psychological Science, University of Vermont, Burlington, VT, USA
| | - Nathan J Doogan
- Center of Excellence in Regulatory Tobacco Science, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Diana R Keith
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Departments of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Allison N Kurti
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Departments of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Alexa A Lopez
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
| | - Tyler Nighbor
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Departments of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Maria A Parker
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Departments of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Amanda J Quisenberry
- Center of Excellence in Regulatory Tobacco Science, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Ryan Redner
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Rehabilitation Institute, Southern Illinois University, Carbondale, IL, USA
| | - Megan E Roberts
- Center of Excellence in Regulatory Tobacco Science, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Cassandra A Stanton
- Westat, Center for Evaluation and Coordination of Training and Research (CECTR) in Tobacco Regulatory Science, Department of Oncology, Georgetown University Medical Center, Washington, DC, USA
| | - Philip A Ades
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Division of Cardiology, University of Vermont College of Medicine, Burlington, VT, USA
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA; Departments of Psychiatry, University of Vermont, Burlington, VT, USA; Psychological Science, University of Vermont, Burlington, VT, USA
| |
Collapse
|
16
|
Lopez AA, Redner R, Kurti AN, Keith DR, Villanti AC, Stanton CA, Gaalema DE, Bunn JY, Doogan NJ, Cepeda-Benito A, Roberts ME, Higgins ST. Tobacco and nicotine delivery product use in a U.S. national sample of women of reproductive age. Prev Med 2018; 117:61-68. [PMID: 29559222 PMCID: PMC6141351 DOI: 10.1016/j.ypmed.2018.03.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [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: 08/10/2017] [Revised: 03/01/2018] [Accepted: 03/09/2018] [Indexed: 01/07/2023]
Abstract
This study examined prevalence and correlates of using cigarettes, e-cigarettes, and other tobacco/nicotine delivery products in a U.S. national sample of women of reproductive age. Weighted data were obtained from women aged 15-44 years who were not currently pregnant in the first wave of the Population Assessment of Health and Tobacco (PATH, 2013-2014) study (N = 12,848). 20.1% of women were current cigarette smokers, 5.9% current e-cigarette users, 4.9% current cigar smokers, and 6.5% current hookah users. Prevalence of current use of other tobacco products was <1.0%. Current cigarette smoking was the strongest correlate of current e-cigarette use (OR = 65.7, 95% CI = 44.8-96.5), cigar smoking (OR = 19.2, 95% CI = 14.1-26.1), and hookah use (OR = 6.6, 95% CI = 5.1-8.5). Among former cigarette smokers, 3.8%, 6.9%, and 3.2% were also currently using e-cigarettes, hookah, and cigars, respectively. Use of other tobacco and nicotine delivery products was low among those who never smoked tobacco cigarettes: 2.5% used hookah and <1.0% used other products. Cigarette smoking prevalence remains relatively high among women of reproductive age and strongly correlated with use of other tobacco products. Monitoring tobacco and nicotine use in this population is important due to the additional risk of adverse health impacts should they become pregnant. Clinicians working with cigarette smokers should assess for use of other tobacco products. Among women of reproductive age, use of emerging tobacco and nicotine products appears to be largely, although not exclusively, restricted to current cigarette smokers.
Collapse
Affiliation(s)
- Alexa A Lopez
- Vermont Center on Behavior and Health, University of Vermont, United States
| | - Ryan Redner
- Vermont Center on Behavior and Health, University of Vermont, United States; Rehabilitation Institute, Southern Illinois University, United States.
| | - Allison N Kurti
- Vermont Center on Behavior and Health, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States
| | - Diana R Keith
- Vermont Center on Behavior and Health, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States
| | - Andrea C Villanti
- Vermont Center on Behavior and Health, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States
| | - Cassandra A Stanton
- Westat, Center for Evaluation and Coordination of Training and Research (CECTR) in Tobacco Regulatory Science, Department of Oncology, Georgetown University Medical Center, United States
| | - Diann E Gaalema
- Vermont Center on Behavior and Health, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States
| | | | - Nathan J Doogan
- College of Public Health, The Ohio State University, United States
| | | | - Megan E Roberts
- College of Public Health, The Ohio State University, United States
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States; Department of Psychological Science, University of Vermont, United States
| |
Collapse
|
17
|
Cepeda-Benito A, Doogan NJ, Redner R, Roberts ME, Kurti AN, Villanti AC, Lopez AA, Quisenberry AJ, Stanton CA, Gaalema DE, Keith DR, Parker MA, Higgins ST. Trend differences in men and women in rural and urban U.S. settings. Prev Med 2018; 117:69-75. [PMID: 29627511 PMCID: PMC6173654 DOI: 10.1016/j.ypmed.2018.04.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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: 12/15/2017] [Revised: 02/21/2018] [Accepted: 04/02/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Smoking prevalence is declining at a slower rate in rural than urban settings in the United States (U.S.), and known predictors of smoking do not readily account for this trend difference. Given that socioeconomic and psychosocial determinants of health disparities accumulate in rural settings and that life-course disadvantages are often greater in women than men, we examined whether smoking trends are different for rural and urban men and women. METHOD We used yearly cross-sectional data (n = 303,311) from the U.S. National Survey on Drug Use and Health (NSDUH) from 2007 through 2014 to compare cigarette smoking trends in men and women across rural and urban areas. Current smoking status was modelled using logistic regression controlling for confounding risk factors. RESULTS Regression derived graphs predicting unadjusted prevalence estimates and 95% confidence bands revealed that whereas the smoking trends of rural men, urban men, and urban women significantly declined from 2007 to 2014, the trend for rural women was flat. Controlling for demographic, socioeconomic and psychosocial predictors of smoking did not explain rural women's significantly different trend from those of the other three groups. CONCLUSION Rural women lag behind rural men, urban men and urban women in decreasing smoking, a health disparity finding that supports the need for tobacco control and regulatory policies and interventions that are more effective in reducing smoking among rural women.
Collapse
Affiliation(s)
- A Cepeda-Benito
- University of Vermont Center of Tobacco Regulatory Science, University of Vermont, United States; Department of Psychological Science, University of Vermont, United States.
| | - N J Doogan
- Center of Excellence in Regulatory Tobacco Science, College of Public Health, The Ohio State University, United States
| | - R Redner
- University of Vermont Center of Tobacco Regulatory Science, University of Vermont, United States; Rehabilitation Institute, Southern Illinois University, United States
| | - M E Roberts
- Center of Excellence in Regulatory Tobacco Science, College of Public Health, The Ohio State University, United States
| | - A N Kurti
- University of Vermont Center of Tobacco Regulatory Science, University of Vermont, United States; Department of Psychological Science, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States
| | - A C Villanti
- University of Vermont Center of Tobacco Regulatory Science, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States
| | - A A Lopez
- University of Vermont Center of Tobacco Regulatory Science, University of Vermont, United States
| | - A J Quisenberry
- Center of Excellence in Regulatory Tobacco Science, College of Public Health, The Ohio State University, United States
| | - C A Stanton
- Westat, Center for Evaluation and Coordination of Training and Research (CECTR) in Tobacco Regulatory Science, Department of Oncology, Georgetown University Medical Center, United States; Department of Oncology, Georgetown University Medical Center / Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, United States
| | - D E Gaalema
- University of Vermont Center of Tobacco Regulatory Science, University of Vermont, United States; Department of Psychological Science, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States
| | - D R Keith
- University of Vermont Center of Tobacco Regulatory Science, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States
| | - M A Parker
- University of Vermont Center of Tobacco Regulatory Science, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States
| | - S T Higgins
- University of Vermont Center of Tobacco Regulatory Science, University of Vermont, United States; Department of Psychological Science, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States
| |
Collapse
|
18
|
Nighbor TD, Doogan NJ, Roberts ME, Cepeda-Benito A, Kurti AN, Priest JS, Johnson HK, Lopez AA, Stanton CA, Gaalema DE, Redner R, Parker MA, Keith DR, Quisenberry AJ, Higgins ST. Smoking prevalence and trends among a U.S. national sample of women of reproductive age in rural versus urban settings. PLoS One 2018; 13:e0207818. [PMID: 30485376 PMCID: PMC6261597 DOI: 10.1371/journal.pone.0207818] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 11/06/2018] [Indexed: 11/19/2022] Open
Abstract
U.S. smoking prevalence is declining at a slower rate in rural than urban settings and contributing to regional health disparities. Cigarette smoking among women of reproductive age is particularly concerning due to the potential for serious maternal and infant adverse health effects should a smoker become pregnant. The aim of the present study was to examine whether this rural-urban disparity impacts women of reproductive age (ages 15-44) including pregnant women. Data came from the ten most recent years of the U.S. National Survey on Drug Use and Health (2007-2016). We estimated prevalence of current smoking and nicotine dependence among women categorized by rural-urban residence, pregnancy status, and trends using chi-square testing and multivariable modeling while adjusting for common risk factors for smoking. Despite overall decreasing trends in smoking prevalence, prevalence was higher among rural than urban women of reproductive age overall (χ2(1) = 579.33, p < .0001) and among non-pregnant (χ2(1) = 578.0, p < .0001) and pregnant (χ2(1) = 79.69, p < .0001) women examined separately. An interaction between residence and pregnancy status showed adjusted odds of smoking among urban pregnant compared to non-pregnant women (AOR = .58, [.53 -.63]) were lower than those among rural pregnant compared to non-pregnant women (AOR = 0.75, [.62 -.92]), consistent with greater pregnancy-related smoking cessation among urban pregnant women. Prevalence of nicotine dependence was also higher in rural than urban smokers overall (χ2(2) = 790.42, p < .0001) and among non-pregnant (χ2(2) = 790.58, p < .0001) and pregnant women examined separately (χ2(2) = 63.69, p < .0001), with no significant changes over time. Associations involving residence and pregnancy status remained significant in models adjusting for covariates (ps < 0.05). Results document greater prevalence of smoking and nicotine dependence and suggest less pregnancy-related quitting among rural compared to urban women, disparities that have potential for direct, multi-generational adverse health impacts.
Collapse
Affiliation(s)
- Tyler D. Nighbor
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, United States of America
- Department of Psychiatry, University of Vermont, Burlington, Vermont, United States of America
| | - Nathan J. Doogan
- Ohio Colleges of Medicine Government Resource Center, The Ohio State University, Columbus, OH, United States of America
| | - Megan E. Roberts
- Ohio Colleges of Medicine Government Resource Center, The Ohio State University, Columbus, OH, United States of America
| | - Antonio Cepeda-Benito
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, United States of America
- Department of Psychological Science, University of Vermont, Burlington, Vermont, United States of America
| | - Allison N. Kurti
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, United States of America
- Department of Psychiatry, University of Vermont, Burlington, Vermont, United States of America
- Department of Psychological Science, University of Vermont, Burlington, Vermont, United States of America
| | - Jeff S. Priest
- Medical Biostatistics, University of Vermont, Burlington, Vermont, United States of America
| | - Harley K. Johnson
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, United States of America
- Department of Psychiatry, University of Vermont, Burlington, Vermont, United States of America
| | - Alexa A. Lopez
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, United States of America
| | - Cassandra A. Stanton
- Westat, Center for Evaluation and Coordination of Training and Research (CECTR) in Tobacco Regulatory Science, Rockville, Maryland, United States of America
- Department of Oncology, Georgetown University Medical Center, Washington District of Columbia, United States of America
| | - Diann E. Gaalema
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, United States of America
- Department of Psychiatry, University of Vermont, Burlington, Vermont, United States of America
- Department of Psychological Science, University of Vermont, Burlington, Vermont, United States of America
| | - Ryan Redner
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, United States of America
- Rehabilitation Institute, Southern Illinois University, Carbondale, Illinois, United States of America
| | - Maria A. Parker
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, United States of America
- Department of Psychiatry, University of Vermont, Burlington, Vermont, United States of America
| | - Diana R. Keith
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, United States of America
- Department of Psychiatry, University of Vermont, Burlington, Vermont, United States of America
| | - Amanda J. Quisenberry
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States of America
| | - Stephen T. Higgins
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, United States of America
- Department of Psychiatry, University of Vermont, Burlington, Vermont, United States of America
- Department of Psychological Science, University of Vermont, Burlington, Vermont, United States of America
| |
Collapse
|
19
|
Affiliation(s)
- Alexa A. Lopez
- United States Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Tacoma, Washington
| | - Amy B. Adler
- Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Oscar A. Cabrera
- United States Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Tacoma, Washington
| | | |
Collapse
|
20
|
Kurti AN, Bunn JY, Villanti AC, Stanton CA, Redner R, Lopez AA, Gaalema DE, Doogan NJ, Cepeda-Benito A, Roberts ME, Phillips JK, Quisenberry AJ, Keith DR, Higgins ST. Patterns of Single and Multiple Tobacco Product Use Among US Women of Reproductive Age. Nicotine Tob Res 2018; 20:S71-S80. [PMID: 30125011 PMCID: PMC6093396 DOI: 10.1093/ntr/nty024] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 01/31/2018] [Indexed: 12/21/2022]
Abstract
Introduction Understanding patterns of single and multiple tobacco product use among reproductive-aged women is critical given the potential for adverse health effects on mother and infant should a woman become pregnant. Methods Patterns of tobacco use over a 2-year period were examined among all women (18-44 years) who completed wave 1 (W1) and wave 2 (W2) of the US Population Assessment of Tobacco and Health (PATH, 2013-2014, 2014-2015) Study. We examined the most common patterns of single and multiple tobacco product use in W1, and longitudinal trajectories of women engaged in each of these patterns of use from W1 to W2, among women not pregnant in either wave (n = 7480), not pregnant in W1 and pregnant in W2 (n = 332), and pregnant in W1 and not pregnant in W2 (n = 325). Results The most prevalent patterns of tobacco use in W1 among all three subgroups were using cigarettes alone followed by using cigarettes plus e-cigarettes. In all three subgroups, women using multiple products in W1 were more likely to adopt new use patterns in W2 relative to single-product users, with the new patterns generally involving dropping rather than adding products. The majority of multiple product use included cigarettes, and transitions to single product use typically involved dropping the noncigarette product. The most common trajectory among tobacco users transitioning to or from pregnancy was to use cigarettes alone in W2. Discussion This study contributes new knowledge characterizing tobacco use patterns across time and reproductive events among reproductive-aged women.
Collapse
Affiliation(s)
- Allison N Kurti
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
- Department of Psychiatry, University of Vermont, Burlington, VT
| | - Janice Y Bunn
- Department of Biostatistics, University of Vermont, Burlington, VT
| | - Andrea C Villanti
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
- Department of Psychiatry, University of Vermont, Burlington, VT
| | - Cassandra A Stanton
- Center for Evaluation and Coordination of Training and Research (CECTR) in Tobacco Regulatory Science, Westat, Rockville, MD
- Department of Oncology, Georgetown University Medical Center, Washington, DC
| | - Ryan Redner
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
- Rehabilitation Institute, Southern Illinois University, Carbondale, IL
| | - Alexa A Lopez
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
| | - Diann E Gaalema
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
- Department of Psychiatry, University of Vermont, Burlington, VT
| | - Nathan J Doogan
- Center for Excellence in Regulatory Tobacco Science, The Ohio State University, Colombus, OH
- College of Public Health, The Ohio State University, Colombus, OH
| | - Antonio Cepeda-Benito
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
- Department of Psychological Science, University of Vermont, Burlington, VT
| | - Megan E Roberts
- College of Public Health, The Ohio State University, Colombus, OH
| | - Julie K Phillips
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont, Burlington, VT
| | - Amanda J Quisenberry
- Center for Excellence in Regulatory Tobacco Science, The Ohio State University, Colombus, OH
| | - Diana R Keith
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
- Department of Psychiatry, 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
| |
Collapse
|
21
|
Abstract
Smoking rates are higher in U.S. soldiers than civilians, with combat-experienced soldiers particularly at risk for heavy smoking (≥20 cigarettes/day). While heavy smoking is correlated with mental health symptoms in civilian samples, the extent to which these symptoms, background variables, and unit climate (self-reported assessments of cohesion, organizational support, and leadership) are linked to smoking in at-risk soldiers remains unclear. The present study examines a range of correlates of smoking-related behavior. Cross-sectional, anonymous surveys were collected from 3,380 soldiers following a deployment in 2008-2009. Measures included demographics, combat exposures, unit climate (e.g., unit cohesion, perceived organizational support, leadership), short sleep duration, and behavioral health variables (e.g., posttraumatic stress disorder, depression, anxiety, alcohol misuse, aggression, adverse childhood experiences [ACEs]). Logistic regression modeled the effects of these variables on two outcome variables: daily smoking and heavy smoking. In the current sample, nearly half (47%) of soldiers reported smoking daily, with 35% of all smokers reporting heavy smoking (17% of the entire sample). Daily smoking was associated with demographic (age, gender, education, rank), behavioral health (ACE, alcohol misuse, sleep duration, aggression), and unit characteristics (unit cohesion); only increased combat exposures and aggression were specifically associated with heavy smoking. Interventions focused on the postdeployment period could incorporate messages about alternatives to smoking as a coping strategy while unit interventions or individual counseling addressing aggression could also address smoking as a negative coping strategy. (PsycINFO Database Record
Collapse
|
22
|
Doogan NJ, Roberts ME, Wewers ME, Stanton CA, Keith DR, Gaalema DE, Kurti AN, Redner R, Cepeda-Benito A, Bunn JY, Lopez AA, Higgins ST. A growing geographic disparity: Rural and urban cigarette smoking trends in the United States. Prev Med 2017; 104:79-85. [PMID: 28315761 PMCID: PMC5600673 DOI: 10.1016/j.ypmed.2017.03.011] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/01/2017] [Accepted: 03/12/2017] [Indexed: 11/17/2022]
Abstract
Rural areas of the United States have a higher smoking prevalence than urban areas. However, no recent studies have rigorously examined potential changes in this disparity over time or whether the disparity can be explained by demographic or psychosocial characteristics associated with smoking. The present study used yearly cross sectional data from the National Survey on Drug Use and Health from 2007 through 2014 to examine cigarette smoking trends in rural versus urban areas of the United States. The analytic sample included 303,311 respondents. Two regression models were built to examine (a) unadjusted rural and urban trends in prevalence of current smoking and (b) whether differences remained after adjusting for demographic and psychosocial characteristics. Results of the unadjusted model showed disparate and diverging cigarette use trends during the 8-year time period. The adjusted model also showed diverging trends, initially with no or small differences that became more pronounced across the 8-year period. We conclude that differences reported in earlier studies may be explained by differences in rural versus urban demographic and psychosocial risk factors, while more recent and growing disparities appear to be related to other factors. These emergent differences may be attributable to policy-level tobacco control and regulatory factors that disproportionately benefit urban areas such as enforcement of regulations around the sale and marketing of tobacco products and treatment availability. Strong federal policies and targeted or tailored interventions may be important to expanding tobacco control and regulatory benefits to vulnerable populations including rural Americans.
Collapse
Affiliation(s)
- N J Doogan
- Center of Excellence in Tobacco Regulatory Science, The Ohio State University, College of Public Health, 1841 Neil Ave., Columbus, OH 43210, USA.
| | - M E Roberts
- Center of Excellence in Tobacco Regulatory Science, The Ohio State University, College of Public Health, 1841 Neil Ave., Columbus, OH 43210, USA
| | - M E Wewers
- Center of Excellence in Tobacco Regulatory Science, The Ohio State University, College of Public Health, 1841 Neil Ave., Columbus, OH 43210, USA
| | - C A Stanton
- Center for Evaluation and Coordination of Training and Research (CECTR) in Tobacco Regulatory Science, Westat, 1600 Research Boulevard, Rockville, MD 20850, USA; Department of Oncology/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Research Building, Suite E501, 3970 Reservoir Road, N.W., Washington D.C. 20057, USA
| | - D R Keith
- Department of Psychiatry, University of Vermont, 1 South Prospect Street, MS 446AR6, Burlington, VT 05401, USA
| | - D E Gaalema
- Vermont Center on Tobacco Regulatory Science, University of Vermont, Given Building, 89 Beaumont Ave., Burlington, VT 05405-0068, USA
| | - A N Kurti
- Vermont Center on Tobacco Regulatory Science, University of Vermont, Given Building, 89 Beaumont Ave., Burlington, VT 05405-0068, USA
| | - R Redner
- Rehabilitation Institute, Southern Illinois University Carbondale, Rehn Hall, Mail Code 4609, Carbondale, IL 62901, USA
| | - A Cepeda-Benito
- Vermont Center on Tobacco Regulatory Science, University of Vermont, Given Building, 89 Beaumont Ave., Burlington, VT 05405-0068, USA; Department of Psychological Science, University of Vermont, John Dewey Hall, Rm 248, 2 Colchester Avenue, Burlington, VT 05405-0134, USA
| | - J Y Bunn
- Vermont Center on Tobacco Regulatory Science, University of Vermont, Given Building, 89 Beaumont Ave., Burlington, VT 05405-0068, USA
| | - A A Lopez
- Department of Psychiatry, University of Vermont, 1 South Prospect Street, MS 446AR6, Burlington, VT 05401, USA
| | - S T Higgins
- Vermont Center on Tobacco Regulatory Science, University of Vermont, Given Building, 89 Beaumont Ave., Burlington, VT 05405-0068, USA
| |
Collapse
|
23
|
Kurti AN, Redner R, Lopez AA, Keith DR, Villanti AC, Stanton CA, Gaalema DE, Bunn JY, Doogan NJ, Cepeda-Benito A, Roberts ME, Phillips J, Higgins ST. Tobacco and nicotine delivery product use in a national sample of pregnant women. Prev Med 2017; 104:50-56. [PMID: 28789981 PMCID: PMC5734954 DOI: 10.1016/j.ypmed.2017.07.030] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [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: 04/05/2017] [Revised: 07/25/2017] [Accepted: 07/31/2017] [Indexed: 11/19/2022]
Abstract
Monitoring use of tobacco products among pregnant women is a public health priority, yet few studies in U.S. national samples have been reported on this topic. We examined prevalence and correlates of using cigarettes, e-cigarettes, and other tobacco/nicotine delivery products in a U.S. national sample of pregnant women. Data were obtained from all pregnant women (≥18 years) in the first wave of the Population Assessment of Tobacco and Health (PATH, 2013-2014) Study (N=388). Prevalence of current and prior use of tobacco/nicotine products was examined overall and among current cigarette smokers. Multiple logistic regression was used to examine correlates of use of cigarettes, e-cigarettes, hookah and cigars. Overall prevalence was highest for cigarettes (13.8%), followed by e-cigarettes (4.9%), hookah (2.5%) and cigars (2.3%), and below 1% for all other products. Prevalence of using other tobacco products is much higher among current smokers than the general population, with e-cigarettes (28.5%) most prevalent followed by cigars (14.0%), hookah (12.4%), smokeless (4.7%), snus (4.6%), and pipes (2.1%). Sociodemographic characteristics (poverty, low educational attainment, White race) and past-year externalizing psychiatric symptoms were correlated with current cigarette smoking. In turn, current cigarette smoking and past year illicit drug use were correlated with using e-cigarettes, hookah, and cigars. These results underscore that tobacco/nicotine use during pregnancy extends beyond cigarettes. The results also suggest that use of these other products should be included in routine clinical screening on tobacco use, and the need for more intensive tobacco control and regulatory strategies targeting pregnant women.
Collapse
Affiliation(s)
- Allison N Kurti
- University of Vermont Tobacco Center of Regulatory Science, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States.
| | - Ryan Redner
- University of Vermont Tobacco Center of Regulatory Science, University of Vermont, United States; Rehabilitation Institute, Southern Illinois University, United States
| | - Alexa A Lopez
- University of Vermont Tobacco Center of Regulatory Science, University of Vermont, United States
| | - Diana R Keith
- University of Vermont Tobacco Center of Regulatory Science, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States
| | - Andrea C Villanti
- University of Vermont Tobacco Center of Regulatory Science, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States
| | - Cassandra A Stanton
- Westat, Center for Evaluation and Coordination of Training and Research (CECTR) in Tobacco Regulatory Science, Department of Oncology, Georgetown University Medical Center, United States
| | - Diann E Gaalema
- University of Vermont Tobacco Center of Regulatory Science, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States
| | - Janice Y Bunn
- Department of Biostatistics, Obstetrics, Gynecology, University of Vermont, United States
| | | | - Antonio Cepeda-Benito
- University of Vermont Tobacco Center of Regulatory Science, University of Vermont, United States
| | | | - Julie Phillips
- University of Vermont Tobacco Center of Regulatory Science, University of Vermont, United States; Department of Reproductive Sciences, University of Vermont, United States
| | - Stephen T Higgins
- University of Vermont Tobacco Center of Regulatory Science, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States; Department of Psychological Science, University of Vermont, United States
| |
Collapse
|
24
|
Keith DR, Stanton CA, Gaalema DE, Bunn JY, Doogan NJ, Redner R, Kurti AN, Cepeda-Benito A, Lopez AA, Morehead AL, Roberts ME, Higgins ST. Disparities in US Healthcare Provider Screening and Advice for Cessation Across Chronic Medical Conditions and Tobacco Products. J Gen Intern Med 2017; 32:974-980. [PMID: 28470547 PMCID: PMC5570737 DOI: 10.1007/s11606-017-4062-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 02/08/2017] [Accepted: 03/31/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Disparities in tobacco use are worsening in the United States, disproportionately affecting those with chronic medical conditions. One possible contributor is that physicians may not screen and advise cessation uniformly across patients and/or tobacco products. OBJECTIVE This study examined provider communications regarding cigarette and non-cigarette tobacco products among adults with chronic conditions. DESIGN Cross-sectional study drawn from two waves (2013-2014) of the National Survey on Drug Use and Health (NSDUH). PARTICIPANTS Adults (≥ 18 years) who used tobacco in the past year. MAIN MEASURES Prevalence of tobacco use included past-year use of cigarettes, cigars, or smokeless tobacco among those with and without chronic conditions. Chronic conditions included asthma, anxiety, coronary heart disease, depression, diabetes, hepatitis, HIV, hypertension, lung cancer, stroke, and substance abuse. Odds ratio of receipt of screening and advice to quit across chronic condition and tobacco product type were reported. Data were analyzed using logistic regression, controlling for basic sociodemographic factors and number of provider visits. KEY RESULTS Adults with anxiety, depression, and substance use disorders had the highest prevalence of past-year cigarette (37.2-58.2%), cigar (9.1-28.0%), and smokeless tobacco (3.1-11.7%) use. Patients with any chronic condition were more likely to receive advice to quit than those without a condition (OR 1.21-2.37, p < 0.01), although the odds were lowest among adults with mental health and substance use disorders (OR 1.21-1.35, p < 0.01). Cigarette smokers were more likely to report being screened and advised to quit than non-cigarette tobacco users (OR 1.54-5.71, p < 0.01). CONCLUSIONS Results support the need for provider training to expand screening and cessation interventions to include the growing spectrum of tobacco products. Screening and referral to interventions are especially needed for those with mental health and substance use disorders to reduce the disparate burden of tobacco-related disease and death.
Collapse
Affiliation(s)
- Diana R Keith
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 South Prospect St. Rm 1415, Burlington, VT, 05403, USA.
| | - Cassandra A Stanton
- Westat, Rockville, MD, USA
- Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Washington, DC, USA
| | - Diann E Gaalema
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 South Prospect St. Rm 1415, Burlington, VT, 05403, USA
| | - Janice Y Bunn
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 South Prospect St. Rm 1415, Burlington, VT, 05403, USA
- Department of Medical Biostatistics, University of Vermont, Burlington, VT, USA
| | - Nathan J Doogan
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Ryan Redner
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 South Prospect St. Rm 1415, Burlington, VT, 05403, USA
- Rehabilitation Institute, Southern Illinois University, Carbondale, IL, USA
| | - Allison N Kurti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 South Prospect St. Rm 1415, Burlington, VT, 05403, USA
| | | | - Alexa A Lopez
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 South Prospect St. Rm 1415, Burlington, VT, 05403, USA
| | - Adam L Morehead
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 South Prospect St. Rm 1415, Burlington, VT, 05403, USA
| | - Megan E Roberts
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 South Prospect St. Rm 1415, Burlington, VT, 05403, USA
| |
Collapse
|
25
|
Roberts ME, Doogan NJ, Stanton CA, Quisenberry AJ, Villanti AC, Gaalema DE, Keith DR, Kurti AN, Lopez AA, Redner R, Cepeda-Benito A, Higgins ST. Rural Versus Urban Use of Traditional and Emerging Tobacco Products in the United States, 2013-2014. Am J Public Health 2017; 107:1554-1559. [PMID: 28817323 DOI: 10.2105/ajph.2017.303967] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine urban-rural differences in US prevalences of traditional and emerging tobacco product use as well as dual or polytobacco use of these products. METHODS Our data were derived from wave 1 (2013-2014) of the Population Assessment of Tobacco and Health (PATH) Study. We estimated weighted prevalences of adult tobacco use across urban-rural geographies and examined prevalences classified by gender, poverty level, and region of the country. RESULTS Nationally, cigarette use and smokeless tobacco use, as well as dual or polytobacco use of traditional products, were more prevalent in rural than in urban areas. Conversely, cigarillo and hookah use and dual or polytobacco use of emerging products were higher in urban areas. There was no significant urban-rural difference in use of e-cigarettes. Gender, poverty, and region of the country did not seem to be driving most urban-rural differences, although differences related to cigarillo use and dual or polytobacco use of emerging products became nonsignificant after control for covariates. CONCLUSIONS Our findings highlight important urban-rural differences in tobacco use. Whether the changing tobacco product landscape will contribute to a continuation of rural health disparities remains to be seen.
Collapse
Affiliation(s)
- Megan E Roberts
- Megan E. Roberts, Nathan J. Doogan, and Amanda J. Quisenberry are with the Center of Excellence in Regulatory Tobacco Science, Ohio State University, Columbus. Cassandra A. Stanton is with Westat, Center for Evaluation and Coordination of Training and Research in Tobacco Regulatory Science, Rockville, MD. Andrea C. Villanti, Diann E. Gaalema, Diana R. Keith, Allison N. Kurti, Alexa A. Lopez, Antonio Cepeda-Benito, and Stephen T. Higgins are with the Vermont Center on Tobacco Regulatory Science, University of Vermont, Burlington. Ryan Redner is with the Rehabilitation Institute, Southern Illinois University, Carbondale
| | - Nathan J Doogan
- Megan E. Roberts, Nathan J. Doogan, and Amanda J. Quisenberry are with the Center of Excellence in Regulatory Tobacco Science, Ohio State University, Columbus. Cassandra A. Stanton is with Westat, Center for Evaluation and Coordination of Training and Research in Tobacco Regulatory Science, Rockville, MD. Andrea C. Villanti, Diann E. Gaalema, Diana R. Keith, Allison N. Kurti, Alexa A. Lopez, Antonio Cepeda-Benito, and Stephen T. Higgins are with the Vermont Center on Tobacco Regulatory Science, University of Vermont, Burlington. Ryan Redner is with the Rehabilitation Institute, Southern Illinois University, Carbondale
| | - Cassandra A Stanton
- Megan E. Roberts, Nathan J. Doogan, and Amanda J. Quisenberry are with the Center of Excellence in Regulatory Tobacco Science, Ohio State University, Columbus. Cassandra A. Stanton is with Westat, Center for Evaluation and Coordination of Training and Research in Tobacco Regulatory Science, Rockville, MD. Andrea C. Villanti, Diann E. Gaalema, Diana R. Keith, Allison N. Kurti, Alexa A. Lopez, Antonio Cepeda-Benito, and Stephen T. Higgins are with the Vermont Center on Tobacco Regulatory Science, University of Vermont, Burlington. Ryan Redner is with the Rehabilitation Institute, Southern Illinois University, Carbondale
| | - Amanda J Quisenberry
- Megan E. Roberts, Nathan J. Doogan, and Amanda J. Quisenberry are with the Center of Excellence in Regulatory Tobacco Science, Ohio State University, Columbus. Cassandra A. Stanton is with Westat, Center for Evaluation and Coordination of Training and Research in Tobacco Regulatory Science, Rockville, MD. Andrea C. Villanti, Diann E. Gaalema, Diana R. Keith, Allison N. Kurti, Alexa A. Lopez, Antonio Cepeda-Benito, and Stephen T. Higgins are with the Vermont Center on Tobacco Regulatory Science, University of Vermont, Burlington. Ryan Redner is with the Rehabilitation Institute, Southern Illinois University, Carbondale
| | - Andrea C Villanti
- Megan E. Roberts, Nathan J. Doogan, and Amanda J. Quisenberry are with the Center of Excellence in Regulatory Tobacco Science, Ohio State University, Columbus. Cassandra A. Stanton is with Westat, Center for Evaluation and Coordination of Training and Research in Tobacco Regulatory Science, Rockville, MD. Andrea C. Villanti, Diann E. Gaalema, Diana R. Keith, Allison N. Kurti, Alexa A. Lopez, Antonio Cepeda-Benito, and Stephen T. Higgins are with the Vermont Center on Tobacco Regulatory Science, University of Vermont, Burlington. Ryan Redner is with the Rehabilitation Institute, Southern Illinois University, Carbondale
| | - Diann E Gaalema
- Megan E. Roberts, Nathan J. Doogan, and Amanda J. Quisenberry are with the Center of Excellence in Regulatory Tobacco Science, Ohio State University, Columbus. Cassandra A. Stanton is with Westat, Center for Evaluation and Coordination of Training and Research in Tobacco Regulatory Science, Rockville, MD. Andrea C. Villanti, Diann E. Gaalema, Diana R. Keith, Allison N. Kurti, Alexa A. Lopez, Antonio Cepeda-Benito, and Stephen T. Higgins are with the Vermont Center on Tobacco Regulatory Science, University of Vermont, Burlington. Ryan Redner is with the Rehabilitation Institute, Southern Illinois University, Carbondale
| | - Diana R Keith
- Megan E. Roberts, Nathan J. Doogan, and Amanda J. Quisenberry are with the Center of Excellence in Regulatory Tobacco Science, Ohio State University, Columbus. Cassandra A. Stanton is with Westat, Center for Evaluation and Coordination of Training and Research in Tobacco Regulatory Science, Rockville, MD. Andrea C. Villanti, Diann E. Gaalema, Diana R. Keith, Allison N. Kurti, Alexa A. Lopez, Antonio Cepeda-Benito, and Stephen T. Higgins are with the Vermont Center on Tobacco Regulatory Science, University of Vermont, Burlington. Ryan Redner is with the Rehabilitation Institute, Southern Illinois University, Carbondale
| | - Allison N Kurti
- Megan E. Roberts, Nathan J. Doogan, and Amanda J. Quisenberry are with the Center of Excellence in Regulatory Tobacco Science, Ohio State University, Columbus. Cassandra A. Stanton is with Westat, Center for Evaluation and Coordination of Training and Research in Tobacco Regulatory Science, Rockville, MD. Andrea C. Villanti, Diann E. Gaalema, Diana R. Keith, Allison N. Kurti, Alexa A. Lopez, Antonio Cepeda-Benito, and Stephen T. Higgins are with the Vermont Center on Tobacco Regulatory Science, University of Vermont, Burlington. Ryan Redner is with the Rehabilitation Institute, Southern Illinois University, Carbondale
| | - Alexa A Lopez
- Megan E. Roberts, Nathan J. Doogan, and Amanda J. Quisenberry are with the Center of Excellence in Regulatory Tobacco Science, Ohio State University, Columbus. Cassandra A. Stanton is with Westat, Center for Evaluation and Coordination of Training and Research in Tobacco Regulatory Science, Rockville, MD. Andrea C. Villanti, Diann E. Gaalema, Diana R. Keith, Allison N. Kurti, Alexa A. Lopez, Antonio Cepeda-Benito, and Stephen T. Higgins are with the Vermont Center on Tobacco Regulatory Science, University of Vermont, Burlington. Ryan Redner is with the Rehabilitation Institute, Southern Illinois University, Carbondale
| | - Ryan Redner
- Megan E. Roberts, Nathan J. Doogan, and Amanda J. Quisenberry are with the Center of Excellence in Regulatory Tobacco Science, Ohio State University, Columbus. Cassandra A. Stanton is with Westat, Center for Evaluation and Coordination of Training and Research in Tobacco Regulatory Science, Rockville, MD. Andrea C. Villanti, Diann E. Gaalema, Diana R. Keith, Allison N. Kurti, Alexa A. Lopez, Antonio Cepeda-Benito, and Stephen T. Higgins are with the Vermont Center on Tobacco Regulatory Science, University of Vermont, Burlington. Ryan Redner is with the Rehabilitation Institute, Southern Illinois University, Carbondale
| | - Antonio Cepeda-Benito
- Megan E. Roberts, Nathan J. Doogan, and Amanda J. Quisenberry are with the Center of Excellence in Regulatory Tobacco Science, Ohio State University, Columbus. Cassandra A. Stanton is with Westat, Center for Evaluation and Coordination of Training and Research in Tobacco Regulatory Science, Rockville, MD. Andrea C. Villanti, Diann E. Gaalema, Diana R. Keith, Allison N. Kurti, Alexa A. Lopez, Antonio Cepeda-Benito, and Stephen T. Higgins are with the Vermont Center on Tobacco Regulatory Science, University of Vermont, Burlington. Ryan Redner is with the Rehabilitation Institute, Southern Illinois University, Carbondale
| | - Stephen T Higgins
- Megan E. Roberts, Nathan J. Doogan, and Amanda J. Quisenberry are with the Center of Excellence in Regulatory Tobacco Science, Ohio State University, Columbus. Cassandra A. Stanton is with Westat, Center for Evaluation and Coordination of Training and Research in Tobacco Regulatory Science, Rockville, MD. Andrea C. Villanti, Diann E. Gaalema, Diana R. Keith, Allison N. Kurti, Alexa A. Lopez, Antonio Cepeda-Benito, and Stephen T. Higgins are with the Vermont Center on Tobacco Regulatory Science, University of Vermont, Burlington. Ryan Redner is with the Rehabilitation Institute, Southern Illinois University, Carbondale
| |
Collapse
|
26
|
McDonald JL, Lopez AA, Lee JD, Capaldi VF, LoPresti ML. 0269 INSOMNIA, SHORT SLEEP DURATION, AND FAILED TEST PERFORMANCE IN A MILITARY ACADEMIC SETTING. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.268] [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: 11/13/2022] Open
|
27
|
Lopez AA, Eissenberg T, Jaafar M, Afifi R. Now is the time to advocate for interventions designed specifically to prevent and control waterpipe tobacco smoking. Addict Behav 2017; 66:41-47. [PMID: 27871044 DOI: 10.1016/j.addbeh.2016.11.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 10/30/2016] [Accepted: 11/10/2016] [Indexed: 12/26/2022]
Abstract
Waterpipe tobacco usage is spreading rapidly worldwide, with reports of more youth being waterpipe users compared to adults. In many areas of the world, waterpipe usage surpasses cigarette smoking. Waterpipes and cigarettes are both mechanisms for inhalation of tobacco smoke and therefore have serious health consequences. However, because of the many differences between the two products, prevention and control strategies that have proven effective for cigarettes may not transfer readily to waterpipe. This report highlights the differences between waterpipes and cigarettes in toxicant exposure and physiologic effects, patterns of use, social norms, the extent of evidence, and the policy environment. There is little evidence to date around effective interventions for waterpipe prevention and control. The current state of evidence for intervention to curb or control waterpipe is at ground zero and critically needs attention from both scientists and policy makers. National and global efforts aimed at cigarette prevention have succeeded, particularly in developed countries. We suggest the time has come to harness what we know works for cigarette prevention and control and adapt it to tackle the growing epidemic of waterpipe tobacco use.
Collapse
Affiliation(s)
- A A Lopez
- Center for the Study of Tobacco Products, Virginia Commonwealth University, USA; Department of Psychology, Virginia Commonwealth University, USA
| | - T Eissenberg
- Center for the Study of Tobacco Products, Virginia Commonwealth University, USA; Department of Psychology, Virginia Commonwealth University, USA
| | - M Jaafar
- Department of Health Promotion and Community Health, American University of Beirut, Lebanon
| | - R Afifi
- Department of Health Promotion and Community Health, American University of Beirut, Lebanon.
| |
Collapse
|
28
|
Affiliation(s)
- Kenneth Silverman
- Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Brantley P Jarvis
- Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | | | - Alexa A Lopez
- Department of Psychology, Virginia Commonwealth University
| |
Collapse
|
29
|
Lopez AA, Hiler M, Maloney S, Eissenberg T, Breland AB. Expanding clinical laboratory tobacco product evaluation methods to loose-leaf tobacco vaporizers. Drug Alcohol Depend 2016; 169:33-40. [PMID: 27768968 PMCID: PMC5140724 DOI: 10.1016/j.drugalcdep.2016.10.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 08/02/2016] [Revised: 09/29/2016] [Accepted: 10/03/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Novel tobacco products entering the US market include electronic cigarettes (ECIGs) and products advertised to "heat, not burn" tobacco. There is a growing literature regarding the acute effects of ECIGs. Less is known about "heat, not burn" products. This study's purpose was to expand existing clinical laboratory methods to examine, in cigarette smokers, the acute effects of a "heat, not burn" "loose-leaf tobacco vaporizer" (LLTV). METHODS Plasma nicotine and breath carbon monoxide (CO) concentration and tobacco abstinence symptom severity were measured before and after two 10-puff (30-s interpuff interval) product use bouts separated by 60min. LLTV effects were compared to participants' own brand (OB) cigarettes and an ECIG (3.3V; 1.5ohm; 18mg/ml nicotine). RESULTS Relative to OB, LLTV increased plasma nicotine concentration to a lesser degree, did not increase CO, and did not appear to reduce abstinence symptoms as effectively. Relative to ECIG, LLTV nicotine and CO delivery and abstinence symptom suppression did not differ. Participants reported that both the LLTV and ECIG were significantly less satisfying than OB. CONCLUSIONS Results demonstrate that LLTVs are capable of delivering nicotine and suppressing tobacco abstinence symptoms partially; acute effects of these products can be evaluated using existing clinical laboratory methods. Results can inform tobacco product regulation and may be predictive of the extent that these products have the potential to benefit or harm overall public health.
Collapse
Affiliation(s)
- Alexa A Lopez
- Virginia Commonwealth University, Department of Psychology and Center for the Study of Tobacco Products, Box 980205, Richmond, VA 23298-0205, USA
| | - Marzena Hiler
- Virginia Commonwealth University, Department of Psychology and Center for the Study of Tobacco Products, Box 980205, Richmond, VA 23298-0205, USA
| | - Sarah Maloney
- Virginia Commonwealth University, Department of Psychology and Center for the Study of Tobacco Products, Box 980205, Richmond, VA 23298-0205, USA
| | - Thomas Eissenberg
- Virginia Commonwealth University, Department of Psychology and Center for the Study of Tobacco Products, Box 980205, Richmond, VA 23298-0205, USA
| | - Alison B Breland
- Virginia Commonwealth University, Department of Psychology and Center for the Study of Tobacco Products, Box 980205, Richmond, VA 23298-0205, USA.
| |
Collapse
|
30
|
Soule EK, Lopez AA, Guy MC, Cobb CO. Reasons for using flavored liquids among electronic cigarette users: A concept mapping study. Drug Alcohol Depend 2016; 166:168-76. [PMID: 27460860 PMCID: PMC4983519 DOI: 10.1016/j.drugalcdep.2016.07.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 07/08/2016] [Accepted: 07/08/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND Electronic cigarettes (ECIGs) aerosolize liquids often containing flavorants for inhalation. Few studies have examined the role of flavors in ECIG use. This study's purpose was to examine reasons for flavored ECIG use using a mixed-method approach, concept mapping (CM). METHODS Forty-six past 30-day adult ECIG users recruited from vape forums/conferences completed three online CM tasks. Participants brainstormed responses to a prompt: "A specific reason I use flavored e-liquid in my electronic cigarette product is…". The final 107 brainstormed statements were sorted by participants into groups of similar content. Participants rated each statement on a 7-point scale (1-Definitely NOT a reason to 7-Definitely a reason) based on a prompt: "This is a specific reason why I used flavored e-liquid in my electronic cigarette product in the past month." A cluster map was generated from participants' sorting and ratings using CM statistical software. Cluster mean ratings were compared. RESULTS Analysis revealed five clusters of reasons for flavored ECIG use including Increased Satisfaction/Enjoyment, Better Feel/Taste than Cigarettes, Variety/Customization, Food Craving Suppression, and Social Impacts. Statements in the Increased Satisfaction/Enjoyment and Better Feel/Taste than Cigarettes clusters were rated significantly higher than statements from other clusters (ps<0.05). Some statements indicated flavors were perceived as masking agents for nicotine or other bad tastes associated with cigarette smoking making ECIG use more palatable. CONCLUSIONS Flavored ECIGs are used for many reasons. Some statements suggested flavors may increase the rewarding and possible addictive effects of ECIGs. These results support continued examination of the role of flavors and ECIG use behaviors.
Collapse
Affiliation(s)
- Eric K. Soule
- Virginia Commonwealth University, Department of Psychology, Center for the Study of Tobacco Products, PO Box 980205, Richmond, VA 23298
| | - Alexa A. Lopez
- Virginia Commonwealth University, Department of Psychology, Center for the Study of Tobacco Products, PO Box 980205, Richmond, VA 23298
| | - Mignonne C. Guy
- Virginia Commonwealth University, Department of Psychology, Center for the Study of Tobacco Products, PO Box 980205, Richmond, VA 23298,Virginia Commonwealth University, Department of African American Studies, PO Box 842509, Richmond, VA 23284
| | - Caroline O. Cobb
- Virginia Commonwealth University, Department of Psychology, Center for the Study of Tobacco Products, PO Box 980205, Richmond, VA 23298
| |
Collapse
|
31
|
Bangasser DA, Rozensky RH, Fowler GA, Kraha A, Lopez AA, O'Connor M, Worrell FC, Kaslow NJ. Psychology’s core knowledge, scientific subfields, and health service specialization: Preparing a competent workforce—recommendations from the Opening Doors Summit. Training and Education in Professional Psychology 2016. [DOI: 10.1037/tep0000117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
32
|
Lopez AA, Cobb CO, Yingst JM, Veldheer S, Hrabovsky S, Yen MS, Foulds J, Eissenberg T. A transdisciplinary model to inform randomized clinical trial methods for electronic cigarette evaluation. BMC Public Health 2016; 16:217. [PMID: 26941050 PMCID: PMC4778292 DOI: 10.1186/s12889-016-2792-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 12/30/2015] [Accepted: 01/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study is a systematic evaluation of a novel tobacco product, electronic cigarettes (ECIGs) using a two-site, four-arm, 6-month, parallel-group randomized controlled trial (RCT) with a follow-up to 9 months. Virginia Commonwealth University is the primary site and Penn State University is the secondary site. This RCT design is important because it is informed by analytical work, clinical laboratory results, and qualitative/quantitative findings regarding the specific ECIG products used. METHODS Participants (N = 520) will be randomized across sites and must be healthy smokers of >9 cigarettes for at least one year, who have not had a quit attempt in the prior month, are not planning to quit in the next 6 months, and are interested in reducing cigarette intake. Participants will be randomized into one of four 24-week conditions: a cigarette substitute that does not produce an inhalable aerosol; or one of three ECIG conditions that differ by nicotine concentration 0, 8, or 36 mg/ml. Blocked randomization will be accomplished with a 1:1:1:1 ratio of condition assignments at each site. Specific aims are to: characterize ECIG influence on toxicants, biomarkers, health indicators, and disease risk; determine tobacco abstinence symptom and adverse event profile associated with real-world ECIG use; and examine the influence of ECIG use on conventional tobacco product use. Liquid nicotine concentration-related differences on these study outcomes are predicted. Participants and research staff in contact with participants will be blinded to the nicotine concentration in the ECIG conditions. DISCUSSION Results from this study will inform knowledge concerning ECIG use as well as demonstrate a model that may be applied to other novel tobacco products. The model of using prior empirical testing of ECIG devices should be considered in other RCT evaluations. TRIAL REGISTRATION TRN: NCT02342795 , registered December 16, 2014.
Collapse
Affiliation(s)
- Alexa A Lopez
- Center for the Study of Tobacco Products, Virginia Commonwealth University, 1112 East Clay Street, Suite B-08, Box 980205, Richmond, VA, 23298, USA.,Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Caroline O Cobb
- Center for the Study of Tobacco Products, Virginia Commonwealth University, 1112 East Clay Street, Suite B-08, Box 980205, Richmond, VA, 23298, USA.,Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Jessica M Yingst
- Tobacco Center of Regulatory Science, Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA.,Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Susan Veldheer
- Tobacco Center of Regulatory Science, Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA.,Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Shari Hrabovsky
- Tobacco Center of Regulatory Science, Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA.,Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Miao-Shan Yen
- Center for the Study of Tobacco Products, Virginia Commonwealth University, 1112 East Clay Street, Suite B-08, Box 980205, Richmond, VA, 23298, USA.,Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Jonathan Foulds
- Tobacco Center of Regulatory Science, Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA.,Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Thomas Eissenberg
- Center for the Study of Tobacco Products, Virginia Commonwealth University, 1112 East Clay Street, Suite B-08, Box 980205, Richmond, VA, 23298, USA. .,Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.
| |
Collapse
|
33
|
Mendoza ES, Lopez AA, Valdez VAU, Cunanan EC, Matawaran BJ, Kho SA, Sero-Gomez MH. Predictors of incomplete response to therapy among Filipino patients with papillary thyroid cancer in a tertiary hospital. J Endocrinol Invest 2016; 39:55-62. [PMID: 26036600 DOI: 10.1007/s40618-015-0319-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 05/21/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Although survival rate in papillary thyroid cancer (PTC) is high, the risk of persistence and recurrence together with the dramatic rise in its incidence cannot be overemphasized. Filipinos are considered to be at greater risk for negative outcomes. A paradigm shift in the management of PTC introduces re-stratification based on response to therapy which was reported to have better correlation with long-term outcome. The study aimed to identify predictors of incomplete response after thyroidectomy and radioiodine therapy among patients with PTC. The results of the study may have important implications in our understanding of the disease process allowing more aggressive treatment and monitoring of certain subgroups of patients. METHODOLOGY Retrospective review of 225 patients with PTC (59% ATA low risk, 30 % ATA intermediate risk and 11% ATA high risk) who underwent thyroidectomy and radioiodine therapy was performed. Thirteen variables were considered (age, gender, histopathological variant, stage, extent of disease, MACIS score, AMES score, primary tumour size, lymph node, lymphovascular invasion, bilaterality, multifocality and preoperative TSH level). Logistic regression analysis using Backward Wald algorithm was used to identify independent predictors of incomplete response to therapy after 24 months. RESULTS Of the 225 patients, 69 (31%) had incomplete response. Biochemical and structural (predominantly thyroid bed, lung and bone) incomplete response was observed in 6 and 63 patients, respectively. Incomplete response was documented in 8, 54 and 92% of low-, intermediate- and high-risk patients based on ATA recommendation. Incomplete response was significantly dependent on gender, lymph node involvement and location, extent of malignancy and multifocality taking into account the size of concurrent tumours (p < 0.05). The model was found to have high sensitivity (71%) and specificity (96%). CONCLUSION A significant fraction of PTC patients experienced incomplete response to therapy. Our data suggest that male gender, lateral or mediastinal lymph node involvement, class III extent of disease by De Groot and multifocality with concurrent tumour or tumours more than 1 cm are major predictors of incomplete response. Not all predictors of recurrence and mortality are consistent predictors of treatment response which may be equally important in a disease with low mortality but significant morbidity like PTC.
Collapse
Affiliation(s)
- E S Mendoza
- Section of Endocrinology Diabetes and Metabolism, Department of Medicine, University of Santo Tomas Hospital, Manila, Philippines.
| | - A A Lopez
- Section of Endocrinology Diabetes and Metabolism, Department of Medicine, University of Santo Tomas Hospital, Manila, Philippines.
| | - V A U Valdez
- Section of Endocrinology Diabetes and Metabolism, Department of Medicine, University of Santo Tomas Hospital, Manila, Philippines.
| | - E C Cunanan
- Section of Endocrinology Diabetes and Metabolism, Department of Medicine, University of Santo Tomas Hospital, Manila, Philippines.
| | - B J Matawaran
- Section of Endocrinology Diabetes and Metabolism, Department of Medicine, University of Santo Tomas Hospital, Manila, Philippines.
| | - S A Kho
- Section of Endocrinology Diabetes and Metabolism, Department of Medicine, University of Santo Tomas Hospital, Manila, Philippines.
| | - M H Sero-Gomez
- Section of Endocrinology Diabetes and Metabolism, Department of Medicine, University of Santo Tomas Hospital, Manila, Philippines.
| |
Collapse
|
34
|
Avila M, Dyment DA, Sagen JV, St-Onge J, Moog U, Chung BHY, Mo S, Mansour S, Albanese A, Garcia S, Martin DO, Lopez AA, Claudi T, König R, White SM, Sawyer SL, Bernstein JA, Slattery L, Jobling RK, Yoon G, Curry CJ, Merrer ML, Luyer BL, Héron D, Mathieu-Dramard M, Bitoun P, Odent S, Amiel J, Kuentz P, Thevenon J, Laville M, Reznik Y, Fagour C, Nunes ML, Delesalle D, Manouvrier S, Lascols O, Huet F, Binquet C, Faivre L, Rivière JB, Vigouroux C, Njølstad PR, Innes AM, Thauvin-Robinet C. Clinical reappraisal of SHORT syndrome with PIK3R1 mutations: toward recommendation for molecular testing and management. Clin Genet 2015; 89:501-506. [PMID: 26497935 DOI: 10.1111/cge.12688] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [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: 08/03/2015] [Revised: 10/10/2015] [Accepted: 10/16/2015] [Indexed: 12/01/2022]
Abstract
SHORT syndrome has historically been defined by its acronym: short stature (S), hyperextensibility of joints and/or inguinal hernia (H), ocular depression (O), Rieger abnormality (R) and teething delay (T). More recently several research groups have identified PIK3R1 mutations as responsible for SHORT syndrome. Knowledge of the molecular etiology of SHORT syndrome has permitted a reassessment of the clinical phenotype. The detailed phenotypes of 32 individuals with SHORT syndrome and PIK3R1 mutation, including eight newly ascertained individuals, were studied to fully define the syndrome and the indications for PIK3R1 testing. The major features described in the SHORT acronym were not universally seen and only half (52%) had four or more of the classic features. The commonly observed clinical features of SHORT syndrome seen in the cohort included intrauterine growth restriction (IUGR) <10th percentile, postnatal growth restriction, lipoatrophy and the characteristic facial gestalt. Anterior chamber defects and insulin resistance or diabetes were also observed but were not as prevalent. The less specific, or minor features of SHORT syndrome include teething delay, thin wrinkled skin, speech delay, sensorineural deafness, hyperextensibility of joints and inguinal hernia. Given the high risk of diabetes mellitus, regular monitoring of glucose metabolism is warranted. An echocardiogram, ophthalmological and hearing assessments are also recommended.
Collapse
Affiliation(s)
- M Avila
- EA4271 "Génétique des Anomalies du Développement" (GAD), Université de Bourgogne, Dijon, France.,Service de Pédiatrie 1, Centre Hospitalier Universitaire Dijon, Dijon, France
| | - D A Dyment
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
| | - J V Sagen
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway.,KJ Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - J St-Onge
- EA4271 "Génétique des Anomalies du Développement" (GAD), Université de Bourgogne, Dijon, France.,CHU Dijon, Laboratoire de Génétique Moléculaire, Dijon, France
| | - U Moog
- Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany
| | - B H Y Chung
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - S Mo
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - S Mansour
- SW Thames Regional Genetics Service, St. George's Hospital Medical School, London, SW17 0RE, UK
| | - A Albanese
- Paediatric Endocrine Unit, St George's Hospital, London, UK
| | - S Garcia
- Institute of Medical and Molecular Genetics (INGEMM), La Paz University Hospital, Madrid, Spain.,Instituto de Salud Carlos III, Unit 753, Centro de Investigacion Biomedica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - D O Martin
- Department of Ophthalmology, Hospital Central de la Cruz Roja San Jose y Santa Adela, Madrid, Spain
| | - A A Lopez
- Puerta de Hierro, University Hospital, Madrid, Spain
| | - T Claudi
- Department of Medicine, Bodø, Norway
| | - R König
- Department of Human Genetics, University of Frankfurt, Frankfurt, Germany
| | - S M White
- Victorian Clinical genetics Services, Murdoch Childrens Research institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - S L Sawyer
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
| | - J A Bernstein
- Division of Medical Genetics, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - L Slattery
- Division of Medical Genetics, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - R K Jobling
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - G Yoon
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - C J Curry
- Genetic Medicine/, University of California, San Francisco, CA, USA
| | - M L Merrer
- Département de Génétique, Hôpital Necker Enfants Malades, Paris, France
| | - B L Luyer
- Service de Pédiatrie, CH Le Havre, Le Havre, France
| | - D Héron
- Département de Génétique et Centre de Référence "Déficiences intellectuelles de causes rares", Paris, France
| | | | - P Bitoun
- Service de Pédiatrie, Bondy, France
| | - S Odent
- Service de Génétique clinique, Rennes, France.,UMR CNRS 6290 IGDR, Universitė Rennes, Rennes, France
| | - J Amiel
- Département de Génétique, Hôpital Necker Enfants Malades, Paris, France
| | - P Kuentz
- EA4271 "Génétique des Anomalies du Développement" (GAD), Université de Bourgogne, Dijon, France
| | - J Thevenon
- EA4271 "Génétique des Anomalies du Développement" (GAD), Université de Bourgogne, Dijon, France.,Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs de l'interrégion Est, FHU-TRANSLAD, Dijon, France
| | - M Laville
- Département d'Endocrinologie, Diabétologie et Nutrition, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France.,Institut National de la Santé et de la Recherche Médicale Unité 1060, Centre Européen pour la nutrition et la Santé, Centre de Recherche en Nutrition Humaine Rhône-Alpes, Université Claude Bernard Lyon, Pierre-Bénite, France
| | - Y Reznik
- Service d'Endocrinologie, Centre Hospitalier Universitaire Côte-de-Nacre, Caen, France
| | - C Fagour
- Département d'Endocrinologie, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - M-L Nunes
- Département d'Endocrinologie, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - D Delesalle
- Service de pédiatrie, CH de Valencienne, Valencienne, France
| | - S Manouvrier
- Centre de Référence CLAD NdF - Service de génétique clinique Guy Fontaine, CHRU de Lille - Hôpital Jeanne de Flandre, Lille, France
| | - O Lascols
- INSERM, UMR_S938, Centre de Recherche Saint-Antoine, Paris, France.,UPMC Univ Paris 06, Paris, France.,ICAN, Institute of Cardiometabolism And Nutrition, Groupe Hospitalier Universitaire La Pitié-Salpêtrière, Paris, France.,AP-HP, Hôpital Saint-Antoine, Laboratoire Commun de Biologie et Génétique Moléculaires, Paris, France
| | - F Huet
- EA4271 "Génétique des Anomalies du Développement" (GAD), Université de Bourgogne, Dijon, France.,Service de Pédiatrie 1, Centre Hospitalier Universitaire Dijon, Dijon, France
| | - C Binquet
- Centre d'Investigation Clinique-Epidémiologique Clinique/essais cliniques du CHU de Dijon, Dijon, France
| | - L Faivre
- EA4271 "Génétique des Anomalies du Développement" (GAD), Université de Bourgogne, Dijon, France.,Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs de l'interrégion Est, FHU-TRANSLAD, Dijon, France
| | - J-B Rivière
- EA4271 "Génétique des Anomalies du Développement" (GAD), Université de Bourgogne, Dijon, France.,CHU Dijon, Laboratoire de Génétique Moléculaire, Dijon, France
| | - C Vigouroux
- INSERM, UMR_S938, Centre de Recherche Saint-Antoine, Paris, France.,UPMC Univ Paris 06, Paris, France.,ICAN, Institute of Cardiometabolism And Nutrition, Groupe Hospitalier Universitaire La Pitié-Salpêtrière, Paris, France.,AP-HP, Hôpital Saint-Antoine, Laboratoire Commun de Biologie et Génétique Moléculaires, Paris, France
| | - P R Njølstad
- Department of Pediatrics, Haukeland, University Hospital, Bergen, Norway
| | - A M Innes
- Department of Medical Genetics, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute for Child and Maternal Health, University of Calgary, Calgary, Canada
| | - C Thauvin-Robinet
- EA4271 "Génétique des Anomalies du Développement" (GAD), Université de Bourgogne, Dijon, France.,Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs de l'interrégion Est, FHU-TRANSLAD, Dijon, France
| |
Collapse
|
35
|
Abstract
OBJECTIVE Electronic cigarettes (ECIGs) have continued to gain popularity among the general public since their introduction in 2003. While all ECIGs work by heating a liquid solution into an aerosol that is then inhaled by the user, there are differences in engineering characteristics and appearance of the devices as well as how the liquid is stored and heated, its nicotine concentration, its ratio of propylene glycol and/or vegetable glycerin, and the flavorants added to the liquid. Some of the research areas previously examined with ECIGs include aerosol toxicant yield, user puffing behavior, physiological effects, subjective effects, abuse liability, and effects on smoking cessation. CONCLUSION Much of this work used earlier device models that delivered very little nicotine to the user, and additional research needs to be conducted using consistent and reliable devices, assays, and methodologies in order to gain a clearer understanding of ECIGs and their implications for individual and public health. Furthermore, the effects that ECIGs have on smoking cessation and among vulnerable populations must be addressed empirically.
Collapse
Affiliation(s)
- Alexa A Lopez
- Center for the Study of Tobacco Products, Virginia Commonwealth University, United States; Department of Psychology, Virginia Commonwealth University, United States
| | - Thomas Eissenberg
- Center for the Study of Tobacco Products, Virginia Commonwealth University, United States; Department of Psychology, Virginia Commonwealth University, United States.
| |
Collapse
|
36
|
Lopez AA, Hiler MM, Soule EK, Ramôa CP, Karaoghlanian NV, Lipato T, Breland AB, Shihadeh AL, Eissenberg T. Effects of Electronic Cigarette Liquid Nicotine Concentration on Plasma Nicotine and Puff Topography in Tobacco Cigarette Smokers: A Preliminary Report. Nicotine Tob Res 2015; 18:720-3. [PMID: 26377515 DOI: 10.1093/ntr/ntv182] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 08/16/2015] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Electronic cigarettes (ECIGs) aerosolize a liquid that usually contains propylene glycol and/or vegetable glycerin, flavorants, and the dependence-producing drug nicotine in various concentrations. This study examined the extent to which ECIG liquid nicotine concentration is related to user plasma nicotine concentration in ECIG-naïve tobacco cigarette smokers. METHODS Sixteen ECIG-naïve cigarette smokers completed four laboratory sessions that differed by the nicotine concentration of the liquid (0, 8, 18, or 36 mg/ml) that was placed into a 1.5 Ohm, dual coil "cartomizer" powered by a 3.3V battery. In each session, participants completed two, 10-puff ECIG use bouts with a 30-second inter-puff interval; bouts were separated by 60 minutes. Venous blood was sampled before and after bouts for later analysis of plasma nicotine concentration; puff duration, volume, and average flow rate were measured during each bout. RESULTS In bout 1, relative to the 0mg/ml nicotine condition (mean = 3.8 ng/ml, SD = 3.3), plasma nicotine concentration increased significantly immediately after the bout for the 8 (mean = 8.8 ng/ml, SD = 6.3), 18 (mean = 13.2 ng/ml, SD = 13.2), and 36 mg/ml (mean = 17.0 ng/ml, SD = 17.9) liquid concentration. A similar pattern was observed after bout 2. Average puff duration in the 36 mg/ml condition was significantly shorter compared to the 0mg/ml nicotine condition. Puff volume increased during the second bout for 8 and 18 mg/ml conditions. CONCLUSIONS For a given ECIG device, nicotine delivery may be directly related to liquid concentration. ECIG-naïve cigarette smokers can, from their first use bout, attain cigarette-like nicotine delivery profiles with some currently available ECIG products. IMPLICATIONS Liquid nicotine concentration can influence plasma nicotine concentration in ECIG-naïve cigarette smokers, and, at some concentrations, the nicotine delivery profile of a 3.3V ECIG with a dual coil, 1.5-Ohm cartomizer approaches that of a combustible tobacco cigarette in this population. Finding a product that delivers nicotine as effectively as a tobacco cigarette, as we report here, may be essential for smokers who want to replace completely their combustible tobacco cigarettes with ECIGs.
Collapse
Affiliation(s)
- Alexa A Lopez
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA; Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Marzena M Hiler
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA; Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Eric K Soule
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA; Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Carolina P Ramôa
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA; Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Nareg V Karaoghlanian
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA; Department of Mechanical Engineering, American University of Beirut, Beirut, Lebanon
| | - Thokozeni Lipato
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA; Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA
| | - Alison B Breland
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA; Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Alan L Shihadeh
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA; Department of Mechanical Engineering, American University of Beirut, Beirut, Lebanon
| | - Thomas Eissenberg
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA; Department of Psychology, Virginia Commonwealth University, Richmond, VA;
| |
Collapse
|
37
|
Lopez AA, Skelly JM, Higgins ST. Financial incentives for smoking cessation among depression-prone pregnant and newly postpartum women: effects on smoking abstinence and depression ratings. Nicotine Tob Res 2015; 17:455-62. [PMID: 25762756 DOI: 10.1093/ntr/ntu193] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION We examined whether pregnant and newly postpartum smokers at risk for postpartum depression respond to an incentive-based smoking-cessation treatment and how the intervention impacts depression ratings. METHODS This study is a secondary data analysis. Participants (N = 289; data collected 2001-2013) were smokers at the start of prenatal care who participated in 4 controlled clinical trials on the efficacy of financial incentives for smoking cessation. Women were assigned either to an intervention wherein they earned vouchers exchangeable for retail items contingent on abstaining from smoking or to a control condition wherein they received vouchers of comparable value independent of smoking status. Treatments were provided antepartum through 12-weeks postpartum. Depression ratings (Beck Depression Inventory [BDI]-1A) were examined across 7 antepartum/postpartum assessments. Women who reported a history of prior depression or who had BDI scores ≥ 17 at the start of prenatal care were categorized as depression-prone (Dep+), while those meeting neither criterion were categorized as depression-negative (Dep-). RESULTS The intervention increased smoking abstinence independent of depression status (p < .001), and it decreased mean postpartum BDI ratings as well as the proportion of women scoring in the clinical range (≥17 and >21) compared with the control treatment (ps ≤ .05). Treatment effects on depression ratings were attributable to changes in Dep+ women. CONCLUSIONS These results demonstrate that depression-prone pregnant and newly postpartum women respond well to this incentive-based smoking-cessation intervention in terms of achieving abstinence, and the intervention also reduces the severity of postpartum depression ratings in this at-risk population.
Collapse
Affiliation(s)
| | - Joan M Skelly
- Department of Medical Biostatistics, University of Vermont, Burlington, VT
| | | |
Collapse
|
38
|
Ramôa CP, Hiler MM, Spindle TR, Lopez AA, Karaoghlanian N, Lipato T, Breland AB, Shihadeh A, Eissenberg T. Electronic cigarette nicotine delivery can exceed that of combustible cigarettes: a preliminary report. Tob Control 2015; 25:e6-9. [PMID: 26324250 DOI: 10.1136/tobaccocontrol-2015-052447] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [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: 05/05/2015] [Accepted: 08/13/2015] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Electronic cigarettes (ECIGs) aerosolise a liquid that usually contains propylene glycol and/or vegetable glycerine, flavourants and the dependence-producing drug, nicotine, in various concentrations. This laboratory study examined the relationship between liquid nicotine concentration and plasma nicotine concentration and puffing behaviour in experienced ECIG users. METHODS Sixteen ECIG-experienced participants used a 3.3-Volt ECIG battery attached to a 1.5-Ohm dual-coil 'cartomiser' loaded with 1 mL of a flavoured propylene glycol/vegetable glycerine liquid to complete four sessions, at least 2 days apart, that differed by nicotine concentration (0, 8, 18 or 36 mg/mL). In each session, participants completed two 10-puff ECIG-use bouts (30 s puff interval) separated by 60 min. Venous blood was sampled to determine plasma nicotine concentration. Puff duration, volume and average flow rate were measured. RESULTS Immediately after bout 1, mean plasma nicotine concentration was 5.5 ng/mL (SD=7.7) for 0 mg/mL liquid, with significantly (p<0.05) higher mean concentrations observed for the 8 (mean=17.8 ng/mL, SD=14.6), 18 (mean=25.9 ng/mL, SD=17.5) and 36 mg/mL (mean=30.2 ng/mL; SD=20.0) concentrations; a similar pattern was observed for bout 2. For bout 1, at 36 mg/mL, the mean post- minus pre-bout difference was 24.1 ng/mL (SD=18.3). Puff topography data were consistent with previous results and revealed few reliable differences across conditions. DISCUSSION This study demonstrates a relationship between ECIG liquid nicotine concentration and user plasma nicotine concentration in experienced ECIG users. Nicotine delivery from some ECIGs may exceed that of a combustible cigarette. The rationale for this higher level of nicotine delivery is uncertain.
Collapse
Affiliation(s)
- Carolina P Ramôa
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Marzena M Hiler
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Tory R Spindle
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Alexa A Lopez
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Nareg Karaoghlanian
- Department of Mechanical Engineering, American University of Beirut, Beirut, Lebanon
| | - Thokozeni Lipato
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Alison B Breland
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Alan Shihadeh
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA Department of Mechanical Engineering, American University of Beirut, Beirut, Lebanon
| | - Thomas Eissenberg
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| |
Collapse
|
39
|
Lopez AA, Skelly JM, White TJ, Higgins ST. Does impulsiveness moderate response to financial incentives for smoking cessation among pregnant and newly postpartum women? Exp Clin Psychopharmacol 2015; 23:97-108. [PMID: 25730417 PMCID: PMC4388785 DOI: 10.1037/a0038810] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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] [Indexed: 11/08/2022]
Abstract
We examined whether impulsiveness moderates response to financial incentives for cessation among pregnant smokers. Participants were randomized to receive financial incentives delivered contingent on smoking abstinence or to a control condition wherein incentives were delivered independent of smoking status. The study was conducted in two steps: First, we examined associations between baseline impulsiveness and abstinence at late pregnancy and 24-weeks-postpartum as part of a planned prospective study of this topic using data from a recently completed, randomized controlled clinical trial (N = 118). Next, to increase statistical power, we conducted a second analysis collapsing results across that recent trial and two prior trials involving the same study conditions (N = 236). Impulsivity was assessed using a delay discounting (DD) of hypothetical monetary rewards task in all three trials and Barratt Impulsiveness Scale (BIS) in the most recent trial. Neither DD nor BIS predicted smoking status in the single or combined trials. Receiving abstinence-contingent incentives, lower baseline smoking rate, and a history of quit attempts prepregnancy predicted greater odds of antepartum abstinence across the single and combined trials. No variable predicted postpartum abstinence across the single and combined trials, although a history of antepartum quit attempts and receiving abstinence-contingent incentives predicted in the single and combined trials, respectively. Overall, this study provides no evidence that impulsiveness as assessed by DD or BIS moderates response to this treatment approach while underscoring a substantial association of smoking rate and prior quit attempts with abstinence across the contingent incentives and control treatment conditions.
Collapse
Affiliation(s)
- Alexa A. Lopez
- Vermont Center on Behavior & Health, University of Vermont,Department of Psychiatry, University of Vermont,Department of Psychology, University of Vermont
| | - Joan M. Skelly
- Department of Medical Biostatistics, University of Vermont
| | - Thomas J. White
- Vermont Center on Behavior & Health, University of Vermont,Department of Psychiatry, University of Vermont
| | - Stephen T. Higgins
- Vermont Center on Behavior & Health, University of Vermont,Department of Psychiatry, University of Vermont,Department of Psychology, University of Vermont
| |
Collapse
|
40
|
Higgins ST, Washio Y, Lopez AA, Heil SH, Solomon LJ, Lynch ME, Hanson JD, Higgins TM, Skelly JM, Redner R, Bernstein IM. Examining two different schedules of financial incentives for smoking cessation among pregnant women. Prev Med 2014; 68:51-7. [PMID: 24704135 PMCID: PMC4183736 DOI: 10.1016/j.ypmed.2014.03.024] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [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: 11/08/2013] [Revised: 03/19/2014] [Accepted: 03/24/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To examine whether an efficacious voucher-based incentives intervention for decreasing smoking during pregnancy and increasing fetal growth could be improved without increasing costs. The strategy was to redistribute the usual incentives so that higher values were available early in the quit attempt. METHOD 118 pregnant smokers in greater Burlington, Vermont (studied December, 2006-June, 2012) were randomly assigned to the revised contingent voucher (RCV) or usual contingent voucher (CV) schedule of abstinence-contingent vouchers, or to a non-contingent voucher (NCV) control condition wherein vouchers were provided independent of smoking status. Smoking status was biochemically verified; serial sonographic estimates of fetal growth were obtained at gestational weeks 30-34. RESULTS RCV and CV conditions increased point-prevalence abstinence above NCV levels at early (RCV: 40%, CV: 46%, NCV: 13%, p=.007) and late-pregnancy (RCV: 45%; CV: 36%; NCV, 18%; p=.04) assessments, but abstinence levels did not differ between the RCV and CV conditions. The RCV intervention did not increase fetal growth above control levels while the CV condition did so (p<.05). CONCLUSION This trial further supports the efficacy of CV for increasing antepartum abstinence and fetal growth, but other strategies (e.g., increasing overall incentive values) will be necessary to improve outcomes further.
Collapse
Affiliation(s)
- Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA; Department of Psychology, University of Vermont, USA.
| | - Yukiko Washio
- Department of Psychiatry, University of Vermont, USA
| | - Alexa A Lopez
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA; Department of Psychology, University of Vermont, USA
| | - Sarah H Heil
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA; Department of Psychology, University of Vermont, USA
| | | | - Mary Ellen Lynch
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA
| | | | | | - Joan M Skelly
- Department of Medical Biostatistics, University of Vermont, USA
| | - Ryan Redner
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA
| | - Ira M Bernstein
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, USA
| |
Collapse
|
41
|
Bradstreet MP, Higgins ST, McClernon FJ, Kozink RV, Skelly JM, Washio Y, Lopez AA, Parry MA. Examining the effects of initial smoking abstinence on response to smoking-related stimuli and response inhibition in a human laboratory model. Psychopharmacology (Berl) 2014; 231:2145-58. [PMID: 24337077 PMCID: PMC4123458 DOI: 10.1007/s00213-013-3360-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 03/05/2013] [Accepted: 11/17/2013] [Indexed: 12/20/2022]
Abstract
RATIONALE Research is needed on initial smoking abstinence and relapse risk. OBJECTIVE This study aims to investigate the effects of different durations of initial abstinence on sensitivity to smoking-related stimuli and response inhibition in the context of a larger battery of outcome measures. METHODS Smokers were randomly assigned to receive payment contingent on smoking abstinence across all 15 study days (15C) or just the final 2 days (2C). Smoking status and subject ratings were assessed daily. Participants completed fMRI sessions at baseline and day 14 during which they completed craving ratings after exposure to smoking-related and neutral stimuli and performed a response inhibition task. On day 15, participants completed a smoking preference session involving 20 exclusive choices between smoking and money. RESULTS The payment contingencies were effective in producing greater smoking abstinence in the 15C vs. 2C conditions. Ratings of withdrawal decreased, while ratings of ease and confidence in abstaining increased in the 15C vs. 2C conditions across the 15-day study. 15C participants were less likely to choose the smoking option in the preference session. 15C participants reported greater reductions in craving compared to the 2C participants in the presence of smoking-related and neutral stimuli (i.e., decreases in generalized craving), but no differences were noted in cue reactivity per se or in response inhibition. CONCLUSIONS Results systematically replicate prior observations that a period 2 weeks of initial abstinence decreases the relative reinforcing effects of smoking and improves other outcomes associated with relapse risk compared to the initial day or two of a cessation effort, and extends them by underscoring the importance of generalized rather than cue-induced craving in relation to relapse risk during the initial weeks of smoking cessation.
Collapse
Affiliation(s)
- Matthew P. Bradstreet
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
- Department of Psychology, University of Vermont, Burlington, VT, USA
| | - Stephen T. Higgins
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
- Department of Psychology, University of Vermont, Burlington, VT, USA
| | - F. Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Rachel V. Kozink
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Joan M. Skelly
- Department of Medical Biostatistics, University of Vermont, Burlington, VT, USA
| | - Yukiko Washio
- The Treatment Research Institute, Philadelphia, PA, USA
| | - Alexa A. Lopez
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
- Department of Psychology, University of Vermont, Burlington, VT, USA
| | - Marie A. Parry
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| |
Collapse
|
42
|
Marcadet DM, Blanc AS, Lopez AA, Preziosi JP, Guignard MM, Baggio S, Sassano P. [Efficacy and tolerance of LA 50 mg nicardipine in hypertensive athletes]. Arch Mal Coeur Vaiss 1991; 84:1569-74. [PMID: 1763923] [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] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The beneficial effects of physical exercise on the blood pressure are widely recognised. Nevertheless, some athletes remain hypertensive and the treatment of this population makes special demands with respect to treatment efficacy and tolerability, the respect of athletic performance and problems of proscribed substances. For example, the Athletic Boards have prohibited betablockers and diuretics in competitive athletes. The aim of this study was to assess nicardipine LA 50 mg administered twice daily in the special context of hypertensive athletes. Thirty-eight athletes with mild or moderate hypertension undergoing endurance training were included in this double blind trial versus placebo. After two months treatment, the systolic and diastolic blood pressures were significantly lower at rest in the nicardipine than in the placebo group (delta SBP = -18.9 vs -4.1 mmHg, p less than 0.001; delta DBP = -15.7 vs -4.1 mmHg, p less than 0.01). In addition the maximum SBP on effort was significantly lower in the nicardipine group (200 vs 215 mmHg, p less than 0.05). On the other hand, no difference was observed between the two groups as regards the maximum oxygen consumption (delta VO2 max = 6.2 vs -0.4 ml/min/kg, NS) and duration of effort (13.75 vs 12.32 min, NS), showing that athletic performance was unchanged in the group treated by nicardipine LA. These results suggest that treatment with nicardipine LA fulfills the special criteria of hypertensive athletes.
Collapse
|
43
|
Mendes EG, Abbud L, Lopez AA. Pharmacological studies on the invertebrate non-striated muscles. I. The response to drugs. Comp Gen Pharmacol 1970; 1:11-22. [PMID: 5527539 DOI: 10.1016/0010-4035(70)90003-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|