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Streck JM, Rigotti NA, Livingstone-Banks J, Tindle HA, Clair C, Munafò MR, Sterling-Maisel C, Hartmann-Boyce J. Interventions for smoking cessation in hospitalised patients. Cochrane Database Syst Rev 2024; 5:CD001837. [PMID: 38770804 PMCID: PMC11106804 DOI: 10.1002/14651858.cd001837.pub4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND In 2020, 32.6% of the world's population used tobacco. Smoking contributes to many illnesses that require hospitalisation. A hospital admission may prompt a quit attempt. Initiating smoking cessation treatment, such as pharmacotherapy and/or counselling, in hospitals may be an effective preventive health strategy. Pharmacotherapies work to reduce withdrawal/craving and counselling provides behavioural skills for quitting smoking. This review updates the evidence on interventions for smoking cessation in hospitalised patients, to understand the most effective smoking cessation treatment methods for hospitalised smokers. OBJECTIVES To assess the effects of any type of smoking cessation programme for patients admitted to an acute care hospital. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 7 September 2022. SELECTION CRITERIA We included randomised and quasi-randomised studies of behavioural, pharmacological or multicomponent interventions to help patients admitted to hospital quit. Interventions had to start in the hospital (including at discharge), and people had to have smoked within the last month. We excluded studies in psychiatric, substance and rehabilitation centres, as well as studies that did not measure abstinence at six months or longer. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcome was abstinence from smoking assessed at least six months after discharge or the start of the intervention. We used the most rigorous definition of abstinence, preferring biochemically-validated rates where reported. We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included 82 studies (74 RCTs) that included 42,273 participants in the review (71 studies, 37,237 participants included in the meta-analyses); 36 studies are new to this update. We rated 10 studies as being at low risk of bias overall (low risk in all domains assessed), 48 at high risk of bias overall (high risk in at least one domain), and the remaining 24 at unclear risk. Cessation counselling versus no counselling, grouped by intensity of intervention Hospitalised patients who received smoking cessation counselling that began in the hospital and continued for more than a month after discharge had higher quit rates than patients who received no counselling in the hospital or following hospitalisation (risk ratio (RR) 1.36, 95% confidence interval (CI) 1.24 to 1.49; 28 studies, 8234 participants; high-certainty evidence). In absolute terms, this might account for an additional 76 quitters in every 1000 participants (95% CI 51 to 103). The evidence was uncertain (very low-certainty) about the effects of counselling interventions of less intensity or shorter duration (in-hospital only counselling ≤ 15 minutes: RR 1.52, 95% CI 0.80 to 2.89; 2 studies, 1417 participants; and in-hospital contact plus follow-up counselling support for ≤ 1 month: RR 1.04, 95% CI 0.90 to 1.20; 7 studies, 4627 participants) versus no counselling. There was moderate-certainty evidence, limited by imprecision, that smoking cessation counselling for at least 15 minutes in the hospital without post-discharge support led to higher quit rates than no counselling in the hospital (RR 1.27, 95% CI 1.02 to 1.58; 12 studies, 4432 participants). Pharmacotherapy versus placebo or no pharmacotherapy Nicotine replacement therapy helped more patients to quit than placebo or no pharmacotherapy (RR 1.33, 95% CI 1.05 to 1.67; 8 studies, 3838 participants; high-certainty evidence). In absolute terms, this might equate to an additional 62 quitters per 1000 participants (95% CI 9 to 126). There was moderate-certainty evidence, limited by imprecision (as CI encompassed the possibility of no difference), that varenicline helped more hospitalised patients to quit than placebo or no pharmacotherapy (RR 1.29, 95% CI 0.96 to 1.75; 4 studies, 829 participants). Evidence for bupropion was low-certainty; the point estimate indicated a modest benefit at best, but CIs were wide and incorporated clinically significant harm and clinically significant benefit (RR 1.11, 95% CI 0.86 to 1.43, 4 studies, 872 participants). Hospital-only intervention versus intervention that continues after hospital discharge Patients offered both smoking cessation counselling and pharmacotherapy after discharge had higher quit rates than patients offered counselling in hospital but not offered post-discharge support (RR 1.23, 95% CI 1.09 to 1.38; 7 studies, 5610 participants; high-certainty evidence). In absolute terms, this might equate to an additional 34 quitters per 1000 participants (95% CI 13 to 55). Post-discharge interventions offering real-time counselling without pharmacotherapy (RR 1.23, 95% CI 0.95 to 1.60, 8 studies, 2299 participants; low certainty-evidence) and those offering unscheduled counselling without pharmacotherapy (RR 0.97, 95% CI 0.83 to 1.14; 2 studies, 1598 participants; very low-certainty evidence) may have little to no effect on quit rates compared to control. Telephone quitlines versus control To provide post-discharge support, hospitals may refer patients to community-based telephone quitlines. Both comparisons relating to these interventions had wide CIs encompassing both possible harm and possible benefit, and were judged to be of very low certainty due to imprecision, inconsistency, and risk of bias (post-discharge telephone counselling versus quitline referral: RR 1.23, 95% CI 1.00 to 1.51; 3 studies, 3260 participants; quitline referral versus control: RR 1.17, 95% CI 0.70 to 1.96; 2 studies, 1870 participants). AUTHORS' CONCLUSIONS Offering hospitalised patients smoking cessation counselling beginning in hospital and continuing for over one month after discharge increases quit rates, compared to no hospital intervention. Counselling provided only in hospital, without post-discharge support, may have a modest impact on quit rates, but evidence is less certain. When all patients receive counselling in the hospital, high-certainty evidence indicates that providing both counselling and pharmacotherapy after discharge increases quit rates compared to no post-discharge intervention. Starting nicotine replacement or varenicline in hospitalised patients helps more patients to quit smoking than a placebo or no medication, though evidence for varenicline is only moderate-certainty due to imprecision. There is less evidence of benefit for bupropion in this setting. Some of our evidence was limited by imprecision (bupropion versus placebo and varenicline versus placebo), risk of bias, and inconsistency related to heterogeneity. Future research is needed to identify effective strategies to implement, disseminate, and sustain interventions, and to ensure cessation counselling and pharmacotherapy initiated in the hospital is sustained after discharge.
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Affiliation(s)
- Joanna M Streck
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts (MA), USA
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital / Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital / Harvard Medical School, Boston, Massachusetts, USA
| | | | - Hilary A Tindle
- Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Carole Clair
- Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Marcus R Munafò
- School of Experimental Psychology and MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | | | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Health Promotion and Policy, University of Massachusetts, Amherst, MA, USA
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Rigotti NA, Benowitz NL, Prochaska JJ, Cain DF, Ball J, Clarke A, Blumenstein BA, Jacobs C. Cytisinicline for Vaping Cessation in Adults Using Nicotine E-Cigarettes: The ORCA-V1 Randomized Clinical Trial. JAMA Intern Med 2024:2818194. [PMID: 38709500 PMCID: PMC11074928 DOI: 10.1001/jamainternmed.2024.1313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 01/30/2024] [Indexed: 05/07/2024]
Abstract
Importance The prevalence of e-cigarette use among US adults, especially young adults, is rising. Many would like to quit vaping nicotine but are unable to do so. Cytisinicline, a plant-based alkaloid, targets nicotinic acetylcholine receptors, reduces nicotine dependence, and helps adults to stop smoking cigarettes. Cytisinicline may also help e-cigarette users to quit vaping. Objective To determine the efficacy and safety of cytisinicline vs placebo to produce abstinence from e-cigarette use in adults seeking to quit vaping nicotine. Design, Setting, and Participants This double-blind placebo-controlled randomized clinical trial compared 12 weeks of treatment with cytisinicline vs placebo, with follow-up to 16 weeks. It was conducted from July 2022 to February 2023 across 5 US clinical trial sites. A total of 160 adults who vaped nicotine daily, sought to quit, and did not currently smoke cigarettes were enrolled, and 131 (81.9%) completed the trial. Intervention Participants were randomized (2:1) to cytisinicline, 3 mg, taken 3 times daily (n = 107) or placebo (n = 53) for 12 weeks. All participants received weekly behavioral support. Main Outcomes and Measures Biochemically verified continuous e-cigarette abstinence during the last 4 weeks of treatment (weeks 9-12; primary outcome) and through 4 weeks posttreatment (weeks 9-16; secondary outcome). Missing outcomes were counted as nonabstinence. Results Of 160 randomized participants (mean [SD] age, 33.6 [11.1] years; 83 [51.9%] female), 115 (71.9%) formerly smoked (≥100 lifetime cigarettes). Continuous e-cigarette abstinence in cytisinicline and placebo groups occurred in 34 of 107 participants (31.8%) vs 8 of 53 participants (15.1%) (odds ratio, 2.64; 95% CI, 1.06-7.10; P = .04) at end of treatment (weeks 9-12) and in 25 of 107 participants (23.4%) vs 7 of 53 participants (13.2%) during weeks 9 to 16 (odds ratio, 2.00; 95% CI, 0.82-5.32; P = .15). There was no evidence, based on nonsignificant interactions, that cytisinicline efficacy differed in subgroups defined by demographic characteristics, vaping pattern, e-cigarette dependence, or smoking history. Cytisinicline was well tolerated, with 4 participants (3.8%) discontinuing cytisinicline due to an adverse event. Conclusions and Relevance In this randomized clinical trial, cytisinicline for 12 weeks, with behavioral support, demonstrated efficacy for cessation of e-cigarette use at end of treatment and was well tolerated by adults, offering a potential pharmacotherapy option for treating nicotine e-cigarette use in adults who seek to quit vaping. These results need confirmation in a larger trial with longer follow-up. Trial Registration ClinicalTrials.gov Identifier: NCT05431387.
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Affiliation(s)
- Nancy A. Rigotti
- Tobacco Research and Treatment Center, Division of General Internal Medicine and the Mongan Institute, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Neal L. Benowitz
- Research Program in Clinical Pharmacology, Division of Cardiology, Department of Medicine, University of California, San Francisco
| | - Judith J. Prochaska
- Stanford Prevention and Research Center, Department of Medicine, Stanford University, Stanford, California
| | | | - Julie Ball
- Achieve Life Sciences, Seattle, Washington
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Hartmann-Boyce J, Conde M, Zhitnik E, Chan J, Begh R, Rigotti NA, Lindson N. Transitions between smoking and vaping: Evidence (or lack thereof) on potential differences by gender and sex. Prev Med 2024:107974. [PMID: 38677482 DOI: 10.1016/j.ypmed.2024.107974] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/16/2024] [Accepted: 04/24/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVE To synthesize existing evidence on possible differential effects by sex and gender from two Cochrane reviews evaluating vaping and smoking transitions. METHODS We screened included studies from two Cochrane reviews for studies reporting smoking outcomes based on gender or sex. The first review examines the effects of using e-cigarettes to help people quit smoking and includes randomized controlled trials and uncontrolled intervention studies published to July 2023. The second review aims to assess the evidence on the relationship between the use and availability of e-cigarettes and subsequent smoking in young people (aged 29 and younger) and includes quasi-experimental and cohort studies published to April 2023. Due to the paucity and heterogeneity of data, we report results narratively. RESULTS 10 of 161 studies included in the two relevant reviews met our criteria. Only five reported analyzing whether observed effects or associations varied based on sex and/or gender. A further three provided relevant descriptive information, and two did not report overall outcomes regarding vaping and smoking transitions but did investigate whether these differed by sex/gender. Synthesized data were largely inconclusive, but there was some suggestion that vaping was more strongly associated with subsequent smoking in young males than females. No studies reported data on nonbinary participants. CONCLUSIONS Despite plausible reasons why sex and gender may be moderators of vaping and smoking transitions, there is little evidence investigating this. Future studies of vaping and smoking transitions should conduct and report analyses investigating potential differences based on sex and gender.
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Affiliation(s)
- Jamie Hartmann-Boyce
- Department of Health Promotion and Policy, University of Massachusetts Amherst, USA; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Monserrat Conde
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Eliza Zhitnik
- Department of Health Promotion and Policy, University of Massachusetts Amherst, USA
| | - Jazmine Chan
- Department of Health Promotion and Policy, University of Massachusetts Amherst, USA
| | - Rachna Begh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Division of General Internal Medicine and Mongan Institute, Massachusetts General Hospital, Harvard Medical School, USA
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Bricker JB, Santiago-Torres M, Mull KE, Sullivan BM, David SP, Schmitz J, Stotts A, Rigotti NA. Do medications increase the efficacy of digital interventions for smoking cessation? Secondary results from the iCanQuit randomized trial. Addiction 2024; 119:664-676. [PMID: 38009551 DOI: 10.1111/add.16396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 10/20/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND AND AIMS iCanQuit is a smartphone application (app) proven efficacious for smoking cessation in a Phase III randomized controlled trial (RCT). This study aimed to measure whether medications approved by the US Food and Drug Administration (FDA) for smoking cessation would further enhance the efficacy of iCanQuit, relative to its parent trial comparator-the National Cancer Institute's (NCI's) QuitGuide app. DESIGN Secondary analysis of the entire parent trial sample of a two-group (iCanQuit and QuitGuide), stratified, doubled-blind RCT. SETTING United States. PARTICIPANTS Participants who reported using an FDA-approved cessation medication on their own (n = 619) and those who reported no use of cessation medications (n = 1469). INTERVENTIONS Participants were randomized to receive iCanQuit app or NCI's QuitGuide app. MEASUREMENTS Use of FDA-approved medications was measured at 3 months post-randomization. Smoking cessation outcomes were measured at 3, 6 and 12 months. The primary outcome was 12-month self-reported 30-day point prevalence abstinence (PPA). FINDINGS The data retention rate at the 12-month follow-up was 94.0%. Participants were aged 38.5 years, 71.0% female, 36.6% minority race/ethnicity, 40.6% high school or less education, residing in all 50 US States and smoking 19.2 cigarettes/day. The 29.6% of all participants who used medications were more likely to choose nicotine replacement therapy (NRT; 78.8%) than other cessation medications (i.e. varenicline or bupropion; 18.3 and 10.5%, respectively) and use did not differ by app treatment assignment (all P > 0.05). There was a significant (P = 0.049) interaction between medication use and app treatment assignment on PPA. Specifically, 12-month quit rates were 34% for iCanQuit versus 20% for QuitGuide [odds ratio (OR) = 2.36, 95% confidence interval (CI) = 1.59, 3.49] among participants reporting any medication use, whereas among participants reporting no medication use, quit rates were 28% for iCanQuit versus 22% for QuitGuide (OR = 1.41, 95% CI = 1.09, 1.82). Results were stronger for those using only NRT: 40% quit rates for iCanQuit versus 18% quit rates for QuitGuide (OR = 3.57, 95% CI = 2.20, 5.79). CONCLUSIONS The iCanQuit smartphone app for smoking cessation was more efficacious than the QuitGuide smartphone app, regardless of whether participants used medications to aid cessation. Smoking cessation medications, especially nicotine replacement therapy, might enhance the efficacy of the iCanQuit app.
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Affiliation(s)
- Jonathan B Bricker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Psychology, University of Washington, Seattle, WA, USA
| | | | - Kristin E Mull
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Brianna M Sullivan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Sean P David
- University of Chicago Pritzker School of Medicine, NorthShore University Health System, Chicago, IL, USA
| | - Joy Schmitz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Angela Stotts
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
- Department of Family and Community Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Rigotti NA. Electronic Cigarettes for Smoking Cessation - Have We Reached a Tipping Point? N Engl J Med 2024; 390:664-665. [PMID: 38354147 DOI: 10.1056/nejme2314977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Affiliation(s)
- Nancy A Rigotti
- From the Tobacco Research and Treatment Center, Division of General Internal Medicine and Mongan Institute, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
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Cruvinel E, Mussulman L, Scheuermann T, Shergina E, He J, Sherman S, Harrington K, Rigotti NA, Tindle H, Zhu SH, Richter K. Hospital-Initiated Smoking Cessation Among Patients Admitted with Behavioral Health Conditions. J Gen Intern Med 2024:10.1007/s11606-024-08646-5. [PMID: 38326585 DOI: 10.1007/s11606-024-08646-5] [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: 09/08/2023] [Accepted: 01/22/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Smoking rates among people living with behavioral health conditions (BHC) range from 30 to 65% and are 2-4 times higher than rates found in the general population. Starting tobacco treatment during a hospital stay is effective for smoking cessation, but little is known regarding treatment response among inpatients with BHC. OBJECTIVE This study pooled data across multiple clinical trials to determine the relative success in quitting among participants with BHC compared to other study participants. PARTICIPANTS Adults who smoke (≥ 18 years old) from five hospital-based smoking cessation randomized clinical trials. DESIGN A retrospective analysis using data from the electronic health record to identify participants with primary diagnoses related to BHC. Recruitment and data analysis were conducted from 2011 to 2016. We used propensity score matching to pair patients with BHC to those with similar characteristics and logistic regression to determine differences between groups. MEASURES The main outcome was self-reported 30-day abstinence 6 months post-discharge. RESULTS Of 6612 participants, 798 patients had a BHC-related primary diagnosis. The matched sample included 642 pairs. Nearly 1 in 3 reported using tobacco medications after hospitalization, with no significant difference between patients with and without BHC (29.3% vs. 31.5%; OR (95% CI) = 0.90 (0.71, 1.14), p = 0.40). Nearly 1 in 5 patients with BHC reported abstinence at 6 months; however, their odds of abstinence were 30% lower than among people without BHC (OR (95% CI) = 0.70 (0.53,0.92), p = 0.01). CONCLUSION When offered tobacco treatment, hospitalized patients with BHC were as likely as people without BHC to accept and engage in treatment. However, patients with BHC were less likely to report abstinence compared to those without BHC. Hospitals are a feasible and promising venue for tobacco treatment among inpatients with BHC. More studies are needed to identify treatment approaches that help people with BHC achieve long-term abstinence.
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Affiliation(s)
- Erica Cruvinel
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Laura Mussulman
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Taneisha Scheuermann
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Elena Shergina
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jianghua He
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Scott Sherman
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Kathleen Harrington
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nancy A Rigotti
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Hilary Tindle
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Shu-Hong Zhu
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
| | - Kimber Richter
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
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Lindson N, Butler AR, McRobbie H, Bullen C, Hajek P, Begh R, Theodoulou A, Notley C, Rigotti NA, Turner T, Livingstone-Banks J, Morris T, Hartmann-Boyce J. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev 2024; 1:CD010216. [PMID: 38189560 PMCID: PMC10772980 DOI: 10.1002/14651858.cd010216.pub8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
BACKGROUND Electronic cigarettes (ECs) are handheld electronic vaping devices which produce an aerosol by heating an e-liquid. People who smoke, healthcare providers and regulators want to know if ECs can help people quit smoking, and if they are safe to use for this purpose. This is a review update conducted as part of a living systematic review. OBJECTIVES To examine the safety, tolerability and effectiveness of using electronic cigarettes (ECs) to help people who smoke tobacco achieve long-term smoking abstinence, in comparison to non-nicotine EC, other smoking cessation treatments and no treatment. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialized Register to 1 February 2023, and Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO to 1 July 2023, and reference-checked and contacted study authors. SELECTION CRITERIA We included trials in which people who smoke were randomized to an EC or control condition. We also included uncontrolled intervention studies in which all participants received an EC intervention as these studies have the potential to provide further information on harms and longer-term use. Studies had to report an eligible outcome. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods for screening and data extraction. Critical outcomes were abstinence from smoking after at least six months, adverse events (AEs), and serious adverse events (SAEs). We used a fixed-effect Mantel-Haenszel model to calculate risk ratios (RRs) with a 95% confidence interval (CI) for dichotomous outcomes. For continuous outcomes, we calculated mean differences. Where appropriate, we pooled data in pairwise and network meta-analyses (NMA). MAIN RESULTS We included 88 completed studies (10 new to this update), representing 27,235 participants, of which 47 were randomized controlled trials (RCTs). Of the included studies, we rated ten (all but one contributing to our main comparisons) at low risk of bias overall, 58 at high risk overall (including all non-randomized studies), and the remainder at unclear risk. There is high certainty that nicotine EC increases quit rates compared to nicotine replacement therapy (NRT) (RR 1.59, 95% CI 1.29 to 1.93; I2 = 0%; 7 studies, 2544 participants). In absolute terms, this might translate to an additional four quitters per 100 (95% CI 2 to 6 more). There is moderate-certainty evidence (limited by imprecision) that the rate of occurrence of AEs is similar between groups (RR 1.03, 95% CI 0.91 to 1.17; I2 = 0%; 5 studies, 2052 participants). SAEs were rare, and there is insufficient evidence to determine whether rates differ between groups due to very serious imprecision (RR 1.20, 95% CI 0.90 to 1.60; I2 = 32%; 6 studies, 2761 participants; low-certainty evidence). There is moderate-certainty evidence, limited by imprecision, that nicotine EC increases quit rates compared to non-nicotine EC (RR 1.46, 95% CI 1.09 to 1.96; I2 = 4%; 6 studies, 1613 participants). In absolute terms, this might lead to an additional three quitters per 100 (95% CI 1 to 7 more). There is moderate-certainty evidence of no difference in the rate of AEs between these groups (RR 1.01, 95% CI 0.91 to 1.11; I2 = 0%; 5 studies, 1840 participants). There is insufficient evidence to determine whether rates of SAEs differ between groups, due to very serious imprecision (RR 1.00, 95% CI 0.56 to 1.79; I2 = 0%; 9 studies, 1412 participants; low-certainty evidence). Due to issues with risk of bias, there is low-certainty evidence that, compared to behavioural support only/no support, quit rates may be higher for participants randomized to nicotine EC (RR 1.88, 95% CI 1.56 to 2.25; I2 = 0%; 9 studies, 5024 participants). In absolute terms, this represents an additional four quitters per 100 (95% CI 2 to 5 more). There was some evidence that (non-serious) AEs may be more common in people randomized to nicotine EC (RR 1.22, 95% CI 1.12 to 1.32; I2 = 41%, low-certainty evidence; 4 studies, 765 participants) and, again, insufficient evidence to determine whether rates of SAEs differed between groups (RR 0.89, 95% CI 0.59 to 1.34; I2 = 23%; 10 studies, 3263 participants; very low-certainty evidence). Results from the NMA were consistent with those from pairwise meta-analyses for all critical outcomes, and there was no indication of inconsistency within the networks. Data from non-randomized studies were consistent with RCT data. The most commonly reported AEs were throat/mouth irritation, headache, cough, and nausea, which tended to dissipate with continued EC use. Very few studies reported data on other outcomes or comparisons, hence, evidence for these is limited, with CIs often encompassing both clinically significant harm and benefit. AUTHORS' CONCLUSIONS There is high-certainty evidence that ECs with nicotine increase quit rates compared to NRT and moderate-certainty evidence that they increase quit rates compared to ECs without nicotine. Evidence comparing nicotine EC with usual care/no treatment also suggests benefit, but is less certain due to risk of bias inherent in the study design. Confidence intervals were for the most part wide for data on AEs, SAEs and other safety markers, with no difference in AEs between nicotine and non-nicotine ECs nor between nicotine ECs and NRT. Overall incidence of SAEs was low across all study arms. We did not detect evidence of serious harm from nicotine EC, but the longest follow-up was two years and the number of studies was small. The main limitation of the evidence base remains imprecision due to the small number of RCTs, often with low event rates. Further RCTs are underway. To ensure the review continues to provide up-to-date information to decision-makers, this review is a living systematic review. We run searches monthly, with the review updated when relevant new evidence becomes available. Please refer to the Cochrane Database of Systematic Reviews for the review's current status.
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Affiliation(s)
- Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ailsa R Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Hayden McRobbie
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Chris Bullen
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Peter Hajek
- Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Rachna Begh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Tari Turner
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Tom Morris
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Jamie Hartmann-Boyce
- Department of Health Promotion and Policy, University of Massachusetts, Amherst, MA, USA
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Bernstein EY, Chang Y, Levy DE, Baggett TP, Lee SS, Tindle HA, Rigotti NA. Tobacco-Related Disease, Health Beliefs, and Post-hospital Tobacco Abstinence. Am J Prev Med 2023; 65:792-799. [PMID: 37217039 PMCID: PMC10592560 DOI: 10.1016/j.amepre.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/16/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Most hospitalized patients who smoke resume after discharge. Associations of tobacco-related disease and health beliefs with post-hospitalization abstinence were examined. METHODS This was a cohort study using data from a 2018-2020 multicenter trial of hospitalized adults who smoked and wanted to quit. Tobacco-related disease was defined using primary discharge diagnosis codes. Baseline health beliefs included (1) smoking caused hospitalization, (2) quitting speeds recovery, and (3) quitting prevents future illness. Outcomes included self-reported 7-day point prevalence abstinence 1, 3, and 6 months after discharge. Separate logistic regression models for each of the three health beliefs were constructed. Models stratified by tobacco-related disease explored effect modification. Analysis was performed in 2022-2023. RESULTS Of 1,406 participants (mean age 52 years, 56% females, 77% non-Hispanic White), 31% had tobacco-related disease, 42% believed that smoking caused hospitalization, 68% believed that quitting speeds recovery, and 82% believed that quitting prevents future illness. Tobacco-related disease was associated with higher 1-month point prevalence abstinence in each health belief model (AOR=1.55, 95% CI=1.15, 2.10; 1.53, 95% CI=1.14, 2.05; and 1.64, 95% CI=1.24, 2.19, respectively) and higher 6-month point prevalence abstinence in models including health beliefs 2 and 3. Quitting speeds recovery was the only belief associated with higher 1-month point prevalence abstinence (AOR=1.39, 95% CI=1.05, 1.85). Among patients with tobacco-related disease, the belief that quitting prevents future illness was associated with higher 1-month point prevalence abstinence (AOR=2.00, 95% CI=1.06, 3.78). CONCLUSIONS Tobacco-related disease predicts abstinence 1 and 6 months after hospitalization independent of health beliefs. Beliefs that quitting speeds recovery and prevents future illness may serve as targets for smoking-cessation interventions.
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Affiliation(s)
- Eden Y Bernstein
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Yuchiao Chang
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Tobacco Research & Treatment Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Douglas E Levy
- Harvard Medical School, Boston, Massachusetts; Tobacco Research & Treatment Center, Massachusetts General Hospital, Boston, Massachusetts; Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts
| | - Travis P Baggett
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Tobacco Research & Treatment Center, Massachusetts General Hospital, Boston, Massachusetts; Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts
| | - Scott S Lee
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hilary A Tindle
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Nancy A Rigotti
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Tobacco Research & Treatment Center, Massachusetts General Hospital, Boston, Massachusetts; Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts
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9
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Lee SS, Chang Y, Rigotti NA, Singer DE, Levy DE, Tyndale RF, Davis EM, Freiberg MS, King S, Wells QS, Tindle HA. Can Treatment Support Mitigate Nicotine Metabolism-Based Disparities in Smoking Abstinence? Secondary Analysis of the Helping HAND 4 Trial. Nicotine Tob Res 2023; 25:1575-1584. [PMID: 37209421 PMCID: PMC10439488 DOI: 10.1093/ntr/ntad079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 04/23/2023] [Accepted: 05/17/2023] [Indexed: 05/22/2023]
Abstract
INTRODUCTION The nicotine metabolite ratio (NMR), a biomarker of CYP2A6-mediated nicotine metabolism, predicts the efficacy of nicotine replacement therapy (NRT), with fast metabolizers benefiting less than slow metabolizers. Whether treatment support to optimize NRT use (henceforth "treatment support") modifies this pharmacogenetic relationship is unknown. METHODS Hospitalized adult daily smokers were assigned to one of two post-discharge smoking cessation interventions offering NRT and counseling: (1) Transitional Tobacco Care Management, which delivered enhanced treatment support via free combination NRT at discharge and automated counseling, and (2) a quitline-based approach representing usual care (UC). The primary outcome was biochemically verified 7-day point prevalence abstinence 6 months after discharge. Secondary outcomes were the use of NRT and counseling during the 3-month intervention period. Logistic regression models tested for interactions between NMR and intervention, controlling for sex, race, alcohol use, and BMI. RESULTS Participants (N = 321) were classified as slow (n = 80) or fast (n = 241) metabolizers relative to the first quartile of NMR (0.012-0.219 vs. 0.221-3.455, respectively). Under UC, fast (vs. slow) metabolizers had lower odds of abstinence at 6 months (aOR 0.35, 95% CI 0.13-0.95) and similar odds of NRT and counseling use. Compared to UC, enhanced treatment support increased abstinence (aOR 2.13, 95% CI 0.98-4.64) and use of combination NRT (aOR 4.62, 95% CI 2.57-8.31) in fast metabolizers, while reducing abstinence in slow metabolizers (aOR 0.21, 95% CI 0.05-0.87; NMR-by-intervention interaction p = .004). CONCLUSIONS Treatment support increased abstinence and optimal use of NRT among fast nicotine metabolizers, thereby mitigating the gap in abstinence between fast and slow metabolizers. IMPLICATIONS In this secondary analysis of two smoking cessation interventions for recently hospitalized smokers, fast nicotine metabolizers quit at lower rates than slow metabolizers, but providing fast metabolizers with enhanced treatment support doubled the odds of quitting in this group and mitigated the disparity in abstinence between fast and slow metabolizers. If validated, these findings could lead to personalized approaches to smoking cessation treatment that improve outcomes by targeting treatment support to those who need it most.
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Affiliation(s)
- Scott S Lee
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yuchiao Chang
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Nancy A Rigotti
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Daniel E Singer
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Douglas E Levy
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Rachel F Tyndale
- Departments of Psychiatry, and Pharmacology and Toxicology, University of Toronto and Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Esa M Davis
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Matthew S Freiberg
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephen King
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Quinn S Wells
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hilary A Tindle
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Rigotti NA, Benowitz NL, Prochaska J, Leischow S, Nides M, Blumenstein B, Clarke A, Cain D, Jacobs C. Cytisinicline for Smoking Cessation: A Randomized Clinical Trial. JAMA 2023; 330:152-160. [PMID: 37432430 PMCID: PMC10336611 DOI: 10.1001/jama.2023.10042] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Received: 02/22/2023] [Accepted: 05/23/2023] [Indexed: 07/12/2023]
Abstract
Importance Cytisinicline (cytisine) is a plant-based alkaloid that, like varenicline, binds selectively to α4β2 nicotinic acetylcholine receptors, which mediate nicotine dependence. Although not licensed in the US, cytisinicline is used in some European countries to aid smoking cessation, but its traditional dosing regimen and treatment duration may not be optimal. Objective To evaluate the efficacy and tolerability of cytisinicline for smoking cessation when administered in a novel pharmacokinetically based dosing regimen for 6 or 12 weeks vs placebo. Design, Setting, and Participants A 3-group, double-blind, placebo-controlled, randomized trial (ORCA-2) compared 2 durations of cytisinicline treatment (6 or 12 weeks) vs placebo, with follow-up to 24 weeks, among 810 adults who smoked cigarettes daily and wanted to quit. It was conducted at 17 US sites from October 2020 to December 2021. Interventions Participants were randomized (1:1:1) to cytisinicline, 3 mg, 3 times daily for 12 weeks (n = 270); cytisinicline, 3 mg, 3 times daily for 6 weeks then placebo 3 times daily for 6 weeks (n = 269); or placebo 3 times daily for 12 weeks (n = 271). All participants received behavioral support. Main Outcomes and Measures Biochemically verified continuous smoking abstinence for the last 4 weeks of cytisinicline treatment vs placebo (primary) and from end of treatment to 24 weeks (secondary). Results Of 810 randomized participants (mean age, 52.5 years; 54.6% female; mean of 19.4 cigarettes smoked daily), 618 (76.3%) completed the trial. For the 6-week course of cytisinicline vs placebo, continuous abstinence rates were 25.3% vs 4.4% during weeks 3 to 6 (odds ratio [OR], 8.0 [95% CI, 3.9-16.3]; P < .001) and 8.9% vs 2.6% during weeks 3 to 24 (OR, 3.7 [95% CI, 1.5-10.2]; P = .002). For the 12-week course of cytisinicline vs placebo, continuous abstinence rates were 32.6% vs 7.0% for weeks 9 to 12 (OR, 6.3 [95% CI, 3.7-11.6]; P < .001) and 21.1% vs 4.8% during weeks 9 to 24 (OR, 5.3 [95% CI, 2.8-11.1]; P < .001). Nausea, abnormal dreams, and insomnia occurred in less than 10% of each group. Sixteen participants (2.9%) discontinued cytisinicline due to an adverse event. No drug-related serious adverse events occurred. Conclusions and Relevance Both 6- and 12-week cytisinicline schedules, with behavioral support, demonstrated smoking cessation efficacy and excellent tolerability, offering new nicotine dependence treatment options. Trial Registration ClinicalTrials.gov Identifier: NCT04576949.
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Affiliation(s)
- Nancy A. Rigotti
- Tobacco Research and Treatment Center, Division of General Internal Medicine and Mongan Institute, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Neal L. Benowitz
- Research Program in Clinical Pharmacology, Division of Cardiology, Department of Medicine, University of California San Francisco
| | - Judith Prochaska
- Department of Medicine and Stanford Prevention and Research Center, Stanford University, Stanford, California
| | - Scott Leischow
- College of Health Solutions, Arizona State University, Phoenix
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Streck JM, Regan S, Werner M, Glynn A, Villanti AC, Park ER, Wakeman SE, Evins AE, Rigotti NA. Preliminary feasibility of integrating tobacco treatment into SUD peer recovery coaching: a mixed-methods study of peer recovery coaches. Addict Sci Clin Pract 2023; 18:25. [PMID: 37122035 PMCID: PMC10148997 DOI: 10.1186/s13722-023-00380-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 10/19/2022] [Accepted: 03/29/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Individuals with substance use disorder (SUD) have high prevalence of cigarette smoking and difficulty quitting. Peer recovery coaches (PRCs; individuals with lived SUD experience) facilitate SUD behavior change in recoverees but it is unknown if/how they address tobacco treatment in SUD recovery coaching. We assessed PRC's tobacco-related practices and attitudes about tobacco treatment in SUD recovery. METHODS The Tobacco use In Peer-recovery Study (TIPS) was a cross-sectional mixed-methods pilot survey (January-March 2022) of the 26 PRCs employed by a Massachusetts-based healthcare system's 12 SUD treatment clinics/programs. PRCs completed a quantitative survey (n = 23/26; 88%) and a telephone-based qualitative interview (n = 20/26; 77%). RESULTS One-third of PRCs reported current smoking, 50% reported former smoking, and 18% never smoked. Among PRCs, 61% reported accompanying recoverees outdoors to smoke, 26% smoked with recoverees, 17% had provided cigarettes to recoverees, 32% used smoking to help build peer-relationships, and 74% rated smoking as socially acceptable in SUD treatment. PRCs reported regularly talking to recoverees about tobacco treatment (65%), believed they should have a role in helping recoverees quit smoking (52%), and were interested in tobacco treatment training (65%). A majority of both nonsmoking and current smoking PRCs (73% vs. 57%) regularly talked to recoverees about quitting smoking. CONCLUSION PRCs' attitudes about integrating tobacco treatment into SUD recovery coaching were generally positive and PRCs reported they could have a role in helping recoverees with tobacco treatment. Barriers to integrating tobacco treatment into SUD recovery include use of cigarettes as a peer-recovery tool and high prevalence and social acceptability of smoking in SUD recovery.
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Affiliation(s)
- Joanna M Streck
- Department of Psychiatry, Massachusetts General Hospital (MGH), 100 Cambridge Street, 16th Floor, Boston, MA, 02114, USA.
- Harvard Medical School, Harvard University, Boston, MA, USA.
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, MGH, Boston, MA, USA.
| | - Susan Regan
- Harvard Medical School, Harvard University, Boston, MA, USA
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, MGH, Boston, MA, USA
| | - Michael Werner
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, MGH, Boston, MA, USA
| | - Alexia Glynn
- Department of Psychiatry, Massachusetts General Hospital (MGH), 100 Cambridge Street, 16th Floor, Boston, MA, 02114, USA
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, MGH, Boston, MA, USA
| | - Andrea C Villanti
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ, USA
| | - Elyse R Park
- Department of Psychiatry, Massachusetts General Hospital (MGH), 100 Cambridge Street, 16th Floor, Boston, MA, 02114, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, MGH, Boston, MA, USA
| | - Sarah E Wakeman
- Harvard Medical School, Harvard University, Boston, MA, USA
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, MGH, Boston, MA, USA
| | - A Eden Evins
- Department of Psychiatry, Massachusetts General Hospital (MGH), 100 Cambridge Street, 16th Floor, Boston, MA, 02114, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
| | - Nancy A Rigotti
- Harvard Medical School, Harvard University, Boston, MA, USA
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, MGH, Boston, MA, USA
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12
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Chidumwa G, Olivier S, Ngubane H, Zulu T, Sewpaul R, Kruse G, Rigotti NA, Siedner MJ, Reddy KP, Wong EB. Tobacco smoking and prevalence of communicable and non-communicable diseases in rural South Africa: A cross-sectional study. Res Sq 2023:rs.3.rs-2730894. [PMID: 37066285 PMCID: PMC10104274 DOI: 10.21203/rs.3.rs-2730894/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Background South Africa is facing a convergence of communicable diseases (CDs) and non-communicable diseases (NCDs). The contribution of tobacco use to the burden of these conditions is unknown. Methods We analyzed the associations between current tobacco smoking and four important CDs and NCDs in Vukuzazi, a cross-sectional study of individuals aged 15 years and older conducted between 2018-2020 in a demographic surveillance area in KwaZulu-Natal, South Africa. Data on HIV, active tuberculosis (TB), hypertension and diabetes mellitus were collected via direct measurement from participants. Results Of 18,024 participants (68% female, median age 37 years [interquartile rage 23-56 years]), 1,301 (7.2%) reported current smoking. Prevalence of HIV infection was similarly high among people who currently smoked (34.6%) and people who had never smoked (33.9%). However, among people living with HIV (PLWH), there was a higher prevalence of detectable viremia in people reporting current smoking compared to people who reported never smoking (28.8% vs. 16.6%; p-value < 0.001). Active TB was more prevalent in people who currently smoked than in people who never smoked (3.1% vs 1.3%, p < 0.001). In contrast, the prevalence of hypertension and diabetes mellitus were lower in people reporting current smoking than in people reporting never smoking (17.1% vs 26.0% (p < 0.001), and 2.5% vs 10.2% (p < 0.001), respectively). In sex-stratified multivariable analyses that were adjusted for potential confounding factors (including body mass index for the NCDs), the magnitude of differences in CD prevalence between people who currently smoked and people who never smoked decreased, whereas the lower prevalence of NCDs among people reporting current smoking persisted. Conclusions In rural South Africa, smoking is associated with higher rates of active TB, and people with HIV who smoke have worse disease control. In contrast, hypertension and diabetes mellitus are less common in those who smoke. Interventions to screen for TB among those who smoke and to address smoking among people with HIV may be particularly impactful.
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Affiliation(s)
| | | | | | - Thando Zulu
- Africa Health Research Institute, KwaZulu-Natal
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13
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Lindson N, Butler AR, Liber A, Levy DT, Barnett P, Theodoulou A, Notley C, Rigotti NA, Hartmann‐Boyce J. An exploration of flavours in studies of e-cigarettes for smoking cessation: secondary analyses of a systematic review with meta-analyses. Addiction 2023; 118:634-645. [PMID: 36399154 PMCID: PMC10952306 DOI: 10.1111/add.16091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 11/02/2022] [Indexed: 11/19/2022]
Abstract
AIMS To estimate associations between e-cigarette flavour and smoking cessation and study product use at 6 months or longer. METHODS Secondary analysis of data from a living systematic review, with meta-analyses and narrative synthesis, incorporating data up to January 2022. Included studies provided people who smoked combustible cigarettes with nicotine e-cigarettes for the purpose of smoking cessation compared with no treatment or other stop smoking interventions. Measurements included smoking cessation and study product use at 6 months or longer reported as risk ratios (RR) with 95% confidence intervals (CI); and flavour use at any time-points. RESULTS We included 16 studies (n = 10 336); 14 contributed to subgroup analyses and 10 provided participants with a choice of e-cigarette flavour. We judged nine, five and two studies at high, low and unclear risk of bias, respectively. Subgroup analyses showed no clear associations between flavour and cessation or product use. In all but one analysis, tests for subgroup differences resulted in I2 values between 0 and 35%. In the comparison between nicotine e-cigarettes and nicotine replacement therapy (NRT) (I2 = 65.2% for subgroup differences), studies offering tobacco flavour e-cigarettes showed evidence of a greater proportion of participants still using at 6 months or longer (RR = 3.81; 95% CI = 1.45-10.05; n = 1181; I2 = 84%), whereas there was little evidence for greater 6-month use when studies offered a choice of flavours (RR = 1.44; 95% CI = 0.80-2.56; n = 454; I2 = 82%). However, substantial statistical heterogeneity within subgroups makes interpretation of this result unclear. In the 10 studies where participants had a choice of flavours, and this was tracked over time, some switching between flavours occurred, but there were no clear patterns in flavour preferences. CONCLUSIONS There does not appear to be a clear association between e-cigarette flavours and smoking cessation or longer-term e-cigarette use, possibly due to a paucity of data. There is evidence that people using e-cigarettes to quit smoking switch between e-cigarette flavours.
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Affiliation(s)
- Nicola Lindson
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Ailsa R. Butler
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Alex Liber
- Cancer Prevention and Control ProgramGeorgetown University‐Lombardi Comprehensive Cancer CenterWashingtonDCUSA
| | - David T. Levy
- Cancer Prevention and Control ProgramGeorgetown University‐Lombardi Comprehensive Cancer CenterWashingtonDCUSA
| | - Phoebe Barnett
- Centre for Outcomes Research and Effectiveness, Research department of Clinical, Educational and Health PsychologyUniversity College LondonLondonUK
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Caitlin Notley
- Addiction Research Group, Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | - Nancy A. Rigotti
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General HospitalHarvard Medical SchoolBostonMAUSA
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14
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Cheng D, Fung V, Shah R, Goldberg S, Lee B, Song G, Doane J, Kingsley M, Henley P, Banthin C, Winickoff JP, Rigotti NA, Levy DE. Smoke-Free Policies and Resident Turnover: An Evaluation in Massachusetts Public Housing From 2009‒2018. Am J Prev Med 2023; 64:503-511. [PMID: 36635198 PMCID: PMC10033366 DOI: 10.1016/j.amepre.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/07/2022] [Accepted: 10/27/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Smoke-free policies (SFP) in multi-unit housing are a promising tool for reducing exposure to tobacco smoke among residents. Concerns about increased housing instability due to voluntary or involuntary transitions induced by SFPs have been a primary barrier to greater widespread adoption. The impact of SFP implementation on transitions out of public housing in federally funded public housing authorities in Massachusetts was evaluated. METHODS Tenancy data from the Department of Housing and Urban Development were used to determine the time from admission to transitioning out of public housing based on a cohort study design. Periods of exposure to SFPs were defined based on dates of SFP implementation at each PHA. Multi-level Cox regression models were fit to estimate the effects of SFPs on the hazard of transitioning, adjusting for household- and PHA-level characteristics. Analyses were conducted in 2021‒2022. RESULTS There were 44,705 households with a record of residence in Massachusetts PHAs over 2009‒2018. Over this period, despite increasing adoption of SFPs among the PHAs, rates of transition remained steady at around 5‒8 transitions per 1,000 household-months. There was no overall association between exposure to SFPs and transitions among the full sample (adjusted HR=0.99, 95% CI=0.95, 1.04, p=0.794). However, the association varied significantly by age group, race/ethnicity, timing of SFP adoption, and era of admission. CONCLUSIONS Adoption of SFPs in public housing had a minimal overall impact on turnover for households in Massachusetts, though disparities in the impact were observed between different demographic and PHA-level subgroups.
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Affiliation(s)
- David Cheng
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts.
| | - Vicki Fung
- Department of Medicine, Harvard Medical School, Boston, Massachusetts; Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Radhika Shah
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Sydney Goldberg
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Boram Lee
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Glory Song
- Office of Statistics and Evaluation, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Jacqueline Doane
- Massachusetts Tobacco Cessation and Prevention Program, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Melody Kingsley
- Office of Statistics and Evaluation, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Patricia Henley
- Massachusetts Tobacco Cessation and Prevention Program, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Christopher Banthin
- Public Health Advocacy Institute, Northeastern University School of Law, Boston, Massachusetts
| | - Jonathan P Winickoff
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts; Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Nancy A Rigotti
- Department of Medicine, Harvard Medical School, Boston, Massachusetts; Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts; Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts; Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Douglas E Levy
- Department of Medicine, Harvard Medical School, Boston, Massachusetts; Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts; Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts
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15
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Jacobs C, Fonseca M, Rigotti NA, Benowitz N, Clarke A, Cain D. A Phase I, Double-blind, Randomized, Placebo-controlled, Single Dose-escalation Study to Evaluate the Tolerability, and Safety of Cytisinicline in Adult Smokers. Nicotine Tob Res 2023; 25:814-820. [PMID: 36198104 DOI: 10.1093/ntr/ntac233] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/18/2022] [Accepted: 10/03/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Cytisinicline is a nicotinic acetylcholine receptor partial agonist marketed historically as oral tablets in Central and Eastern Europe as an aid to smoking cessation. Dosing and scheduled regimen for cytisinicline treatment is currently being redeveloped for market approval in the United States and elsewhere. AIMS AND METHODS A phase 1, double-blind, randomized, placebo-controlled, single-ascending dose clinical trial was conducted under fasting conditions in healthy adults who were current daily (>10 cigarettes) smokers. Safety parameters for the identification of a maximum tolerated dose (MTD) and limited supportive pharmacokinetic assessments were evaluated. Ascending single oral doses of cytisinicline or placebo were administered to 9 cohorts, each comprised of eight unique participants (randomization: 6 cytisinicline; 2 placebo). Dose escalation to the next cohort was dependent upon the safety review of preceding cohorts. Dose levels tested were 6, 9, 12, 15, 18, 21, 24, 27, and 30 mg. Treatment-emergent adverse events (TEAEs) and clinically relevant changes in laboratory blood tests, vital signs, and 12-lead electrocardiograms were evaluated. RESULTS Seventy-two participants completed the study (54 cytisinicline; 18 placebo). Nausea was the most common TEAE (10 participants [19%]). The MTD was defined as cytisinicline 30 mg based on gastrointestinal symptoms, predominantly vomiting (2 of 6 subjects, 33%). Maximum plasma concentration (observed Cmax) values appeared to plateau at higher dose levels (beyond 24 mg). CONCLUSIONS Single cytisinicline doses up to 30 mg were well tolerated and raised no new safety concerns in fasting adult smokers. An increased frequency of gastrointestinal symptoms defined the MTD at 30 mg. IMPLICATIONS The cytisinicline therapeutic dose being evaluated in phase 3 clinical trials is 3 mg, which is a 10-fold lower dose than the 30 mg MTD level for cytisinicline, resulting in an excellent safety margin.
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Affiliation(s)
- Cindy Jacobs
- Achieve Life Sciences Inc., 22722 29th Dr SE Suite 100, Bothell WA 98021, USA
| | | | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Neal Benowitz
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA
| | - Anthony Clarke
- Achieve Life Sciences Inc., 22722 29th Dr SE Suite 100, Bothell WA 98021, USA
| | - Dan Cain
- Achieve Life Sciences Inc., 22722 29th Dr SE Suite 100, Bothell WA 98021, USA
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Hartmann‐Boyce J, Butler AR, Theodoulou A, Onakpoya IJ, Hajek P, Bullen C, Rigotti NA, Lindson N. Biomarkers of potential harm in people switching from smoking tobacco to exclusive e-cigarette use, dual use or abstinence: secondary analysis of Cochrane systematic review of trials of e-cigarettes for smoking cessation. Addiction 2023; 118:539-545. [PMID: 36208090 PMCID: PMC10092879 DOI: 10.1111/add.16063] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 09/21/2022] [Indexed: 02/07/2023]
Abstract
AIMS This study aims to compare biomarkers of potential harm between people switching from smoking combustible cigarettes (CC) completely to electronic cigarettes (EC), continuing to smoke CC, using both EC and CC (dual users) and using neither (abstainers), based on behaviour during EC intervention studies. DESIGN Secondary analysis following systematic review, incorporating inverse variance random-effects meta-analysis and effect direction plots. SETTING This study was conducted in Greece, Italy, Poland, the United Kingdom and the United States. PARTICIPANTS A total of 1299 adults smoking CC (nine studies) and provided EC. MEASUREMENTS Measurements were conducted using carbon monoxide (CO) and 26 other biomarkers. FINDINGS In pooled analyses, exhaled CO (eCO) was lower in EC versus EC + CC [mean difference (MD) = -4.40 parts per million (p.p.m.), 95% confidence interval (CI) = -12.04 to 3.24, two studies] and CC (MD = -9.57 p.p.m., 95% CI = -17.30 to -1.83, three studies). eCO was lower in dual users versus CC only (MD = -1.91 p.p.m., 95% CI = -3.38 to -0.45, two studies). Magnitude rather than direction of effect drove substantial statistical heterogeneity. Effect direction plots were used for other biomarkers. Comparing EC with CC, 12 of 13 biomarkers were significantly lower in EC users, with no difference for the 13th. Comparing EC with dual users, 12 of the 25 biomarkers were lower for EC, and five were lower for dual use. For the remaining eight measures, single studies did not detect statistically significant differences, or the multiple studies contributing to the outcome had inconsistent results. Only one study provided data comparing dual use with CC; of the 13 biomarkers measured, 12 were significantly lower in the dual use group, with no statistically significant difference detected for the 13th. Only one study provided data on abstainers. CONCLUSIONS Switching from smoking to vaping or dual use appears to reduce levels of biomarkers of potential harm significantly.
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Affiliation(s)
| | - Ailsa R. Butler
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | | | - Peter Hajek
- Wolfson Institute of Population Health, Barts & The London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - Chris Bullen
- National Institute for Health InnovationUniversity of AucklandAucklandNew Zealand
| | - Nancy A. Rigotti
- Tobacco Research and Treatment Center, Department of MedicineMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Nicola Lindson
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
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Affiliation(s)
- Kenneth E Warner
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
| | - Neal L Benowitz
- Department of Medicine, University of California at San Francisco, San Francisco, CA, USA
| | - Ann McNeill
- National Addiction Centre, King's College London, London, UK
| | - Nancy A Rigotti
- Department of Medicine, Harvard Medical School, Boston, MA, USA
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Warner ASC, Ufere NN, Patel NJ, Lau ES, Uchida AM, Hills-Dunlap K, Bromberg GK, Cunningham EA, Tagerman MD, Mills GG, Palamara K, Rigotti NA, Burnett-Bowie SAM, Yeh DD, Tanguturi VK. A Women in Medicine Trainees' Council: a model for women trainee professional development. Postgrad Med J 2023; 99:79-82. [PMID: 36841227 DOI: 10.1093/postmj/qgad018] [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] [Received: 09/28/2022] [Revised: 01/07/2023] [Accepted: 01/21/2023] [Indexed: 02/27/2023]
Abstract
Women physicians are promoted less often, more likely to experience harassment and bias, and paid less than their male peers. Although many institutions have developed initiatives to help women physicians overcome these professional hurdles, few are specifically geared toward physicians-in-training. The Women in Medicine Trainees' Council (WIMTC) was created in 2015 to support the professional advancement of women physicians-in-training in the Massachusetts General Hospital Department of Medicine (MGH-DOM). In a 2021 survey, the majority of respondents agreed that the WIMTC ameliorated the challenges of being a woman physician-in-training and contributed positively to overall wellness. Nearly all agreed that they would advise other training programs to implement a similar program. We present our model for women-trainee support to further the collective advancement of women physicians.
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Affiliation(s)
- A Sofia C Warner
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Nneka N Ufere
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Naomi J Patel
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Emily S Lau
- Division of Cardiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Amiko M Uchida
- Division of Gastroenterology, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Kelsey Hills-Dunlap
- Division of Pulmonary and Critical Care, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Gabrielle K Bromberg
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | - Michelle D Tagerman
- Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Gabrielle G Mills
- Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Kerri Palamara
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Nancy A Rigotti
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | - Doreen DeFaria Yeh
- Division of Cardiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Varsha K Tanguturi
- Division of Cardiology, Massachusetts General Hospital, Boston, MA 02114, USA
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Mendelsohn CP, Hall W, Borland R, Wodak A, Beaglehole R, Benowitz NL, Britton J, Bullen C, Etter JF, McNeill A, Rigotti NA. A critique of the Australian National Health and Medical Research Council CEO statement on electronic cigarettes. Addiction 2023; 118:1184-1192. [PMID: 36808672 DOI: 10.1111/add.16143] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/13/2023] [Indexed: 02/23/2023]
Abstract
This paper critically analyses a statement by Australia's National Health and Medical Research Council (NHMRC) on e-cigarettes in May 2022 that will be used to guide national policy. We reviewed the evidence and the conclusions drawn in the NHMRC Statement. In our view, the Statement is not a balanced reflection of the benefits and risks of vaping because it exaggerates the risks of vaping and fails to compare them to the far greater risks of smoking; it uncritically accepts evidence of harms from e-cigarettes while adopting a highly sceptical attitude towards evidence of their benefits; it incorrectly claims that the association between adolescent vaping and subsequent smoking is causal; and it understates the evidence of the benefits of e-cigarettes in assisting smokers to quit. The Statement dismisses the evidence that vaping is probably already having a positive net public health effect and misapplies the precautionary principle. Several sources of evidence supporting our assessment were published after the NHMRC Statement's publication and are also referenced. The NHMRC Statement on e-cigarettes does not present a balanced assessment of the available scientific literature and fails to meet the standard expected of a leading national scientific body.
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Affiliation(s)
| | - Wayne Hall
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Queensland, Australia
| | - Ron Borland
- Melbourne Centre for Behaviour Change, School of Psychological Sciences, The University of Melbourne, Victoria, Australia
| | - Alex Wodak
- Emeritus Consultant, Alcohol and Drug Service, St Vincents' Hospital, Sydney, Australia
| | | | - Neal L Benowitz
- Department of Medicine, University of California San Francisco, California, USA
| | - John Britton
- University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Chris Bullen
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Jean-François Etter
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Ann McNeill
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Nancy A Rigotti
- Harvard Medical School, Director, Tobacco Research and Treatment Center, Massachusetts General Hospital, Massachusetts, Boston, USA
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20
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Kruse GR, Joyce A, Yu L, Park ER, Neil J, Chang Y, Rigotti NA. A pilot adaptive trial of text messages, mailed nicotine replacement therapy, and telephone coaching among primary care patients who smoke. J Subst Use Addict Treat 2023; 145:208930. [PMID: 36880910 PMCID: PMC10016234 DOI: 10.1016/j.josat.2022.208930] [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] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 07/01/2022] [Accepted: 10/31/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Sequential multiple assignment randomized trials (SMART) inform the design of adaptive treatment interventions. We tested the feasibility of a SMART to deliver a stepped-care intervention among primary care patients who smoked daily. METHODS In a 12-week pilot SMART (NCT04020718), we tested the feasibility of recruiting and retaining (>80 %) participants to an adaptive intervention starting with cessation text messages (SMS). The study randomly assigned participants (R1) to assessment of quit status, the tailoring variable, after either 4 or 8 weeks of SMS. The study offered continued SMS alone to those reporting abstinence. Those reporting smoking were randomized (R2) to SMS + mailed NRT or SMS + NRT + brief telephone coaching. RESULTS During Jan-March and July-Aug 2020, we enrolled 35 patients (>18 years) from a primary care network in Massachusetts. Two (6 %) of 31 participants reported seven-day point prevalence abstinence at their tailoring variable assessment. The 29 participants who continued to smoke at 4 or 8 weeks were randomized (R2) to SMS + NRT (n = 16) or SMS + NRT + coaching (n = 13). Thirty of 35 participants (86 %) completed 12-weeks; 13 % (2/15) of those in 4-week group and 27 % (4/15) of those in 8-week group had CO < 6 ppm at 12-weeks (p = 0.65). Among 29 participants in R2, one was lost to follow-up, 19 % (3/16) of the SMS + NRT group had CO < 6 ppm vs. 17 % (2/12) of SMS + NRT + coaching (p = 1.00). Treatment satisfaction was high (93 %, 28 of 30 who completed 12-weeks). CONCLUSIONS A SMART exploring a stepped-care adaptive intervention combining SMS, NRT, and coaching for primary care patients was feasible. Retention and satisfaction were high and quit rates were promising.
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Affiliation(s)
- G R Kruse
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, United States of America; Tobacco Research and Treatment Center, Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America.
| | - A Joyce
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, United States of America; Tobacco Research and Treatment Center, Massachusetts General Hospital, United States of America
| | - L Yu
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, United States of America
| | - E R Park
- Tobacco Research and Treatment Center, Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America; Department of Psychiatry, Massachusetts General Hospital, United States of America; Health Policy Research Center, Massachusetts General Hospital, United States of America
| | - J Neil
- Tobacco Research and Treatment Center, Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America; Health Policy Research Center, Massachusetts General Hospital, United States of America; Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, United States of America
| | - Y Chang
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, United States of America; Tobacco Research and Treatment Center, Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America
| | - N A Rigotti
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, United States of America; Tobacco Research and Treatment Center, Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America; Health Policy Research Center, Massachusetts General Hospital, United States of America
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21
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Butler AR, Lindson N, Fanshawe TR, Theodoulou A, Begh R, Hajek P, McRobbie H, Bullen C, Notley C, Rigotti NA, Hartmann-Boyce J. Corrigendum to "Longer-term use of electronic cigarettes when provided as a stop smoking aid: Systematic review with meta-analyses" [Preventive Medicine, Volume 165, Part B, December 2022, 1-12/107182]. Prev Med 2023; 167:107406. [PMID: 36610807 DOI: 10.1016/j.ypmed.2022.107406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Ailsa R Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rachna Begh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Peter Hajek
- Wolfson Institute of Preventive Medicine, Barts, The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Hayden McRobbie
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Chris Bullen
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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22
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Steffens EB, Park ER, Muzikansky A, Streck JM, Ostroff JS, Rasmussen AW, Ponzani C, Perez GK, Regan S, Rigotti NA, Irwin KE. Patients With Serious Mental Illness Can Engage in Tobacco Treatment Trials and Tobacco Cessation Interventions During Cancer Treatment. JCO Oncol Pract 2023; 19:e238-e247. [PMID: 36351206 PMCID: PMC9970276 DOI: 10.1200/op.22.00505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/29/2022] [Accepted: 09/12/2022] [Indexed: 11/11/2022] Open
Abstract
PURPOSE More than half of individuals with serious mental illness (SMI) smoke, contributing to premature cancer mortality. A cancer diagnosis provides an opportunity to assist with smoking cessation; however, supportive oncology trials frequently exclude patients with SMI. To fill this gap, we examined differences in engagement and tobacco cessation in a pragmatic clinical trial. METHODS We recruited 303 participants from two National Cancer Institute-designated Comprehensive Cancer Centers, of which 10% had prior diagnoses of SMI (major depressive disorder, bipolar disorder, and schizophrenia spectrum disorders). We compared self-reported smoking behaviors, patient attitudes and beliefs about cessation, and rates of trial completion, engagement, and smoking abstinence among recently diagnosed patients with cancer with and without SMI. Six months after trial completion, we completed qualitative interviews on barriers and facilitators to tobacco cessation in a random sample of participants with SMI. RESULTS Trial participants with SMI had similar motivation to quit smoking as those without SMI. Additionally, participants with SMI had a similar ability to engage in a tobacco treatment trial (6.5 counseling sessions completed v 7.3 sessions) and benefit from tobacco treatment as those without SMI (32.3% v 27.8% 6-month quit rates). CONCLUSION Patients with cancer and SMI were able to engage in and benefit from a tobacco cessation trial integrated into cancer care. A cancer diagnosis provides an opportunity to assist patients with SMI with smoking cessation referrals and treatment. Pragmatic supportive oncology trials that include a diverse population of adults with SMI are needed to inform care delivery and improve cancer outcomes for patients with SMI and cancer.
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Affiliation(s)
- Eleanor B. Steffens
- Department of Psychological Sciences, University of Missouri—St Louis, St Louis, MO
| | - Elyse R. Park
- Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
- Massachusetts General Hospital Cancer Center, Center for Psychiatric Oncology and Behavioral Sciences, Boston, MA
| | - Alona Muzikansky
- MGH Biostatistics Center, Massachusetts General Hospital, Boston, MA
| | - Joanna M. Streck
- Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
| | - Jamie S. Ostroff
- Department of Psychiatry & Behavioral Sciences, Tobacco Treatment Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Autumn W. Rasmussen
- Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA
| | - Colin Ponzani
- Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA
| | - Giselle K. Perez
- Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Susan Regan
- Harvard Medical School, Boston, MA
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Nancy A. Rigotti
- Harvard Medical School, Boston, MA
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Kelly E. Irwin
- Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Massachusetts General Hospital Cancer Center, Center for Psychiatric Oncology and Behavioral Sciences, Boston, MA
- Massachusetts General Hospital Schizophrenia Program, Massachusetts General Hospital, Boston, MA
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23
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Santiago-Torres M, Mull KE, Sullivan BM, Rigotti NA, Bricker JB. Acceptance and Commitment Therapy-Based Smartphone Applications for Cessation of Tobacco Use among Adults with High Nicotine Dependence: Results from the iCanQuit Randomized Trial. Subst Use Misuse 2023; 58:354-364. [PMID: 36683573 PMCID: PMC9901262 DOI: 10.1080/10826084.2022.2161317] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Indexed: 01/24/2023]
Abstract
Background: With 1 in 2 adult tobacco users being highly dependent on nicotine, population-based interventions specifically designed for this group are urgently needed. This study used data from a randomized trial to evaluate whether (1) Acceptance and Commitment Therapy (ACT) delivered via a smartphone application (iCanQuit) would be more efficacious for cessation of nicotine-containing tobacco products than the US Clinical Practice Guidelines (USCPG)-based application (QuitGuide) among highly nicotine-dependent adults, (2) the effect of treatment on cessation was mediated by increases in acceptance of cravings to smoke, and (3) treatment utilization and satisfaction differed by arm. Methods: A total of 1452 highly nicotine-dependent adults received the iCanQuit or QuitGuide application for 12-months. Cessation outcomes were self-reported complete-case 30-day abstinence of nicotine-containing tobacco products (e.g., combustible cigarettes, e-cigarettes, chewing tobacco, snus, hookahs, cigars, cigarillos, tobacco pipes, and kreteks) at 3, 6, and 12-month post-randomization timepoints, missing-as-smoking, and multiple imputation analyses. Acceptance of cues to smoke and satisfaction with the applications was also reported. Results: Participants who received iCanQuit were significantly more likely to report 30-day abstinence of nicotine-containing tobacco products than those who received QuitGuide at 12-months (24% vs. 17%; OR = 1.47 95% CI: 1.11, 1.95). iCanQuit participants utilized their application more frequently and reported greater satisfaction than those who received QuitGuide. Increases in participants' acceptance of cues to smoke mediated the intervention effect on cessation of nicotine-containing tobacco products. Conclusions: Among nicotine-dependent adults, an application-delivered ACT-based intervention was more engaging and efficacious than a USCPG-based intervention for cessation of nicotine-containing tobacco products.
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Affiliation(s)
- Margarita Santiago-Torres
- Fred Hutchinson Cancer Research Center, Division of Public
Health Sciences, Seattle, Washington, USA
| | - Kristin E. Mull
- Fred Hutchinson Cancer Research Center, Division of Public
Health Sciences, Seattle, Washington, USA
| | - Brianna M. Sullivan
- Fred Hutchinson Cancer Research Center, Division of Public
Health Sciences, Seattle, Washington, USA
| | - Nancy A. Rigotti
- Tobacco Research and Treatment Center, Division of General
Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard
Medical School, Boston, Massachusetts, USA
| | - Jonathan B. Bricker
- Fred Hutchinson Cancer Research Center, Division of Public
Health Sciences, Seattle, Washington, USA
- University of Washington, Department of Psychology,
Seattle, Washington, USA
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Hohl SD, Shoenbill KA, Taylor KL, Minion M, Bates-Pappas GE, Hayes RB, Nolan MB, Simmons VN, Steinberg MB, Park ER, Ashing K, Beneventi D, Sanderson Cox L, Goldstein AO, King A, Kotsen C, Presant CA, Sherman SE, Sheffer CE, Warren GW, Adsit RT, Bird JE, D’Angelo H, Fiore MC, Van Thanh Nguyen C, Pauk D, Rolland B, Rigotti NA. The Impact of the COVID-19 Pandemic on Tobacco Treatment Program Implementation at National Cancer Institute-Designated Cancer Centers. Nicotine Tob Res 2023; 25:345-349. [PMID: 35778237 PMCID: PMC9384385 DOI: 10.1093/ntr/ntac160] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 05/17/2022] [Accepted: 06/27/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION The COVID-19 pandemic disrupted cancer screening and treatment delivery, but COVID-19's impact on tobacco cessation treatment for cancer patients who smoke has not been widely explored. AIMS AND METHODS We conducted a sequential cross-sectional analysis of data collected from 34 National Cancer Institute (NCI)-designated cancer centers participating in NCI's Cancer Center Cessation Initiative (C3I), across three reporting periods: one prior to COVID-19 (January-June 2019) and two during the pandemic (January-June 2020, January-June 2021). Using McNemar's Test of Homogeneity, we assessed changes in services offered and implementation activities over time. RESULTS The proportion of centers offering remote treatment services increased each year for Quitline referrals (56%, 68%, and 91%; p = .000), telephone counseling (59%, 79%, and 94%; p = .002), and referrals to Smokefree TXT (27%, 47%, and 56%; p = .006). Centers offering video-based counseling increased from 2020 to 2021 (18% to 59%; p = .006), Fewer than 10% of centers reported laying off tobacco treatment staff. Compared to early 2020, in 2021 C3I centers reported improvements in their ability to maintain staff and clinician morale, refer to external treatment services, train providers to deliver tobacco treatment, and modify clinical workflows. CONCLUSIONS The COVID-19 pandemic necessitated a rapid transition to new telehealth program delivery of tobacco treatment for patients with cancer. C3I cancer centers adjusted rapidly to challenges presented by the pandemic, with improvements reported in staff morale and ability to train providers, refer patients to tobacco treatment, and modify clinical workflows. These factors enabled C3I centers to sustain evidence-based tobacco treatment implementation during and beyond the COVID-19 pandemic. IMPLICATIONS This work describes how NCI-designated cancer centers participating in the Cancer Center Cessation Initiative (C3I) adapted to challenges to sustain evidence-based tobacco use treatment programs during the COVID-19 pandemic. This work offers a model for resilience and rapid transition to remote tobacco treatment services delivery and proposes a policy and research agenda for telehealth services as an approach to sustaining evidence-based tobacco treatment programs.
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Affiliation(s)
- Sarah D Hohl
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Kimberly A Shoenbill
- Department of Family Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Kathryn L Taylor
- Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Washington, DC, USA
| | - Mara Minion
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Gleneara E Bates-Pappas
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rashelle B Hayes
- Department of Psychiatry, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Margaret B Nolan
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Vani N Simmons
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Michael B Steinberg
- Center for Tobacco Studies, Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Elyse R Park
- Department of Psychiatry, Massachusetts General Hospital (MGH), Boston, MA, USA
| | - Kimlin Ashing
- Department of Population Sciences, Center of Community Alliance for Research & Education, City of Hope National Medical Center, Duarte, CA, USA
| | - Diane Beneventi
- Tobacco Research and Treatment Program, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Lisa Sanderson Cox
- Cancer Prevention and Control, University of Kansas School of Medicine, University of Kansas Cancer Center, Kansas City, KS, USA
| | - Adam O Goldstein
- Department of Family Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Andrea King
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Chris Kotsen
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cary A Presant
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA
| | - Scott E Sherman
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Christine E Sheffer
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Graham W Warren
- Department of Radiation Oncology, Medical University of South Carolina, Hollings Cancer Center, Charleston, SC, USA
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Hollings Cancer Center, Charleston, SC, USA
| | - Robert T Adsit
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jennifer E Bird
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Heather D’Angelo
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Michael C Fiore
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Danielle Pauk
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Betsy Rolland
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
- Institute for Clinical and Translational Research, University of Wisconsin-Madison, Madison, WI, USA
| | - Nancy A Rigotti
- Department of Medicine, Division of General Internal Medicine and Mongan Institute, Tobacco Research and Treatment Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
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Schwamm E, Noubary F, Rigotti NA, Reddy KP. Longitudinal transitions in initiation, cessation, and relapse of cigarette smoking and e-cigarette use among US youth and adults: Validation of a microsimulation model. PLoS One 2023; 18:e0284426. [PMID: 37058462 PMCID: PMC10104340 DOI: 10.1371/journal.pone.0284426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/31/2023] [Indexed: 04/15/2023] Open
Abstract
INTRODUCTION Estimates of initiation, cessation, and relapse rates of tobacco cigarette smoking and e-cigarette use can facilitate projections of longer-term impact of their use. We aimed to derive transition rates and apply them to validate a microsimulation model of tobacco that newly incorporated e-cigarettes. METHODS We fit a Markov multi-state model (MMSM) for participants in Waves 1-4.5 of the Population Assessment of Tobacco and Health (PATH) longitudinal study. The MMSM had nine cigarette smoking and e-cigarette use states (current/former/never use of each), 27 transitions, two sex categories, and four age categories (youth: 12-17y; adults: 18-24y/25-44y/≥45y). We estimated transition hazard rates, including initiation, cessation, and relapse. We then validated the Simulation of Tobacco and Nicotine Outcomes and Policy (STOP) microsimulation model, by: (a) using transition hazard rates derived from PATH Waves 1-4.5 as inputs, and (b) comparing STOP-projected prevalence of smoking and e-cigarette use at 12 and 24 months to empirical data from PATH Waves 3 and 4. We compared the goodness-of-fit of validations with "static relapse" and "time-variant relapse," wherein relapse rates did not or did depend on abstinence duration. RESULTS Per the MMSM, youth smoking and e-cigarette use was generally more volatile (lower probability of maintaining the same e-cigarette use status over time) than that of adults. Root-mean-squared error (RMSE) for STOP-projected versus empirical prevalence of smoking and e-cigarette use was <0.7% for both static and time-variant relapse simulations, with similar goodness-of-fit (static relapse: RMSE 0.69%, CI 0.38-0.99%; time-variant relapse: RMSE 0.65%, CI 0.42-0.87%). PATH empirical estimates of prevalence of smoking and e-cigarette use were mostly within the margins of error estimated by both simulations. DISCUSSION A microsimulation model incorporating smoking and e-cigarette use transition rates from a MMSM accurately projected downstream prevalence of product use. The microsimulation model structure and parameters provide a foundation for estimating the behavioral and clinical impact of tobacco and e-cigarette policies.
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Affiliation(s)
- Eli Schwamm
- Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Farzad Noubary
- Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, United States of America
| | - Nancy A Rigotti
- Harvard Medical School, Boston, Massachusetts, United States of America
- Tobacco Research and Treatment Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Krishna P Reddy
- Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Tobacco Research and Treatment Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
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Lee B, Fung V, Cheng D, Winickoff JP, Rigotti NA, Shah R, McGlave C, Goldberg S, Song G, Doane J, Kingsley M, Henley P, Ursprung S, Banthin C, Levy DE. Implementation Activities in Smoke-Free Public Housing: The Massachusetts Experience. Int J Environ Res Public Health 2022; 20:78. [PMID: 36612394 PMCID: PMC9819479 DOI: 10.3390/ijerph20010078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
A 2018 rule requiring federally-subsidized public housing authorities (PHAs) in the United States to adopt smoke-free policies (SFPs) has sparked interest in how housing agencies can best implement SFPs. However, to date, there is little quantitative data on the implementation of SFPs in public housing. Massachusetts PHAs were among the pioneers of SFPs in public housing, and many had instituted SFPs voluntarily prior to the federal rule. The aim of this study was to examine the adoption, implementation, and outcomes of SFPs instituted in Massachusetts PHAs prior to 2018 using a survey conducted that year. The survey asked if PHAs had SFPs and, if so, what activities were used to implement them: providing information sessions, offering treatment or referral for smoking cessation, soliciting resident input, training staff, partnering with outside groups, using a toolkit, and/or providing outdoor smoking areas. We used multivariable regression to investigate associations between implementation activities and respondent-reported policy outcomes (resident support, complaints about neighbors' smoking, and the number of violations reported per year). Of 238 Massachusetts PHAs, 218 (91%) completed the survey and 161 had an SFP prior to 2018. Common implementation activities were offering smoking cessation treatment/referral (89%) and information sessions for residents (85%). Information sessions for residents were associated with higher resident support (adjusted odds ratio [AOR] 4.3; 95%CI 1.2-15.3). Training staff (AOR 6.3, 95%CI 1.2-31.8) and engaging in ≥5 implementation activities (AOR 4.1, 95%CI 1.2-14.1) were associated with fewer smoking-related complaints. Utilization of multiple implementation activities, especially ones that informed residents and trained PHA staff, was associated with more favorable policy outcomes. We identified five groups of PHAs that shared distinct patterns of SFP implementation activities. Our findings, documenting implementation activities and their associations with SFP outcomes among the early adopters of SPFs in Massachusetts public housing, can help inform best practices for the future implementation of SFPs in multiunit housing.
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Affiliation(s)
- Boram Lee
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA 02114, USA
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Vicki Fung
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - David Cheng
- Harvard Medical School, Boston, MA 02115, USA
- Biostatistics Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Jonathan P. Winickoff
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
- Division of General Academic Pediatrics, Massachusetts General for Children, Boston, MA 02114, USA
| | - Nancy A. Rigotti
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA 02114, USA
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Radhika Shah
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Claire McGlave
- School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Sydney Goldberg
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Glory Song
- Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA 02108, USA
| | - Jacqueline Doane
- Massachusetts Tobacco Cessation and Prevention Program, Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA 02108, USA
| | - Melody Kingsley
- Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA 02108, USA
| | - Patricia Henley
- Massachusetts Tobacco Cessation and Prevention Program, Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA 02108, USA
| | - Sanouri Ursprung
- Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA 02108, USA
| | - Christopher Banthin
- Public Health Advocacy Institute, Northeastern University, Boston, MA 02115, USA
| | - Douglas E. Levy
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA 02114, USA
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
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Pesko MF, Cummings KM, Douglas CE, Foulds J, Miller T, Rigotti NA, Warner KE. United States public health officials need to correct e-cigarette health misinformation. Addiction 2022; 118:785-788. [PMID: 36507802 DOI: 10.1111/add.16097] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/09/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Michael F Pesko
- Department of Economics, Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA, USA
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Clifford E Douglas
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Jonathan Foulds
- Department of Public Health Sciences, Penn State University - College of Medicine, Hershey, PA, USA
| | | | - Nancy A Rigotti
- Department of Medicine, Harvard Medical School, Boston, MA, USA.,Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA
| | - Kenneth E Warner
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
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Butler AR, Lindson N, Fanshawe TR, Theodoulou A, Begh R, Hajek P, McRobbie H, Bullen C, Notley C, Rigotti NA, Hartmann-Boyce J. Longer-term use of electronic cigarettes when provided as a stop smoking aid: Systematic review with meta-analyses. Prev Med 2022; 165:107182. [PMID: 35933001 DOI: 10.1016/j.ypmed.2022.107182] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 02/01/2022] [Revised: 06/22/2022] [Accepted: 07/30/2022] [Indexed: 01/09/2023]
Abstract
Moderate certainty evidence supports use of nicotine electronic cigarettes to quit smoking combustible cigarettes. However, there is less certainty regarding how long people continue to use e-cigarettes after smoking cessation attempts. We set out to synthesise data on the proportion of people still using e-cigarettes or other study products at 6 months or longer in studies of e-cigarettes for smoking cessation. We updated Cochrane searches (November 2021). For the first time, we meta-analysed prevalence of continued e-cigarette use among individuals allocated to e-cigarette conditions, and among those individuals who had successfully quit smoking. We updated meta-analyses comparing proportions continuing product use among individuals allocated to use nicotine e-cigarettes and other treatments. We included 19 studies (n = 7787). The pooled prevalence of continued e-cigarette use at 6 months or longer was 54% (95% CI: 46% to 61%, I2 86%, N = 1482) in participants assigned to e-cigarette conditions. Of participants who had quit combustible cigarettes overall 70% were still using e-cigarettes at six months or longer (95% CI: 53% to 82%, I2 73%, N = 215). Heterogeneity in direction of effect precluded meta-analysis comparing long-term use of nicotine e-cigarettes with NRT. More people were using nicotine e-cigarettes at longest follow-up compared to non-nicotine e-cigarettes, but CIs included no difference (risk ratio 1.15, 95% CI: 0.94 to 1.41, n = 601). The levels of continued e-cigarette use observed may reflect the success of e-cigarettes as a quitting tool. Further research is needed to establish drivers of variation in and implications of continued use of e-cigarettes.
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Affiliation(s)
- Ailsa R Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Rachna Begh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Peter Hajek
- Wolfson Institute of Preventive Medicine, Barts, The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
| | - Hayden McRobbie
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
| | - Chris Bullen
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand.
| | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich, UK.
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
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Hartmann-Boyce J, Lindson N, Butler AR, McRobbie H, Bullen C, Begh R, Theodoulou A, Notley C, Rigotti NA, Turner T, Fanshawe TR, Hajek P. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev 2022; 11:CD010216. [PMID: 36384212 PMCID: PMC9668543 DOI: 10.1002/14651858.cd010216.pub7] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Electronic cigarettes (ECs) are handheld electronic vaping devices which produce an aerosol by heating an e-liquid. Some people who smoke use ECs to stop or reduce smoking, although some organizations, advocacy groups and policymakers have discouraged this, citing lack of evidence of efficacy and safety. People who smoke, healthcare providers and regulators want to know if ECs can help people quit smoking, and if they are safe to use for this purpose. This is a review update conducted as part of a living systematic review. OBJECTIVES To examine the effectiveness, tolerability, and safety of using electronic cigarettes (ECs) to help people who smoke tobacco achieve long-term smoking abstinence. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO to 1 July 2022, and reference-checked and contacted study authors. SELECTION CRITERIA: We included randomized controlled trials (RCTs) and randomized cross-over trials, in which people who smoke were randomized to an EC or control condition. We also included uncontrolled intervention studies in which all participants received an EC intervention. Studies had to report abstinence from cigarettes at six months or longer or data on safety markers at one week or longer, or both. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods for screening and data extraction. Our primary outcome measures were abstinence from smoking after at least six months follow-up, adverse events (AEs), and serious adverse events (SAEs). Secondary outcomes included the proportion of people still using study product (EC or pharmacotherapy) at six or more months after randomization or starting EC use, changes in carbon monoxide (CO), blood pressure (BP), heart rate, arterial oxygen saturation, lung function, and levels of carcinogens or toxicants, or both. We used a fixed-effect Mantel-Haenszel model to calculate risk ratios (RRs) with a 95% confidence interval (CI) for dichotomous outcomes. For continuous outcomes, we calculated mean differences. Where appropriate, we pooled data in meta-analyses. MAIN RESULTS We included 78 completed studies, representing 22,052 participants, of which 40 were RCTs. Seventeen of the 78 included studies were new to this review update. Of the included studies, we rated ten (all but one contributing to our main comparisons) at low risk of bias overall, 50 at high risk overall (including all non-randomized studies), and the remainder at unclear risk. There was high certainty that quit rates were higher in people randomized to nicotine EC than in those randomized to nicotine replacement therapy (NRT) (RR 1.63, 95% CI 1.30 to 2.04; I2 = 10%; 6 studies, 2378 participants). In absolute terms, this might translate to an additional four quitters per 100 (95% CI 2 to 6). There was moderate-certainty evidence (limited by imprecision) that the rate of occurrence of AEs was similar between groups (RR 1.02, 95% CI 0.88 to 1.19; I2 = 0%; 4 studies, 1702 participants). SAEs were rare, but there was insufficient evidence to determine whether rates differed between groups due to very serious imprecision (RR 1.12, 95% CI 0.82 to 1.52; I2 = 34%; 5 studies, 2411 participants). There was moderate-certainty evidence, limited by imprecision, that quit rates were higher in people randomized to nicotine EC than to non-nicotine EC (RR 1.94, 95% CI 1.21 to 3.13; I2 = 0%; 5 studies, 1447 participants). In absolute terms, this might lead to an additional seven quitters per 100 (95% CI 2 to 16). There was moderate-certainty evidence of no difference in the rate of AEs between these groups (RR 1.01, 95% CI 0.91 to 1.11; I2 = 0%; 5 studies, 1840 participants). There was insufficient evidence to determine whether rates of SAEs differed between groups, due to very serious imprecision (RR 1.00, 95% CI 0.56 to 1.79; I2 = 0%; 8 studies, 1272 participants). Compared to behavioural support only/no support, quit rates were higher for participants randomized to nicotine EC (RR 2.66, 95% CI 1.52 to 4.65; I2 = 0%; 7 studies, 3126 participants). In absolute terms, this represents an additional two quitters per 100 (95% CI 1 to 3). However, this finding was of very low certainty, due to issues with imprecision and risk of bias. There was some evidence that (non-serious) AEs were more common in people randomized to nicotine EC (RR 1.22, 95% CI 1.12 to 1.32; I2 = 41%, low certainty; 4 studies, 765 participants) and, again, insufficient evidence to determine whether rates of SAEs differed between groups (RR 1.03, 95% CI 0.54 to 1.97; I2 = 38%; 9 studies, 1993 participants). Data from non-randomized studies were consistent with RCT data. The most commonly reported AEs were throat/mouth irritation, headache, cough, and nausea, which tended to dissipate with continued EC use. Very few studies reported data on other outcomes or comparisons, hence evidence for these is limited, with CIs often encompassing clinically significant harm and benefit. AUTHORS' CONCLUSIONS There is high-certainty evidence that ECs with nicotine increase quit rates compared to NRT and moderate-certainty evidence that they increase quit rates compared to ECs without nicotine. Evidence comparing nicotine EC with usual care/no treatment also suggests benefit, but is less certain. More studies are needed to confirm the effect size. Confidence intervals were for the most part wide for data on AEs, SAEs and other safety markers, with no difference in AEs between nicotine and non-nicotine ECs nor between nicotine ECs and NRT. Overall incidence of SAEs was low across all study arms. We did not detect evidence of serious harm from nicotine EC, but longest follow-up was two years and the number of studies was small. The main limitation of the evidence base remains imprecision due to the small number of RCTs, often with low event rates, but further RCTs are underway. To ensure the review continues to provide up-to-date information to decision-makers, this review is a living systematic review. We run searches monthly, with the review updated when relevant new evidence becomes available. Please refer to the Cochrane Database of Systematic Reviews for the review's current status.
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Affiliation(s)
- Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ailsa R Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Hayden McRobbie
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Chris Bullen
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Rachna Begh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Tari Turner
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Peter Hajek
- Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Park ER, Neil JM, Noonan E, Howard SE, Gonzalez I, Marotta C, Wint AJ, Levy DE, Chang Y, Rigotti NA, Haas JS. Leveraging the Clinical Timepoints in Lung Cancer Screening to Engage Individuals in Tobacco Treatment. JNCI Cancer Spectr 2022; 6:pkac073. [PMID: 36350049 PMCID: PMC9653214 DOI: 10.1093/jncics/pkac073] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/07/2022] [Accepted: 10/03/2022] [Indexed: 10/02/2023] Open
Abstract
The US Preventive Services Task Force recommends lung cancer screening (LCS) to promote early lung cancer detection, and tobacco cessation services are strongly recommended in adjunct. Screen ASSIST (NCT03611881) is a randomized factorial trial to ascertain the best tobacco treatment intervention for smokers undergoing LCS; trial outreach is conducted during 3 recruitment points (RPs): when LCS is ordered (RP1), at screening (RP2), and following results (RP3). Among 177 enrollees enrolled from April 2019 to March 2020, 31.6% enrolled at RP1, 13.0% at RP2, and 55.4% at RP3. The average number of enrollees (per 1000 recruitment days) was 2.26 in RP1, 3.37 in RP2, and 1.04 in RP3. LCS provides an opportunity to offer tobacco treatment at multiple clinical timepoints. Repeated and proactive outreach throughout the LCS experience was beneficial to enrolling patients in tobacco cessation services.
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Affiliation(s)
- Elyse R Park
- Health Promotion and Resiliency and Intervention Research Program, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Mongan Institue, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jordan M Neil
- Health Promotion and Resiliency and Intervention Research Program, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, USA
| | - Elise Noonan
- Health Promotion and Resiliency and Intervention Research Program, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Mongan Institue, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sydney E Howard
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Irina Gonzalez
- Health Promotion and Resiliency and Intervention Research Program, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Mongan Institue, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Caylin Marotta
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Amy J Wint
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Douglas E Levy
- Mongan Institue, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yuchiao Chang
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nancy A Rigotti
- Mongan Institue, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jennifer S Haas
- Mongan Institue, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Reddy KP, Kruse GR, Lee S, Shuter J, Rigotti NA. Tobacco Use and Treatment of Tobacco Dependence Among People With Human Immunodeficiency Virus: A Practical Guide for Clinicians. Clin Infect Dis 2022; 75:525-533. [PMID: 34979543 PMCID: PMC9427148 DOI: 10.1093/cid/ciab1069] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Indexed: 01/05/2023] Open
Abstract
More than 40% of people with human immunodeficiency virus (PWH) in the United States smoke tobacco cigarettes. Among those on antiretroviral therapy, smoking decreases life expectancy more than human immunodeficiency virus (HIV) itself. Most PWH who smoke want to quit, but tobacco dependence treatment has not been widely integrated into HIV care. This article summarizes the epidemiology of tobacco use among PWH, health consequences of tobacco use and benefits of cessation in PWH, and studies of treatment for tobacco dependence among the general population and among PWH. We provide practical guidance for providers to treat tobacco dependence among PWH. A 3-step Ask-Advise-Connect framework includes asking about tobacco use routinely during clinical encounters, advising about tobacco cessation with emphasis on the benefits of cessation, and actively connecting patients to cessation treatments, including prescription of pharmacotherapy (preferably varenicline) and direct connection to behavioral interventions via telephone quitline or other means to increase the likelihood of a successful quit attempt.
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Affiliation(s)
- Krishna P Reddy
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Gina R Kruse
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Stephanie Lee
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jonathan Shuter
- Department of Medicine and Department of Epidemiology and Population Health, Division of Infectious Diseases, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts, USA
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Reddy KP, Price MC, Barnes JA, Rigotti NA, Crotty RK. Case 26-2022: A 48-Year-Old Woman with Cystic Lung Disease. N Engl J Med 2022; 387:738-747. [PMID: 36001715 DOI: 10.1056/nejmcpc2201247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Krishna P Reddy
- From the Departments of Medicine (K.P.R., J.A.B., N.A.R.), Radiology (M.C.P.), and Pathology (R.K.C.), Massachusetts General Hospital, and the Departments of Medicine (K.P.R., J.A.B., N.A.R.), Radiology (M.C.P.), and Pathology (R.K.C.), Harvard Medical School - both in Boston
| | - Melissa C Price
- From the Departments of Medicine (K.P.R., J.A.B., N.A.R.), Radiology (M.C.P.), and Pathology (R.K.C.), Massachusetts General Hospital, and the Departments of Medicine (K.P.R., J.A.B., N.A.R.), Radiology (M.C.P.), and Pathology (R.K.C.), Harvard Medical School - both in Boston
| | - Jeffrey A Barnes
- From the Departments of Medicine (K.P.R., J.A.B., N.A.R.), Radiology (M.C.P.), and Pathology (R.K.C.), Massachusetts General Hospital, and the Departments of Medicine (K.P.R., J.A.B., N.A.R.), Radiology (M.C.P.), and Pathology (R.K.C.), Harvard Medical School - both in Boston
| | - Nancy A Rigotti
- From the Departments of Medicine (K.P.R., J.A.B., N.A.R.), Radiology (M.C.P.), and Pathology (R.K.C.), Massachusetts General Hospital, and the Departments of Medicine (K.P.R., J.A.B., N.A.R.), Radiology (M.C.P.), and Pathology (R.K.C.), Harvard Medical School - both in Boston
| | - Rory K Crotty
- From the Departments of Medicine (K.P.R., J.A.B., N.A.R.), Radiology (M.C.P.), and Pathology (R.K.C.), Massachusetts General Hospital, and the Departments of Medicine (K.P.R., J.A.B., N.A.R.), Radiology (M.C.P.), and Pathology (R.K.C.), Harvard Medical School - both in Boston
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Rigotti NA, Chang Y, Davis EM, Regan S, Levy DE, Ylioja T, Kelley JHK, Notier AE, Gilliam K, Douaihy AB, Singer DE, Tindle HA. Comparative Effectiveness of Postdischarge Smoking Cessation Interventions for Hospital Patients: The Helping HAND 4 Randomized Clinical Trial. JAMA Intern Med 2022; 182:814-824. [PMID: 35759282 PMCID: PMC9237801 DOI: 10.1001/jamainternmed.2022.2300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
IMPORTANCE Smoking cessation interventions for hospitalized patients must continue after discharge to improve long-term tobacco abstinence. How health systems can best deliver postdischarge tobacco treatment is uncertain. OBJECTIVE To determine if health system-based tobacco cessation treatment after hospital discharge produces more long-term tobacco abstinence than referral to a community-based quitline. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted September 2018 to November 2020 in 3 hospitals in Massachusetts, Pennsylvania, and Tennessee. Cigarette smokers admitted to a study hospital who received brief in-hospital tobacco treatment and wanted to quit smoking were recruited for participation and randomized for postdischarge treatment to health system-based Transitional Tobacco Care Management (TTCM) or electronic referral to a community-based quitline (QL). Both multicomponent interventions offered smoking cessation counseling and nicotine replacement therapy (NRT) for up to 3 months. Data were analyzed from February 1, 2021, to April 25, 2022. INTERVENTIONS TTCM provided 8 weeks of NRT at discharge and 7 automated calls with a hospital-based counselor call-back option. The QL intervention sent referrals from the hospital electronic health record to the state quitline, which offered 5 counseling calls and an NRT sample. MAIN OUTCOMES AND MEASURES The main outcome was biochemically verified past 7-day tobacco abstinence at 6 months. Self-reported point-prevalence and continuous tobacco abstinence and tobacco treatment utilization were assessed 1, 3, and 6 months after discharge. RESULTS A total of 1409 participants (mean [SD] age, 51.7 [12.6] years; 784 [55.6%] women; mean [SD] 16.4 [10.6] cigarettes/day) were recruited, including 706 randomized to TTCM and 703 randomized to QL. Participants were comparable at baseline, including 216 Black participants (15.3%), 82 Hispanic participants (5.8%), and 1089 White participants (77.3%). At 1 and 3 months after discharge, more TTCM participants than QL participants used cessation counseling (1 month: 245 participants [34.7%] vs 154 participants [21.9%]; 3 months: 248 participants [35.1%] vs 123 participants [17.5%]; P < .001) and pharmacotherapy (1 month: 455 participants [64.4%] vs 324 participants [46.1%]; 3 months: 367 participants [52.0%] vs 264 participants [37.6%]; P < .001). More TTCM than QL participants reported continuous abstinence for 3 months (RR, 1.30; 95% CI, 1.06-1.58) and point-prevalence abstinence at 1 month (RR, 1.22; 95% CI, 1.08-1.35) and 3 months (RR, 1.23; 95% CI, 1.09-1.37) but not at 6 months (RR, 1.14; 95% CI, 0.99-1.29). The primary outcome, biochemically verified point-prevalence abstinence at 6 months, was not statistically significantly different between groups (19.9% vs 16.9%; RR, 1.18; 95% CI, 0.92-1.50). CONCLUSIONS AND RELEVANCE In this randomized clinical trial, biochemically verified tobacco abstinence rates were not significantly different between groups at the 6-month follow-up. However, the health system-based model was superior to the community-based quitline model throughout the 3 months of active treatment. A longer duration of postdischarge treatment may sustain the superiority of the health system-based model. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03603496.
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Affiliation(s)
- Nancy A Rigotti
- Tobacco Research & Treatment Center, Massachusetts General Hospital, Boston.,Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston.,Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, Massachusetts
| | - Yuchiao Chang
- Tobacco Research & Treatment Center, Massachusetts General Hospital, Boston.,Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, Massachusetts
| | - Esa M Davis
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Susan Regan
- Tobacco Research & Treatment Center, Massachusetts General Hospital, Boston.,Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, Massachusetts
| | - Douglas E Levy
- Tobacco Research & Treatment Center, Massachusetts General Hospital, Boston.,Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, Massachusetts
| | | | | | - Anna E Notier
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Karen Gilliam
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Antoine B Douaihy
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Daniel E Singer
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston.,Harvard Medical School, Boston, Massachusetts
| | - Hilary A Tindle
- Vanderbilt University Medical Center, Nashville, Tennessee.,Geriatric Research Education and Clinical Centers, Veterans Affairs Tennessee Valley Healthcare System, Nashville
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Burris JL, Borger TN, Baker TB, Bernstein SL, Ostroff JS, Rigotti NA, Joseph AM. Proposing a Model of Proactive Outreach to Advance Clinical Research and Care Delivery for Patients Who Use Tobacco. J Gen Intern Med 2022; 37:2548-2552. [PMID: 35474504 PMCID: PMC9360368 DOI: 10.1007/s11606-022-07553-x] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/30/2022] [Indexed: 11/25/2022]
Abstract
There are evidence-based treatments for tobacco dependence, but inequities exist in the access to and reach of these treatments. Traditional models of tobacco treatment delivery are "reactive" and typically provide treatment only to patients who are highly motivated to quit and seek out tobacco treatment. Newer models involve "proactive" outreach, with benefits that include increasing access to tobacco treatment, prompting quit attempts among patients with low motivation, addressing health disparities, and improving population-level quit rates. However, the definition of "proactive" is not clear, and adoption has been slow. This commentary introduces a comprehensive yet flexible model of proactive outreach and describes how proactive outreach can optimize clinical research and care delivery in these domains: (1) identifying the population, (2) offering treatment, and (3) delivering treatment. Dimensions relevant to each domain are the intensity of proactive outreach (low to high) and the extent to which proactive outreach activities rely on human interaction or are facilitated by information technology (IT). Adoption of the proposed proactive outreach model could improve the precision and rigor with which tobacco cessation research and tobacco treatment programs report data, which could have a positive effect on care delivery and patient outcomes.
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Affiliation(s)
- Jessica L Burris
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Tia N Borger
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Timothy B Baker
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Steven L Bernstein
- Department of Emergency Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Jamie S Ostroff
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nancy A Rigotti
- Department of Medicine, Harvard Medical School, MB, Boston, USA
| | - Anne M Joseph
- Department of Medicine and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
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Kruse G, Zulu T, Ngubane H, Reddy K, Siedner M, Rigotti NA, Seeley J, Ngwenya N, Wong E. The ethics of conducting observational tobacco research without providing treatment to people who use tobacco: a case example from South Africa. BMJ Glob Health 2022; 7:e009732. [PMID: 35831036 PMCID: PMC9280873 DOI: 10.1136/bmjgh-2022-009732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 06/25/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Gina Kruse
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thando Zulu
- Africa Health Research Institute, Durban, Kwa-Zulu Natal, South Africa
| | | | - Krishna Reddy
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mark Siedner
- Harvard Medical School, Boston, Massachusetts, USA
- Africa Health Research Institute, Durban, Kwa-Zulu Natal, South Africa
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Janet Seeley
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Nothando Ngwenya
- Africa Health Research Institute, Durban, Kwa-Zulu Natal, South Africa
| | - Emily Wong
- Africa Health Research Institute, Durban, Kwa-Zulu Natal, South Africa
- Division of Infectious Diseases, University of Alabama Birmingham, Birmingham, Alabama, USA
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Kalkhoran S, Streck JM, Kruse GR, Rigotti NA, Perez GK, Regan S, Ponzani CJ, Muzikansky A, Park ER, Ostroff JS. Longitudinal Electronic Cigarette Use Among Patients Recently Diagnosed With Cancer Enrolled in a Smoking Cessation Trial. Nicotine Tob Res 2022; 24:970-977. [PMID: 35134988 PMCID: PMC9199950 DOI: 10.1093/ntr/ntac031] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 01/14/2022] [Accepted: 02/02/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Many cancer patients who smoke report concurrent e-cigarette use. Using a mixed-methods approach, we aimed to (1) describe longitudinal e-cigarette use over 6 months after a cancer diagnosis and (2) assess the association between e-cigarette use and smoking cessation, among cancer patients in a smoking cessation trial. AIMS AND METHODS Data were from a 2-site randomized controlled trial of Standard (brief counseling) versus Intensive treatment (sustained counseling plus smoking cessation medication) in individuals who smoke recently diagnosed with cancer. Participants (n = 303) reported e-cigarette use at baseline, 3 months, and 6 months. Biochemically-verified past 7-day cigarette abstinence was collected at 6 months. Qualitative interviews at 6 months explored factors related to e-cigarette use. RESULTS E-cigarette use prevalence was highest between baseline and 3 months (16%) and declined over time. Participants using e-cigarettes at follow-up had higher baseline cigarette dependence and smoked more heavily. Multivariable analyses found no significant association between follow-up e-cigarette use and 6-month cigarette abstinence. E-cigarette use at follow-up was higher in the Standard versus Intensive treatment group (p = .003 and .001 at 3 and 6 mo, respectively). Smoking cessation and health concerns were primary reasons for using e-cigarettes. CONCLUSIONS Among individuals who smoke recently diagnosed with cancer and enrolled in a smoking cessation intervention trial, e-cigarette use during trial participation was not associated with smoking abstinence. Individuals who chose to use e-cigarettes were less likely to be receiving intensive cessation support as part of the trial. Further studies are needed to evaluate the association between e-cigarette use and smoking cessation in cancer patients. IMPLICATIONS E-cigarette use was not associated with cigarette abstinence at 6 months among adults who smoke recently diagnosed with cancer enrolled in a smoking cessation trial. Individuals with easier access to evidence-based smoking cessation treatment may be less likely to use e-cigarettes.
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Affiliation(s)
- Sara Kalkhoran
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- The Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Joanna M Streck
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Health Promotion and Resiliency Intervention Research (HPRIR) Program, Massachusetts General Hospital, Boston, MA, USA
| | - Gina R Kruse
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- The Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- The Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Giselle K Perez
- Harvard Medical School, Boston, MA, USA
- The Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Health Promotion and Resiliency Intervention Research (HPRIR) Program, Massachusetts General Hospital, Boston, MA, USA
| | - Susan Regan
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Colin J Ponzani
- The Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | | | - Elyse R Park
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- The Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Health Promotion and Resiliency Intervention Research (HPRIR) Program, Massachusetts General Hospital, Boston, MA, USA
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Streck JM, Regan S, Neil J, Kalkhoran S, Gupta PS, Bearnot B, Coker FK, Kalagher KM, Park ER, Wakeman S, Rigotti NA. Interest in Electronic Cigarettes for Smoking Cessation Among Adults With Opioid Use Disorder in Buprenorphine Treatment: A Mixed-Methods Investigation. Nicotine Tob Res 2022; 24:1134-1138. [PMID: 34915581 PMCID: PMC9199932 DOI: 10.1093/ntr/ntab259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/13/2021] [Accepted: 12/14/2021] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Individuals in treatment for opioid use disorder (OUD) have high smoking rates and limited success with Food and Drug Administration (FDA)-approved cessation aids, suggesting need for novel approaches. Electronic cigarettes (e-cigarettes) might benefit this population, but e-cigarettes' acceptability for tobacco reduction or cessation among smokers in OUD treatment is not known. METHODS A cross-sectional mixed-methods study of 222 adults in OUD treatment with buprenorphine in the Boston, Massachusetts metropolitan area was conducted in 2020. We used quantitative and qualitative data to investigate individuals' experience with and interest in e-cigarettes and other methods for smoking cessation and assessed factors associated with interest in e-cigarette use. RESULTS One hundred sixty (72%) of the 222 participants were past 30-day cigarette smokers. They most frequently reported having ever used nicotine replacement therapy (NRT; 83%) and e-cigarettes (71%) for smoking cessation and most often indicated interest in using NRT (71%) and e-cigarettes (44%) for future smoking cessation. In multiple logistic regression analysis, interest in using e-cigarettes for future smoking cessation was independently associated with having ever used e-cigarettes for smoking cessation, current e-cigarette use, and perceiving e-cigarettes to be less harmful than cigarettes (ps < .05). In qualitative data, many current vapers/former smokers reported that e-cigarettes had been helpful for quitting cigarettes. For current smokers who currently or formerly vaped, frequently reported challenges in switching to e-cigarettes were concerns about replacing one addiction with another and e-cigarettes not adequately substituting for cigarettes. CONCLUSIONS E-cigarettes had a moderate level of acceptability for smoking cessation among cigarette smokers in OUD treatment. More research is warranted to test the efficacy of this approach. IMPLICATIONS Individuals in treatment for opioid use disorder (OUD) have high smoking rates and limited success with existing smoking cessation tools, suggesting a need for novel cessation treatment approaches. In this mixed-methods study of individuals receiving medication treatment for OUD with buprenorphine in Massachusetts in 2020, we found a moderate level of acceptability of e-cigarettes for smoking cessation.
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Affiliation(s)
- Joanna M Streck
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston MA, USA
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Susan Regan
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston MA, USA
| | - Jordan Neil
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, USA
| | - Sara Kalkhoran
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston MA, USA
| | - Priya S Gupta
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston MA, USA
| | - Benjamin Bearnot
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston MA, USA
| | - Faith K Coker
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston MA, USA
| | - Kelly M Kalagher
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston MA, USA
| | - Elyse R Park
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston MA, USA
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Sarah Wakeman
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston MA, USA
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston MA, USA
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Levy DE, Regan S, Perez GK, Muzikansky A, Friedman ER, Rabin J, Rigotti NA, Ostroff JS, Park ER. Cost-effectiveness of Implementing Smoking Cessation Interventions for Patients With Cancer. JAMA Netw Open 2022; 5:e2216362. [PMID: 35679043 PMCID: PMC9185176 DOI: 10.1001/jamanetworkopen.2022.16362] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
IMPORTANCE Guidelines recommend cancer care clinicians offer smoking cessation treatment. Cost analyses will help stakeholders understand and plan for implementation of cessation programs. OBJECTIVE To estimate the incremental cost per quit (ICQ) of adopting an intensive smoking cessation intervention among patients undergoing treatment at cancer care clinics, from a clinic perspective. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation, a secondary analysis of the Smokefree Support Study (conducted 2013-2018; completed 2021), used microcosting methods and sensitivity analyses to estimate the ICQ of the interventions. Participants included patients undergoing treatment for a broad range of solid tumors and lymphomas who reported current smoking and were receiving care at cancer care clinics within 2 academic medical centers. EXPOSURES Intensive smoking cessation treatment (up to 11 counseling sessions with free medications), standard of care (up to 4 counseling sessions with medication advice), or usual care (referral to the state quitline). MAIN OUTCOMES AND MEASURES Total costs, component-specific costs, and the ICQ of the intensive smoking cessation treatment relative to both standard of care (comparator in the parent randomized trial) and usual care (a common comparator outside this trial) were calculated. Overall and post hoc site-specific estimates are provided. Because usual care was not included in the parent trial, sensitivity analyses were conducted to assess how assumptions about usual care quit rates affected study outcomes (ie, base case [from a published smoking cessation trial among patients with thoracic cancer], best case, and conservative case scenarios). RESULTS The per-patient costs of offering intensive smoking cessation treatment, standard of care, and usual care were $1989, $1482, and $0, respectively. For intensive treatment, the dominant costs were treatment (35%), staff supervision (26%), and patient enrollment (24%). Relative to standard of care, intensive treatment had an overall ICQ of $3906, and one site had an ICQ of $2892. Relative to usual care, intensive treatment had an ICQ of $9866 overall (base case), although at one site, the ICQ was $5408 (base case) and $3786 (best case). CONCLUSIONS AND RELEVANCE In this economic evaluation study, implementation of an intensive smoking cessation treatment intervention was moderately to highly cost-effective, depending on existing smoking cessation services in place.
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Affiliation(s)
- Douglas E. Levy
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Susan Regan
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
| | - Giselle K. Perez
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston
- Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Alona Muzikansky
- MGH Biostatistics Center, Massachusetts General Hospital, Boston
| | - Emily R. Friedman
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston
| | - Julia Rabin
- Department of Psychology, University of Cincinnati, Cincinnati, Ohio
| | - Nancy A. Rigotti
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
| | - Jamie S. Ostroff
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elyse R. Park
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Health Promotion and Resiliency Intervention Research Program, Massachusetts General Hospital, Boston
- Department of Psychiatry, Massachusetts General Hospital, Boston
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Abstract
INTRODUCTION With concerns about tobacco use being a risk factor for severe disease from COVID-19, understanding nicotine- and tobacco-use patterns is important for preventive efforts. This study aims to understand changes in combustible cigarette and E-cigarette use among U.S. adults. METHODS In August 2020, a cross-sectional survey of a nationally representative sample of adults aged ≥18 years in the National Opinion Research Center's AmeriSpeak Panel who reported past 6-month use of combustible cigarettes or E-cigarettes was conducted. Multivariable logistic regression assessed the factors associated with increased product use and quit attempts since hearing about COVID-19. RESULTS A total of 1,024 past 6-month cigarette smokers/E-cigarette users were surveyed. Among cigarette smokers, 45% reported no change in cigarette smoking, and 33% reported increased cigarette smoking since hearing about COVID-19. Higher stress was associated with increased cigarette smoking. Among E-cigarette users, 41% reported no change in E-cigarette use, and 23% reported increasing E-cigarette use. A total of 26% of cigarette smokers and 41% of E-cigarette users tried to quit because of COVID-19. Higher perceived risk of COVID-19 was associated with attempts to quit combustible cigarettes (AOR=2.37, 95% CI=1.59, 3.55) and E-cigarettes (AOR=3.14, 95% CI=1.73, 5.70). CONCLUSIONS Cigarette and E-cigarette use patterns varied in response to the COVID-19 pandemic. Most cigarette smokers and E-cigarette users perceived product use as increasing COVID-19‒related health risks, and this was associated with attempts to quit. Some cigarette smokers, especially those reporting higher stress, increased product use. Proactive provision of cessation support to smokers and E-cigarette users may help mitigate the stress-related increases in product use during the COVID-19 pandemic.
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Affiliation(s)
- Sara M Kalkhoran
- From the Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Tobacco Research & Treatment Center, Massachusetts General Hospital, Boston, Massachusetts; The Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Douglas E Levy
- Tobacco Research & Treatment Center, Massachusetts General Hospital, Boston, Massachusetts; The Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Nancy A Rigotti
- From the Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Tobacco Research & Treatment Center, Massachusetts General Hospital, Boston, Massachusetts; The Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts.
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Stone NJ, Smith SC, Orringer CE, Rigotti NA, Navar AM, Khan SS, Jones DW, Goldberg R, Mora S, Blaha M, Pencina MJ, Grundy SM. Managing Atherosclerotic Cardiovascular Risk in Young Adults: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 79:819-836. [PMID: 35210038 DOI: 10.1016/j.jacc.2021.12.016] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [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: 11/12/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 02/08/2023]
Abstract
There is a need to identify high-risk features that predict early-onset atherosclerotic cardiovascular disease (ASCVD). The authors provide insights to help clinicians identify and address high-risk conditions in the 20- to 39-year age range (young adults). These include tobacco use, elevated blood pressure/hypertension, family history of premature ASCVD, primary severe hypercholesterolemia such as familial hypercholesterolemia, diabetes with diabetes-specific risk-enhancing factors, or the presence of multiple other risk-enhancing factors, including in females, a history of pre-eclampsia or menopause under age 40. The authors update current thinking on lipid risk factors such as triglycerides, non-high-density lipoprotein cholesterol, apolipoprotein B, or lipoprotein (a) that are useful in understanding an individual's long-term ASCVD risk. The authors review emerging strategies, such as coronary artery calcium and polygenic risk scores in this age group, that have potential clinical utility, but whose best use remains uncertain. Finally, the authors discuss both the obstacles and opportunities for addressing prevention in early adulthood.
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Affiliation(s)
- Neil J Stone
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
| | - Sidney C Smith
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Carl E Orringer
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Ann Marie Navar
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sadiya S Khan
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Daniel W Jones
- University of Mississippi School of Medicine, Jackson, Mississippi, USA
| | - Ronald Goldberg
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Samia Mora
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Scott M Grundy
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Streck JM, Regan S, Kalkhoran S, Kalagher KM, Bearnot B, Gupta PS, Wakeman S, Rigotti NA. Perceptions of E-cigarettes among adults in treatment for opioid use disorder. Drug Alcohol Depend Rep 2022; 2:100023. [PMID: 36845890 PMCID: PMC9949332 DOI: 10.1016/j.dadr.2022.100023] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 10/19/2022]
Abstract
Background Individuals with opioid use disorder (OUD) have a high prevalence of smoking and limited success quitting smoking with existing tools. There is ongoing debate about whether electronic cigarettes (e-cigarettes) may be a viable harm reduction strategy. We sought to determine the potential acceptability of e-cigarettes for cigarette harm reduction among individuals receiving medication treatment for opioid use disorder (MOUD) with buprenorphine. Among individuals receiving MOUD we investigated health harm perceptions of cigarettes, nicotine e-cigarettes, and nicotine replacement therapy (NRT), and perceptions of the helpfulness of e-cigarettes and NRT for quitting cigarettes. Methods Cross-sectional telephone survey conducted among adults in buprenorphine treatment at five community health centers in the Boston, MA metropolitan area from February to July 2020. Results 93% and 63% of participants rated cigarettes and e-cigarettes, respectively, as very or extremely harmful to health, and 62% rated NRT as not to slightly harmful to health. Over half (58%) rated cigarettes as more harmful than e-cigarettes; 65% and 83% perceived e-cigarettes and NRT, respectively, to be helpful for reducing/quitting cigarette use. In bivariate analyses, nicotine e-cigarette users, compared to nonusers, perceived e-cigarettes to be less harmful to health and more often rated e-cigarettes as helpful for reducing/quitting cigarette use (both p<0.05). Conclusions This study suggests that Massachusetts patients receiving MOUD with buprenorphine have concerns about the health harms of e-cigarettes yet rate them as helpful tools for reducing or quitting cigarette smoking. Future research is needed to test the efficacy of e-cigarettes for cigarette harm reduction.
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Affiliation(s)
- Joanna M. Streck
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Susan Regan
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Sara Kalkhoran
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kelly M. Kalagher
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Benjamin Bearnot
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Priya S. Gupta
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Sarah Wakeman
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Nancy A. Rigotti
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Abstract
IMPORTANCE More deaths in the US are attributed to cigarette smoking each year than to any other preventable cause. Approximately 34 million people and an estimated 14% of adults in the US smoke cigarettes. If they stopped smoking, they could reduce their risk of tobacco-related morbidity and mortality and potentially gain up to 10 years of life. OBSERVATIONS Tobacco smoking is a chronic disorder maintained by physical nicotine dependence and learned behaviors. Approximately 70% of people who smoke cigarettes want to quit smoking. However, individuals who attempt to quit smoking make an average of approximately 6 quit attempts before achieving long-term abstinence. Both behavioral counseling and pharmacotherapy while using nicotine replacement therapy (NRT) products, varenicline, or bupropion are effective treatments when used individually, but they are most effective when combined. In a meta-analysis including 19 488 people who smoked cigarettes, the combination of medication and behavioral counseling was associated with a quit rate of 15.2% over 6 months compared with a quit rate of 8.6% with brief advice or usual care. The EAGLES trial, a randomized double-blind clinical trial of 8144 people who smoked, directly compared the efficacy and safety of varenicline, bupropion, nicotine patch, and placebo and found a significantly higher 6-month quit rate for varenicline (21.8%) than for bupropion (16.2%) and the nicotine patch (15.7%). Each therapy was more effective than placebo (9.4%). Combining a nicotine patch with other NRT products is more effective than use of a single NRT product. Combining drugs with different mechanisms of action, such as varenicline and NRT, has increased quit rates in some studies compared with use of a single product. Brief or intensive behavioral support can be delivered effectively in person or by telephone, text messages, or the internet. The combination of a clinician's brief advice to quit and assistance to obtain tobacco cessation treatment is effective when routinely administered to tobacco users in virtually all health care settings. CONCLUSIONS AND RELEVANCE Approximately 34 million people in the US smoke cigarettes and could potentially gain up to a decade of life expectancy by stopping smoking. First-line therapy should include both pharmacotherapy and behavioral support, with varenicline or combination NRT as preferred initial interventions.
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Affiliation(s)
- Nancy A Rigotti
- Tobacco Research and Treatment Center, Mongan Institute, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Gina R Kruse
- Tobacco Research and Treatment Center, Mongan Institute, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | | | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Baggett TP, Barbosa Teixeira J, Rodriguez EC, Anandakugan N, Sporn N, Chang Y, Percac-Lima S, Park ER, Rigotti NA. Patient navigation to promote lung cancer screening in a community health center for people experiencing homelessness: Protocol for a pragmatic randomized controlled trial. Contemp Clin Trials 2022; 113:106666. [PMID: 34971796 DOI: 10.1016/j.cct.2021.106666] [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] [Received: 11/04/2021] [Revised: 12/13/2021] [Accepted: 12/23/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Lung cancer is a major cause of death among people experiencing homelessness, with mortality rates more than double those in the general population. Lung cancer screening (LCS) with low-dose computed tomography (LDCT) could reduce lung cancer deaths in this population, although the circumstances of homelessness present multiple barriers to LCS LDCT completion. Patient navigation is a promising strategy for overcoming these barriers. METHODS The Investigating Navigation to Help Advance Lung Equity (INHALE) Study is a pragmatic randomized controlled trial of patient navigation for LCS among individuals receiving primary care at Boston Health Care for the Homeless Program (BHCHP). Three hundred BHCHP patients who meet Medicare/Medicaid criteria for LCS will be randomized 2:1 to usual care with (n = 200) or without (n = 100) LCS navigation. Following a structured, theory-based protocol, the patient navigator assists with each step in the LCS process, providing lung cancer education, facilitating shared decision-making visits with primary care providers (PCPs), assisting in making and attending LCS LDCT appointments, arranging follow-up when needed, and offering tobacco cessation support for smokers. The primary outcome is receipt of LCS LDCT at 6 months. Using a sequential explanatory mixed methods approach, qualitative interviews with participants and PCPs will aid in interpreting and contextualizing the trial results. DISCUSSION This trial will produce the first experimental evidence on patient navigation for cancer screening in a homeless health care setting. Results could inform cancer health equity efforts at the 299 Health Care for the Homeless programs that serve over 900,000 patients annually in the US.
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Affiliation(s)
- Travis P Baggett
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America; Institute for Research, Quality & Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, MA, United States of America.
| | - Joana Barbosa Teixeira
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Elijah C Rodriguez
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America; New York University Grossman School of Medicine, New York, NY, United States of America
| | - Nillani Anandakugan
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Nora Sporn
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Yuchiao Chang
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Sanja Percac-Lima
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Elyse R Park
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Nancy A Rigotti
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
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Streck JM, Luberto CM, Muzikansky A, Skurla S, Ponzani CJ, Perez GK, Hall DL, Gonzalez A, Mahaffey B, Rigotti NA, Ostroff JS, Park ER. Corrigendum to “Examining the effects of stress and psychological distress on smoking abstinence in cancer patients” [Prev. Med. Rep. 23 (2021) 101402]. Prev Med Rep 2022; 25:101693. [PMID: 35127366 PMCID: PMC8800054 DOI: 10.1016/j.pmedr.2021.101693] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Cromer SJ, D’Silva KM, Phadke NA, Lord E, Rigotti NA, Baer HJ. Gender Differences in the Amount and Type of Student Participation During In-Person and Virtual Classes in Academic Medicine Learning Environments. JAMA Netw Open 2022; 5:e2143139. [PMID: 35019985 PMCID: PMC8756329 DOI: 10.1001/jamanetworkopen.2021.43139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This cohort study examines gender differences in the amount and type of student participation during in-person and virtual classes in graduate-level academic medicine learning environments.
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Affiliation(s)
- Sara J. Cromer
- Division of Endocrinology, Diabetes, and Metabolism, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Kristin M. D’Silva
- Harvard Medical School, Boston, Massachusetts
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
| | - Neelam A. Phadke
- Harvard Medical School, Boston, Massachusetts
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
| | - Emma Lord
- Northeastern University, Boston, Massachusetts
| | - Nancy A. Rigotti
- Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
| | - Heather J. Baer
- Harvard Medical School, Boston, Massachusetts
- Division of General Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Balfour DJK, Benowitz NL, Colby SM, Hatsukami DK, Lando HA, Leischow SJ, Lerman C, Mermelstein RJ, Niaura R, Perkins KA, Pomerleau OF, Rigotti NA, Swan GE, Warner KE, West R. Balfour et al. Respond. Am J Public Health 2022; 112:e2-e3. [PMID: 34936419 PMCID: PMC8713616 DOI: 10.2105/ajph.2021.306555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 11/04/2022]
Affiliation(s)
- David J K Balfour
- David J. K. Balfour is retired from the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California, San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois-Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Neal L Benowitz
- David J. K. Balfour is retired from the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California, San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois-Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Suzanne M Colby
- David J. K. Balfour is retired from the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California, San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois-Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Dorothy K Hatsukami
- David J. K. Balfour is retired from the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California, San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois-Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Harry A Lando
- David J. K. Balfour is retired from the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California, San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois-Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Scott J Leischow
- David J. K. Balfour is retired from the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California, San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois-Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Caryn Lerman
- David J. K. Balfour is retired from the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California, San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois-Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Robin J Mermelstein
- David J. K. Balfour is retired from the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California, San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois-Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Raymond Niaura
- David J. K. Balfour is retired from the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California, San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois-Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Kenneth A Perkins
- David J. K. Balfour is retired from the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California, San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois-Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Ovide F Pomerleau
- David J. K. Balfour is retired from the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California, San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois-Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Nancy A Rigotti
- David J. K. Balfour is retired from the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California, San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois-Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Gary E Swan
- David J. K. Balfour is retired from the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California, San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois-Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Kenneth E Warner
- David J. K. Balfour is retired from the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California, San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois-Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Robert West
- David J. K. Balfour is retired from the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California, San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois-Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
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Streck JM, Regan S, Bearnot B, Gupta PS, Kalkhoran S, Kalagher KM, Wakeman S, Rigotti NA. Prevalence of Cannabis Use and Cannabis Route of Administration among Massachusetts Adults in Buprenorphine Treatment for Opioid Use Disorder. Subst Use Misuse 2022; 57:1104-1110. [PMID: 35410577 PMCID: PMC10091221 DOI: 10.1080/10826084.2022.2063899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Recent prevalence estimates of cannabis use among individuals receiving medication treatment for OUD (MOUD) are lacking, and no study has characterized cannabis route of administration (cROA) in this population. These knowledge gaps are relevant because cannabis' effects and health outcomes vary by cROA and the availability and perceptions of cROA (e.g., vaping devices) are changing. METHODS The Vaping In Buprenorphine-treated patients Evaluation (VIBE) cross-sectional survey assessed the prevalence and correlates of cannabis use and cROA among adults receiving buprenorphine MOUD from 02/20 to 07/20 at five community health centers in Massachusetts, a state with legal recreational and medical cannabis use. RESULTS Among the 92/222 (41%) respondents reporting past 30-day cannabis use, smoking was the most common cROA (75%), followed by vaping (38%), and eating (26%). Smoking was more often used as a single cROA vs. in combination others (p = 0.01), whereas vaping, eating, and dabbing were more often used in combination with another cROA (all p < 0.05). Of the 39% of participants reporting multiple cROA, smoking and vaping (61%), and smoking and eating (50%), were the most prevalent combinations. Nonwhite race (vs. white) and current cigarette smoking (vs. no nicotine use) were associated with past 30-day cannabis use in multiple logistic regression. CONCLUSIONS Prevalence of past 30-day cannabis use among individuals receiving buprenorphine MOUD in Massachusetts in 2020 was nearly double the prevalence of cannabis use in Massachusetts' adult general population in 2019 (21%). Our data are consistent with state and national data showing smoking as the most common cROA.
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Affiliation(s)
- Joanna M Streck
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Susan Regan
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Benjamin Bearnot
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Priya S Gupta
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Sara Kalkhoran
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Kelly M Kalagher
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sarah Wakeman
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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48
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Balfour DJK, Benowitz NL, Colby SM, Hatsukami DK, Lando HA, Leischow SJ, Lerman C, Mermelstein RJ, Niaura R, Perkins KA, Pomerleau OF, Rigotti NA, Swan GE, Warner KE, West R. Balfour et al. Respond. Am J Public Health 2022; 112:e5-e6. [PMID: 34936414 PMCID: PMC8713597 DOI: 10.2105/ajph.2021.306570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 11/04/2022]
Affiliation(s)
- David J K Balfour
- David J. K. Balfour is retired from the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California, San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois-Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Neal L Benowitz
- David J. K. Balfour is retired from the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California, San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois-Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Suzanne M Colby
- David J. K. Balfour is retired from the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California, San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois-Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Dorothy K Hatsukami
- David J. K. Balfour is retired from the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California, San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois-Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Harry A Lando
- David J. K. Balfour is retired from the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California, San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois-Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Scott J Leischow
- David J. K. Balfour is retired from the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California, San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois-Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Caryn Lerman
- David J. K. Balfour is retired from the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California, San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois-Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Robin J Mermelstein
- David J. K. Balfour is retired from the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California, San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois-Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Raymond Niaura
- David J. K. Balfour is retired from the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California, San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois-Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Kenneth A Perkins
- David J. K. Balfour is retired from the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California, San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois-Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Ovide F Pomerleau
- David J. K. Balfour is retired from the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California, San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois-Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Nancy A Rigotti
- David J. K. Balfour is retired from the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California, San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois-Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Gary E Swan
- David J. K. Balfour is retired from the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California, San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois-Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Kenneth E Warner
- David J. K. Balfour is retired from the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California, San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois-Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
| | - Robert West
- David J. K. Balfour is retired from the Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK. Neal L. Benowitz is with the Department of Medicine, School of Medicine, University of California, San Francisco. Suzanne M. Colby is with the Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI. Dorothy K. Hatsukami is with the Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis. Harry A. Lando is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. Scott J. Leischow is with the College of Health Solutions, Arizona State University, Phoenix. Caryn Lerman is with the Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles. Robin J. Mermelstein is with the Department of Psychology, University of Illinois-Chicago. Raymond Niaura is with the Department of Epidemiology, School of Global Public Health, New York University, New York, NY. Kenneth A. Perkins is with the Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Ovide F. Pomerleau is with the Department of Psychiatry, Medical School, University of Michigan, Ann Arbor. Nancy A. Rigotti is with the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Gary E. Swan is with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA. Kenneth E. Warner is with the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor. Robert West is with the Department of Behavioural Science and Health, University College London, London, UK
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Styklunas GM, Shahid NN, Park ER, Haberer JE, Rigotti NA, Howard SE, Kruse GR. A qualitative analysis of nicotine replacement therapy uptake, consistent use, and persistence among primary care patients who smoke. Drug Alcohol Depend Rep 2021; 2:100018. [PMID: 36845902 PMCID: PMC9948942 DOI: 10.1016/j.dadr.2021.100018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/05/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
•Adherence can be broken into three processes: uptake, consistent use, and persistence.•Barriers and facilitators to NRT use vary over the three adherence processes.•Information gaps and negative stories about NRT are common barriers to adherence.•NRT adherence may be improved by addressing patient knowledge and concerns.
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Affiliation(s)
- GM Styklunas
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States,Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, United States,Tufts University School of Medicine, Boston, MA, United States,Corresponding author at: Internal Medicine, Massachusetts General Hospital, 100 Cambridge Street, 16th Floor, Boston, Massachusetts 02114, United States.
| | - NN Shahid
- Department of Psychology, University of Miami, Miami, FL, United States
| | - ER Park
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, United States,Harvard Medical School, Boston, MA, United States,Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - JE Haberer
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States,Center for Global Health, Massachusetts General Hospital, Boston, MA, United States,Harvard Medical School, Boston, MA, United States
| | - NA Rigotti
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States,Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, United States,Harvard Medical School, Boston, MA, United States,Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - SE Howard
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - GR Kruse
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States,Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, United States,Harvard Medical School, Boston, MA, United States
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50
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Rigotti NA, Chang Y, Regan S, Lee S, Kelley JHK, Davis E, Levy DE, Singer DE, Tindle HA. Cigarette Smoking and Risk Perceptions During the COVID-19 Pandemic Reported by Recently Hospitalized Participants in a Smoking Cessation Trial. J Gen Intern Med 2021; 36:3786-3793. [PMID: 34100230 PMCID: PMC8183588 DOI: 10.1007/s11606-021-06913-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/04/2021] [Indexed: 10/27/2022]
Abstract
BACKGROUND Cigarette smoking is a risk factor for severe COVID-19 disease. Understanding smokers' responses to the pandemic will help assess its public health impact and inform future public health and provider messages to smokers. OBJECTIVE To assess risk perceptions and change in tobacco use among current and former smokers during the COVID-19 pandemic. DESIGN Cross-sectional survey conducted in May-July 2020 (55% response rate) PARTICIPANTS: 694 current and former daily smokers (mean age 53, 40% male, 78% white) who had been hospitalized pre-COVID-19 and enrolled into a smoking cessation clinical trial at hospitals in Massachusetts, Pennsylvania, and Tennessee. MAIN MEASURES Perceived risk of COVID-19 due to tobacco use; changes in tobacco consumption and interest in quitting tobacco use; self-reported quitting and relapse since January 2020. KEY RESULTS 68% (95% CI, 65-72%) of respondents believed that smoking increases the risk of contracting COVID-19 or having a more severe case. In adjusted analyses, perceived risk was higher in Massachusetts where COVID-19 had already surged than in Pennsylvania and Tennessee which were pre-surge during survey administration (AOR 1.56, 95% CI, 1.07-2.28). Higher perceived COVID-19 risk was associated with increased interest in quitting smoking (AOR 1.72, 95% CI 1.01-2.92). During the pandemic, 32% (95% CI, 27-37%) of smokers increased, 37% (95% CI, 33-42%) decreased, and 31% (95% CI, 26-35%) did not change their cigarette consumption. Increased smoking was associated with higher perceived stress (AOR 1.49, 95% CI 1.16-1.91). Overall, 11% (95% CI, 8-14%) of respondents who smoked in January 2020 (pre-COVID-19) had quit smoking at survey (mean, 6 months later) while 28% (95% CI, 22-34%) of former smokers relapsed. Higher perceived COVID-19 risk was associated with higher odds of quitting and lower odds of relapse. CONCLUSIONS Most smokers believed that smoking increased COVID-19 risk. Smokers' responses to the pandemic varied, with increased smoking related to stress and increased quitting associated with perceived COVID-19 vulnerability.
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Affiliation(s)
- Nancy A Rigotti
- Tobacco Research and Treatment Center, Division of General Internal Medicine, and Mongan Institute, Department of Medicine, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Yuchiao Chang
- Tobacco Research and Treatment Center, Division of General Internal Medicine, and Mongan Institute, Department of Medicine, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Susan Regan
- Tobacco Research and Treatment Center, Division of General Internal Medicine, and Mongan Institute, Department of Medicine, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Scott Lee
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jennifer H K Kelley
- Tobacco Research and Treatment Center, Division of General Internal Medicine, and Mongan Institute, Department of Medicine, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
| | - Esa Davis
- Department of Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Douglas E Levy
- Tobacco Research and Treatment Center, Division of General Internal Medicine, and Mongan Institute, Department of Medicine, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Daniel E Singer
- Tobacco Research and Treatment Center, Division of General Internal Medicine, and Mongan Institute, Department of Medicine, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Hilary A Tindle
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, USA
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