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Onigbogi O, Pratt R, Luo X, Everson-Rose SA, Cooney NL, Specker S, Okuyemi K. Association between psychosocial factors and co-morbid cigarette smoking and alcohol use in a population experiencing homelessness. Addict Behav Rep 2024; 19:100523. [PMID: 38155753 PMCID: PMC10753056 DOI: 10.1016/j.abrep.2023.100523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 12/30/2023] Open
Abstract
The prevalence of combustible cigarette smoking in populations experiencing homelessness in the United States is five times that of the general population. The psychosocial well-being of persons who smoke and experience homelessness is poorer if such persons also use alcohol heavily. The PTQ2 study was a randomized clinical trial among persons experiencing homelessness who were also current smokers and heavy alcohol consumers. Secondary data analysis of the PTQ2 baseline data was conducted to examine associations among psychosocial variables (anxiety, depression, hopelessness, social network size), heaviness of smoking (cigarettes/day) and alcohol consumption (drinking days/month), and duration and frequency of homelessness. Among the 420 participants, the majority were male (75%), black (70%) and non-Hispanic (94%) with a mean age of 46.6 years (SD = 11.6). Bivariate analyses show that heaviness of smoking was positively correlated with social network size (r = 0.16, p = .001). Heaviness of drinking was positively correlated with the MINI anxiety score (r = 0.13, p = .009) and marijuana use (median total number of drinks in past 30 days among those who used marijuana in past 30 days vs. did not use: 50 vs. 24, p < .0001), and associated with frequency of homelessness (median total number of drinks in past 30 days among those experiencing homelessness once vs. >1 time: 30 vs. 44, p = .022). The findings highlight the psychosocial factors that warrant consideration when addressing heavy smoking and alcohol consumption in persons experiencing homelessness.
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Affiliation(s)
- Olanrewaju Onigbogi
- Department of Family and Preventive Medicine, Spencer Fox Eccles School of Medicine, University of Utah, 375 Chipeta Way, Suite A, Salt Lake City, UT 84108, USA
| | - Rebekah Pratt
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware Street SE, Suite 166, Minneapolis, MN 55414, USA
| | - Xianghua Luo
- Division of Biostatistics and Health Data Science, School of Public Health and Biostatistics Core, Masonic Cancer Center, University of Minnesota, 2221 University Ave SE, Suite 300, Minneapolis, MN 55414, USA
| | - Susan A. Everson-Rose
- Program in Health Disparities, School of Public Health, University of Minnesota Medical School, 717 Delaware Street SE, Suite 166, Minneapolis, MN 55414, USA
- Department of Medicine, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455, USA
| | - Ned L. Cooney
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, USA
| | - Sheila Specker
- Department of Psychiatry and Behavioral Sciences, F282/2A West, 2450 Riverside Ave, Minneapolis, MN 55454, USA
| | - Kolawole Okuyemi
- Department of Family and Preventive Medicine, Spencer Fox Eccles School of Medicine, University of Utah, 375 Chipeta Way, Suite A, Salt Lake City, UT 84108, USA
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Gu D, Rafferty H, Vijayaraghavan M. Factors Associated with Smoking Cessation and the Receipt of Cessation Services in a Public, Safety-Net Primary Care System. J Gen Intern Med 2024:10.1007/s11606-024-08664-3. [PMID: 38332442 DOI: 10.1007/s11606-024-08664-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/25/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Prevalence of smoking is high among patients receiving care in safety-net settings, and there is a need to better understand patient factors associated with smoking cessation and receipt of cessation services. OBJECTIVE To identify patient factors associated with smoking cessation attempts and receipt of cessation counseling and pharmacotherapy in a large safety-net health system. DESIGN We conducted a retrospective cohort analysis using EHR data in a safety-net system in San Francisco, CA. PARTICIPANTS We included 7384 adult current smokers who had at least three unique primary care encounters with documented smoking status between August 2019 and April 2022. MAIN MEASURES We assessed four outcomes using multivariate generalized estimating equation models: (1) any cessation attempt, indicating a transition in smoking status from "current smoker" to "former smoker"; (2) sustained cessation, defined as transition in smoking status from current smoker to former smokers for two or more consecutive visits; (3) receipt of smoking cessation counseling from healthcare providers; and (4) receipt of pharmacotherapy. KEY RESULTS Of 7384 current adult smokers, 17.6% had made any cessation attempt, and of those 66.5% had sustained cessation. Most patients (81.1%) received counseling and 41.8% received pharmacotherapy. Factors associated with lower odds of any cessation attempt included being aged 45-64, non-Hispanic black, and experiencing homelessness. The factor associated with lower odds of sustained cessation was being male. Factors associated with lower odds of receiving counseling were being insured by Medicaid or being uninsured. Factors associated with lower odds of receiving pharmacotherapy included speaking languages other than English, being male, and identifying as racial and ethnic minorities. CONCLUSIONS Health system interventions could close the gap in access to smoking cessation services for unhoused and racial/ethnic minority patients in safety-net settings, thereby increasing cessation among these populations.
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Affiliation(s)
- Dian Gu
- Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, CA, USA.
- Division of General Internal Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA.
| | - Henry Rafferty
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Maya Vijayaraghavan
- Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, CA, USA
- San Francisco Department of Public Health, San Francisco, CA, USA
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Pandya A, K S M, Mishra S, Bajaj K. Effectiveness of the QuitSure Smartphone App for Smoking Cessation: Findings of a Prospective Single Arm Trial. JMIR Form Res 2023; 7:e51658. [PMID: 38157243 PMCID: PMC10787327 DOI: 10.2196/51658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/01/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Digital therapies, especially smartphone apps for active and continuous smoking cessation support, are strongly emerging as an alternative smoking cessation therapy. In the Indian context, there is a growing interest in the use of app-based smoking cessation programs; however, there is limited evidence regarding their effectiveness in achieving long-term continuous abstinence. OBJECTIVE This study aimed to evaluate the long-term abstinence effect (up to 30-d abstinence postprogram completion) of a smartphone app, QuitSure, for smoking cessation in active smokers from India. METHODS In this prospective single-arm study, participants who signed up for the QuitSure app were enrolled in this study. The primary end point was the prolonged abstinence (PA) rate from weeks 1 to 4 (day 7 to day 30). Furthermore, data for withdrawal symptoms, relapse reasons, and reasons for not continuing the program were also assessed. RESULTS The quit rate was calculated considering only the participants who followed up and completed the survey sent to them (per protocol) at day 7 and at day 30, respectively. The PA rate at day 7 was found to be 64.5% (111/172; 95% CI 56% to 72%), and the PA rate at day 30 was found to be 55.8% (72/129; 95% CI 45% to 65%). Within the 7-day abstinence period, 60.4% (67/111) of the participants did not have any withdrawal symptoms. The most common mild withdrawal symptoms were mild sleep disturbance (21/111, 18.9%), mild digestive changes (19/111, 17.1%), and coughing (17/111, 15.3%). Severe withdrawal symptoms were rare, with only 5.4% (6/111) experiencing them. For those achieving 30-day postprogram abstinence, 85% (61/72) had no mild withdrawal symptoms, and 99% (71/72) had no severe withdrawal symptoms. Among successful quitters at day 7, a total of 72.1% (80/111) reported minimal to no cravings, which increased to 88% (63/72) at day 30. Furthermore, 78% (56/72) of those with PA at day 30 reported no change in weight or reduced weight. Among participants experiencing relapse, 48% (28/58) cited intense cravings, 28% (16/58) mentioned facing a tragedy, and 26% (15/58) reported relapsing due to alcohol consumption. The PA rates as a result of the QuitSure program were found to be better than those reported in the results of other smoking-cessation app programs' studies. CONCLUSIONS The QuitSure app yields high PA rates and ameliorates symptoms associated with smoking cessation. In order to obtain conclusive evidence regarding the effectiveness and efficacy of the QuitSure program, future research should include appropriate control measures. Nevertheless, the QuitSure program can serve as a valuable adjunct to a conventional smoking cessation treatment program to aid sustained abstinence.
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Affiliation(s)
- Apurvakumar Pandya
- Parul Institute of Public Health, Parul University, Vadodara, India
- Indian Institute of Public Health, Gandhinagar, India
| | - Mythri K S
- Parul Institute of Public Health, Parul University, Vadodara, India
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Wilson SM, Blalock DV, Young JR, Griffin SC, Hertzberg JS, Calhoun PS, Beckham JC. Mobile health contingency management for smoking cessation among veterans experiencing homelessness: A comparative effectiveness trial. Prev Med Rep 2023; 35:102311. [PMID: 37455761 PMCID: PMC10345125 DOI: 10.1016/j.pmedr.2023.102311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/30/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023] Open
Abstract
Tobacco cessation is reduced in U.S. military veterans experiencing homelessness. Mobile contingency management (mCM) is a promising treatment for tobacco use among populations experiencing homelessness, but past CM studies have largely been small, have relied on in-person follow-up, and/or lacked long-term biochemically verified abstinence measures. Veterans who smoked and were experiencing homelessness (N = 127) were randomly assigned to mCM treatment (4 weeks of mCM, 5 weeks of telehealth counseling, and the option of 12 weeks of pharmacotherapy) or VA standard care (3 biweekly group sessions and clinically appropriate pharmacotherapy), and all participants were randomly assigned to a $100 longer-term financial incentive for abstinence at 3-month follow-up. Participants were followed at 3-, 6-, and 12-months post-randomization, with the a priori main outcome designated as biochemically verified prolonged abstinence (with lapses) at 6-month follow-up. At 6-months, participants in the mCM group were significantly more likely to meet criteria for prolonged abstinence (OR = 3.1). Across time points, veterans in the mCM group had twice the odds of prolonged abstinence as those in the standard care group. However, by the 12-month follow-up, there was no statistically significant group difference in abstinence. Cost-effectiveness analysis indicated a modest increase in cost ($1,133) associated with an increase of one quality-adjusted life year saved for the intervention compared to standard care. mCM is a cost-effective approach to smoking cessation among veterans experiencing homelessness. Considering waning potency of this and other tobacco cessation interventions at 12-month follow-up, it is crucial to implement strategies to sustain abstinence for individuals experiencing homelessness.
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Affiliation(s)
- Sarah M. Wilson
- VA Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT COIN), Durham Veterans Affairs Health Care System, Durham, NC, United States
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham Veterans Affairs Health Care System, Durham, NC, United States
| | - Dan V. Blalock
- VA Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT COIN), Durham Veterans Affairs Health Care System, Durham, NC, United States
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Jonathan R. Young
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham Veterans Affairs Health Care System, Durham, NC, United States
- Duke Clinical Research Institute (DCRI), Duke University School of Medicine, Durham, NC, United States
| | - Sarah C. Griffin
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham Veterans Affairs Health Care System, Durham, NC, United States
| | - Jeffrey S. Hertzberg
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham Veterans Affairs Health Care System, Durham, NC, United States
| | - Patrick S. Calhoun
- VA Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT COIN), Durham Veterans Affairs Health Care System, Durham, NC, United States
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham Veterans Affairs Health Care System, Durham, NC, United States
| | - Jean C. Beckham
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham Veterans Affairs Health Care System, Durham, NC, United States
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Zhou X, Wei X, Cheng A, Liu Z, Su Z, Li J, Qin R, Zhao L, Xie Y, Huang Z, Xia X, Liu Y, Song Q, Xiao D, Wang C. Mobile Phone-Based Interventions for Smoking Cessation Among Young People: Systematic Review and Meta-Analysis. JMIR Mhealth Uhealth 2023; 11:e48253. [PMID: 37706482 PMCID: PMC10510452 DOI: 10.2196/48253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/04/2023] [Accepted: 07/25/2023] [Indexed: 09/15/2023] Open
Abstract
Background Mobile phone-based cessation interventions have emerged as a promising alternative for smoking cessation, while evidence of the efficacy of mobile phone-based smoking cessation programs among young people is mixed. Objective This study aimed to determine the efficacy of mobile phone-based interventions compared to usual practice or assessment-only controls on smoking cessation in young people. Methods In this systematic review and meta-analysis, we searched Cochrane Library, Embase, PubMed, and Web of Science on March 8, 2023. We included randomized controlled trials that examined the efficacy of mobile phone-based interventions on smoking cessation in young people (age ≤30 years). The risk of bias was assessed with Cochrane Risk of Bias 2. Results A total of 13 eligible studies, comprising 27,240 participants, were included in this analysis. The age range of the participants was between 16 and 30 years. Nine studies were SMS text messaging interventions, and 4 studies were app-based interventions. The duration of the smoking cessation intervention varied from 5 days to 6 months. The included studies were conducted in the following countries: the United States, China, Sweden, Canada, Switzerland, and Thailand. The meta-analysis revealed that SMS text messaging interventions significantly improved continuous abstinence rates compared to inactive control conditions (risk ratio [RR] 1.51, 95% CI 1.24-1.84). The subgroup analysis showed pooled RRs of 1.90 (95% CI 1.29-2.81), 1.64 (95% CI 1.23-2.18), and 1.35 (95% CI 1.04-1.76) for continuous abstinence at the 1-, 3-, and 6- month follow-up, respectively. Pooling across 7 studies, SMS text messaging interventions showed efficacy in promoting 7-day point prevalence abstinence (PPA), with an RR of 1.83 (95% CI 1.34-2.48). The subgroup analysis demonstrated a significant impact at the 1- and 3-month follow-ups, with pooled RRs of 1.72 (95% CI 1.13-2.63) and 2.54 (95% CI 2.05-3.14), respectively, compared to inactive control conditions. However, at the 6-month follow-up, the efficacy of SMS text messaging interventions in promoting 7-day PPA was not statistically significant (RR 1.45, 95% CI 0.92-2.28). In contrast, app-based interventions did not show significant efficacy in promoting continuous abstinence or 7-day PPA. However, it is important to note that the evidence for app-based interventions was limited. Conclusions SMS text messaging-based smoking cessation interventions compared to inactive controls were associated with abstinence among young people and could be considered a viable option for smoking cessation in this population. More research is needed on smoking cessation apps, especially apps that target young people. Future research should focus on identifying the most effective mobile phone-based cessation approaches and on developing strategies to increase their uptake and intention.
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Affiliation(s)
- Xinmei Zhou
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Tobacco Control and Prevention of Respiratory Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Xiaowen Wei
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Tobacco Control and Prevention of Respiratory Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- China-Japan Friendship School of Clinical Medicine, Capital Medical University, Beijing, China
| | - Anqi Cheng
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Tobacco Control and Prevention of Respiratory Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Zhao Liu
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Tobacco Control and Prevention of Respiratory Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Zheng Su
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Tobacco Control and Prevention of Respiratory Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Jinxuan Li
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Tobacco Control and Prevention of Respiratory Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- China-Japan Friendship School of Clinical Medicine, Capital Medical University, Beijing, China
| | - Rui Qin
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Tobacco Control and Prevention of Respiratory Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- Graduate School, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liang Zhao
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Tobacco Control and Prevention of Respiratory Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ying Xie
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Tobacco Control and Prevention of Respiratory Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhenxiao Huang
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Tobacco Control and Prevention of Respiratory Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xin Xia
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Tobacco Control and Prevention of Respiratory Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yi Liu
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Tobacco Control and Prevention of Respiratory Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qingqing Song
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Tobacco Control and Prevention of Respiratory Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- China-Japan Friendship School of Clinical Medicine, Capital Medical University, Beijing, China
| | - Dan Xiao
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Tobacco Control and Prevention of Respiratory Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Chen Wang
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
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Calvo F, Guillén A, Carbonell X, Alfranca R, Beranuy M, Parés-Bayerri A, Font-Mayolas S. "Healthy immigrant effect" among individuals experiencing homelessness in Spain?: Foreign-born individuals had higher average age at death in 15-year retrospective cohort study. BMC Public Health 2023; 23:1212. [PMID: 37349708 PMCID: PMC10286494 DOI: 10.1186/s12889-023-16109-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 06/12/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Individuals experiencing homelessness (IEHs) suffer from severe health inequities. Place of origin is linked to health and mortality of IEHs. In the general population the "healthy immigrant effect" provides a health advantage to foreign-born people. This phenomenon has not been sufficiently studied among the IEH population. The objectives are to study morbidity, mortality, and age at death among IEHs in Spain, paying special attention to their origin (Spanish-born or foreign-born) and to examine correlates and predictors of age at death. METHODS Retrospective cohort study (observational study) of a 15-year period (2006-2020). We included 391 IEHs who had been attended at one of the city's public mental health, substance use disorder, primary health, or specialized social services. Subsequently, we noted which subjects died during the study period and analyzed the variables related to their age at death. We compared the results based on origin (Spanish-born vs. foreign-born) and fitted a multiple linear regression model to the data to establish predictors of an earlier age at death. RESULTS The mean age at death was 52.38 years. Spanish-born IEHs died on average almost nine years younger. The leading causes of death overall were suicide and drug-related disorders (cirrhosis, overdose, and chronic obstructive pulmonary disease [COPD]). The results of the linear regression showed that earlier death was linked to COPD (b = - 0.348), being Spanish-born (b = 0.324), substance use disorder [cocaine (b =-0.169), opiates (b =.-243), and alcohol (b =-0.199)], cardiovascular diseases (b = - 0.223), tuberculosis (b = - 0.163), high blood pressure (b =-0.203), criminal record (b =-0.167), and hepatitis C (b =-0.129). When we separated the causes of death for Spanish-born and foreign-born subjects, we found that the main predictors of death among Spanish-born IEHs were opiate use disorder (b =-0.675), COPD (b =-0.479), cocaine use disorder (b =-0.208), high blood pressure (b =-0.358), multiple drug use disorder (b =-0.365), cardiovascular disease (b =-0.306), dual pathology (b =-0.286), female gender (b =-0.181), personality disorder (b =-0.201), obesity (b =-0.123), tuberculosis (b =-0.120) and having a criminal record (b =-0.153). In contrast, the predictors of death among foreign-born IEHs were psychotic disorder (b =-0.134), tuberculosis (b =-0.132), and opiate (b =-0.119) or alcohol use disorder (b =-0.098). CONCLUSIONS IEHs die younger than the general population, often due to suicide and drug use. The healthy immigrant effect seems to hold in IEHs as well as in the general population.
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Affiliation(s)
- Fran Calvo
- Serra Húnter Fellow, Department of Pedagogy, Quality of Life Research Institute, Universitat de Girona, Girona, Spain.
| | - Ana Guillén
- Department of Personality, Evaluation and Clinical Psychology, Universidad Complutense, Madrid, Spain
| | | | - Rebeca Alfranca
- Primary Care Centre Santa Clara, Catalan Institute of Health, Girona, Spain
| | - Marta Beranuy
- Department of Health Sciences, Faculty of Health Sciences, Universidad Pública de Navarra (UPNA), Pamplona, Spain
- Cyberpsychology research group, Universidad Internacional de La Rioja, Logroño, Spain
| | - Alícia Parés-Bayerri
- Department of Psychology, Quality of Life Research Institute, Universitat de Girona, Girona, Spain
| | - Sílvia Font-Mayolas
- Department of Psychology, Quality of Life Research Institute, Universitat de Girona, Girona, Spain
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Luchenski SA, Dawes J, Aldridge RW, Stevenson F, Tariq S, Hewett N, Hayward AC. Hospital-based preventative interventions for people experiencing homelessness in high-income countries: A systematic review. EClinicalMedicine 2022; 54:101657. [PMID: 36311895 PMCID: PMC9597099 DOI: 10.1016/j.eclinm.2022.101657] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 08/15/2022] [Accepted: 08/29/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND People experiencing homelessness have significant unmet needs and high rates of unplanned care. We aimed to describe preventative interventions, defined in their broadest sense, for people experiencing homelessness in a hospital context. Secondary aims included mapping outcomes and assessing intervention effectiveness. METHODS We searched online databases (MEDLINE, Embase, PsycINFO, HMIC, CINAHL, Web of Science, Cochrane Library) from 1999-2019 and conducted backward and forward citation searches to 31 December 2020 (PROSPERO CRD42019154036). We included quantitative studies in emergency and inpatient settings measuring health or social outcomes for adults experiencing homelessness in high income countries. We assessed rigour using the "Quality Assessment Tool for Quantitative Studies" and summarised findings using descriptive quantitative methods, a binomial test, a Harvest Plot, and narrative synthesis. We used PRISMA and SWiM reporting guidelines. FINDINGS Twenty-eight studies identified eight intervention types: care coordination (n=18); advocacy, support, and outreach (n=13); social welfare assistance (n=13); discharge planning (n=12); homelessness identification (n=6); psychological therapy and treatment (n=6); infectious disease prevention (n=5); and screening, treatment, and referrals (n=5). The evidence strength was weak (n=16) to moderate (n=10), with two high quality randomised controlled trials. We identified six outcome categories with potential benefits observed for psychosocial outcomes, including housing (11/13 studies, 95%CI=54.6-98.1%, p=0.023), healthcare use (14/17, 56.6-96.2%, p=0.013), and healthcare costs (8/8, 63.1-100%, p=0.008). Benefits were less likely for health outcomes (4/5, 28.3-99.5%, p=0.375), integration with onward care (2/4, 6.8-93.2%, p=1.000), and feasibility/acceptability (5/6, 35.9-99.6%, p=0.219), but confidence intervals were very wide. We observed no harms. Most studies showing potential benefits were multi-component interventions. INTERPRETATION Hospital-based preventative interventions for people experiencing homelessness are potentially beneficial, but more rigorous research is needed. In the context of high needs and extreme inequities, policymakers and healthcare providers may consider implementing multi-component preventative interventions. FUNDING SL is supported by an NIHR Clinical Doctoral Research Fellowship (ICA-CDRF-2016-02-042). JD is supported by an NIHR School of Public Health Research Pre-doctoral Fellowship (NU-004252). RWA is supported by a Wellcome Clinical Research Career Development Fellowship (206602).
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Affiliation(s)
- Serena A. Luchenski
- Collaborative Centre for Inclusion Health, Institute of Epidemiology and Healthcare, University College London, 1-19 Torrington Place, London WC1E 7HT, United Kingdom
- Corresponding author.
| | - Joanna Dawes
- Collaborative Centre for Inclusion Health, Institute of Epidemiology and Healthcare, University College London, 1-19 Torrington Place, London WC1E 7HT, United Kingdom
| | - Robert W. Aldridge
- Centre for Public Health Data Science, Institute for Health Informatics, University College London, 255 Euston Road, London NW1 2DA, United Kingdom
| | - Fiona Stevenson
- Department of Primary Care and Population Health, Institute of Epidemiology and Healthcare, University College London, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, United Kingdom
| | - Shema Tariq
- Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, Mortimer Market Centre, off Capper Street, London WC1E 6JB, United Kingdom
| | - Nigel Hewett
- Pathway, 4th Floor, East, 250 Euston Rd, London NW1 2PG, United Kingdom
| | - Andrew C. Hayward
- Collaborative Centre for Inclusion Health, Institute of Epidemiology and Healthcare, University College London, 1-19 Torrington Place, London WC1E 7HT, United Kingdom
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8
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O'Leary C, Ralphs R, Stevenson J, Smith A, Harrison J, Kiss Z. PROTOCOL: The effectiveness of abstinence-based and harm reduction-based interventions in reducing problematic substance use in adults who are experiencing severe and multiple disadvantage homelessness: A systematic review and meta-analysis. CAMPBELL SYSTEMATIC REVIEWS 2022; 18:e1246. [PMID: 36909874 PMCID: PMC9261927 DOI: 10.1002/cl2.1246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Background Homelessness is a major social and public health concern. It is a traumatic experience, and can have a devastating effect on those experiencing it. People who are homeless often face significant barriers when accessing public services, and those experiencing more visible and extreme forms of homelessness have often faced adverse childhood events, extreme social disadvantage, physical, emotional and sexual abuse, neglect, low self-esteem, poor physical and mental health, and much lower life expectancy compared to the general population. Problematic substance use is disproportionately high amongst people experiencing homelessness, with many using drugs and alcohol to deal with the stress of living on the street, to keep warm, or to block out memories of previous abuse or trauma. Drug overdose is a major cause of death for people experiencing street homelessness. Substance dependency can also create barriers to successful transition to stable housing. There is ongoing policy interest in the effectiveness of different interventions that aim to stop, reduce or prevent problematic substance use, and there is specific interest in the relative effectiveness of interventions that adopt harm reduction or abstinence-based approaches. Objectives The objective of this review is to understand the effectiveness of different substance use interventions. The review will consider the effectiveness of harm reduction-based interventions, and abstinence-based interventions, for adults experiencing homelessness. The focus of the review is on high-income countries. Search Methods The primary source of studies for potential inclusion in this review is the Homelessness Effectiveness Studies Evidence and Gaps Maps (EGM). The first of these was published in 2018, with updates published in 2019 and 2020. A further update is due to be published in the summer of 2022. It is this update that provides the final list of studies from which this review will draw. The search for this update (EGM 4th edition) was completed in September 2021. Other potential studies will be identified through a call for grey evidence and hand-searching key journals. Selection Criteria Eligible studies will be impact evaluations with designs at levels, 3, 4 and 5 of the Maryland Scientific Methods scale. This therefore includes all studies categorised as either 'Randomised Controlled Trials' or 'nonexperimental designs with a comparison group' from the studies which form the basis of the Homelessness Effectiveness Studies Evidence and Gap Maps (EGM) created by CHI and the Campbell Collaboration. We are interested in studies that examine the effect of interventions on substance use outcomes. Studies to be excluded are those with designs at levels 1 and 2 of the Maryland Scientific Methods scale, for example, studies without a control or comparison group, 'before vs. after' designs (without an untreated comparison group), and cross-sectional regressions. Data Collection and Analysis Descriptive characteristics and statistical information in included studies will be coded and checked by at least two members of the review team. Studies selected for the review will be assessed for confidence in the findings using a critical appraisal tool for determining confidence in primary studies. Standardised effect sizes will be calculated and, if a study does not provide sufficient raw data for the calculation of an effect size, we will attempt to contact the author(s) to obtain this data. We will aim to use random-effects meta-analysis and robust-variance estimation procedures to synthesise effect sizes. If a study includes multiple effects, we will carry out a critical assessment to determine (even if only theoretically) whether the effects are likely to be dependent. Where we suspect dependent effects, we will determine whether we can account for these by robust variance estimation. We will explore the moderating influence of participant and study characteristics, such as gender, race, substances targeted and length of follow-up. Where effect sizes are converted from a binary to continuous measure (or vice versa), we will undertake a sensitivity analysis to investigate the effect of the inclusion of studies with a converted effect size in the meta-analysis by running an additional analysis with these studies omitted. We will also assess the sensitivity of results to inclusion of non-randomised studies and studies classified as low confidence in findings. All analyses will include an assessment of statistical heterogeneity. Finally, we will undertake analysis to assess whether publication bias is likely to be a factor in our findings.
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Affiliation(s)
- Chris O'Leary
- Policy Evaluation and Research UnitManchester Metropolitan UniversityManchesterUK
| | - Rob Ralphs
- Substance Use and Associated Behaviours Research UnitManchester Metropolitan UniversityManchesterUK
| | | | - Andrew Smith
- Policy Evaluation and Research UnitManchester Metropolitan UniversityManchesterUK
| | - Jordan Harrison
- Policy Evaluation and Research UnitManchester Metropolitan UniversityManchesterUK
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Druckrey-Fiskaaen KT, Furulund E, Daltveit JT, Vold JH, Lid TG, Madebo T, Fadnes LT. Integration of smoking cessation into standard treatment for patients receiving opioid agonist therapy who are smoking tobacco: protocol for a randomised controlled trial (ATLAS4LAR). Trials 2022; 23:663. [PMID: 35978355 PMCID: PMC9382815 DOI: 10.1186/s13063-022-06560-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND About 85% of patients receiving opioid agonist therapy (OAT) for opioid dependence are smoking tobacco. Although smoke-related pulmonary diseases are significant contributors to morbidity and mortality, few smoking cessation interventions are evaluated within this group, and few OAT patients are offered smoking cessation as an integrated part of their addiction treatment. This study protocol describes an integrated smoking cessation intervention aimed at patients receiving OAT and smoking tobacco. METHODS This is a multicentre, randomised controlled clinical trial that will recruit 266 daily tobacco smoking patients receiving OAT in OAT outpatient clinics in Bergen and Stavanger, Norway. The patients randomised for the intervention arm will be offered smoking cessation therapy consisting of weekly brief behavioural interventions and prescription-free nicotine replacement products. In the control arm, patients will receive standard care without any added interventions related to smoking cessation. The smoking cessation intervention includes psychoeducational techniques with components from motivational interviewing, and nicotine replacement products such as nicotine lozenges, patches, and chewing gum. The duration of the intervention is 16 weeks, with the option of extending it by a further 8 weeks. The main outcomes are measured at 16 weeks after initiation of the intervention, and sustained effects are evaluated 1 year after intervention initiation. The primary outcome is smoking cessation verified by carbon monoxide (CO) levels or at least a 50% reduction in the number of cigarettes smoked. Secondary outcomes are changes in psychological well-being, biochemical inflammation markers, changes in physical health, quality of life, and fatigue. DISCUSSION Integration of other treatments to standard OAT care improves adherence and completion rates providing another rationale for integrated smoking cessation treatment. Thus, if integrated smoking cessation treatment is superior to standard care, this trial provides important information on further scale-up. TRIAL REGISTRATION ClinicalTrials.gov NCT05290025. Registered on 22 March 2022.
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Affiliation(s)
- Karl Trygve Druckrey-Fiskaaen
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Einar Furulund
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
| | - Jan Tore Daltveit
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| | - Jørn Henrik Vold
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Torgeir Gilje Lid
- Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
| | - Tesfaye Madebo
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Respiratory Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Lars Thore Fadnes
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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10
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Fornaro M, Dragioti E, De Prisco M, Billeci M, Mondin AM, Calati R, Smith L, Hatcher S, Kaluzienski M, Fiedorowicz JG, Solmi M, de Bartolomeis A, Carvalho AF. Homelessness and health-related outcomes: an umbrella review of observational studies and randomized controlled trials. BMC Med 2022; 20:224. [PMID: 35818057 PMCID: PMC9273695 DOI: 10.1186/s12916-022-02423-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Homelessness has been associated with multiple detrimental health outcomes across observational studies. However, relatively few randomized controlled trials (RCTs) have been conducted on people who experience homelessness (PEH). Thus, this umbrella review ranked the credibility of evidence derived from systematic reviews (SRs) and meta-analyses (MAs) of observational studies investigating the associations between homelessness and any health outcome as well as RCTs targeting health needs in this population. METHODS Several databases were systematically searched from inception through April 28, 2021. Any SR and/or MA reporting quantitative data and providing a control group were eligible for inclusion. The credibility of the evidence derived from observational studies was appraised by considering the significance level of the association and the largest study, the degree of heterogeneity, the presence of small-study effects as well as excess significance bias. The credibility of evidence was then ranked in five classes. For SRs and/or MAs of RCTs, we considered the level of significance and whether the prediction interval crossed the null. The AMSTAR-2 and AMSTAR-plus instruments were adopted to further assess the methodological quality of SRs and/or MAs. The Newcastle-Ottawa Scale (NOS) was employed to further appraise the methodological quality of prospective cohort studies only; a sensitivity analysis limited to higher quality studies was conducted. RESULTS Out of 1549 references, 8 MAs and 2 SRs were included. Among those considering observational studies, 23 unique associations were appraised. Twelve of them were statistically significant at the p≤0.005 level. Included cases had worst health-related outcomes than controls, but only two associations reached a priori-defined criteria for convincing (class I) evidence namely hospitalization due to any cause among PEH diagnosed with HIV infection, and the occurrence of falls within the past year among PEH. According to the AMSTAR-2 instrument, the methodological quality of all included SRs and/or MAs was "critically low." Interventional studies were scant. CONCLUSION While homelessness has been repeatedly associated with detrimental health outcomes, only two associations met the criteria for convincing evidence. Furthermore, few RCTs were appraised by SRs and/or MAs. Our umbrella review also highlights the need to standardize definitions of homelessness to be incorporated by forthcoming studies to improve the external validity of the findings in this vulnerable population.
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Affiliation(s)
- Michele Fornaro
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden
| | - Michele De Prisco
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Martina Billeci
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Anna Maria Mondin
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Raffaella Calati
- Department of Psychology, University of Milan-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, Italy
- Department of Adult Psychiatry, Nimes University Hospital, 4 Rue du Professeur Robert Debré, 30029 Nimes, France
| | - Lee Smith
- Cambridge Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Simon Hatcher
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Mark Kaluzienski
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
| | - Jess G. Fiedorowicz
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology, London, UK
- Faculty of Environmental and Life Sciences, Center for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
| | - Andrea de Bartolomeis
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
- UNESCO staff, Chair - “Education for Health and Sustainable Development”, University of Naples, Federico II Naples, Naples, Italy
| | - André F. Carvalho
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
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11
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Pakhale S, Visentin C, Tariq S, Kaur T, Florence K, Bignell T, Jama S, Huynh N, Boyd R, Haddad J, Alvarez GG. Lung disease burden assessment by oscillometry in a systematically disadvantaged urban population experiencing homelessness or at-risk for homelessness in Ottawa, Canada from a prospective observational study. BMC Pulm Med 2022; 22:235. [PMID: 35710334 PMCID: PMC9202668 DOI: 10.1186/s12890-022-02030-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 06/13/2022] [Indexed: 12/02/2022] Open
Abstract
Rationale Oscillometry is an emerging technique that offers some advantages over spirometry as it does not require forced exhalation and may detect early changes in respiratory pathology. Obstructive lung disease disproportionately impacts people experiencing homelessness with a high symptoms burden, yet oscillometry is not studied in this population. Objectives To assess lung disease and symptom burden using oscillometry in people experiencing homelessness or at-risk of homelessness using a community-based participatory action research approach (The Bridge Model™).
Methods Of 80 recruited, 55 completed baseline oscillometry, 64 completed spirometry, and all completed patient-reported outcomes with demographics, health, and respiratory symptom related questionnaires in the Participatory Research in Ottawa: Management and Point-of-Care for Tobacco Dependence project. Using a two-tail t-test, we compared mean oscillometry values for airway resistance (R5–20), reactance area under the curve (Ax) and reactance at 5 Hz (X5) amongst individuals with fixed-ratio method (FEV1/FVC ratio < 0.70) and LLN (FEV1/FVC ratio ≤ LLN) spirometry diagnosed chronic obstructive pulmonary disease (COPD). We compared mean oscillometry parameters based on participants’ COPD assessment test (CAT) scores using ANOVA test. Results There was no significant difference between the pre- and post- bronchodilator values of R5–20 and Ax for the fixed ratio method (p = 0.63 and 0.43) and the LLN method (p = 0.45 and 0.36). There was a significant difference in all three of the oscillometry parameters, R5–20, Ax and X5, based on CAT score (p = 0.009, 0.007 and 0.05, respectively). There was a significant difference in R5–20 and Ax based on the presence of phlegm (p = 0.03 and 0.02, respectively) and the presence of wheeze (p = 0.05 and 0.01, respectively). Oscillometry data did not correlate with spirometry data, but it was associated with CAT scores and correlated with the presence of self-reported symptoms of phlegm and wheeze in this population. Conclusions Oscillometry is associated with respiratory symptom burden and highlights the need for future studies to generate more robust data regarding the use of oscillometry in systematically disadvantaged populations where disease burden is disproportionately higher than the general population. TrialRegistration: ClinicalTrails.gov—NCT03626064, Retrospective registered: August 2018, https://clinicaltrials.gov/ct2/show/NCT03626064
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Affiliation(s)
- Smita Pakhale
- Department of Medicine, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada. .,The Ottawa Hospital Research Institute (OHRI), Ottawa, Canada. .,University of Ottawa, Ottawa, Canada.
| | - Carly Visentin
- Department of Medicine, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.,University of Ottawa, Ottawa, Canada
| | - Saania Tariq
- The Ottawa Hospital Research Institute (OHRI), Ottawa, Canada
| | - Tina Kaur
- University of Toronto, Toronto, Canada
| | - Kelly Florence
- Community (Peer) Researcher, The Bridge Engagement Centre, Ottawa, Canada
| | - Ted Bignell
- Community (Peer) Researcher, The Bridge Engagement Centre, Ottawa, Canada
| | - Sadia Jama
- The Ottawa Hospital Research Institute (OHRI), Ottawa, Canada.,University of Ottawa, Ottawa, Canada
| | - Nina Huynh
- The Ottawa Hospital Research Institute (OHRI), Ottawa, Canada
| | - Robert Boyd
- Oasis, Sandy Hill Community Health Centre, Ottawa, Canada
| | - Joanne Haddad
- Canadian Mental Health Association, The Ottawa Branch, Ottawa, Canada
| | - Gonzalo G Alvarez
- Department of Medicine, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.,The Ottawa Hospital Research Institute (OHRI), Ottawa, Canada
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12
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A community-based tobacco cessation program for individuals experiencing homelessness. Addict Behav 2022; 129:107282. [PMID: 35184003 DOI: 10.1016/j.addbeh.2022.107282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/26/2022] [Accepted: 02/12/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Tobacco use is common among persons experiencing homelessness (PEH), and interventions are needed. We conducted a community-based, single-arm uncontrolled trial of a pharmacy-linked intervention for smoking cessation for PEH. METHODS The intervention took place between September 2019 and June 2021 in homeless shelters in San Francisco, CA. We trained shelter staff on how to provide brief cessation counseling, then tested a program among PEH in two shelters that included one-time pharmacist-delivered cessation counseling and nicotine replacement therapy (NRT) for 3 months. We examined factors associated with cigarette consumption and quit attempts. RESULTS We trained 69 staff from 8 shelters and selected 2 of those shelters as pilot sites for the program. Of the 52 participants, 71% were male and 49% were Black. The majority of participants reported making a quit attempt (70%) and using NRT (84%). Having an encounter with staff in the past week was associated with a 40% reduction in weekly consumption (Incidence rate ratio (IRR) 0.61, 95% CI 0.57-0.67) and using medications in the past week was associated with a 23% reduction in weekly consumption (IRR 0.78, 95% CI 0.75-0.81). Using medications in the past week increased the odds of a quit attempt 2.89 times compared to not using medications (Adjusted odds ratio (AOR), 2.89, 95% CI 1.45-5.77). CONCLUSIONS Our findings highlight a role for leveraging community-based pharmacists to expand smoking cessation services in homeless shelters to reduce tobacco use among PEH.
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13
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Cox S, Murray J, Ford A, Holmes L, Robson D, Dawkins L. A cross-sectional survey of smoking and cessation support policies in a sample of homeless services in the United Kingdom. BMC Health Serv Res 2022; 22:635. [PMID: 35562816 PMCID: PMC9098377 DOI: 10.1186/s12913-022-08038-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 05/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Smoking is extremely common amongst adults experiencing homelessness. To date, there is no nationally representative data on how tobacco dependence is treated and if and how smoking cessation is supported across the homeless sector. The aim of this study was to document smoking and e-cigarette policies of UK homeless services and identify areas of good practice and where improvements could be made. METHODS A cross-sectional survey with homeless centre staff was conducted between June 2020-December 2020 totalling 99 homeless centres. Quotas were stratified based on population and service type across Scotland, Northern Ireland, Wales, and England. Interviews were conducted over the phone or online in a minority of cases. Survey questions were themed to assess, i) onsite smoking and e-cigarette (vaping) policies ii) screening and recording of smoking status, iii) cessation training and resources available to staff, iv) cessation support for service users. RESULTS 92% accounted for smoking within their policies in some form (stand-alone policy (56%) or embedded within another health and safety policy (36%)). 84% allowed smoking in at least some (indoor and outdoor) areas. In areas where smoking was not allowed, vaping was also disallowed in 96% of cases. Staff smoking rates were 23% and 62% of centres reported staff smoked with service users. Just over half (52%) reported screening and recording smoking status and 58% made referrals to Stop Smoking Services (SSS), although established links with SSS were low (12%) and most centres did not provide staff training on supporting smoking cessation. Areas of good practice included regular offers of smoking cessation support embedded in routine health reviews or visits from SSS and offering tangible harm reduction support. Areas for improvement include staff training, staff smoking with service users and skipping routine screening questions around smoking. CONCLUSIONS Smoking is accounted for across different policy types and restricted in some areas within most settings. Smoking cessation support is not routinely offered across the sector and there is little involvement with the SSS.
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Affiliation(s)
- Sharon Cox
- Department of Behavioural Science and Health, University College London, London, UK.
- Spectrum Research Consortium, London, UK.
| | - Jaimi Murray
- Centre for Addictive Behaviours Research, London South Bank University, London, UK
| | - Allison Ford
- Institute of Social Marketing and Health, University of Stirling, Stirling, UK
| | | | - Deborah Robson
- Spectrum Research Consortium, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Lynne Dawkins
- Centre for Addictive Behaviours Research, London South Bank University, London, UK
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14
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Hiatt RA, Sibley A, Venkatesh B, Cheng J, Dixit N, Fox R, Ling P, Nguyen T, Oh D, Palmer NR, Pasick RJ, Potter MB, Somsouk M, Vargas RA, Vijayaraghavan M, Ashworth A. From Cancer Epidemiology to Policy and Practice: the Role of a Comprehensive Cancer Center. CURR EPIDEMIOL REP 2022; 9:10-21. [PMID: 35342686 PMCID: PMC8935108 DOI: 10.1007/s40471-021-00280-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 11/24/2022]
Abstract
Purpose of Review Cancer incidence and mortality are decreasing, but inequities in outcomes persist. This paper describes the San Francisco Cancer Initiative (SF CAN) as a model for the systematic application of epidemiological evidence to reduce the cancer burden and associated inequities. Recent Findings SF CAN is a multi-institutional implementation of existing evidence on the prevention and early detection of five common cancers (i.e., breast, prostate, colorectal, liver, and lung/tobacco-related cancers) accounting for 50% of cancer deaths in San Francisco. Five Task Forces follow individual logic models designating inputs, outputs, and outcomes. We describe the progress made and the challenges faced by each Task Force after 5 years of activity. Summary SF CAN is a model for how the nation’s Comprehensive Cancer Centers are ideally positioned to leverage cancer epidemiology for evidence-based initiatives that, along with genuine community engagement and multiple stakeholders, can reduce the population burden of cancer.
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Affiliation(s)
- Robert A Hiatt
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, USA.,Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, USA.,Mission Hall UCSF, 550 16th Street, 2nd Floor, San Francisco, CA 94158 USA
| | - Amanda Sibley
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, USA
| | - Brinda Venkatesh
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, USA
| | - Joyce Cheng
- Chinese Community Health Resource Center, San Francisco, USA
| | - Niharika Dixit
- Division of Hematology/Oncology, UCSF at Zuckerberg San Francisco General Hospital, San Francisco, USA
| | - Rena Fox
- Department of Medicine, UCSF, San Francisco, USA
| | - Pamela Ling
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, USA.,Department of Medicine, UCSF, San Francisco, USA.,Center for Tobacco Control Research and Education, UCSF, San Francisco, USA
| | - Tung Nguyen
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, USA.,Department of Medicine, UCSF, San Francisco, USA
| | - Debora Oh
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, USA
| | | | | | - Michael B Potter
- Department of Family and Community Medicine, UCSF, San Francisco, USA
| | - Ma Somsouk
- Division of Gastroenterology, UCSF, San Francisco, USA
| | - Roberto Ariel Vargas
- Center for Community Engagement, UCSF, San Francisco, USA.,Clinical and Translational Science Institute, UCSF, San Francisco, USA
| | | | - Alan Ashworth
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, USA
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15
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Guest Support for Outdoor Smoke-Free Policies within a Homeless Shelter. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042408. [PMID: 35206595 PMCID: PMC8872137 DOI: 10.3390/ijerph19042408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/11/2022] [Accepted: 02/18/2022] [Indexed: 12/10/2022]
Abstract
Roughly 70-80% of adults experiencing homelessness smoke cigarettes. Smoke-free living/workplace policies are an empirically-supported tobacco control intervention. However, homeless shelters may be reluctant to implement smoke-free policies due to fears of it discouraging current/potential shelter guests from taking refuge there. The current study was meant to characterize guest support for on-property smoke-free policies within a homeless shelter with an extant indoor tobacco use ban amongst never smokers, former smokers, and current smokers to provide data on this point. Participants comprised a convenience sample of adult guests of a homeless shelter in Texas (N = 394, 28.2% women; 10.2% former; and 75.9% current smokers). Participant sociodemographics, smoking status, behavioral health diagnoses, and support for two versions of an on-property outdoor courtyard smoke-free policy (one partial, one complete) were assessed. Data were collected in two waves in a repeated cross-sectional design. Overall, 64.0% of participants supported a partial, and 32.0% a full smoking ban. Logistic regressions, controlling for wave of data collection, age, sex, and any additional significant predictors from a semi-adjusted model, examined associations between participant characteristics and policy support. Older participants (OR = 1.024, CI0.95 = 1.005-1.044), non-veterans (OR = 2.523, CI0.95 = 1.156-5.506), former smokers (OR = 2.730, CI0.95 = 1.191-6.258), and those without severe mental illness (OR = 1.731, CI0.95 = 1.061-2.824) had significantly greater odds of supporting a partial smoking ban. Relative to current smokers, never smokers (OR = 3.902, CI0.95 = 2.133-7.137) and former smokers (OR = 8.257, CI0.95 = 3.951-17.258) had significantly greater odds of supporting a complete smoking ban. The implementation of smoke-free living/workplace policies in homeless shelters may enjoy more support from guests-specifically, non-smokers-than anticipated by shelter administrators. Aside from reducing ambient smoke exposure for never and former smokers, these policies can help to reduce ubiquitous smoking cues for those who may want to quit, are undergoing a quit attempt, or are trying to maintain abstinence. Interventionists might partner with shelter guests, particularly smokers, to inform the roll-out of such policies for maximal acceptance and adoption.
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16
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Vijayaraghavan M, Elser H, Frazer K, Lindson N, Apollonio D. Interventions to reduce tobacco use in people experiencing homelessness. Cochrane Database Syst Rev 2020; 12:CD013413. [PMID: 33284989 PMCID: PMC8130995 DOI: 10.1002/14651858.cd013413.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Populations experiencing homelessness have high rates of tobacco use and experience substantial barriers to cessation. Tobacco-caused conditions are among the leading causes of morbidity and mortality among people experiencing homelessness, highlighting an urgent need for interventions to reduce the burden of tobacco use in this population. OBJECTIVES To assess whether interventions designed to improve access to tobacco cessation interventions for adults experiencing homelessness lead to increased numbers engaging in or receiving treatment, and whether interventions designed to help adults experiencing homelessness to quit tobacco lead to increased tobacco abstinence. To also assess whether tobacco cessation interventions for adults experiencing homelessness affect substance use and mental health. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialized Register, MEDLINE, Embase and PsycINFO for studies using the terms: un-housed*, homeless*, housing instability, smoking cessation, tobacco use disorder, smokeless tobacco. We also searched trial registries to identify unpublished studies. Date of the most recent search: 06 January 2020. SELECTION CRITERIA We included randomized controlled trials that recruited people experiencing homelessness who used tobacco, and investigated interventions focused on the following: 1) improving access to relevant support services; 2) increasing motivation to quit tobacco use; 3) helping people to achieve abstinence, including but not limited to behavioral support, tobacco cessation pharmacotherapies, contingency management, and text- or app-based interventions; or 4) encouraging transitions to long-term nicotine use that did not involve tobacco. Eligible comparators included no intervention, usual care (as defined by the studies), or another form of active intervention. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods. Tobacco cessation was measured at the longest time point for each study, on an intention-to-treat basis, using the most rigorous definition available. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) for smoking cessation for each study where possible. We grouped eligible studies according to the type of comparison (contingent reinforcement in addition to usual smoking cessation care; more versus less intensive smoking cessation interventions; and multi-issue support versus smoking cessation support only), and carried out meta-analyses where appropriate, using a Mantel-Haenszel random-effects model. We also extracted data on quit attempts, effects on mental and substance-use severity, and meta-analyzed these outcomes where sufficient data were available. MAIN RESULTS We identified 10 studies involving 1634 participants who smoked combustible tobacco at enrolment. One of the studies was ongoing. Most of the trials included participants who were recruited from community-based sites such as shelters, and three included participants who were recruited from clinics. We judged three studies to be at high risk of bias in one or more domains. We identified low-certainty evidence, limited by imprecision, that contingent reinforcement (rewards for successful smoking cessation) plus usual smoking cessation care was not more effective than usual care alone in promoting abstinence (RR 0.67, 95% CI 0.16 to 2.77; 1 trial, 70 participants). We identified very low-certainty evidence, limited by risk of bias and imprecision, that more intensive behavioral smoking cessation support was more effective than brief intervention in promoting abstinence at six-month follow-up (RR 1.64, 95% CI 1.01 to 2.69; 3 trials, 657 participants; I2 = 0%). There was low-certainty evidence, limited by bias and imprecision, that multi-issue support (cessation support that also encompassed help to deal with other challenges or addictions) was not superior to targeted smoking cessation support in promoting abstinence (RR 0.95, 95% CI 0.35 to 2.61; 2 trials, 146 participants; I2 = 25%). More data on these types of interventions are likely to change our interpretation of these data. Single studies that examined the effects of text-messaging support, e-cigarettes, or cognitive behavioral therapy for smoking cessation provided inconclusive results. Data on secondary outcomes, including mental health and substance use severity, were too sparse to draw any meaningful conclusions on whether there were clinically-relevant differences. We did not identify any studies that explicitly assessed interventions to increase access to tobacco cessation care; we were therefore unable to assess our secondary outcome 'number of participants receiving treatment'. AUTHORS' CONCLUSIONS There is insufficient evidence to assess the effects of any tobacco cessation interventions specifically in people experiencing homelessness. Although there was some evidence to suggest a modest benefit of more intensive behavioral smoking cessation interventions when compared to less intensive interventions, our certainty in this evidence was very low, meaning that further research could either strengthen or weaken this effect. There is insufficient evidence to assess whether the provision of tobacco cessation support and its effects on quit attempts has any effect on the mental health or other substance-use outcomes of people experiencing homelessness. Although there is no reason to believe that standard tobacco cessation treatments work any differently in people experiencing homelessness than in the general population, these findings highlight a need for high-quality studies that address additional ways to engage and support people experiencing homelessness, in the context of the daily challenges they face. These studies should have adequate power and put effort into retaining participants for long-term follow-up of at least six months. Studies should also explore interventions that increase access to cessation services, and address the social and environmental influences of tobacco use among people experiencing homelessness. Finally, studies should explore the impact of tobacco cessation on mental health and substance-use outcomes.
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Affiliation(s)
- Maya Vijayaraghavan
- Division of General Internal Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Holly Elser
- Epidemiology, University of California, Berkeley, Berkeley, California, USA
| | - Kate Frazer
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin 4, Ireland
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Dorie Apollonio
- Clinical Pharmacy, University of California San Francisco, San Francisco, CA, USA
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