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De Genna NM, Germeroth LJ, Benno MT, Wang B, Levine MD. Cohort Study of Cannabis Use History and Perinatal Cigarette Use Among Overweight and Obese Women. Matern Child Health J 2022; 26:389-396. [PMID: 34623574 PMCID: PMC8816869 DOI: 10.1007/s10995-021-03246-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES In non-pregnant populations, cannabis use and cannabis use disorder (CUD) have been linked to tobacco use and less successful quit attempts. We compared perinatal cigarette use in women across 3 groups: never used cannabis (No CU group); used cannabis but did not meet CUD criteria (CU group); history of CUD (CUD group). METHODS Interviews with 257 pregnant women with overweight/obesity (M age = 28 years; 52% white) were conducted for a study of eating behavior in Western Pennsylvania from 2012-2016. Tobacco use was assessed early in pregnancy (< 20 weeks gestation), late in pregnancy (34-38 weeks gestation) and 6 months postpartum. CUD was measured with the Structured Clinical Interview for DSM-IV (SCID). Data relevant to the proposed analyses were available for 252 women. Generalized mixed effect models were used to predict perinatal cigarette use based on cannabis use group, time and their interaction, adjusting for age, race, education, income, parity, and mood/anxiety disorder. RESULTS Forty-eight percent of participants reported prior cannabis use and 15% were diagnosed with lifetime CUD. History of cannabis use predicted cigarette smoking in early pregnancy (OR 11.12, CI 3.27-37.85), late pregnancy (OR 6.55, CI 1.70-25.27), and 6 months postpartum (OR 7.57, CI 2.72-21.07), regardless of CUD. CONCLUSIONS A history of CUD did not appear to confer additional risk for perinatal cigarette use. Given increasing rates of cannabis use among pregnant women, these results highlight the importance of addressing history of cannabis use in conjunction with tobacco use to improve smoking cessation efforts.
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Affiliation(s)
- Natacha M. De Genna
- Department of Psychiatry, University of Pittsburgh School of Medicine and Department of Epidemiology, Graduate School of Public Health. 3811 O’Hara St, Pittsburgh, PA 15213 USA
| | - Lisa J. Germeroth
- Department of Psychiatry, University of Pittsburgh School of Medicine. 3811 O’Hara St, Pittsburgh, PA 15213 USA
| | - Maria Tina Benno
- School of Education, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA 15282
| | - Bang Wang
- Department of Statistics, University of Pittsburgh. 1826 Wesley W. Posvar Hall, 230 S Bouquet Street. Pittsburgh, PA 15260 USA
| | - Michele D. Levine
- Departments of Psychiatry, Psychology and Obstetrics, Gynecology and Reproductive Sciences at the University of Pittsburgh School of Medicine. 3811 O’Hara St, Pittsburgh, PA 15231 USA
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Shoesmith E, Huddlestone L, Lorencatto F, Shahab L, Gilbody S, Ratschen E. Supporting smoking cessation and preventing relapse following a stay in a smoke-free setting: a meta-analysis and investigation of effective behaviour change techniques. Addiction 2021; 116:2978-2994. [PMID: 33620737 DOI: 10.1111/add.15452] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/16/2020] [Accepted: 02/10/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Admission to a smoke-free setting presents a unique opportunity to encourage smokers to quit. However, risk of relapse post-discharge is high, and little is known about effective strategies to support smoking cessation following discharge. We aimed to identify interventions that maintain abstinence following a smoke-free stay and determine their effectiveness, as well as the probable effectiveness of behaviour change techniques (BCTs) used in these interventions. METHODS Systematic review and meta-analyses of studies of adult smokers aged ≥ 18 years who were temporarily or fully abstinent from smoking to comply with institutional smoke-free policies. Institutions included prison, inpatient mental health, substance misuse or acute hospital settings. A Mantel-Haenszel random-effects meta-analysis of randomized controlled trials (RCTs) was conducted using biochemically verified abstinence (7-day point prevalence or continuous abstinence). BCTs were defined as 'promising' in terms of probable effectiveness (if BCT was present in two or more long-term effective interventions) and feasibility (if BCT was also delivered in ≥ 25% of all interventions). RESULTS Thirty-seven studies (intervention n = 9041, control n = 6195) were included: 23 RCTs (intervention n = 6593, control n = 5801); three non-randomized trials (intervention n = 845, control n = 394) and 11 cohort studies (n = 1603). Meta-analysis of biochemically verified abstinence at longest follow-up (4 weeks-18 months) found an overall effect in favour of intervention [risk ratio (RR) = 1.27, 95% confidence interval (CI) = 1.08-1.49, I2 = 42%]. Nine BCTs (including 'pharmacological support', 'goal-setting (behaviour)' and 'social support') were characterized as 'promising' in terms of probable effectiveness and feasibility. CONCLUSIONS A systematic review and meta-analyses indicate that behavioural and pharmacological support is effective in maintaining smoking abstinence following a stay in a smoke-free institution. Several behaviour change techniques may help to maintain smoking abstinence up to 18 months post-discharge.
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Affiliation(s)
- Emily Shoesmith
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Lisa Huddlestone
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | | | - Lion Shahab
- Department of Behavioural Science and Health, University College London, London, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Elena Ratschen
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
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3
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Westmaas JL, Strollo SE, Newton CC, Carter BD, Diver WR, Flanders WD, Stevens VL, Patel AV, Alcaraz KI, Thrul J, Jacobs EJ. Association between Smoking Cannabis and Quitting Cigarettes in a Large American Cancer Society Cohort. Cancer Epidemiol Biomarkers Prev 2021; 30:1956-1964. [PMID: 34348959 PMCID: PMC9398124 DOI: 10.1158/1055-9965.epi-20-1810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/19/2021] [Accepted: 07/30/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Cannabis use is increasing, including among smokers, an at-risk population for cancer. Research is equivocal on whether using cannabis inhibits quitting cigarettes. The current longitudinal study investigated associations between smoking cannabis and subsequently quitting cigarettes. METHODS Participants were 4,535 adult cigarette smokers from a cohort enrolled in the American Cancer Society's Cancer Prevention Study-3 in 2009-2013. Cigarette quitting was assessed on a follow-up survey in 2015-2017, an average of 3.1 years later. Rates of quitting cigarettes at follow-up were examined by retrospectively assessed baseline cannabis smoking status (never, former, recent), and by frequency of cannabis smoking among recent cannabis smokers (low: ≤3 days/month; medium: 4-19 days/month; high: ≥20 days/month). Logistic regression models adjusted for sociodemographic factors, smoking- and health-related behaviors, and time between baseline and follow-up. RESULTS Adjusted cigarette quitting rates at follow-up did not differ significantly by baseline cannabis smoking status [never 36.2%, 95% confidence interval (CI), 34.5-37.8; former 34.1%, CI, 31.4-37.0; recent 33.6%, CI, 30.1-37.3], nor by frequency of cannabis smoking (low 31.4%, CI, 25.6-37.3; moderate 36.7%, CI, 30.7-42.3; high 34.4%, CI, 28.3-40.2) among recent baseline cannabis smokers. In cross-sectional analyses conducted at follow-up, the proportion of cigarette smokers intending to quit smoking cigarettes in the next 30 days did not differ by cannabis smoking status (P = 0.83). CONCLUSIONS Results do not support the hypothesis that cannabis smoking inhibits quitting cigarette smoking among adults. IMPACT Future longitudinal research should include follow-ups of >1 year, and assess effects of intensity/frequency of cannabis use and motivation to quit on smoking cessation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Johannes Thrul
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Voci S, Zawertailo L, Baliunas D, Masood Z, Selby P. Is cannabis use associated with tobacco cessation outcome? An observational cohort study in primary care. Drug Alcohol Depend 2020; 206:107756. [PMID: 31786396 DOI: 10.1016/j.drugalcdep.2019.107756] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/18/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Some studies suggest cannabis use negatively affects tobacco cessation outcomes, but findings have been mixed. We examined whether cannabis use was associated with tobacco cessation outcomes in a real-world primary care setting. METHODS The analytic dataset consisted of 35,246 patients who enrolled between 2014 and 2016 in a primary care-based smoking cessation program in Ontario, Canada. Past 30-day cannabis use, for recreational or medical purposes, was self-reported at enrollment. Thirty-day point prevalence tobacco smoking abstinence was self-reported via online or telephone survey at 6 months post-enrollment. RESULTS Thirty days prior to enrollment, 79.9 % of patients had not used cannabis, 16.3 % used cannabis for recreational purposes only, and 3.8 % used cannabis for medical purposes. Unadjusted and adjusted odds of tobacco cessation at 6 months were reduced for patients using cannabis compared to non-users (ORs = 0.76-0.86, ps<0.05). When cannabis use was categorized by purpose, both unadjusted and adjusted odds of cessation were significantly lower for recreational users (ORs = 0.77-0.84, ps<0.05). Medical users had decreased odds of cessation in unadjusted analysis (OR = 0.74, 95 % CI = 0.61-0.89, p = 0.001), but not after adjustment for potential confounders. However, post-estimation contrasts did not indicate a significant difference between the effect of recreational and medical cannabis use. CONCLUSIONS In a large real-world sample of patients seeking smoking cessation treatment, concurrent cannabis use was associated with decreased success with quitting smoking. Recreational cannabis use was consistently related to poorer cessation outcomes, but medical use was not. Additional research is needed to inform treatment strategies for this growing sub-population of smokers.
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Affiliation(s)
- Sabrina Voci
- Nicotine Dependence Services, Centre for Addiction and Mental Health, 175 College St., Toronto, Ontario, M5T 1P7, Canada.
| | - Laurie Zawertailo
- Nicotine Dependence Services, Centre for Addiction and Mental Health, 175 College St., Toronto, Ontario, M5T 1P7, Canada; Department of Pharmacology and Toxicology, University of Toronto, 1 King's College Circle, Toronto, Ontario, M5S 1A8, Canada.
| | - Dolly Baliunas
- Nicotine Dependence Services, Centre for Addiction and Mental Health, 175 College St., Toronto, Ontario, M5T 1P7, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.
| | - Zara Masood
- Nicotine Dependence Services, Centre for Addiction and Mental Health, 175 College St., Toronto, Ontario, M5T 1P7, Canada.
| | - Peter Selby
- Nicotine Dependence Services, Centre for Addiction and Mental Health, 175 College St., Toronto, Ontario, M5T 1P7, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada; Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, Ontario, M5G 1V7, Canada.
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Cunradi CB, Lee J, Pagano A, Caetano R, Alter HJ. Gender Differences in Smoking Among an Urban Emergency Department Sample. Tob Use Insights 2019; 12:1179173X19879136. [PMID: 31598064 PMCID: PMC6763935 DOI: 10.1177/1179173x19879136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 09/04/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Urban emergency department (ED) patients have elevated smoking and substance
use compared with the general population. We analyzed gender differences in
smoking among an urban ED sample and assessed the contribution of substance
use, demographic, and couple factors. Methods: We conducted a secondary analysis of data obtained from a cross-sectional,
observational survey (N = 1037 participants) on drinking, drug use, and
intimate partner violence (IPV). Gender-specific logistic regression models
for current (past 30-day) smoking and multinomial regression models for
smoking intensity (light: ⩽5 cigarettes per day [CPD]; moderate: 6 to 10
CPD; heavier: >10 CPD) were estimated. Results: Smoking prevalence was higher among men than women (35.5% vs 18.9%;
P < .001). Substance use (frequency of intoxication,
marijuana, amphetamine, and cocaine use), demographic (food insufficiency,
unemployment), and couple-related factors (having a spouse/partner who
smoked, IPV involvement, being in a same-gender couple) were differentially
associated with current smoking and level of intensity among men and
women. Conclusions: Emergency department staff should consider the impact of polysubstance use,
food insufficiency, unemployment, and whether both partners in the couple
smoke when screening patients for smoking and formulating cessation
treatment plans. Women in same-gender relationships and those who have
experienced IPV involvement may require additional referral.
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Affiliation(s)
- Carol B Cunradi
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA, USA
| | - Juliet Lee
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA, USA
| | - Anna Pagano
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA, USA
| | - Raul Caetano
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA, USA
| | - Harrison J Alter
- The Andrew Levitt Center for Social Emergency Medicine, Highland Hospital, Alameda Health System, Oakland, CA, USA
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Gass JC, Morris DH, Winters J, VanderVeen JW, Chermack S. Characteristics and clinical treatment of tobacco smokers enrolled in a VA substance use disorders clinic. J Subst Abuse Treat 2018; 84:1-8. [PMID: 29195588 DOI: 10.1016/j.jsat.2017.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 11/29/2022]
Abstract
Individuals with a substance use disorder (SUD) diagnosis are more than twice as likely to smoke cigarettes as the general population. Emerging research has suggested that treating a substance use disorder simultaneously with tobacco use leads to a higher rate of treatment success for both substances. Despite this, substance use treatment protocols tend not to focus on tobacco use; in fact, traditional substance use treatments often discourage patients from attempting to quit smoking. One rationale is that patients may not be motivated to quit smoking. In the current study, data from veterans enrolled in outpatient treatment for a SUD were examined to assess for general characteristics of smokers as compared to non-smokers as well as to examine motivation to quit smoking. Baseline (i.e., pre-treatment) data from 277 Veterans were used. Charts of smokers in the SUD clinic (SUDC) were reviewed to assess how smoking is handled by SUDC providers, and if smokers attempt cessation. Of 277, 163 (59%) SUDC patients reported that they currently smoke cigarettes (M=16.3 cigarettes per day, SD=11.1). Smokers in the clinic reported greater general impairment than nonsmokers on the Short Index of Problems, F(1248)=8.9, p=0.003, as well as greater specific impairment: Physical Problems, F(1258)=13.5, p=0.000; Interpersonal Problems, F(1262)=5.6, p=0.019; Intrapersonal Problems, F(1260)=6.5, p=0.011, and Social Responsibility, F(1262)=14.7, p=0.000. Smokers in the sample were marginally more anxious than their non-smoking counterparts as measured by the GAD-7, F(1254)=4.6, p=0.053, though they were not significantly more depressed (p=0.19). On a 1-10 scale, smokers reported moderate levels of importance (M=5.4, SD=3.1), readiness (M=5.6, SD=3.2), and confidence (M=5.0, SD=3.0) regarding quitting smoking. Review of smokers' medical records reveal that while SUDC providers assess tobacco use at intake (90%) and offer treatment (86.5%), a substantially small portion of smokers attempt cessation (41.1%) while enrolled in SUDC. Moreover, no patients were enrolled in smoking-specific behavioral interventions while in SUDC, though 78 patients did obtain nicotine replacement or another smoking cessation medication (41% were prescribed by a SUDC provider). Contrary to the belief that treatment-seeking substance users are not motivated to quit smoking, these preliminary analyses demonstrate that Veterans were at least contemplating quitting smoking while they were enrolled in substance use treatment. Further, there is evidence that cigarette smokers have greater impairment caused by substance use, suggesting that this subgroup is of particular high need. Specific treatment recommendations are discussed, including how behavioral health providers in SUD clinics may be better able to capitalize on patients' moderate motivation to quit at intake.
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Affiliation(s)
- Julie C Gass
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States.
| | - David H Morris
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Jamie Winters
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Joseph W VanderVeen
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Stephen Chermack
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
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