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Rubenstein D, Carroll DM, Denlinger-Apte RL, Cornacchione Ross J, McClernon FJ. Differences in Normative Beliefs and Tobacco Product Use by Age Among Adults Who Smoke: Cross-Sectional Analysis of a Nationally Representative Sample. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:54-64. [PMID: 38258860 DOI: 10.1177/29767342231210554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND The prevalence of combusted cigarette (CC) smoking among older adults is stagnant, with 0 declines attributable to e-cigarette (EC) use. Given that normative beliefs are associated with quitting and switching to ECs, we assessed cross-sectional associations between age, CC, and EC descriptive and injunctive norms and potential interactions with tobacco use behavior. METHODS Data are from people with current, established (≥100 lifetime CCs) CC use (n = 8072) at Wave 5 (2018-2019) of the adult Population Assessment of Tobacco and Health Study. We used adjusted multivariable logistic regressions to model social norms as a function of age (18-24, 25-34, 35-44, 45-54, 55-64, ≥65 years). We also dichotomized age (≥55 vs 18-54) to investigate interactions between age and social norms on past 12-month CC quit attempts and past-month EC use. RESULTS Older age was positively associated with pro- and anti-CC norms and anti-EC norms. Significant interactive effects revealed that being advised to quit smoking by a healthcare provider was more strongly associated with CC quit attempts among adults ≥55 years (adjusted odds ratio [aOR] [95% CI]: 2.12 [1.66, 2.71]) than adults <55 years (aOR: 1.63 [1.34, 2.00]). Reporting people close to you use ECs was also more strongly associated with EC use among adults ≥55 years (aOR: 4.37 [3.35, 5.69]) than among adults <55 years (aOR: 3.43 [2.89, 4.08]). CONCLUSIONS This study identified modifiable risk factors for tobacco use that may be particularly beneficial for older adults. Behavioral and communication interventions that target normative beliefs may maximize smoking cessation, or harm reduction when cessation is not possible.
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Affiliation(s)
- Dana Rubenstein
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Clinical and Translational Science Institute, Duke University School of Medicine, Durham, NC, USA
| | - Dana M Carroll
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Rachel L Denlinger-Apte
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jennifer Cornacchione Ross
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Clinical and Translational Science Institute, Duke University School of Medicine, Durham, NC, USA
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Manns A, Torregrossa H, Mahdjoub S, Gomajee R, Melchior M, El-Khoury Lesueur F. Do Determinants of Smoking Cessation and Relapse Differ between Men and Women? Data from a French National Study. Subst Use Misuse 2023; 59:167-176. [PMID: 37813814 DOI: 10.1080/10826084.2023.2267106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Introduction: There is limited understanding of different predictors of smoking cessation success (SCS) among women and men, despite well-documented differences in smoking behavior.Methods: Using data from DePICT (Description des Perceptions, Images, et Comportements liés au Tabagisme), a national survey of French adults which recruited 2377 regular and former smokers we investigated whether major determinants of SCS differed by sex. Factors associated with unsuccessful vs. No successful quit attempt; vs. SCS were studied using multivariate multinomial logistic regression analyses stratified by sex.Results: Women and men share some determinants of SCS including no cannabis use, living in a nonsmoker household and importance giving to being a nonsmoker. However, no e-cigarette use, low-to-moderate alcohol consumption, early smoking initiation, and higher education were associated with SCS only among women. No use of nicotine replacement, having family members who smoke, family opinion on smoking and current employment, were associated with SCS only among men. Neutral or negative friends' opinion on smoking or living with a smoker were associated with unsuccessful smoking attempts among men.Conclusions: Our results show differences between determinants of SCS according to sex, which highlights the importance of developing tailored interventions that account for sex/gender differences in smoking cessation.
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Affiliation(s)
- Aurélia Manns
- Department of Social Epidemiology, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, IPLESP, Paris, France
| | - Hugo Torregrossa
- Department of Social Epidemiology, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, IPLESP, Paris, France
| | - Sarah Mahdjoub
- Department of Social Epidemiology, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, IPLESP, Paris, France
| | - Ramchandar Gomajee
- Department of Social Epidemiology, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, IPLESP, Paris, France
| | - Maria Melchior
- Department of Social Epidemiology, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, IPLESP, Paris, France
| | - Fabienne El-Khoury Lesueur
- Department of Social Epidemiology, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, IPLESP, Paris, France
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3
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Jin W, Xian B, Zhao L, Li C. Association between personality traits and smoking cessation among Chinese adults. BMC Psychol 2023; 11:398. [PMID: 37978396 PMCID: PMC10656871 DOI: 10.1186/s40359-023-01442-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Although the tobacco epidemic is one of the greatest public health threats, the smoking cessation rate among Chinese adults is considerably lower. Personality information may indicate which treatments or interventions are more likely to be effective. China is the largest producer and consumer of tobacco worldwide. However, little is known about the association between smoking cessation and personality traits in China. AIM This study aimed to examine the association between successful smoking cessation and personality traits among Chinese adults. METHODS This cross-sectional study used data from the 2018 China Family Panel Studies. Probit regression models were employed to analyze the association between successful smoking cessation and personality traits stratified by sex. RESULTS Lower scores for neuroticism (Coef.=-0.055, p < 0.1), lower scores for extraversion (Coef.=-0.077, p < 0.05), and higher scores for openness to experience (Coef.=0.045, p < 0.1) predicted being a successful male quitter after adjusting for demographics. Moreover, lower scores for conscientiousness (Coef.=-0.150, p < 0.1) predicted being a successful female quitter after adjusting for demographics. CONCLUSION The empirical findings suggested that among Chinese men, lower levels of neuroticism, lower levels of extraversion, and higher levels of openness to experience were associated with a higher likelihood of smoking cessation. Moreover, lower levels of conscientiousness were associated with successful smoking cessation among Chinese women. These results showed that personality information should be included in smoking cessation interventions.
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Affiliation(s)
- Weiyun Jin
- College of Humanities Education, Inner Mongolia Medical University, Hohhot, China
| | - Bensong Xian
- School of Health Management, Inner Mongolia Medical University, Hohhot, China
| | - Longlong Zhao
- School of Health Management, Inner Mongolia Medical University, Hohhot, China
| | - Changle Li
- School of Health Management, Fujian Medical University, Fuzhou, 350122, Fujian, China.
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Gautier S, Cloppet A, Mir S, Duville C, Morvillers JM, Simzac AB, Miliani K, Josseran L. Knowledge, attitudes and practices of primary healthcare professionals regarding smoking and smoking cessation among the elderly in France. Tob Prev Cessat 2023; 9:32. [PMID: 37915359 PMCID: PMC10616976 DOI: 10.18332/tpc/173401] [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: 05/15/2023] [Revised: 10/02/2023] [Accepted: 10/05/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION Smoking remains a leading cause of preventable death in France, even among the elderly. Although smoking prevalence has decreased overall, it still affects a significant portion of older adults. This study investigates the knowledge, attitudes, and practices of primary healthcare professionals regarding smoking and smoking cessation among the elderly in France. METHODS A cross-sectional study involved 300 primary care professionals (general practitioners, pharmacists, nurses) in the Ile-de-France region. Data collection occurred via telephone interviews in September and October 2019. The study employed a questionnaire focusing on knowledge (10 questions), attitudes (12 statements), and clinical practices (7 questions) related to tobacco dependence in older adults. Responses were scored based on correctness for knowledge and appropriateness for attitudes and practices. RESULTS The surveyed professionals were predominantly female (57.7%), with a mean age of 53.0 years, and most were non-smokers or former smokers (85.3%). While 66.7% believed older smokers had lower cessation rates, only 64.3% knew it was safe to prescribe nicotine replacement therapy for the elderly. Attitude scores averaged 8.8/12, with pharmacists scoring highest (9.9) and nurses lowest (8.2). Practices scores averaged 2.8/7, with physicians scoring highest (3.8) and pharmacists lowest (1.9). CONCLUSIONS Primary healthcare professionals have a relatively good knowledge of the management of tobacco dependence in the elderly and consider it to be part of their mission. However, their confidence in their abilities needs to be strengthened, and many opportunities to counsel and assist this population to quit smoking are still being missed. Preventive approaches to older smokers are essential, in keeping with the concept that 'every contact with the healthcare system counts'. Improving practice will require education and training that will not only build knowledge but also change perceptions, leading to better attitudes and practices in the management of smoking cessation among older adults.
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Affiliation(s)
- Sylvain Gautier
- Département Hospitalier d’Epidémiologie et de Santé Publique, GHU Paris Saclay, Hôpital R. Poincaré, Garches, France
- Université de Versailles Saint Quentin, Université Paris Saclay, Montigny le Bretonneux, France
| | - Anaïs Cloppet
- Gérond’if – Le Gérontopôle d’Île-de-France, Paris, France
| | - Sarah Mir
- Département Hospitalier d’Epidémiologie et de Santé Publique, GHU Paris Saclay, Hôpital R. Poincaré, Garches, France
| | | | | | | | - Katiuska Miliani
- Département Hospitalier d’Epidémiologie et de Santé Publique, GHU Paris Saclay, Hôpital R. Poincaré, Garches, France
| | - Loïc Josseran
- Département Hospitalier d’Epidémiologie et de Santé Publique, GHU Paris Saclay, Hôpital R. Poincaré, Garches, France
- Université de Versailles Saint Quentin, Université Paris Saclay, Montigny le Bretonneux, France
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Faust I, Warden M, Camacho-Soto A, Racette BA, Searles Nielsen S. A predictive algorithm to identify ever smoking in medical claims-based epidemiologic studies. Ann Epidemiol 2023; 85:59-67.e6. [PMID: 37142065 DOI: 10.1016/j.annepidem.2023.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 04/12/2023] [Accepted: 04/28/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE To develop and validate an algorithm to estimate probability of ever smoking using administrative claims. METHODS Using population-based samples of Medicare-aged individuals (121,278 Behavioral Risk Factor Surveillance System survey respondents and 207,885 Medicare beneficiaries), we developed a logistic regression model to predict probability of ever smoking from demographic and claims data. We applied the model in 1,657,266 additional Medicare beneficiaries and calculated area under the receiver operating characteristic curve (AUC) using presence or absence of a tobacco-specific diagnosis or procedure code as our "gold standard." We used these "gold standard" and lung/laryngeal cancer codes to over-ride predicted probability as 100%. We calculated Spearman's rho between probability from this full algorithm and smoking assessed in prior Parkinson disease studies, by substituting our observed and prior ("true") smoking-Parkinson disease odds ratios into the attenuation equation. RESULTS The predictive model contained 23 variables, including basic demographics, high alcohol consumption, asthma, cardiovascular disease and associated risk factors, selected cancers, and indicators of routine medical usage. The AUC was 67.6% (95% confidence interval 67.5%-67.7%) comparing smoking probability to tobacco-specific diagnosis or procedure codes. Spearman's rho for the full algorithm was 0.82. CONCLUSIONS Ever smoking might be approximated in administrative data for use as a continuous, probabilistic variable in epidemiologic analyses.
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Affiliation(s)
- Irene Faust
- Washington University School of Medicine in St. Louis, Department of Neurology, 660 S. Euclid Avenue, St. Louis, MO; Barrow Neurological Institute, Department of Neurology, 240 W. Thomas Road, Phoenix, AZ.
| | - Mark Warden
- Washington University School of Medicine in St. Louis, Department of Neurology, 660 S. Euclid Avenue, St. Louis, MO.
| | - Alejandra Camacho-Soto
- Washington University School of Medicine in St. Louis, Department of Neurology, 660 S. Euclid Avenue, St. Louis, MO; Washington University School of Medicine, Department of Orthopedic Surgery, Neurological Rehabilitation Division, 660 S. Euclid, St. Louis, MO.
| | - Brad A Racette
- Washington University School of Medicine in St. Louis, Department of Neurology, 660 S. Euclid Avenue, St. Louis, MO; Barrow Neurological Institute, Department of Neurology, 240 W. Thomas Road, Phoenix, AZ; University of the Witwatersrand, School of Public Health, Faculty of Health Sciences, 27 St. Andrews Road, Parktown, Johannesburg, South Africa.
| | - Susan Searles Nielsen
- Washington University School of Medicine in St. Louis, Department of Neurology, 660 S. Euclid Avenue, St. Louis, MO.
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Rubenstein D, Denlinger-Apte RL, Cornacchione Ross J, McClernon FJ. Adoption of E-Cigarettes Among Older Adults Who Smoke to Reduce Harm and Narrow Age-Related Disparities: An Application of the Health Belief Model. Nicotine Tob Res 2023; 25:1212-1214. [PMID: 36702774 PMCID: PMC10202631 DOI: 10.1093/ntr/ntad016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/19/2022] [Accepted: 01/24/2023] [Indexed: 01/28/2023]
Affiliation(s)
- Dana Rubenstein
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27705, USA
| | - Rachel L Denlinger-Apte
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27705, USA
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7
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Rubenstein D, Denlinger-Apte RL, Cornacchione Ross J, Carroll DM, McClernon FJ. Older age is associated with greater misperception of the relative health risk of e-cigarettes and cigarettes among US adults who smoke. Tob Control 2023:tc-2023-057943. [PMID: 37137702 PMCID: PMC10622327 DOI: 10.1136/tc-2023-057943] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/25/2023] [Indexed: 05/05/2023]
Abstract
INTRODUCTION The prevalence of cigarette smoking among adults aged ≥55 has remained stagnant over the past decade. National data modelling suggests no reduction in cigarette smoking prevalence attributable to e-cigarette use in the USA among people aged ≥45. Misperceptions about the absolute risks (ie, cigarettes are not harmful) and relative risks (ie, e-cigarettes are more harmful than cigarettes) of tobacco products may contribute to sustained smoking prevalence and hesitancy to switch from cigarettes to e-cigarettes among older adults. METHODS Participants reported cigarette use (n=8072) at Wave 5 (2018-2019) of the Population Assessment of Tobacco and Health Study. Weighted multivariable logistic regressions included six age categories (independent variable) and cigarette and e-cigarette risk perceptions (outcomes). Additional models assessed the associations between dichotomous age (≥55 vs 18-54), risk perceptions and an interaction term (independent variables) with past 12-month quit attempts and past-month e-cigarette use (outcomes). RESULTS Adults aged ≥65 were less likely than adults aged 18-24 to rate cigarettes as very/extremely harmful (p<0.05). Odds of rating e-cigarettes as more harmful than cigarettes among adults aged 55-64 and ≥65 were 1.71 (p<0.001) and 1.43 (p=0.024) greater than for adults aged 18-24. This misperception was negatively associated with past-month e-cigarette use and was stronger among adults aged ≥55 (p<0.001) than adults aged <55 (p<0.001). DISCUSSION Adults aged ≥55 are more likely to have misperceptions about the absolute and relative risks of tobacco products, which may contribute to continued smoking. Health communications targeting this age group could modify beliefs about the perceived harms of tobacco products.
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Affiliation(s)
- Dana Rubenstein
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Clinical and Translational Science Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rachel L Denlinger-Apte
- Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jennifer Cornacchione Ross
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Dana Mowls Carroll
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Clinical and Translational Science Institute, Duke University School of Medicine, Durham, North Carolina, USA
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8
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Hunt LJ, Covinsky KE, Cenzer I, Espejo E, Boscardin WJ, Leutwyler H, Lee AK, Cataldo J. The Epidemiology of Smoking in Older Adults: A National Cohort Study. J Gen Intern Med 2023; 38:1697-1704. [PMID: 36538157 PMCID: PMC10212889 DOI: 10.1007/s11606-022-07980-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Older smokers account for the greatest tobacco-related morbidity and mortality in the USA, while quitting smoking remains the single most effective preventive health intervention for reducing the risk of smoking-related illness. Yet, knowledge about patterns of smoking and smoking cessation in older adults is lacking. OBJECTIVE Assess trends in prevalence of cigarette smoking between 1998 and 2018 and identify patterns and predictors of smoking cessation in US older adults. DESIGN Retrospective cohort study PARTICIPANTS: Individuals aged 55+ enrolled in the nationally representative Health and Retirement Study, 1998-2018 MAIN MEASURES: Current smoking was assessed with the question: "Do you smoke cigarettes now?" Quitting smoking was defined as having at least two consecutive waves (between 2 and 4 years) in which participants who were current smokers in 1998 reported they were not currently smoking in subsequent waves. KEY RESULTS Age-adjusted smoking prevalence decreased from 15.9% in 1998 (95% confidence interval (CI) 15.2, 16.7) to 11.2% in 2018 (95% CI 10.4, 12.1). Among 2187 current smokers in 1998 (mean age 64, 56% female), 56% of those living to age 90 had a sustained period of smoking cessation. Smoking less than 10 cigarettes/day was strongly associated with an increased likelihood of quitting smoking (subdistribution hazard ratio 2.3; 95% CI 1.9, 2.8), compared to those who smoked more than 20 cigarettes/day. CONCLUSIONS Smoking prevalence among older persons has declined and substantial numbers of older smokers succeed in quitting smoking for a sustained period. These findings highlight the need for continued aggressive efforts at tobacco cessation among older persons.
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Affiliation(s)
- Lauren J Hunt
- Department of Physiological Nursing, University of California, San Francisco, 2 Koret Way Box 605 N, San Francisco, CA, 94143, USA.
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA.
- Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA.
| | - Kenneth E Covinsky
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Irena Cenzer
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Edie Espejo
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
- Northern Californian Center for Research and Education, San Francisco, CA, USA
| | - W John Boscardin
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Heather Leutwyler
- Department of Physiological Nursing, University of California, San Francisco, 2 Koret Way Box 605 N, San Francisco, CA, 94143, USA
| | - Alexandra K Lee
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Janine Cataldo
- Department of Physiological Nursing, University of California, San Francisco, 2 Koret Way Box 605 N, San Francisco, CA, 94143, USA
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Fahey MC, Dahne J, Wahlquist AE, Carpenter MJ. The Impact of Older Age on Smoking Cessation Outcomes After Standard Advice to Quit. J Appl Gerontol 2023:7334648231158228. [PMID: 36797652 DOI: 10.1177/07334648231158228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Older adults are a high priority population for smoking cessation. This study observed the influence of older age on the relationship between quitting predictors and cessation. Secondary analysis was conducted of a primary care trial of adults who smoke cigarettes randomized to standard advice to quit or advice plus 2 week supply of nicotine replacement therapy. Logistic regressions assessed interactions of age (<60 vs. ≥ 60 years) by predictors in relation to quit attempts and 6-month cessation controlling for treatment. Predicting quit attempts, there was an interaction of age by motivation (p = .025) and trend of age by nicotine dependence (p = .057). Predicting 6-month cessation, an interaction of age by motivation was observed (p = .020) and a trend of age by dependence (p = .067). For those with high nicotine dependence, older adults had less successful outcomes compared to younger counterparts. Yet among participants unmotivated to quit, older adults had more successful outcomes than those younger.
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Affiliation(s)
- Margaret C Fahey
- Department of Psychiatry and Behavioral Sciences, 2345Medical University of South Carolina(MUSC), Charleston, SC, USA
| | - Jennifer Dahne
- Department of Psychiatry and Behavioral Sciences, 2345Medical University of South Carolina(MUSC), Charleston, SC, USA
| | | | - Mathew J Carpenter
- Department of Psychiatry and Behavioral Sciences, 2345Medical University of South Carolina(MUSC), Charleston, SC, USA
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Zeren OG, Ilknur D, Rumeysa DH, Gunher AS. The Evaluation Of Smoking Cessation Treatment Success and Related Factors in Adults Age 65 Years and Older. Clin Gerontol 2022; 46:424-432. [PMID: 36576075 DOI: 10.1080/07317115.2022.2158767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The aim was to evaluate smoking cessation treatment success and factors associated in older adults. METHODS In the retrospective cohort study, the patients' sociodemographic data, smoking history, Fagerström Test for Nicotine Dependence scores (FTND), type of treatments (Pharmacological treatments, behavioral counseling, and/or both) and the number of follow-up sessions in the Smoking Cessation Outpatient Clinic were taken from hospital files of the patients. Treatment success was evaluated as one year of abstinence from smoking. RESULTS Participants' reported with 53% classified as high-very high nicotine dependence. Overall, 36% reported abstinence from smoking for one year or more. Treatment success was associated with higher attendance at follow-up sessions. Using pharmacologic treatments and behavioral counseling together was proved to be more effective than behavioral counseling alone. CONCLUSIONS One-year smoking cessation was achieved in one-third of older adults attending a smoking cessation clinic. In older adults in this sample low FTND scores, use of combined pharmacologic and behavioral treatment, and attendance at follow up sessions were associated with one year smoking abstinence. CLINICAL IMPLICATIONS Older adults should be referred for smoking cessation treatment. Use of combined pharmacological and behavioral counseling is recommended. Efforts to enhance attendance at follow-up sessions should be considered.
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Affiliation(s)
- Ozturk Guzin Zeren
- Family Medicine Depertmant, Sisli Hamidiye Etfal Research and Training Hospital, İstanbul, Turkey
| | - Demir Ilknur
- Family Medicine Depertmant, Sisli Hamidiye Etfal Research and Training Hospital, İstanbul, Turkey
| | | | - Arıca Secıl Gunher
- Family Medicine Department, Cemil Tasçıoğlu City Hospital, İstanbul, Turkey
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11
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Kwon DM, Santiago-Torres M, Mull KE, Sullivan BM, Bricker JB. Older adults who smoke: Do they engage with and benefit from web-based smoking cessation interventions? Prev Med 2022; 161:107118. [PMID: 35718119 DOI: 10.1016/j.ypmed.2022.107118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/27/2022] [Accepted: 06/13/2022] [Indexed: 10/18/2022]
Abstract
Quitting smoking at any age increases life expectancy, but older adults face barriers to receiving cessation services. Despite the promise of web-based smoking cessation interventions to help address access barriers, whether older adults who participate in smoking cessation programs engage with and benefit from these tools at the same rate as younger adults remains unknown. In this secondary analysis, we compared engagement and satisfaction with two web-based smoking cessation interventions and quit rates between older, middle-aged, and young adults in the United States enrolled in the WebQuit trial between March 2014 and August 2015. Participants were divided into age groups: older (60 years and older, n = 439/2637), middle-aged (40-59 years, n = 1308/2637), and young adults (18-39 years, n = 890/2637). Treatment engagement and satisfaction, and 12-month quit rates (self-reported complete-case 30-day PPA and missing-as-smoking) were compared between groups. Older adults engaged more with the websites than young adults through multiple indicators of intervention engagement (i.e., number of sessions, unique days of use, and time spent on the site), and older adults spent more time on the site per session than their counterparts. Satisfaction with websites was high (81%) and non-differential between groups. Older and middle-aged adults quit smoking at a similar rate as younger adults (24%, 24%, 27%, respectively, p = 0.905). Older and middle-aged adults who participated in a web-delivered smoking cessation intervention engaged more with the intervention than their younger counterparts and they quit smoking at a similar rate, thereby demonstrating high acceptability and potential of digital interventions to help older adults quit smoking. Trial registration:ClinicalTrials.gov Identifier: NCT1166334.
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Affiliation(s)
- Diana M Kwon
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA, USA; University of Washington, Department of Psychology, Seattle, WA, USA
| | | | - Kristin E Mull
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA, USA
| | - Brianna M Sullivan
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA, USA
| | - Jonathan B Bricker
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA, USA; University of Washington, Department of Psychology, Seattle, WA, USA
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Incidence and Predictors of Mortality among Community-Dwelling Older Adults in Malaysia: A 5 Years Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19158943. [PMID: 35897315 PMCID: PMC9331297 DOI: 10.3390/ijerph19158943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/30/2022] [Accepted: 07/11/2022] [Indexed: 02/04/2023]
Abstract
With older adults accounting for 10.7% of the Malaysian population, determining the predictors of mortality has now become crucial. Thus, this community-based longitudinal study aimed to investigate the predictors for mortality among community-dwelling older adults using a wide range of factors, including clinical or subclinical. A total of 2322 older adults were interviewed and assessed by trained fieldworkers using validated structured questionnaires. The questionnaire consisted of information on socio-demographic characteristics, health status, neuropsychological and psychosocial functions, lifestyle, dietary intake and biophysical measures. The incidence rate of mortality was 2.9 per 100 person-years. Cox regression analysis indicated that advancing age (Adjusted Hazard Ratio, Adj HR = 1.044, 95% CI: 1.024–1.064), male (Adj HR = 1.937, 95% CI: 1.402–2.675), non-married status (Adj HR = 1.410, 95% CI: 1.078–1.843), smoking (Adj HR = 1.314, 95% CI: 1.004–1.721), a higher fasting blood sugar (Adj HR = 1.075, 95% CI: 1.029–1.166), a lower serum albumin (Adj HR = 0.947, 95% CI: 0.905–0.990), a longer time to complete the TUG test (Adj HR = 1.059, 95% CI: 1.022–1.098), and a lower intake of total dietary fibre (Adj HR = 0.911, 95% CI: 0.873–0.980) were the predictors of mortality in this study. These findings provide an estimated rate of multiethnic mortality in middle-income countries and diet is one of the predictors. These predictors of mortality could be a reference in identifying new public health strategies to ensure longer healthier life spans with lower disability rate among community-dwelling older adults in Malaysia.
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Acute Effects of Nicotine on Physiological Responses and Sport Performance in Healthy Baseball Players. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19010515. [PMID: 35010774 PMCID: PMC8745004 DOI: 10.3390/ijerph19010515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/21/2021] [Accepted: 12/30/2021] [Indexed: 12/04/2022]
Abstract
There is interest in whether nicotine could enhance attention in sporting performance, but evidence on the acute effect of nicotine on physical response and sports performance in baseball players remains scant. This was an observational study to examine whether nicotine gum chewed before exercise could provide acute effects on physiological responses and sport performance. Accordingly, heart rate variability (HRV), saliva cotinine concentration and α-amylase activity, cognitive function, muscle strength, and baseball-hitting performance were measured. Thirteen healthy male non-smoker baseball players were recruited. Conducting two sequences with 7-day intervals, they chewed nicotine gum (nicotine group) or flavor-matched placebo gum (placebo group) for 30 min. HRV and saliva analyses were conducted before gum consumption (S1), after gum consumption (S2), and after test completion (S3). Cognitive, muscle strength, and baseball-hitting performance tests were performed after nicotine or placebo gum chewing. The outcomes of all assessed variables were compared within and between the groups. Significant changes in HRV, α-amylase, testosterone, and cortisol were observed in the nicotine group at S2 and S3 (p < 0.05). Compared with the placebo group, the nicotine group exhibited enhanced motor reaction times, grooved pegboard test (GPT) results on cognitive function, and baseball-hitting performance, and small effect sizes were noted (d = 0.47, 0.46 and 0.41, respectively). Nicotine could induce changes in endocrine and sympathetic nerve activity and enhance cognitive function and baseball-hitting performance. However, no increase in muscle strength was observed after nicotine intake.
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El Hayek S, Geagea L, El Bourji H, Kadi T, Talih F. Prevention Strategies of Alcohol and Substance Use Disorders in Older Adults. Clin Geriatr Med 2021; 38:169-179. [PMID: 34794700 DOI: 10.1016/j.cger.2021.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Older adults are increasingly engaging in unhealthy substance use. Owing to aging and comorbid medical conditions, older adults are at increased risk of adverse effects from alcohol, tobacco, and illicit drug use. Preventative measures, regular screening, and appropriate intervention can protect older adults from the negative outcomes of substance use and potentially improve their quality of life. This article reviews the latest trends of substance use in older adults, impact on health, and the best practice approaches for the clinical assessment of substance use disorders in this age group.
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Affiliation(s)
- Samer El Hayek
- Department of Psychiatry, American University of Beirut, P.O. Box: 11-0236, Riad El-Solh 1107 2020, Beirut, Lebanon. https://twitter.com/samerelhayek
| | - Luna Geagea
- Department of Psychiatry, American University of Beirut, P.O. Box: 11-0236, Riad El-Solh 1107 2020, Beirut, Lebanon
| | | | - Tamara Kadi
- American University of Beirut, Beirut, Lebanon
| | - Farid Talih
- Department of Psychiatry, American University of Beirut, P.O. Box: 11-0236, Riad El-Solh 1107 2020, Beirut, Lebanon.
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15
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Patterson JG, Hinton A, Cooper SE, Wewers ME. Differences in Quit Attempts, Successful Quits, Methods, and Motivations in a Longitudinal Cohort of Adult Tobacco Users by Sexual Orientation. Nicotine Tob Res 2021; 23:1952-1957. [PMID: 34060633 PMCID: PMC8562360 DOI: 10.1093/ntr/ntab116] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/28/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Sexual minority (SM) tobacco users are less likely to successfully quit than heterosexuals, yet little evidence describes cessation behaviors in this population over time. AIMS AND METHODS Our study investigated quit motivations, attempts, and methods in a longitudinal cohort of adult tobacco users by sexual orientation. Participants (N = 1177) completed interviews every 6 months through 48 months and reported quit attempts (24-hour tobacco free), successful quits (7-day point prevalence abstinence), motivations, and methods. Chi-squared and Fisher's exact tests assessed differences by heterosexual and SM orientation, gender, and quit outcome (attempt-only vs. successful quit). RESULTS Quit rates were similar for heterosexual and SM adults. Over half attempted to quit at least once over 48 months, but few remained abstinent (SM: 16.9%; heterosexual: 12.1%). Most used nicotine replacement therapy (SM: 31.9%; heterosexual: 26.1%) or tobacco product substitution (SM: 27.7%; heterosexual: 21.2%). Few used quitlines (SM: 4.3%; heterosexual: 1.3%) or Internet-based programs (SM: 6.4%; heterosexual: 1.3%). Quit motivations included health concerns, family, and physical fitness. Participants reporting a successful quit were more likely to report a household member quit smoking than 24-hour quit attempters. Among participants reporting a successful quit, more SM than heterosexual participants reported that a coworker quit smoking (55.6% vs. 33.1%, p = .009). CONCLUSIONS We found few differences between heterosexual and SM tobacco users in our sample. Many repeatedly attempt to quit, yet few used evidence-based methods. Leveraging online quit programs, health messages, and family members in tailored cessation interventions may help SM and heterosexual tobacco users successfully quit. IMPLICATIONS SM and heterosexual tobacco users evidenced few differences in quit behaviors. Over 4 years, a majority attempted to quit, with over a third making repeated quit attempts. Nicotine replacement therapy and tobacco product substitution were mostly used during quit attempts; however, more SM than heterosexual men reported using web-based quit programs. Personal health and family concerns were universal motivations to quit, yet SM women also cited physical fitness as a primary motivation. Tobacco users reporting that a household member stopped smoking were more likely to successfully quit. More SM than heterosexual men reported that a coworker quit smoking.
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Affiliation(s)
| | - Alice Hinton
- Ohio State University College of Public Health, Division
of Biostatistics, Columbus, OH, USA
| | - Sarah E Cooper
- Ohio State University College of Public Health, Division
of Health Behavior and Health Promotion, Columbus,
OH, USA
| | - Mary Ellen Wewers
- Ohio State University Comprehensive Cancer
Center, Columbus, OH, USA
- Ohio State University College of Public Health, Division
of Health Behavior and Health Promotion, Columbus,
OH, USA
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16
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Pfoh ER, Heinberg LJ, Rothberg MB. Factors Impacting Physician Referral To and Patient Attendance at Weight Management Programs Within a Large Integrated Health System. J Gen Intern Med 2021; 36:2339-2345. [PMID: 33483826 PMCID: PMC8342643 DOI: 10.1007/s11606-020-06520-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/20/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Identifying which patients receive referrals to and which ones attend weight management programs can provide insights into how physicians manage obesity. OBJECTIVE To describe patient factors associated with referrals, which primarily reflect physician priorities, and attendance, which reflects patient priorities. We also examine the influence of the individual physician by comparing adjusted rates of referral and attendance across physicians. DESIGN Retrospective cohort study. PARTICIPANTS Adults with a body mass index (BMI) ≥ 30 kg/m2 who had a primary care visit between 2015 and 2018 at a large integrated health system MAIN MEASURES: Referrals and visits to programs were collected from the EHR in 2019 and analyzed in 2019-2020. Multilevel logistic regression models were used to identify the association between patient characteristics and (1) receiving a referral, and (2) attending a visit after a referral. We compared physicians' adjusted probabilities of referring patients and of their patients attending a visit. KEY RESULTS Our study included 160,163 adults, with a median BMI of 35 kg/m2. Seventeen percent of patients received ≥ 1 referral and 29% of those attended a visit. The adjusted odds of referral increased 57% for patients with a BMI 35-39 (versus 30-34) and 32% for each comorbidity (p < 0.01). Attending a visit was less strongly associated with BMI (aOR 1.18 for 35-39 versus 30-34, 95% CI 1.09-1.27) and not at all with comorbidity. For the physician-level analysis, the adjusted probability of referral had a much wider range (0 to 83%; mean = 19%) than did the adjusted probability of attendance (range 27 to 34%). CONCLUSIONS Few patients attended a weight management program. Physicians vary greatly in their probability of referring patients to programs but not in their patients' probability of attending.
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Affiliation(s)
- Elizabeth R Pfoh
- Center for Value-Based Care Research, Cleveland Clinic Community Care, Cleveland, OH, USA.
| | - Leslie J Heinberg
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA.,Enterprise Weight Management Center, Cleveland Clinic, Cleveland, OH, USA
| | - Michael B Rothberg
- Center for Value-Based Care Research, Cleveland Clinic Community Care, Cleveland, OH, USA
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Sex-Specific Association of Uric Acid and Kidney Function Decline in Taiwan. J Pers Med 2021; 11:jpm11050415. [PMID: 34063419 PMCID: PMC8156506 DOI: 10.3390/jpm11050415] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/09/2021] [Accepted: 05/12/2021] [Indexed: 12/11/2022] Open
Abstract
An elevated serum urate concentration is associated with kidney damage. Men’s uric acid levels are usually higher than women’s. However, postmenopausal women have a higher risk of gout than men, and comorbidities are also higher than in men. This study examined the sex differences in the relationship between hyperuricemia and renal progression in early chronic kidney disease (CKD) and non-CKD, and further examined the incidence of CKD in non-CKD populations among patients over 50 years of age. We analyzed 1856 women and 1852 men participating in the epidemiology and risk factors surveillance of the CKD database. Women showed a significantly higher risk of renal progression and CKD than men within the hyperuricemia group. After adjusting covariates, women, but not men resulted in an hazard ratio (HR) for developing renal progression (HR = 1.12; 95% CI 1.01–1.24 in women and HR = 1.03; 95% CI 0.93–1.13 in men) and CKD (HR = 1.11; 95% CI 1.01–1.22 in women and HR = 0.95; 95% CI 0.85–1.05 in men) for each 1 mg/dL increase in serum urate levels. The association between serum urate levels and renal progression was stronger in women. Given the prevalence and impact of kidney disease, factors that impede optimal renal function management in women and men must be identified to provide tailored treatment recommendations.
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Liu B, Zhan S, Wilson KM, Mazumdar M, Li L. The Influence of Increasing Levels of Provider-Patient Discussion on Quit Behavior: An Instrumental Variable Analysis of a National Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094593. [PMID: 33926078 PMCID: PMC8123707 DOI: 10.3390/ijerph18094593] [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] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/18/2021] [Accepted: 04/22/2021] [Indexed: 11/16/2022]
Abstract
Objective: We aimed to examine the influence of increasing levels of discussion (both asked and advised, either asked or advised but not both, and neither asked nor advised) on quit behavior. Methods: We included 4133 adult current smokers from the 2015 National Health Interview Survey. The primary outcomes were quit intent and quit attempt, and the secondary outcomes were methods used for quitting. We used an instrumental variable analysis, as well as propensity score weighted and multivariable logistic regressions. Results: Compared to no discussion, having both or only one discussion, respectively, increased quit intent (OR = 1.65, 95% CI = 1.63–1.66 and OR = 1.02, 95% CI = 0.99–1.05), quit attempt (OR = 1.76, 95% CI = 1.75–1.77 and OR = 1.60, 95% CI = 1.57–1.63). Among those who attempted to quit (n = 1536), having both or only one discussion increased the use of pharmacologic (OR = 1.99, 95% CI = 1.97–2.02 and OR = 1.56, 95% CI = 1.49–1.63) or behavioral (OR = 2.01, 95% CI = 1.94–2.08 and OR = 2.91, 95% CI = 2.74–3.08) quit methods. Conclusions: Increasing levels of provider–patient discussion encourages quit behavior, and should be an integral part of reducing the health and economic burden of smoking. Strategies that promote the adherence and compliance of providers to communicate with patients may help increase the success of smoking cessation.
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Affiliation(s)
- Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA; (S.Z.); (M.M.); (L.L.)
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA
- Tisch Cancer Institute, New York, NY 10029-6574, USA
- Correspondence:
| | - Serena Zhan
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA; (S.Z.); (M.M.); (L.L.)
- Tisch Cancer Institute, New York, NY 10029-6574, USA
- Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA
| | - Karen M. Wilson
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA;
| | - Madhu Mazumdar
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA; (S.Z.); (M.M.); (L.L.)
- Tisch Cancer Institute, New York, NY 10029-6574, USA
- Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA
| | - Lihua Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA; (S.Z.); (M.M.); (L.L.)
- Tisch Cancer Institute, New York, NY 10029-6574, USA
- Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA
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Trapl ES, VanFrank B, Kava CM, Trinh V, Land SR, Williams RS, Frost E, Babb S. Smoking and cessation behaviors in patients at federally funded health centers - United States, 2014. Drug Alcohol Depend 2021; 221:108615. [PMID: 33652378 PMCID: PMC11001259 DOI: 10.1016/j.drugalcdep.2021.108615] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/12/2021] [Accepted: 01/29/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Federally funded health centers (HCs) provide care to the most vulnerable populations in the U.S., including populations with disproportionately higher smoking prevalence such as those with lower incomes. METHODS This study compared characteristics of adult HC patients, by cigarette smoking status, and assessed smoking cessation-related behaviors using 2014 Health Center Patient Survey data; analysis was restricted to adults with data on cigarette smoking status (n = 5583). Chi-square and logistic regression analyses were conducted. RESULTS Overall, 28.1 % were current smokers and 19.2 % were former smokers. Current smokers were more likely to report fair/poor health (48.2 %) and a high burden of behavioral health conditions (e.g., severe psychological distress 23.9 %) versus former and never smokers. Most current smokers reported wanting to quit in the past 12 months (79.0 %) and receiving advice to quit from a healthcare professional (78.7 %). In a multivariable model, age <45, non-white race, COPD diagnosis, and past 3-month marijuana use were significantly associated with desire to quit. Few former smokers (15.2 %) reported using cessation treatment, though use was higher among those who quit within the previous year (30.6 %). CONCLUSIONS Although most current smokers reported a desire to quit, low uptake of evidence-based treatment may reduce the number who attempt to quit and succeed. Given the burden of tobacco use, future efforts could focus on identifying and overcoming unique personal, healthcare professional, or health system barriers to connecting them with cessation treatments. Increasing access to cessation treatments within HCs could reduce smoking-related disparities and improve population health.
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Affiliation(s)
- Erika S Trapl
- Prevention Research Center for Healthy Neighborhoods, Dept. of Population and Quantitative Health Sciences, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106-7069, USA.
| | - Brenna VanFrank
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy. NE, MS: S107-7, Atlanta, GA, 30341, USA
| | - Christine M Kava
- Health Promotion Research Center, Department of Health Services, University of Washington School of Public Health, 3980 15th Avenue NE, Seattle, WA, 98105, USA
| | - Vinh Trinh
- Prevention Research Center for Healthy Neighborhoods, Dept. of Population and Quantitative Health Sciences, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106-7069, USA
| | - Stephanie R Land
- Tobacco Control Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, USA
| | - Rebecca S Williams
- Center for Health Promotion and Disease Prevention, Campus Box 7424, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA; Lineberger Comprehensive Cancer Center, Campus Box 7424, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Elizabeth Frost
- Prevention Research Center for Healthy Neighborhoods, Dept. of Population and Quantitative Health Sciences, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106-7069, USA
| | - Stephen Babb
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy. NE, MS: S107-7, Atlanta, GA, 30341, USA
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20
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Shen J, Crothers K, Kross EK, Petersen K, Melzer AC, Triplette M. Provision of Smoking Cessation Resources in the Context of In-Person Shared Decision-Making for Lung Cancer Screening. Chest 2021; 160:765-775. [PMID: 33745990 DOI: 10.1016/j.chest.2021.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 03/04/2021] [Accepted: 03/06/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Lung cancer screening (LCS) is effective at reducing mortality for high-risk smokers. Mortality benefits go beyond early cancer detection, because shared decision-making (SDM) may present a "teachable moment" to reinforce cessation and provide resources. RESEARCH QUESTION How well is smoking cessation performed during LCS SDM encounters, and what patient and provider characteristics are associated with smoking cessation assistance? STUDY DESIGN AND METHODS This is a retrospective cohort study of current smokers participating in initial LCS SDM through a multisite program in Seattle, Washington, between 2015-2018. The LCS tracking database and electronic health record were reviewed for demographics, comorbidity data, and clinical encounter information. The primary outcome was provision of a smoking cessation resource, defined as referral to cessation resources, recommendation for nicotine replacement, or prescription for cessation medication. Participant and provider factor associations with the outcome were evaluated using χ2 testing and multivariable logistic regression. RESULTS Most of the 423 study participants were men (70%), with a median age of 61 (IQR, 58-66) years and median of 50 (41-72) pack-years of smoking. Only 26% of encounters had documentation consistent with SDM. Thirty-nine percent of participants received at least one smoking cessation resource, and only 5% received both counseling referrals and medication. In a multivariable model, the provision of any smoking cessation resource was half as likely in participants with higher levels of comorbidity (Charlson Index >2; OR, 0.53; 95% CI, 0.31-0.81), and half as likely if the ordering provider was not the patient's PCP or their specialist (OR, 0.55; 95% CI, 0.32-0.96). INTERPRETATION Overall provision of smoking cessation resources was moderate during SDM encounters for LCS, and lower in patients with more comorbidities and when not performed by the patient's PCP or specialist. Interventions are needed to improve smoking cessation counseling and resource utilization at the time of LCS encounters.
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Affiliation(s)
| | - Kristina Crothers
- University of Washington, Seattle, WA; Veterans Affairs Puget Sound Medical Center, Seattle, WA
| | - Erin K Kross
- University of Washington, Seattle, WA; Cambia Palliative Care Center of Excellence at UW Medicine, Seattle, WA
| | | | - Anne C Melzer
- Division of Pulmonary, Allergy and Critical Care, University of Minnesota, Minneapolis, MN; Minneapolis Veterans Affairs Health Care System, Minneapolis, MN
| | - Matthew Triplette
- University of Washington, Seattle, WA; Seattle Cancer Care Alliance, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Research Center and Department of Medicine, University of Washington, Seattle, WA.
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21
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Hu L, Li L, Ji J. Machine learning to identify and understand key factors for provider-patient discussions about smoking. Prev Med Rep 2020; 20:101238. [PMID: 33224719 PMCID: PMC7666379 DOI: 10.1016/j.pmedr.2020.101238] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 10/07/2020] [Accepted: 10/20/2020] [Indexed: 12/15/2022] Open
Abstract
We sought to identify key determinants of the likelihood of provider-patient discussions about smoking and to understand the effects of these determinants. We used data on 3666 self-reported current smokers who talked to a health professional within a year of the time the survey was conducted using the 2017 National Health Interview Survey. We included wide-ranging information on 43 potential covariates across four domains, demographic and socio-economic status, behavior, health status and healthcare utilization. We exploited a principled nonparametric permutation based approach using Bayesian machine learning to identify and rank important determinants of discussions about smoking between health providers and patients. In the order of importance, frequency of doctor office visits, intensity of cigarette use, length of smoking history, chronic obstructive pulmonary disease, emphysema, marital status were major determinants of disparities in provider-patient discussions about smoking. There was a distinct interaction between intensity of cigarette use and length of smoking history. Our analysis may provide some insights into strategies for promoting discussions on smoking and facilitating smoking cessation. Health care resource usage, smoking intensity and duration and smoking-related conditions were key drivers. The "usual suspects", age, gender, race and ethnicity were less important, and gender, in particular, had little effect.
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Affiliation(s)
- Liangyuan Hu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,The Institute for Healthcare Delivery, Mount Sinai Health System, New York, NY, USA
| | - Lihua Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,The Institute for Healthcare Delivery, Mount Sinai Health System, New York, NY, USA
| | - Jiayi Ji
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,The Institute for Healthcare Delivery, Mount Sinai Health System, New York, NY, USA
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