1
|
Vander Weg MW, Howren MB, Grant KM, Prochazka AV, Duffy S, Burke R, Cretzmeyer M, Parker C, Thomas EBK, Rizk MT, Bayer J, Kinner EM, Clark JM, Katz DA. A smoking cessation intervention for rural veterans tailored to individual risk factors: A multicenter randomized clinical trial. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 156:209191. [PMID: 37866436 DOI: 10.1016/j.josat.2023.209191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/24/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Rates of cigarette use remain elevated among those living in rural areas. Depressive symptoms, risky alcohol use, and weight concerns frequently accompany cigarette smoking and may adversely affect quitting. Whether treatment for tobacco use that simultaneously addresses these issues affects cessation outcomes is uncertain. METHODS The study was a multicenter, two-group, randomized controlled trial involving mostly rural veterans who smoke (N = 358) receiving treatment at one of five Veterans Affairs Medical Centers. The study randomly assigned participants to a tailored telephone counseling intervention or referral to their state tobacco quitline. Both groups received guideline-recommended smoking cessation pharmacotherapy, selected using a shared decision-making approach. The primary outcome was self-reported seven-day point prevalence abstinence (PPA) at three and six months. The study used salivary cotinine to verify self-reported quitting at six months. RESULTS Self-reported PPA was significantly greater in participants assigned to Tailored Counseling at three (OR = 1.66; 95 % CI: 1.07-2.58) but not six (OR = 1.35; 95 % CI: 0.85-2.15) months. Post hoc subgroup analyses examining treatment group differences based on whether participants had a positive screen for elevated depressive symptoms, risky alcohol use, and/or concerns about weight gain indicated that the cessation benefit of Tailored Counseling at three months was limited to those with ≥1 accompanying concern (OR = 2.02, 95 % CI: 1.20-3.42). Biochemical verification suggested low rates of misreporting. CONCLUSIONS A tailored smoking cessation intervention addressing concomitant risk factors enhanced short-term abstinence but did not significantly improve long-term quitting. Extending the duration of treatment may be necessary to sustain treatment effects.
Collapse
Affiliation(s)
- Mark W Vander Weg
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, United States of America; Department of Community and Behavioral Health, University of Iowa College of Public Health, United States of America; Department of Internal Medicine, University of Iowa Carver College of Medicine, United States of America; Department of Psychological and Brain Sciences, University of Iowa, United States of America; VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, United States of America.
| | - M Bryant Howren
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, United States of America; Department of Behavioral Sciences and Social Medicine, Florida State University, United States of America; Florida Blue Center for Rural Health Research & Policy, United States of America
| | - Kathleen M Grant
- VA Nebraska-Western Iowa Health Care System, United States of America; University of Nebraska Medical Center Department of Medicine, United States of America
| | - Allan V Prochazka
- Primary Care, VA Eastern Colorado Health Care System, United States of America; Denver Seattle Center for Veteran-centric Value-based Research (DiSCoVVR), United States of America
| | - Sonia Duffy
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, United States of America; College of Nursing, Ohio State University, United States of America
| | - Randy Burke
- Mental Health Service, G.V. (Sonny) Montgomery VA Medical Center, United States of America; Department of Psychiatry, University of Mississippi School of Medicine, United States of America
| | | | - Christopher Parker
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, United States of America
| | - Emily B K Thomas
- Department of Psychological and Brain Sciences, University of Iowa, United States of America
| | | | - Jennifer Bayer
- Department of Psychological and Brain Sciences, University of Iowa, United States of America
| | - Ellen M Kinner
- Department of Psychological and Brain Sciences, University of Iowa, United States of America
| | - Jennifer M Clark
- Department of Neurology, University of Iowa, Carver College of Medicine, United States of America
| | - David A Katz
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, United States of America; Department of Internal Medicine, University of Iowa Carver College of Medicine, United States of America; Department of Epidemiology, University of Iowa College of Public Health, United States of America
| |
Collapse
|
2
|
Hock ES, Franklin M, Baxter S, Clowes M, Chilcott J, Gillespie D. Covariates of success in quitting smoking: a systematic review of studies from 2008 to 2021 conducted to inform the statistical analyses of quitting outcomes of a hospital-based tobacco dependence treatment service in the United Kingdom. NIHR OPEN RESEARCH 2023; 3:28. [PMID: 37881466 PMCID: PMC10596416 DOI: 10.3310/nihropenres.13427.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 10/27/2023]
Abstract
Background Smoking cessation interventions are being introduced into routine secondary care in the United Kingdom (UK), but there are person and setting-related factors that could moderate their success in quitting smoking. This review was conducted as part of an evaluation of the QUIT hospital-based tobacco dependence treatment service ( https://sybics-quit.co.uk). The aim of the review was to identify a comprehensive set of variables associated with quitting success among tobacco smokers contacting secondary healthcare services in the UK who are offered support to quit smoking and subsequently set a quit date. The results would then be used to inform the development of a statistical analysis plan to investigate quitting outcomes. Methods Systematic literature review of five electronic databases. Studies eligible for inclusion investigated quitting success in one of three contexts: (a) the general population in the UK; (b) people with a mental health condition; (c) quit attempts initiated within a secondary care setting. The outcome measures were parameters from statistical analysis showing the effects of covariates on quitting success with a statistically significant (i.e., p-value <0.05) association. Results The review identified 29 relevant studies and 14 covariates of quitting success, which we grouped into four categories: demographics (age; sex; ethnicity; socio-economic conditions; relationship status, cohabitation and social network), individual health status and healthcare setting (physical health, mental health), tobacco smoking variables (current tobacco consumption, smoking history, nicotine dependence; motivation to quit; quitting history), and intervention characteristics (reduction in amount smoked prior to quitting, the nature of behavioural support, tobacco dependence treatment duration, pharmacological aids). Conclusions In total, 14 data fields were identified that should be considered for inclusion in datasets and statistical analysis plans for evaluating the quitting outcomes of smoking cessation interventions initiated in secondary care contexts in the UK. PROSPERO registration CRD42021254551 (13/05/2021).
Collapse
Affiliation(s)
- Emma S. Hock
- Sheffield Centre for Health and Related Research (SCHARR), Division of Population Health, School of Medicine and Population Health School, The University of Sheffield, Sheffield, England, UK
| | - Matthew Franklin
- Sheffield Centre for Health and Related Research (SCHARR), Division of Population Health, School of Medicine and Population Health School, The University of Sheffield, Sheffield, England, UK
| | - Susan Baxter
- Sheffield Centre for Health and Related Research (SCHARR), Division of Population Health, School of Medicine and Population Health School, The University of Sheffield, Sheffield, England, UK
| | - Mark Clowes
- Sheffield Centre for Health and Related Research (SCHARR), Division of Population Health, School of Medicine and Population Health School, The University of Sheffield, Sheffield, England, UK
| | - James Chilcott
- Sheffield Centre for Health and Related Research (SCHARR), Division of Population Health, School of Medicine and Population Health School, The University of Sheffield, Sheffield, England, UK
| | - Duncan Gillespie
- Sheffield Centre for Health and Related Research (SCHARR), Division of Population Health, School of Medicine and Population Health School, The University of Sheffield, Sheffield, England, UK
| |
Collapse
|
3
|
Patel SY, Wayne GF, Progovac AM, Flores M, Moyer M, Mullin B, Levy D, Saloner B, Cook BL. Effects of Medicaid coverage on receipt of tobacco dependence treatment among Medicaid beneficiaries with substance use disorder. Health Serv Res 2022; 57:1303-1311. [PMID: 35584242 PMCID: PMC9643088 DOI: 10.1111/1475-6773.14007] [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] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Individuals with substance use disorder (SUD) smoke cigarettes at a rate that is more than double the rate of the general population. Tobacco dependence treatment (TDT) is effective at reducing smoking, yet it is unclear whether expanding insurance coverage of these services increases TDT use among Medicaid beneficiaries with SUD. DATA SOURCE 2009-2013 Medicaid data in all 50 states and Washington DC. STUDY DESIGN We conducted a retrospective analysis of the 2009-2013 de-identified Medicaid Analytic Extract (MAX) claims for a 100% national sample of fee-for-service (FFS) Medicaid adult beneficiaries. Using a difference-in-difference-in-differences analysis, we assessed the association of full TDT coverage on TDT medication use and tobacco cessation counseling services between beneficiaries with and without SUD. We adjusted for age, sex, race/ethnicity, diagnosis of co-occurring chronic illness, state tobacco taxes, and state and year fixed effects. DATA COLLECTION/EXTRACTION METHODS We excluded patients not continuously enrolled in Medicaid for 12 months during the calendar year, adults aged 65 and older (given their dual enrollment in Medicaid and Medicare), minors aged 12-17, and pregnant women (for whom different TDT coverage policies apply). PRINCIPAL FINDINGS We separately modeled the association between full coverage of (1) counseling, (2) over-the-counter nicotine replacement therapy, and (3) prescription cessation medications on TDT medication treatment and counseling services. We found that each coverage led to increases in any TDT medication treatment and counseling services for beneficiaries with SUD. The effects of each coverage on medication treatment were greater for beneficiaries with SUD compared to beneficiaries without SUD (ranging from 4.9 to 6.1 percentage point difference). CONCLUSION Coverage of tobacco cessation counseling, over-the-counter nicotine replacement therapy, and prescription cessation medications holds promise for reducing the wide disparities in rates of smoking between those with and without SUD.
Collapse
Affiliation(s)
- Sadiq Y. Patel
- Department of Health Care PolicyHarvard Medical SchoolBostonMassachusettsUSA
| | - Geoffrey F. Wayne
- Department of PsychiatryCambridge Health AllianceCambridgeMassachusettsUSA
| | - Ana M. Progovac
- Department of PsychiatryCambridge Health AllianceCambridgeMassachusettsUSA
- Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA
| | - Michael Flores
- Department of PsychiatryCambridge Health AllianceCambridgeMassachusettsUSA
- Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA
| | - Margo Moyer
- Department of PsychiatryCambridge Health AllianceCambridgeMassachusettsUSA
| | - Brian Mullin
- Department of PsychiatryCambridge Health AllianceCambridgeMassachusettsUSA
| | - Douglas Levy
- Department of MedicineHarvard Medical SchoolBostonMassachusettsUSA
- Mongan Institute Health Policy Research Center and Tobacco Research and Treatment CenterMassachusetts General HospitalBostonMassachusettsUSA
| | - Brendan Saloner
- Department of Health Policy and ManagementJohns Hopkins School of Public HealthBaltimoreMarylandUSA
| | - Benjamin Lê Cook
- Department of PsychiatryCambridge Health AllianceCambridgeMassachusettsUSA
- Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA
| |
Collapse
|
4
|
Tinsel I, Metzner G, Schlett C, Sehlbrede M, Bischoff M, Anger R, Brame J, König D, Wurst R, Fuchs R, Lindinger P, Bredenkamp R, Farin-Glattacker E. Effectiveness of an interactive web-based health program for adults: a study protocol for three concurrent controlled-randomized trials (EVA-TK-Coach). Trials 2021; 22:526. [PMID: 34376228 PMCID: PMC8353439 DOI: 10.1186/s13063-021-05470-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 07/20/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND A healthy lifestyle can help prevent diseases that impair quality of life and lead to premature death. The Techniker health insurance fund offers a comprehensive online health program to support users in achieving their health goals of Increasing Fitness, Losing and Maintaining Weight, or Smoking Cessation. METHODS The aim of this study is to test the long-term effectiveness of the web-based TK-HealthCoach with regard to the primary outcomes of increased physical activity, sustainable weight reduction, and smoking abstinence. We are conducting three interconnected, randomized controlled trials (RCT), one for each health goal, within which participants are allocated to an intervention group (interactive online health program) or a control group (non-interactive online health program). The effects of the intervention groups compared to the control groups will be analyzed by multi-level models for change. Participants' data are captured via online questionnaires before the program starts (baseline t0), again when it ends (t1), and later at two follow-up surveys (t2 and t3); the latter 12 months after t1. We are documenting socio-demographic, health-related, and psychological variables as well as usage behavior data of the programs. According to our sample size calculation, we have to enroll 1114 participants in each Losing and Maintaining Weight and Increasing Fitness RCT and 339 participants in the Smoking Cessation RCT. Additionally, 15-20 participants in the interactive smoking-cessation program will be invited to qualitative telephone interviews with the aim to obtain detailed information concerning utilization, compliance, and satisfaction. The online RCTs' inclusion criteria are: adults of each gender regardless of whether they are insured with Techniker health insurance fund. Persons with impairments or pre-existing conditions require a medical assessment as to whether the program is suitable for them. Specific exclusion criteria apply to each program/RCT. DISCUSSION We assume that study participants will improve their health behavior by using the offered online health programs and that each health goal's intervention group will reveal advantages regarding the outcome variables compared to the control groups. Study enrollment started on January 1, 2020. TRIAL REGISTRATION German Clinical Trials Register, Universal Trial Number (UTN): U1111-1245-0273 . Registered on 11 December 2019.
Collapse
Affiliation(s)
- Iris Tinsel
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 49, 79106, Freiburg, Germany.
| | - Gloria Metzner
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 49, 79106, Freiburg, Germany
| | - Christian Schlett
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 49, 79106, Freiburg, Germany
| | - Matthias Sehlbrede
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 49, 79106, Freiburg, Germany
| | - Martina Bischoff
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 49, 79106, Freiburg, Germany
| | - Robin Anger
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 49, 79106, Freiburg, Germany
| | - Judith Brame
- Department of Sport and Sport Science (IfSS), University of Freiburg, Freiburg, Germany
| | - Daniel König
- Department of Sport and Sport Science (IfSS), University of Freiburg, Freiburg, Germany
| | - Ramona Wurst
- Department of Sport and Sport Science (IfSS), University of Freiburg, Freiburg, Germany
| | - Reinhard Fuchs
- Department of Sport and Sport Science (IfSS), University of Freiburg, Freiburg, Germany
| | - Peter Lindinger
- Scientific Working Group in Smoking Cessation (WAT), Tübingen, Germany
| | - Rainer Bredenkamp
- Clinical Trials Unit UMG, University Medical Center Göttingen, Georg-August-University, Göttingen, Germany
| | - Erik Farin-Glattacker
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 49, 79106, Freiburg, Germany
| |
Collapse
|
5
|
Aonso-Diego G, González-Roz A, Krotter A, García-Pérez A, Secades-Villa R. Contingency management for smoking cessation among individuals with substance use disorders: In-treatment and post-treatment effects. Addict Behav 2021; 119:106920. [PMID: 33798921 DOI: 10.1016/j.addbeh.2021.106920] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/18/2021] [Accepted: 03/18/2021] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Smokers with substance use disorders (SUDs) show elevated tobacco prevalence, and smoking abstinence rates are considerably low. This randomized controlled trial sought to compare the effect of a cognitive behavioral treatment (CBT) that includes an episodic future thinking (EFT) component with the same treatment protocol plus contingency management (CM). This study aims to examine the effect of CM on smoking outcomes and in-treatment behaviors (i.e., retention, session attendance and adherence to nicotine use reduction guidelines), and to analyze whether these in-treatment variables predicted days of continuous abstinence at end-of-treatment. METHOD A total of 54 treatment-seeking participants (75.9% males, M = 46.19 years old) were allocated to CBT + EFT (n = 30) or CBT + EFT + CM (n = 24). Intervention consisted of eight weeks of group-based sessions. Tobacco abstinence was verified biochemically by testing levels of carbon monoxide (≤4ppm) and urine cotinine (≤80 ng/ml). RESULTS CM intervention increased 24-hour tobacco abstinence (50% vs. 20%, χ2(1) = 5.4; p = .021) and days of continuous abstinence (M = 5.92 ± 7.67 vs. 5.53 ± 12.42; t(52) = -0.132; p = 0.89) at end-of-treatment in comparison with CBT + EFT intervention. Although not statistically significant, CBT + EFT + CM enhanced in-treatment behaviors, in terms of retention (83.3% vs. 70%; χ2(1) = 0.255; p = .208), sessions attended (12.29 ± 3.22 vs. 10.93 ± 3.26; t(52) = -1.527; p = .133) and adherence to weekly nicotine use reduction targets (41.07% ± 31.96 vs. 35% ±2 6.28; t(52) = -0.766; p = .447). A higher percentage of samples meeting reduction guidelines (β = 0.609; p<.001) predicted days of continuous abstinence at end-of-treatment. CONCLUSION Combining CM with CBT + EFT improves short-term quitting rates. Findings suggest the need to incorporate strategies for improving adherence to nicotine reduction guidelines.
Collapse
|
6
|
Quisenberry AJ, Pittman J, Goodwin RD, Bickel WK, D'Urso G, Sheffer CE. Smoking relapse risk is increased among individuals in recovery. Drug Alcohol Depend 2019; 202:93-103. [PMID: 31325822 PMCID: PMC6685745 DOI: 10.1016/j.drugalcdep.2019.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 07/03/2019] [Accepted: 07/05/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The prevalence of cigarette smoking among individuals with a history of substance use disorders (SUDs) remains up to four times higher than those without a history of SUDs. More than half of individuals who attain sustained remission from SUDs will die of tobacco-related diseases. The aim of this secondary data analysis was to compare the risk for smoking relapse among smokers with no history of SUDs and smokers in recovery from SUDs after multi-component, cognitive-behavioral treatment for tobacco dependence. METHODS Participants were randomized to receive 6 sessions of multicomponent cognitive-behavioral therapy (adapted for lower socioeconomic groups or standard), 8 weeks of nicotine patches, and were followed for 6 months in the parent randomized clinical trial. Participants passed a urine drug test prior to enrollment. Recovery was assessed at baseline by self-report to the question, "Do consider yourself in recovery from drugs or alcohol?" Relapse was defined as any smoking for 7 consecutive days. RESULTS Participants were primarily lower SES and identified as racial and/or ethnic minorities. Cox proportional hazards models revealed that the risk of smoking relapse following tobacco dependence treatment was greater among smokers in long-term (HR: 1.44; 95% CI: 1.01, 2.05) and short-term (HR: 1.98; 95% CI: 1.30, 3.03) recovery than for smokers with no history of SUDs. CONCLUSIONS Our findings indicate that smokers in recovery from SUDs have 1.5-2 times the risk of relapse than smokers with no history of SUDs. More effective relapse prevention interventions are needed for this vulnerable, high-risk group of smokers.
Collapse
Affiliation(s)
- Amanda J Quisenberry
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14203, United States.
| | - Jami Pittman
- College of Liberal Arts & Sciences, Wayne State University, 4841 Cass Avenue, Detroit, MI, 48201, United States
| | - Renee D Goodwin
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, United States; Institute of Implementation in Population Health, The City University of New York, 55 West 125th Street, New York, New York, 10027, United States
| | - Warren K Bickel
- Addiction Recovery Research Center, Virginia Tech Carilion Research Institute, 2 Riverside Circle, Roanoke, VA, 24016, United States
| | - Giordano D'Urso
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Christine E Sheffer
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14203, United States
| |
Collapse
|
7
|
Weiss-Gerlach E, McCarthy WJ, Wellmann J, Graunke M, Spies C, Neuner B. Secondary analysis of an RCT on Emergency Department-Initiated Tobacco Control: Repeatedly assessed point-prevalence abstinence up to 12 months and extension of results through a 10-year follow-up. Tob Induc Dis 2019; 17:26. [PMID: 31582937 PMCID: PMC6751984 DOI: 10.18332/tid/105579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/08/2019] [Accepted: 03/12/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Emergency departments (EDs) are opportune places for tobacco control interventions. The ‘Tobacco Control in an Urban Emergency Department’ (TED) study, ISRCTN41527831, originally evaluated the effect of motivational interviewing on-site plus up to four booster telephone calls on 12-month abstinence. This study’s aim was to evaluate the effect of the intervention on 7-day point-prevalence abstinence at 10 years follow-up (primary outcome) as well as on repeated point-prevalence abstinence at 1, 3, 6, 12 months and at 10 years (continual smoking abstinence, secondary outcome). METHODS At the 10 years follow-up and after informed consent, study participants responded to a mailed questionnaire. The primary outcome was analyzed in observed-only and in all-cases analyses. The secondary outcomes were analyzed using a multiple adjusted GLMM for binary outcomes. RESULTS Out of 1012 TED-study participants, 986 (97.4%) were alive and 231 (23.4% of 986) responded to the follow-up at 10 years. For observed-only and all-cases analyses, the effect of the baseline intervention on 7-day point-prevalence abstinence at the 10 years follow-up was statistically non-significant. However, when taking into account all repeated measures, the intervention significantly influenced continual abstinence with odds ratio 1.32 (95% CI: 1.01–1.73; p=0.042). Baseline motivation, perceived self-efficacy to stop smoking, and nicotine dependency were independently associated with long-term continual smoking abstinence (all p<0.05). CONCLUSIONS A conventional analysis failed to confirm a significant effect of the ED-initiated tobacco control intervention on the point-prevalence abstinence at 10 years. Results from a more integrative analysis nonetheless indicated an enduring intervention effect on continual abstinence among smokers first encountered in the emergency department setting 10 years earlier.
Collapse
Affiliation(s)
- Edith Weiss-Gerlach
- Department of Anesthesiology and Intensive Care Medicine, Charité- Universitätsmedizin Berlin, Berlin, Germany
| | - William J McCarthy
- Center for Cancer Prevention and Control Research, UCLA Fielding School of Public Health, Los Angeles, United States
| | - Jürgen Wellmann
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Marie Graunke
- Department of Anesthesiology and Intensive Care Medicine, Charité- Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia Spies
- Department of Anesthesiology and Intensive Care Medicine, Charité- Universitätsmedizin Berlin, Berlin, Germany
| | - Bruno Neuner
- Department of Anesthesiology and Intensive Care Medicine, Charité- Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
8
|
Worley MJ, Isgro M, Heffner JL, Lee SY, Daniel BE, Anthenelli RM. Predictors of reduced smoking quantity among recovering alcohol dependent men in a smoking cessation trial. Addict Behav 2018; 84:263-270. [PMID: 29763835 DOI: 10.1016/j.addbeh.2018.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 05/04/2018] [Accepted: 05/07/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Adults with alcohol dependence (AD) have exceptionally high smoking rates and poor smoking cessation outcomes. Discovery of factors that predict reduced smoking among AD smokers may help improve treatment. This study examined baseline predictors of smoking quantity among AD smokers in a pharmacotherapy trial for smoking cessation. METHODS The sample includes male, AD smokers (N = 129) with 1-32 months of alcohol abstinence who participated in a 12-week trial of medication (topiramate vs. placebo) and adjunct counseling with 6 months of follow-up. Baseline measures of nicotine dependence, AD severity, psychopathology, motivation to quit smoking, and smoking-related cognitions were used to predict smoking quantity (cigarettes per day) at post-treatment and follow-up. RESULTS Overall, the sample had statistically significant reductions in smoking quantity. Greater nicotine dependence (Incidence rate ratios (IRRs) = 0.82-0.90), motivation to quit (IRRs = 0.65-0.85), and intrinsic reasons for quitting (IRRs = 0.96-0.98) predicted fewer cigarettes/day. Conversely, greater lifetime AD severity (IRR = 1.02), depression severity (IRRs = 1.05-1.07), impulsivity (IRRs = 1.01-1.03), weight-control expectancies (IRRs = 1.10-1.15), and childhood sexual abuse (IRRs = 1.03-1.07) predicted more cigarettes/day. CONCLUSIONS Smokers with AD can achieve large reductions in smoking quantity during treatment, and factors that predict smoking outcomes in the general population also predict greater smoking reductions in AD smokers. Treatment providers can use severity of nicotine dependence and AD, motivation to quit, smoking-related cognitions, and severity of depression to guide treatment and improve outcomes among AD smokers.
Collapse
Affiliation(s)
- Matthew J Worley
- Pacific Treatment and Research Center (Pac-TARC), 3350 La Jolla Village Drive, 116A, San Diego, CA 92161, United States; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0821, United States.
| | - Melodie Isgro
- Pacific Treatment and Research Center (Pac-TARC), 3350 La Jolla Village Drive, 116A, San Diego, CA 92161, United States; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0821, United States
| | - Jaimee L Heffner
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N., M3-B232, PO Box 19024, Seattle, WA 98109, United States
| | - Soo Yong Lee
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0821, United States
| | - Belinda E Daniel
- Pacific Treatment and Research Center (Pac-TARC), 3350 La Jolla Village Drive, 116A, San Diego, CA 92161, United States
| | - Robert M Anthenelli
- Pacific Treatment and Research Center (Pac-TARC), 3350 La Jolla Village Drive, 116A, San Diego, CA 92161, United States; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0821, United States
| |
Collapse
|
9
|
Kelly PJ, Townsend CJ, Osborne BA, Baker AL, Deane FP, Keane C, Ingram I, Lunn J. Predicting Intention to Use Nicotine Replacement Therapy in People Attending Residential Treatment for Substance Dependence. J Dual Diagn 2018; 14:120-129. [PMID: 29488836 DOI: 10.1080/15504263.2018.1442951] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Nicotine replacement therapy (NRT) is recommended as a frontline smoking cessation tool for people attending mental health and substance dependence treatment services. Previous research suggests that NRT is underutilized in these settings. To improve the use of NRT among people attending residential treatment for substance use disorders, it is important that the factors influencing smokers' decisions to use NRT are understood. The study aimed to examine (1) smoking cessation strategies used by participants in previous quit attempts, (2) participants' attitudes toward NRT (i.e., safety concerns and perceived efficacy), and (3) the predictors of participants' intention to use NRT to support future quit attempts. METHODS Participants completed a cross-sectional survey that examined their smoking behaviors, previous experiences using smoking cessation strategies, attitudes and beliefs regarding NRT, and intention to use NRT as part of future quit attempts (N = 218). All participants were attending residential treatment for substance use disorders provided by We Help Ourselves, a large provider of specialist alcohol and other drug treatment in Australia. RESULTS The majority of respondents (98%) reported that they had smoked regularly in their lifetime, and 89% were current smokers. Forty-five percent of the current smokers reported that they had previously used NRT to support a quit attempt, with 54% reporting that they intended to use NRT to support a future quit attempt. Intentions to use NRT were not related to the participants' mental health status or the participants' perceptions regarding the safety or potential drawbacks associated with using NRT. However, participants were more likely to report that they would use NRT to support future quit attempts if they were female, had previously used NRT, and perceived NRT to be effective. CONCLUSIONS Improving the use of evidence-based smoking cessation strategies within substance use treatment continues to be a priority. To enhance the use of NRT among consumers attending mental health and addiction treatment services, NRT should be universally offered. Future research should consider strategies that help to improve participants' positive perceptions regarding the efficacy of NRT.
Collapse
Affiliation(s)
- Peter J Kelly
- a Illawarra Institute for Mental Health, School of Psychology, University of Wollongong , Wollongong , New South Wales , Australia
| | - Camilla J Townsend
- a Illawarra Institute for Mental Health, School of Psychology, University of Wollongong , Wollongong , New South Wales , Australia
| | - Briony A Osborne
- a Illawarra Institute for Mental Health, School of Psychology, University of Wollongong , Wollongong , New South Wales , Australia
| | - Amanda L Baker
- b School of Medicine and Public Health, Faculty of Health, University of Newcastle , Newcastle , New South Wales , Australia
| | - Frank P Deane
- a Illawarra Institute for Mental Health, School of Psychology, University of Wollongong , Wollongong , New South Wales , Australia
| | - Carol Keane
- a Illawarra Institute for Mental Health, School of Psychology, University of Wollongong , Wollongong , New South Wales , Australia
| | - Isabella Ingram
- a Illawarra Institute for Mental Health, School of Psychology, University of Wollongong , Wollongong , New South Wales , Australia
| | - Joanne Lunn
- c We Help Ourselves, Rozelle , Sydney , New South Wales , Australia
| |
Collapse
|
10
|
Metse AP, Wiggers J, Wye P, Wolfenden L, Freund M, Clancy R, Stockings E, Terry M, Allan J, Colyvas K, Prochaska JJ, Bowman JA. Efficacy of a universal smoking cessation intervention initiated in inpatient psychiatry and continued post-discharge: A randomised controlled trial. Aust N Z J Psychiatry 2017; 51:366-381. [PMID: 28195010 DOI: 10.1177/0004867417692424] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Interventions are required to redress the disproportionate tobacco-related health burden experienced by persons with a mental illness. This study aimed to assess the efficacy of a universal smoking cessation intervention initiated within an acute psychiatric inpatient setting and continued post-discharge in reducing smoking prevalence and increasing quitting behaviours. METHOD A randomised controlled trial was undertaken across four psychiatric inpatient facilities in Australia. Participants ( N = 754) were randomised to receive either usual care ( n = 375) or an intervention comprising a brief motivational interview and self-help material while in hospital, followed by a 4-month pharmacological and psychosocial intervention ( n = 379) upon discharge. Primary outcomes assessed at 6 and 12 months post-discharge were 7-day point prevalence and 1-month prolonged smoking abstinence. A number of secondary smoking-related outcomes were also assessed. Subgroup analyses were conducted based on psychiatric diagnosis, baseline readiness to quit and nicotine dependence. RESULTS Seven-day point prevalence abstinence was higher for intervention participants (15.8%) than controls (9.3%) at 6 months post-discharge (odds ratio = 1.07, p = 0.04), but not at 12 months (13.4% and 10.0%, respectively; odds ratio = 1.03, p = 0.25). Significant intervention effects were not found on measures of prolonged abstinence at either 6 or 12 months post-discharge. Differential intervention effects for the primary outcomes were not detected for any subgroups. At both 6 and 12 months post-discharge, intervention group participants were significantly more likely to smoke fewer cigarettes per day, have reduced cigarette consumption by ⩾50% and to have made at least one quit attempt, relative to controls. CONCLUSIONS Universal smoking cessation treatment initiated in inpatient psychiatry and continued post-discharge was efficacious in increasing 7-day point prevalence smoking cessation rates and related quitting behaviours at 6 months post-discharge, with sustained effects on quitting behaviour at 12 months. Further research is required to identify strategies for achieving longer term smoking cessation.
Collapse
Affiliation(s)
- Alexandra P Metse
- 1 The University of Newcastle, Australia, Callaghan, NSW, Australia.,2 Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - John Wiggers
- 1 The University of Newcastle, Australia, Callaghan, NSW, Australia.,2 Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,3 Hunter New England Population Health, Wallsend, NSW, Australia
| | - Paula Wye
- 1 The University of Newcastle, Australia, Callaghan, NSW, Australia.,2 Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,3 Hunter New England Population Health, Wallsend, NSW, Australia
| | - Luke Wolfenden
- 1 The University of Newcastle, Australia, Callaghan, NSW, Australia.,2 Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,3 Hunter New England Population Health, Wallsend, NSW, Australia
| | - Megan Freund
- 1 The University of Newcastle, Australia, Callaghan, NSW, Australia.,2 Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Richard Clancy
- 1 The University of Newcastle, Australia, Callaghan, NSW, Australia.,2 Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,4 Centre for Translational Neuroscience and Mental Health, Calvary Mater Hospital, Waratah, NSW, Australia
| | - Emily Stockings
- 5 National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
| | - Margarett Terry
- 6 Mental Health and Substance Use Service, Calvary Mater Hospital, Waratah, NSW, Australia
| | - John Allan
- 7 Mental Health Alcohol and Other Drugs Branch, Queensland Health, Fortitude Valley, QLD, Australia
| | - Kim Colyvas
- 1 The University of Newcastle, Australia, Callaghan, NSW, Australia
| | - Judith J Prochaska
- 8 Stanford Prevention Research Center, School of Medicine, Stanford University, Stanford, CA, USA
| | - Jenny A Bowman
- 1 The University of Newcastle, Australia, Callaghan, NSW, Australia.,2 Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| |
Collapse
|
11
|
Walker ER, Pratt LA, Schoenborn CA, Druss BG. Excess mortality among people who report lifetime use of illegal drugs in the United States: A 20-year follow-up of a nationally representative survey. Drug Alcohol Depend 2017; 171:31-38. [PMID: 28012429 PMCID: PMC5263065 DOI: 10.1016/j.drugalcdep.2016.11.026] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/28/2016] [Accepted: 11/21/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the mortality risks, over 20 years of follow-up in a nationally representative sample, associated with illegal drug use and to describe risk factors for mortality. METHODS We analyzed data from the 1991 National Health Interview Survey, which is a nationally representative household survey in the United States, linked to the National Death Index through 2011. This study included 20,498 adults, aged 18-44 years in 1991, with 1047 subsequent deaths. A composite variable of self-reported lifetime illegal drug use was created (hierarchical categories of heroin, cocaine, hallucinogens/inhalants, and marijuana use). RESULTS Mortality risk was significantly elevated among individuals who reported lifetime use of heroin (HR=2.40, 95% CI: 1.65-3.48) and cocaine (HR=1.27, 95% CI: 1.04-1.55), but not for those who used hallucinogens/inhalants or marijuana, when adjusting for demographic characteristics. Baseline health risk factors (smoking, alcohol use, physical activity, and BMI) explained the greatest amount of this mortality risk. After adjusting for all baseline covariates, the association between heroin or cocaine use and mortality approached significance. In models adjusted for demographics, people who reported lifetime use of heroin or cocaine had an elevated mortality risk due to external causes (poisoning, suicide, homicide, and unintentional injury). People who had used heroin, cocaine, or hallucinogens/inhalants had an elevated mortality risk due to infectious diseases. CONCLUSIONS Heroin and cocaine are associated with considerable excess mortality, particularly due to external causes and infectious diseases. This association can be explained mainly by health risk behaviors.
Collapse
Affiliation(s)
- Elizabeth Reisinger Walker
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Rd., Atlanta, GA 30322, United States.
| | - Laura A Pratt
- Office of Analysis and Epidemiology, National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Rd., Hyattsville, MD 20782, United States.
| | - Charlotte A Schoenborn
- Division of Health Interview Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Rd., Hyattsville, MD 20782, United States.
| | - Benjamin G Druss
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Rd., Atlanta, GA 30322, United States.
| |
Collapse
|
12
|
Lukowski AV, Morris CD, Young SE, Tinkelman D. Quitline Outcomes for Smokers in 6 States: Rates of Successful Quitting Vary by Mental Health Status. Nicotine Tob Res 2015; 17:924-30. [DOI: 10.1093/ntr/ntu252] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|