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Tomioka K, Shima M, Saeki K. Smaller household size and higher prevalence of serious psychological distress in younger people and never-married people: a nationwide cross-sectional survey in Japan. Front Public Health 2024; 12:1292371. [PMID: 38528867 PMCID: PMC10962682 DOI: 10.3389/fpubh.2024.1292371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/28/2024] [Indexed: 03/27/2024] Open
Abstract
Background Small-member households are increasing worldwide. However, most previous studies have focused on older people and living alone. Using the latest national survey data, we investigated a dose-response relationship between household size and serious psychological distress (SPD). Methods We analyzed data from the 2019 Comprehensive Survey of Living Conditions in Japan. The study participants were 405,560 community-dwelling adults aged 20 or older. Household size was classified into 5 or more, 3 or 4, two, and one (i.e., living alone). SPD was defined as ≥13 points based on the Kessler 6-item Psychological Distress Scale. We used multivariable logistic regressions and included age, education, equivalent household expenditures, housing tenure, employment contract, smoking, and illness under treatment as covariates. Results After stratified analyses by age and gender, a dose-response relationship between smaller household size and more common SPD was significant for younger, but not for older people (p-trend was <0.001 in men aged 20-59 and women aged 20-39). After stratified analyses by gender and marital status, a dose-response relationship was significant only for the never-married group in both genders (p-trend was <0.001 in never-married men and women). Conclusion Smaller households were associated with higher prevalence of SPD in younger adults and in never-married individuals, regardless of gender. Our findings suggest a need to focus on younger people and never-married people to reduce the mental health risks due to small household sizes.
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Affiliation(s)
- Kimiko Tomioka
- Nara Prefectural Health Research Center, Nara Medical University, Kashihara, Japan
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Wang Y, Sung HY, Lea Watkins S, Lightwood J, Yao T, Max W. The association of current exclusive e-cigarette use and dual use of e-cigarettes and cigarettes with psychological distress among U.S. adults. Prev Med Rep 2023; 36:102425. [PMID: 37810268 PMCID: PMC10556823 DOI: 10.1016/j.pmedr.2023.102425] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 10/10/2023] Open
Abstract
This observational study examines the association of current e-cigarette use and dual use of e-cigarettes and cigarettes (dual use) with psychological distress among U.S. adults. We differentiate dual use based on the smoking frequency and compare the relationship between dual use and psychological distress to that of exclusive cigarette smoking with the same smoking frequency. Using data from the 2015-2018 National Health Interview Surveys, we analyzed adults aged 18+ (N = 55,780) who currently use e-cigarettes or/and cigarettes and have no history of using other tobacco products, and adults who never used any tobacco. Multinomial logistic regression models estimate the association of current e-cigarette use and dual use with psychological distress severity (no/mild, moderate, and severe).In the sample, 15.3% and 2.9% of adults experienced moderate and severe psychological distress. Compared to never tobacco users, current exclusive e-cigarette users and dual users who smoke daily had higher odds of moderate and severe psychological distress. Dual users who smoke nondaily had higher odds of moderate, but not severe psychological distress than never tobacco users. Compared to exclusive daily smokers, dual users with daily smoking had higher odds of moderate and severe psychological distress. Compared to exclusive nondaily smokers, dual users with nondaily smoking had higher odds of moderate but not severe psychological distress. Our findings suggest that exclusive e-cigarette use is associated with psychological distress severity. Dual use is associated with higher odds of psychological distress severity compared to never tobacco users and exclusive cigarette smoking, and this association differs by smoking frequency.
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Affiliation(s)
- Yingning Wang
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, CA, USA
| | - Hai-Yen Sung
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, CA, USA
| | - Shannon Lea Watkins
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - James Lightwood
- Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, CA, USA
| | - Tingting Yao
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, CA, USA
| | - Wendy Max
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, CA, USA
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Pacek LR, Sawdey MD, Nguyen KH, Cooper M, Park-Lee E, Gross AL, Donaldson EA, Cullen KA. Trends and Associations of Past-30-Day Cigar Smoking in the U.S. by Age, Race/Ethnicity, and Sex, NSDUH 2002-2020. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6716. [PMID: 37754576 PMCID: PMC10531240 DOI: 10.3390/ijerph20186716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/22/2023] [Accepted: 08/27/2023] [Indexed: 09/28/2023]
Abstract
Cigar smoking remains a public health issue in the United States (U.S.), with a heterogeneous prevalence based on sociodemographic characteristics. Nationally representative data suggest changes in cigar smoking over time, with some evidence for sociodemographic differences. Using data from the 2002-2019 National Survey on Drug Use and Health (NSDUH), the prevalence of past-30-day cigar smoking was examined overall and stratified by sociodemographic characteristics; joinpoint regression examined the trends. Logistic regression analyses identified the correlates of cigar smoking using 2020 NSDUH data. From 2002 to 2004, the prevalence of cigar smoking remained stable (5.33-5.73%), but declined from 2004 to 2019 (5.73-4.29%). Cigar smoking declined in some periods between 2002-2019 among the non-Hispanic White, Hispanic, ages 12-17, ages 18-20, ages 21-25, age ≥ 35, and male subgroups, but remained unchanged among the non-Hispanic Other, ages 26-34, and female subgroups. Cigar smoking increased among non-Hispanic Black persons overall from 2002 to 2019 (6.67-8.02%). Past-30-day cigarette smoking and drug or alcohol use disorder was associated with an increased likelihood of cigar use, while female sex was associated with a decreased likelihood of cigar use, across all age groups. Though a decline in the prevalence of past-30-day cigar smoking is seen in the general population, the same is not evident among all sociodemographic subgroups. Our findings have the potential to inform tobacco cessation efforts within clinical practice, as well as regulatory efforts to reduce cigar use.
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Affiliation(s)
- Lauren R. Pacek
- Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD 20993, USA; (M.D.S.); (K.H.N.); (M.C.); (E.P.-L.); (A.L.G.); (E.A.D.); (K.A.C.)
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Wang JH, Yang YF, Zhao SL, Liu HT, Xiao L, Sun L, Wu X, Yuan DC, Ma LY, Ju BZ, Liu JP. Attitudes and influencing factors associated with smoking cessation: An online cross-sectional survey in China. Tob Induc Dis 2023; 21:87. [PMID: 37377525 PMCID: PMC10291730 DOI: 10.18332/tid/166108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/22/2023] [Accepted: 05/12/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION Quitting smoking, the critical path to reach the global targets of reducing tobacco use, can bring major and immediate health benefits to smokers. Exploring factors that help individuals to quit smoking is of great importance. The present study explored influencing factors on smoking cessation, in order to provide comprehensive reference for tobacco control policies. METHODS Ex-smokers and current smokers were recruited online in this cross-sectional survey, from 1 October to 31 November 2022, in China. The observational data were collected using a questionnaire to collect information with respect to sociodemographic characteristics of smokers, attitudes towards smoking cessation, details of smoking cessation, and different potential factors related to smoking cessation through open-ended questions. RESULTS A total of 638 smokers from 30 provinces were recruited as eligible respondents, with a mean age of 37.3 ± 11.7 years and a mean smoking history of 15.9 ± 13.7 years. The percentage of males was 92.3%. Of the 638 respondents, only 3.9% had no intention to stop smoking. Among 155 subjects who had quitted smoking successfully, willpower (55.5%) was considered as the most important contributing factor. Among 365 subjects who tried to quit but failed, lack of willpower (28.2%), tobacco dependence (16.2%), influence of surrounding smokers or smoking environments (15.9%), bad moods (9.9%), stress from work or life (7.9%), habits (7.1%), socialization (4.1%), and easy availability of tobacco (2.7%) were considered as the adverse factors leading to failure in quitting smoking. CONCLUSIONS Willpower and support from family members were the vital factors that lead to successful smoking cessation. Future tobacco control policies should also focus on addressing withdrawal symptoms and creating smoke-free environments as well as other factors.
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Affiliation(s)
- Jian-Hua Wang
- Institute of Chinese Medicine, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Yu-Feng Yang
- Institute of Chinese Medicine, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Shi-Lei Zhao
- Department of Anesthesia, General Hospital of Northern Theater Command, Shenyang, China
| | - Hai-Tao Liu
- Department of Cardiovascular Medicine, The People's Hospital of Liaoning Province, Shenyang, China
| | - Lei Xiao
- Affiliated Hospital, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Li Sun
- Institute of Chinese Medicine, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Xi Wu
- College of Acupuncture, Moxibustion, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Dong-Chao Yuan
- Institute of Chinese Medicine, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Li-Yao Ma
- School of Pharmaceutical Sciences, Liaoning University of Traditional Chinese Medicine, Dalian, China
| | - Bao-Zhao Ju
- Institute of Chinese Medicine, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Jian-Ping Liu
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
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Yang X, Zhang L, Lin H, Lin H, Cao W, Chang C. Psychiatric symptoms and intentions to quit smoking: How regularity and volume of cigarette consumption moderate the relationship. Tob Induc Dis 2023; 21:78. [PMID: 37323507 PMCID: PMC10266331 DOI: 10.18332/tid/163258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/10/2023] [Accepted: 04/14/2023] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION Smoking prevalence is disproportionately higher in those with psychiatric symptoms. Smokers with psychiatric symptoms are less likely to have an intention to quit smoking and attain eventual smoking abstinence. This study presents the relationship between depressive/anxiety symptoms and the intention to quit smoking and related influencing factors. METHODS A cross-sectional study recruited 931 current smoking individuals covering two provinces in China in July 2022. The online survey comprised questions concerning sociodemographic characteristics, smoking conditions and psychiatric symptoms. Chi-squared analyses and moderation analyses were applied. RESULTS The proportion of smokers who had the intention to quit smoking within six months was 46.1%. In comparison with subjects without depressive/anxiety symptoms, individuals who had both psychiatric symptoms were less likely to have the intention to quit smoking (39.3% vs 49.8%, χ2=9.130, p=0.028). As for the moderating model of depression, the interaction term of depressive symptoms and smoking regularly was significant (β=0.554, t=3.260, p=0.001). For those who were occasional smokers, depressive symptoms significantly lowered their quitting intentions. The regularity of smoking similarly moderated the effect of anxiety symptoms on quitting intentions. When the number of cigarettes used weekly served as the moderator, the interaction of this number and depressive symptoms was significant, as well as for anxiety (p<0.001), indicating that the volume of cigarette consumption moderated the relationship between depressive/anxiety symptoms and intention to quit smoking. CONCLUSIONS Psychiatric symptoms were significant factors in reducing the willingness of smokers to quit smoking, and the effects were moderated by smokers' cigarette consumption conditions. Interventions are urged to enhance quitting intentions of these vulnerable smokers.
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Affiliation(s)
- Xiaochen Yang
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Lanchao Zhang
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Hao Lin
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Haoxiang Lin
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Wangnan Cao
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Chun Chang
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
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Vuong JT, Ruedisueli I, Beaudin CS, Middlekauff HR. Electronic Cigarettes: an Overlooked Tool to Alleviate Disparities in Tobacco Use Disorder Among People with Mental Health and Substance Use Disorders. J Gen Intern Med 2023; 38:1970-1974. [PMID: 36952082 PMCID: PMC10271991 DOI: 10.1007/s11606-023-08137-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/01/2023] [Indexed: 03/24/2023]
Abstract
The remarkable decline in cigarette smoking since 1964 has plateaued; approximately 12.5% of Americans still smoke. People who continue to smoke are largely members of marginalized groups, such as people with behavioral health conditions (BHC), encompassing both mental health and substance use disorders. Certified smoking cessation interventions can increase smoking abstinence in trials in people with BHC, yet smoking rates remain markedly increased, leading to increased mortality from smoking-related diseases, and worsening health disparities. A novel approach tailored to the unique needs, characteristics, and circumstances of people with BHC is mandated. One promising approach, the electronic cigarette, has not been embraced in the USA, likely due to an understandable concern for non-smoking young people among whom electronic cigarettes have been popular. Recent data confirm that electronic cigarette use is declining among young people, yet cigarette smoking is not declining among people with BHC. We propose smoking cessation trials utilizing electronic cigarettes in people with BHC. To this goal, the UK has already begun allowing companies to submit their products for approval as medically licensed electronic cigarettes that can be prescribed as smoking cessation aids. Our proposal is timely, backed by evidence, and aims to save hundreds of thousands of American lives.
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Affiliation(s)
- Jacqueline T Vuong
- Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Isabelle Ruedisueli
- Division of Cardiology, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
- Department of Physiology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Catherine S Beaudin
- Division of Cardiology, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Holly R Middlekauff
- Division of Cardiology, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
- Department of Physiology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
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Schnoll RA, Leone FT, Quinn MH, Stevens N, Flitter A, Wileyto P, Kimberly J, Beidas RS, Hatzell J, Siegel SD, Crawford G, Hill N, Deatley T, Ziedonis D. A randomized clinical trial testing two implementation strategies to promote the treatment of tobacco dependence in community mental healthcare. Drug Alcohol Depend 2023; 247:109873. [PMID: 37084508 DOI: 10.1016/j.drugalcdep.2023.109873] [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: 03/02/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/23/2023]
Abstract
INTRODUCTION People with serious mental illness (SMI) are more likely to smoke and less likely to receive tobacco treatment. Implementation strategies may address clinician and organizational barriers to treating tobacco in mental healthcare. METHODS A cluster-randomized trial (Clinic N=13, Client N=610, Staff N=222) tested two models to promote tobacco treatment in community mental healthcare: standard didactic training vs. Addressing Tobacco Through Organizational Change (ATTOC), an organizational model that provides clinician and leadership training and addresses system barriers to tobacco treatment. Primary outcomes were changes in tobacco treatment from clients, staff, and medical records. Secondary outcomes were changes in smoking, mental health, and quality of life (QOL), and staff skills and barriers to treat tobacco. RESULTS Clients at ATTOC sites reported a significant increase in receiving tobacco treatment from clinician at weeks 12 and 24 (ps<0.05) and tobacco treatments and policies from clinics at weeks 12, 24, 36, and 52 (ps<0.05), vs. standard sites. ATTOC staff reported a significant increase in skills to treat tobacco at week 36 (p=0.05), vs. standard sites. For both models, tobacco use medications, from clients (week 52) and medical records (week 36), increased (ps<0.05), while perceived barriers decreased at weeks 24 and 52 (ps<0.05); 4.3% of clients quit smoking which was not associated with model. QOL and mental health improved over 24 weeks for both models (ps<0.05). CONCLUSIONS Standard training and ATTOC improve use of evidence-based tobacco treatments in community mental healthcare without worsening mental health, but ATTOC may more effectively address this practice gap.
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Affiliation(s)
- Robert A Schnoll
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, United States.
| | - Frank T Leone
- Pulmonary, Allergy, & Critical Care Division, University of Pennsylvania, United States
| | - Mackenzie Hosie Quinn
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Nathaniel Stevens
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Alex Flitter
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Paul Wileyto
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - John Kimberly
- The Wharton School of Business, University of Pennsylvania, United States
| | - Rinad S Beidas
- Perelman School of Medicine, University of Pennsylvania, United States; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, United States
| | - Jane Hatzell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Scott D Siegel
- Institute for Research on Equity & Community Health (iREACH) and Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System,United States
| | - Grace Crawford
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Naja Hill
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Teresa Deatley
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
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Steinberg ML, Rosen RL, Ganz O, Wackowski OA, Jeong M, Delnevo CD. Communicating the benefits of quitting smoking on mental health increases motivation to quit in people with anxiety and/or depression: A randomized trial of two health messages. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.17.23286103. [PMID: 36865337 PMCID: PMC9980264 DOI: 10.1101/2023.02.17.23286103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Background Although smoking rates have declined over time, this decline has not been observed among those with mental health concerns. It is therefore important to develop effective messaging to support quitting in this population. Methods We conducted an online experiment with 419 adults who smoke cigarettes daily. Participants with, or without a lifetime history of anxiety and/or depression were randomized to view a message focused on the benefits of quitting smoking on mental or physical health. Participants then reported motivation to quit smoking, mental health concerns about quitting, and perceived effectiveness of the message. Results Participants with a lifetime history of anxiety and/or depression who saw the message focused on the benefits of quitting smoking on mental health reported greater motivation to quit than when they saw a message focused on the benefits to physical health. This was not replicated when examining current symptoms instead of lifetime history. Pre-existing beliefs that smoking improves one's mood were greater in those experiencing current symptoms and in those with a lifetime history of anxiety and/or depression. There was no main or interaction (message type X mental health status) effect of message type received on mental health related concerns about quitting. Conclusions This study is one of the first to evaluate a smoking cessation message with content specifically targeted to those with mental health concerns about quitting smoking. Additional work is needed to determine how to best target those with mental health concerns with messages focused on the benefits of quitting on mental health. Implications These data can begin to inform regulatory efforts to address tobacco use in those with comorbid anxiety and/or depression by providing information on how to effectively communicate the benefits of quitting smoking on mental health.
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Affiliation(s)
- Marc L. Steinberg
- Rutgers Robert Wood Johnson Medical School
- Rutgers Center for Tobacco Studies
| | - Rachel L. Rosen
- Rutgers, The State University of New Jersey
- Rutgers Center for Tobacco Studies
| | - Ollie Ganz
- Rutgers School of Public Health
- Rutgers Center for Tobacco Studies
| | | | - Michelle Jeong
- Rutgers School of Public Health
- Rutgers Center for Tobacco Studies
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Creedon TB, Wayne GF, Progovac AM, Levy DE, Cook BL. Trends in cigarette use and health insurance coverage among US adults with mental health and substance use disorders. Addiction 2023; 118:353-364. [PMID: 36385708 DOI: 10.1111/add.16052] [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: 10/28/2021] [Accepted: 09/10/2022] [Indexed: 11/18/2022]
Abstract
AIMS To estimate recent trends in cigarette use and health insurance coverage for United States adults with and without mental health and substance use disorders (MH/SUD). DESIGN Event study analysis of smoking and insurance coverage trends among US adults with and without MH/SUD using 2008-19 public use data from the National Survey on Drug Use and Health, an annual, cross-sectional survey. SETTING USA. PARTICIPANTS A nationally representative sample of non-institutionalized respondents aged 18-64 years (n = 448 762). MEASUREMENTS Outcome variables were three measures of recent cigarette use and one measure of past-year health insurance coverage. We compared outcomes between people with and without MH/SUD (MH disorder: past-year mental illness, predicted from Kessler-6 and the World Health Organization-Disability Assessment Schedule impairment scale; SUD: met survey-based DSM-IV criteria for past-year alcohol, cannabis, cocaine or heroin use disorder) and over time. FINDINGS Comparing pooled data from 2008 to 2009 and from 2018 to 2019, current smoking rates of adults with MH/SUD decreased from 37.9 to 27.9% while current smoking rates of adults without MH/SUD decreased from 21.4 to 16.3%, a significant difference in decrease of 4.9 percentage points (pts) [95% confidence interval (CI) = 3.3-6.6 pts]. Daily smoking followed similar patterns (difference in decrease of 3.9 pts (95% CI = 2.3-5.4 pts). Recent smoking abstinence rates for adults with MH/SUD increased from 7.4 to 10.9%, while recent smoking abstinence rates for adults without MH/SUD increased from 9.6 to 12.0%, a difference in increase of 1.0 pts (95% CI = -3.0 to 0.9 pts). In 2018-19, 11% of net reductions in current smoking, 12% of net reductions in daily smoking and 12% of net increases in recent smoking abstinence coincided with greater gains in insurance coverage for adults with MH/SUD compared to those without MH/SUD. CONCLUSIONS Improvements in smoking and abstinence outcomes for US adults with mental health and substance use disorders appear to be associated with increases in health insurance coverage.
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Affiliation(s)
- Timothy B Creedon
- Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services, Washington, DC, USA
| | | | - Ana M Progovac
- Health Equity Research Laboratory, Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Douglas E Levy
- Mongan Institute, Health Policy Research Center, Massachusetts General Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Benjamin Lê Cook
- Health Equity Research Laboratory, Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Zhang X, Ren H, Gao L, Shia BC, Chen MC, Ye L, Wang R, Qin L. Identifying the predictors of severe psychological distress by auto-machine learning methods. INFORMATICS IN MEDICINE UNLOCKED 2023; 39:101258. [PMID: 37152204 PMCID: PMC10141788 DOI: 10.1016/j.imu.2023.101258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 05/09/2023] Open
Abstract
Social stress in daily life and the COVID-19 pandemic have greatly impacted the mental health of the population. Early detection of a predisposition to severe psychological distress is essential for timely interventions. This paper analyzed 4036 samples participating in the 2019-2020 National Health Information Trends Survey (HINTS) and identified 57 candidate predictors of severe psychological distress based on univariate chi-square and t-test analyses. Five machine learning methods, namely logistic regression (LR), automatic generalized linear models (Auto-GLM), automatic random forests (Auto-Random Forests), automatic deep neural networks (Auto-Deep learning) and automatic gradient boosting machines (Auto-GBM), were employed to model synthetic minority oversampling technique-based (SMOTE) resampled data and identify predictors of severe psychological distress. Predictors were evaluated by odds ratios in logistic models and variable importance in the other models. Forty-seven variables were identified as significant predictors of severe psychological distress, including 13 sociodemographic variables and 34 variables related to individual lifestyle and behavioral habits. Among them, new potentially relevant variables related to an individual's level of concern and trust in cancer information, exposure to health care providers, and cancer screening and awareness are included. The performance of each model was evaluated using five-fold cross-validation. The optimal model performance-wise was Auto-GBM with an accuracy of 89.75%, a precision of 89.68%, a recall of 89.31%, an F1-score of 89.48% and an AUC of 95.57%. Significant predictors of severe psychological distress were identified in this study and the value of machine learning methods in predicting severe psychological distress is demonstrated, thereby enhancing pre-prediction and clinical decision-making of severe psychological distress problems.
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Affiliation(s)
- Xiaomei Zhang
- School of Statistics, University of International Business and Economics, Beijing, China
| | - Haoying Ren
- School of Statistics, University of International Business and Economics, Beijing, China
| | - Lei Gao
- School of Law, University of International Business and Economics, Beijing, China
| | - Ben-Chang Shia
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Ming-Chih Chen
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Linglong Ye
- School of Public Affairs, Xiamen University, Xiamen, China
| | - Ruojia Wang
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Lei Qin
- School of Statistics, University of International Business and Economics, Beijing, China
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, China
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Xi Q, Meza R, Leventhal A, Tam J. Modeling cigarette smoking disparities between people with and without serious psychological distress in the US, 1997-2100. Prev Med 2023; 166:107385. [PMID: 36495925 PMCID: PMC9994605 DOI: 10.1016/j.ypmed.2022.107385] [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: 07/01/2022] [Revised: 12/02/2022] [Accepted: 12/04/2022] [Indexed: 12/12/2022]
Abstract
Cigarette smoking rates are significantly higher among people with serious psychological distress (SPD) compared to the general population. US simulation models that project future smoking disparities by SPD status could inform policy interventions, but have not been developed. We calibrated two compartmental models to the National Health Interview Survey 1997-2018 for populations with and without SPD, calculating smoking prevalence, mortality, and life-years lost by SPD status under different scenarios from 2023 to 2100. Under the Status Quo, smoking prevalence among women with SPD falls from 27.0% in 2023 to 10.7% in 2100 (men: 30.1% to 12.2%). For women without SPD, it declines from 9.4% to 3.1% (men: 11.5% to 4.0%). The absolute difference in smoking prevalence between those with and without SPD decreases over time, whereas the relative smoking prevalence ratio increases. From 2023 to 2100, 609,000 premature smoking-attributable deaths would occur in the SPD population, with 8 million life-years lost. Under an ideal tobacco control scenario for people with SPD, in which all smokers quit in 2023 and no new smoking initiation occurs thereafter, up to 386,000 of these premature deaths could be averted with 4.9 million life-years gained. Preventing smoking initiation could avert up to 18% of these deaths, while improving smoking cessation could avert up to 82%. Smoking-related disparities for people with SPD will persist unless a shift in tobacco control substantially improves cessation and prevents initiation in this subpopulation. Smoking disparities by SPD may widen in relative but narrow in absolute terms, so both perspectives should be evaluated.
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Affiliation(s)
- Qin Xi
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; Yale School of Public Health, 60 College St., New Haven, CT 06520, United States of America.
| | - Rafael Meza
- BC Cancer Research Institute, 675 West 10th Avenue, Vancouver, BC V5Z 1L3, Canada.
| | - Adam Leventhal
- University of Southern California, School of Medicine, Soto Street Health Sciences Campus, Los Angeles, CA 90033, United States of America.
| | - Jamie Tam
- Yale School of Public Health, 60 College St., New Haven, CT 06520, United States of America.
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12
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Cigarette, electronic cigarette, and marijuana use among young adults under policy changes in California. Addict Behav Rep 2022; 16:100459. [PMID: 36176360 PMCID: PMC9513090 DOI: 10.1016/j.abrep.2022.100459] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 09/15/2022] [Accepted: 09/18/2022] [Indexed: 10/25/2022] Open
Abstract
Introduction Since 2016, California has implemented a series of policies, including prohibiting the sale of tobacco products and electronic cigarettes (e-cigarettes) to persons under 21, cigarette tax increase, and recreational marijuana legalization. The study aims to examine the use of cigarettes, e-cigarettes, and marijuana among young adults (ages 18-25) and their associations with other factors in the context of these policy changes. Methods We used the data from the California Health Interview Survey (CHIS) 2017-2018 to compare the rates of using cigarettes, e-cigarettes, and marijuana separately or any use of the three. Using CHIS 2018 data, weighted logistic regression models were used to examine associations of using cigarettes, e-cigarettes, and marijuana separately or any use of these products/substance with demo-socioeconomic factors, psychological distress, and use of each product/substances. Results Cigarette smoking remained flat while the use of e-cigarettes and marijuana escalated among young adults from 2017 to 2018. Using tobacco products increased the use of marijuana or vice versa among young adults. Severe psychological distress was significantly associated with cigarette use (adjusted odds ratio [AOR] = 4.06; 95% CI = 1.32, 12.55), marijuana use (AOR = 2.32; 95% CI = 1.10, 4.48), and any use (AOR = 4.11; 95% CI = 1.93, 8.77). Moderate psychological distress was also significantly associated with the use of these products/substance. Underage (ages 18-20) young adults had lower odds of using cigarettes than other young adults (ages 21-25). Conclusions Our findings highlight the importance of addressing the use of cigarettes, e-cigarettes, and marijuana simultaneously through policies to curtail tobacco and marijuana use among young adults.
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13
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Steinberg ML, Rosen RL, Billingsley B, Shah D, Bender M, Shargo K, Aamir A, Bridgeman MB. Tobacco/nicotine use among individuals using cannabis for therapeutic purposes. Am J Addict 2022; 31:486-493. [PMID: 35962766 DOI: 10.1111/ajad.13323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/13/2022] [Accepted: 07/31/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND OBJECTIVES While the relationship between recreational cannabis and nicotine use is well established, little is known about nicotine use among users of cannabis for therapeutic purposes (CTP). METHODS Patients attending a medical marijuana dispensary (N = 697; 75.3% White; 60.0% male) completed a survey examining nicotine use, motivation to quit cigarette smoking, routes of administration of nicotine and cannabis, and CTP qualifying conditions. RESULTS More than one-third (39.3%) of participants reported current nicotine use. Compared to exclusive cigarette smokers, e-cigarette users and non-users of nicotine were approximately four times more likely to vape, rather than to smoke, cannabis. Furthermore, 46.8% of cigarette smokers reported plans to quit smoking in the next 6 months (but not in the next month) and an additional 31.6% planned to quit in the next month. Having a psychiatric condition was associated with nicotine use and higher motivation to quit smoking. DISCUSSION AND CONCLUSIONS Users of CTP are more likely to use nicotine products than the general population and the route of administration of nicotine products is related to the route of administration of CTP. If aerosolized CTP is a less harmful route of administration than smoked CTP, dispensary staff should be aware of this relationship and take this into account when recommending a noncombustible route. SCIENTIFIC SIGNIFICANCE This study further characterizes nicotine use behaviors and motivation to quit smoking among users of CTP and may be among the first to examine nicotine use among patients of a medical marijuana dispensary.
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Affiliation(s)
- Marc L Steinberg
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Rachel L Rosen
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Benjamin Billingsley
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Drashya Shah
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Michele Bender
- Rutgers, Ernest Mario School of Pharmacy, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Kyra Shargo
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Affan Aamir
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Mary Barna Bridgeman
- Rutgers, Ernest Mario School of Pharmacy, The State University of New Jersey, Piscataway, New Jersey, USA
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14
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Goodwin RD, Shevorykin A, Carl E, Budney AJ, Rivard C, Wu M, McClure EA, Hyland A, Sheffer CE. Daily Cannabis Use Is a Barrier to Tobacco Cessation Among Tobacco Quitline Callers at 7-Month Follow-up. Nicotine Tob Res 2022; 24:1684-1688. [PMID: 35417562 PMCID: PMC9759104 DOI: 10.1093/ntr/ntac096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/08/2022] [Accepted: 04/07/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Cannabis use is increasing among cigarette smokers in the United States. Prior studies suggest that cannabis use may be a barrier to smoking cessation. Yet, the extent to which this is the case among adults seeking to quit tobacco use remains unclear. Tobacco quitlines are the most common provider of no-cost treatment for adults who use smoke in the United States. This study investigated the association between cannabis use and smoking cessation outcomes among quitline callers. AIMS AND METHODS Participants included callers to the New York State Smokers' Quitline, who were seeking to quit smoking cigarettes and were contacted for outcome assessment 7 months after intake. Thirty-day point prevalence abstinence rates were calculated and compared among cannabis use groups, based on frequency of past-30-day cannabis use at baseline (none: 0 days, occasional: 1-9 days, regular: 10-19 days, and daily: 20-30 days). RESULTS Approximately 8.3% (n = 283) of participants (n = 3396) reported past-30-day cannabis use at baseline. Callers with daily cannabis use (20-30 days per month) had significantly lower odds of 30-day abstinence, relative to those who did not use cannabis (odds ratio = 0.5; 95% confidence interval [0.3, 0.9]). CONCLUSIONS Daily cannabis use appears to be associated with poorer smoking cessation treatment outcomes among adults seeking to quit smoking cigarettes via a quitline. Because quitlines are among the most accessible, affordable, and frequently utilized community-based treatments available in the United States, and the prevalence of cannabis use is increasing among cigarette smokers, detailed inquiry into cannabis use might enhance cigarette smoking cessation outcomes. IMPLICATIONS Quitlines are free of cost and accessible to millions of smokers in the United States. The current study found an inverse relationship between daily cannabis use at baseline and 30-day abstinence from cigarette smoking at 7-month follow-up among New York State Smokers' Quitline callers. Findings suggest that daily cannabis use may be a barrier to smoking cessation and sustained abstinence among those seeking help to stop smoking cigarettes.
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Affiliation(s)
- Renee D Goodwin
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Alina Shevorykin
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Ellen Carl
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Alan J Budney
- Department of Psychiatry, Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Cheryl Rivard
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Melody Wu
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Erin A McClure
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
- Department of Psychiatry and Behavioral Sciences and Hollings Cancer Center, Technology Applications Center for Healthful Lifestyles (TACHL), South Carolina Center of Economic Excellence, Medical University of South Carolina (MUSC), Charleston, SC, USA
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Christine E Sheffer
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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15
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Shafie-Khorassani F, Piper ME, Jorenby DE, Baker TB, Benowitz NL, Hayes-Birchler T, Meza R, Brouwer AF. Associations of Demographics, Dependence, and Biomarkers With Transitions in Tobacco Product Use in a Cohort of Cigarette Users and Dual Users of Cigarettes and E-cigarettes. Nicotine Tob Res 2022; 25:462-469. [PMID: 36037523 PMCID: PMC9910158 DOI: 10.1093/ntr/ntac207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/09/2022] [Accepted: 08/24/2022] [Indexed: 11/14/2022]
Abstract
INTRODUCTION It is uncertain whether e-cigarettes facilitate smoking cessation in the real world. We aimed to understand whether and how transitions among cigarette, e-cigarette, and dual use are associated with sociodemographics, dependence measures, and biomarkers. AIMS AND METHODS We followed 380 adult daily cigarette users and dual users every 2 months for up to 2 years. We estimated transition rates between noncurrent, cigarette-only, e-cigarette-only, and dual use states using a multistate transition model. We estimated univariable hazard ratios (HR) for demographics, dependence measures for cigarettes and e-cigarettes, biomarkers, spousal or partner behaviors, and other measures. RESULTS We estimated that participants transitioned from cigarette-only to e-cigarette-only through a period of dual use. Dual users ceased smoking (transitioning to e-cigarette-only use) at a greater rate than cigarette-only users did (HR 2.44, 95% CI: 1.49, 4.02). However, of the 60% of dual users estimated to transition to single product use in 1 year, 83% would transition to cigarette-only use and only 17% to e-cigarette-only use. E-cigarette dependence measures were generally associated with reduced e-cigarette cessation rather than enhanced cigarette cessation. E-cigarette users motivated by harm or toxicity reduction or because of restrictions on where or when they could smoke had reduced rates of smoking relapse. Cigarette dependence and spousal smoking were barriers to cigarette cessation for dual users, while using e-cigarettes first in the morning, motivation to quit smoking, and sensory, social, and emotional enjoyment of e-cigarettes (secondary dependence motives) were facilitators of smoking cessation among dual users. CONCLUSIONS Tobacco control policy and interventions may be informed by the barriers and facilitators of product transitions. IMPLICATIONS Although e-cigarettes have the potential to promote smoking cessation, their real-world impact is uncertain. In this cohort, dual users were more likely to quit smoking than cigarette-only users, but the overall impact was small because most dual users returned to cigarette-only use. Moreover, e-cigarette dependence promoted continued dual use rather than smoking cessation. Yet, high motivation to quit smoking and the sensory, social, and emotional enjoyment of e-cigarettes facilitated smoking cessation in dual users. Better understanding the barriers and facilitators of transitions can help to develop regulations and interventions that lead to more effective use of e-cigarettes for smoking cessation.
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Affiliation(s)
| | - Megan E Piper
- Department of Medicine, University of Wisconsin, Madison, WI, USA
| | | | - Timothy B Baker
- Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Neal L Benowitz
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Andrew F Brouwer
- Corresponding Author: Andrew F. Brouwer, Department of Epidemiology, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA. Telephone: 734-764-7373; Fax: 734-764-3192; E-mail:
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16
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Nagawa CS, Wang B, Davis M, Pbert L, Cutrona SL, Lemon SC, Sadasivam RS. Examining pathways between family or peer factors and smoking cessation in a nationally representative US sample of adults with mental health conditions who smoke: a structural equation analysis. BMC Public Health 2022; 22:1566. [PMID: 35978318 PMCID: PMC9382825 DOI: 10.1186/s12889-022-13979-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Supportive family or peer behaviors positively impact smoking cessation in people with mental health problems who smoke. However, the limited understanding of the pathways through which family or peer factors impact quitting limits the development of effective support interventions. This study examined pathways through which family or peer views on tobacco use, family or peer smoking status, and rules against smoking in the home influenced quitting in adults with mental health problems who smoke. Methods We used data from the Population Assessment of Tobacco and Health Study, a national longitudinal survey. Baseline data were collected in 2015, and follow-up data in 2016. We included adults’ current smokers who had experienced two or more mental health symptoms in the past year (unweighted n = 4201). Structural equation modeling was used to test the relationships between family and peer factors, mediating factors, and smoking cessation. Results We found that having family or peers with negative views on tobacco use had a positive indirect effect on smoking cessation, mediated through the individual’s intention to quit (regression coefficient: 0.19) and the use of evidence-based approaches during their past year quit attempt (regression coefficient: 0.32). Having rules against smoking in the home (regression coefficient: 0.33) and having non-smoking family members or peers (regression coefficient: 0.11) had a positive indirect effect on smoking cessation, mediated through smoking behaviors (regression coefficient: 0.36). All paths were statistically significant (p < 0.01). The model explained 20% of the variability in smoking outcomes. Conclusion Family or peer-based cessation interventions that systematically increase intentions to quit and monitor smoking behavior may be able to assess the efficacy of family and peer support on quitting in people with mental health problems who smoke. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13979-z.
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Affiliation(s)
- Catherine S Nagawa
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.
| | - Bo Wang
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Maryann Davis
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Lori Pbert
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Sarah L Cutrona
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.,Health Services Research & Development, Center of Innovation Edith Nurse Rogers Memorial Hospital Veterans Health Administration, Bedford, USA
| | - Stephenie C Lemon
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Rajani S Sadasivam
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.,Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
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17
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Nagawa CS, Pbert L, Wang B, Cutrona SL, Davis M, Lemon SC, Sadasivam RS. Association between family or peer views towards tobacco use and past 30-day smoking cessation among adults with mental health problems. Prev Med Rep 2022; 28:101886. [PMID: 35855923 PMCID: PMC9287352 DOI: 10.1016/j.pmedr.2022.101886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/16/2022] [Accepted: 07/01/2022] [Indexed: 11/17/2022] Open
Abstract
Adults with mental health problems have a higher prevalence of cigarette smoking. Our findings suggest that neutral or positive family or peer views towards tobacco use may deter cessation efforts. Efforts to modify views family or peers are needed to improve quit rates in this population.
Adults with mental health problems have a higher prevalence of cigarette smoking. We examined the association between family or peer views towards tobacco use and past 30-day cessation among adult with mental health conditions who smoke. We used nationally representative data from the Population Assessment of Tobacco and Health Study. We included individuals who currently smoked and reported mental health symptoms over the past year (n = 4201). We used the Global Appraisal of Individual Needs Short Screener questionnaire to assess mental health conditions. Logistic regression models were used to estimate the odds ratios (OR) and 95% confidence intervals (95%CI) in the association between family and peer views towards tobacco use and past 30-day smoking cessation. Compared to participants who had family or peers with negative views towards tobacco use, those with family or peers with neutral or positive views were 32% less likely (adjusted OR: 0.68, 95%CI: 0.51 – 0.93) to report past 30-day smoking cessation. The association between family/peer views towards tobacco use and smoking cessation was statisitcally significant for individuals with symptoms on the both internalizing and externalizing sub-scales (adjusted OR: 0.62, 95%CI: 0.42 – 0.92), but not for those reporting symptoms on a single sub scale. Our findings suggest that having family members or peers who hold neutral or positive views towards tobacco use may deter cessation efforts of people with mental health conditions who smoke. Efforts to modify these views are needed to improve quit rates in people with mental health conditions who smoke.
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Affiliation(s)
- Catherine S. Nagawa
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
- Corresponding author at: University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01605, USA.
| | - Lori Pbert
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Bo Wang
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Sarah L. Cutrona
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Maryann Davis
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
- Center of Innovation, Edith Nurse Rogers Memorial Hospital Veterans Health Administration, USA
| | - Stephenie C. Lemon
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Rajani S. Sadasivam
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
- Center of Innovation, Edith Nurse Rogers Memorial Hospital Veterans Health Administration, USA
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18
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Fairman RT, Weaver SR, Nyman AL, Popova L, Massey Z, Reynolds RM, Spears CA. Disparities among smokers during the COVID-19 pandemic: Examination of COVID-19-related worries by sociodemographic factors in a U.S. Nationally representative survey. Prev Med Rep 2022; 28:101835. [PMID: 35607523 PMCID: PMC9116960 DOI: 10.1016/j.pmedr.2022.101835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/01/2022] [Accepted: 05/16/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Scott R. Weaver
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Amy L. Nyman
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Zachary Massey
- Missouri School of Journalism, University of Missouri, Columbia, MO, USA
| | - Reed M. Reynolds
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Claire A. Spears
- School of Public Health, Georgia State University, Atlanta, GA, USA
- Corresponding author.
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Weinberger AH, Wyka K, Kim JH, Smart R, Mangold M, Schanzer E, Wu M, Goodwin RD. A difference-in-difference approach to examining the impact of cannabis legalization on disparities in the use of cigarettes and cannabis in the United States, 2004-17. Addiction 2022; 117:1768-1777. [PMID: 34985165 DOI: 10.1111/add.15795] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/14/2021] [Indexed: 12/15/2022]
Abstract
AIMS To estimate the impact of recreational and medical cannabis laws (RCL, MCL) on the use of cannabis and cigarettes in the United States. DESIGN A difference-in-difference approach was applied to data from the 2004-17 National Survey on Drug Use and Health (NSDUH). SETTING United States. PARTICIPANTS Nationally representative cross-sectional survey of Americans aged 12 years and older (combined analytical sample for 2004-17, n = 783 663). MEASUREMENTS Data on past-month use of (1) cigarettes and (2) cannabis were used to classify respondents into four groups: cigarette and cannabis co-use, cigarette-only use, cannabis-only use or no cigarette or cannabis use. State of residence was measured by self-report. MCL/RCL status came from state government websites. FINDINGS Difference-in-difference analyses suggest that MCL was associated with an increase in cigarette-cannabis co-use overall [adjusted odds ratio (aOR) = 1.09; 95% confidence interval (CI) = 1.02-1.16], with the greatest increases among those aged 50 years and above (aOR = 1.60; CI = 1.39-1.84), married (aOR = 1.19; CI = 1.07-1.31), non-Hispanic (NH) black (aOR = 1.14; CI = 1.02-1.07) and with a college degree or above (aOR = 1.15; CI = 1.06-1.24). MCL was associated with increases in cigarette-only use among those aged 50 years and above (aOR = 1.07; CI = 1.01-1.14) and NH black (aOR = 1.16; CI = 1.06-1.27) and increases in cannabis-only use among those aged 50 years and above (aOR = 1.24; CI = 1.07-1.44) and widowed/divorced/separated (aOR = 1.18; CI = 1.01-1.37). RCL was associated with an increase in cannabis-only use overall (aOR = 1.21; 95% CI = 1.09-1.34), a decline in cigarette-only use overall (aOR = 0.89; 95% CI = 0.81-0.97) and increases in co-use among those who were married (aOR = 1.24; CI = 1.02-1.50) and aged 50 years and above (aOR = 1.37; CI = 1.03-1.84). CONCLUSIONS Recreational and medical cannabis legalization have had a varying impact on the use, and co-use, of cannabis and cigarettes in the United States.
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Affiliation(s)
- Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.,Department of Epidemiology and Population Health, Yeshiva University Albert Einstein College of Medicine, Bronx, NY, USA
| | - Katarzyna Wyka
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA
| | - June H Kim
- Institute for Implementation Science in Population Health, The City University of New York, New York, NY, USA
| | | | - Michael Mangold
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Ellen Schanzer
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Melody Wu
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Renee D Goodwin
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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20
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Validity of the DSM-5 tobacco use disorder diagnostics in adults with problematic substance use. Drug Alcohol Depend 2022; 234:109411. [PMID: 35338898 PMCID: PMC9035622 DOI: 10.1016/j.drugalcdep.2022.109411] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND DSM-5 tobacco use disorder (TUD) nosology differs from DSM-IV nicotine dependence (ND) by including craving and DSM-IV abuse criteria, a lower threshold (≥ 2 criteria), and severity levels (mild; moderate; severe). We assessed concurrent and prospective validity of the DSM-5 TUD diagnosis and severity and compared validity with DSM-IV ND diagnosis. METHODS The sample included U.S. adults with current problematic substance use and past year cigarette smoking (N = 396). Baseline assessment collected information on DSM-IV ND and DSM-5 TUD criteria, smoking-related variables, and psychopathology. Over the following 90 days, electronic daily assessments queried smoking and cigarette craving. Variables expected to be related to TUD were validators: cigarette consumption, cigarette craving scale, Fagerström Test for Nicotine Dependence, and psychiatric disorders. Regression models estimated the association of each validator with DSM-5 TUD and severity levels, and differential association between DSM-5 TUD and DSM-IV ND diagnoses. RESULTS DSM-5 TUD and DSM-IV ND were associated with most baseline validators (p-values < 0.05), with significantly stronger associations with DSM-5 TUD for number of days smoked (p = 0.023) and cigarette craving scale (p = 0.007). Baseline DSM-5 TUD and DSM-IV ND predicted smoking and craving on any given day during follow-up, with stronger associations for DSM-5 TUD (association difference [95% CI%]: any smoking, 0.53 [0.27, 0.77]; number of cigarettes smoked, 1.36 [0.89, 1.78]; craving scale, 0.19 [0.09, 0.28]). Validators were associated with TUD severity in a dose-dependent manner. CONCLUSION DSM-5 TUD diagnostic measures as operationalized here demonstrated concurrent and prospective validity. Inclusion of new criteria, particularly craving, improved validity and clinical relevance.
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Perman-Howe PR, Horton M, Robson D, McDermott MS, McNeill A, Brose LS. Harm perceptions of nicotine-containing products and associated sources of information in UK adults with and without mental ill health: A cross-sectional survey. Addiction 2022; 117:715-729. [PMID: 34338387 DOI: 10.1111/add.15657] [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: 12/30/2020] [Accepted: 07/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS People with mental ill health are more likely to smoke and experience smoking-related harm than those without. Switching from combustible tobacco to lower-risk nicotine-containing products may be of benefit; however, misperceptions of harm may prevent their use. We aimed to assess, among adults with and without mental ill health, (1) perceptions of harm from nicotine and relative harm and addictiveness of different nicotine-containing products and (2) sources of information associated with harm perceptions. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS On-line survey of adults (n = 3400) who smoke cigarettes and/or use e-cigarettes, or have recently stopped, in the United Kingdom. MEASUREMENTS Outcomes: harm perceptions of nicotine; relative perceived harm and addictiveness of different nicotine-containing products; sources of information for harm perceptions of nicotine, cigarette smoking and e-cigarettes. Demographics: sex, age, education, ethnic group and region. Other measures: self-reported smoking, vaping and mental health status. ANALYSES frequencies and logistic regressions adjusting for demographic/other measures. FINDINGS Among those with serious mental distress (versus no/low mental distress): 9.6% [13.9%, adjusted odds ratio (aOR) = 0.69, 95% confidence interval (CI) = 0.50-0.97] correctly identified that none/a very small amount of the health risks of smoking cigarettes come from nicotine; 41.7% (53.5%, aOR = 0.67, 95% CI = 0.54-0.84) perceived e-cigarettes and 53.2% (70.3%, aOR = 0.62, 95% CI = 0.50-0.77) perceived nicotine replacement therapy to be less harmful than cigarettes; and 42.1% (51.3%, aOR = 0.77, 95% CI = 0.62-0.95) perceived e-cigarettes as being less likely than cigarettes to cause cancer, 35.4% (45.5%, aOR = 0.71, 95% CI = 0.57-0.88) heart attacks and 34.9% (42.3%, aOR = 0.80, 95% CI = 0.64-0.99) lung problems. The most popular sources of information for cigarette smoking, e-cigarettes and nicotine were scientific experts' opinions and media reports, with little variation by mental distress. CONCLUSIONS Among adults with a history of tobacco and/or e-cigarette use, those with serious mental distress appear to have less accurate harm perceptions of nicotine and nicotine-containing products than those with no/low distress, despite reporting similar sources of information.
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Affiliation(s)
- Parvati R Perman-Howe
- King's College London, Addiction Sciences Building, London, UK
- SPECTRUM Consortium, UK
| | - Marie Horton
- Public Health UK, South Bank, London, UK
- SPECTRUM Consortium, UK
| | - Deborah Robson
- King's College London, Addiction Sciences Building, London, UK
- SPECTRUM Consortium, UK
| | | | - Ann McNeill
- King's College London, Addiction Sciences Building, London, UK
- SPECTRUM Consortium, UK
| | - Leonie S Brose
- King's College London, Addiction Sciences Building, London, UK
- SPECTRUM Consortium, UK
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22
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Internalizing problems are associated with initiation and past 30-Day use of flavored tobacco products. Addict Behav 2022; 125:107162. [PMID: 34763300 PMCID: PMC8637941 DOI: 10.1016/j.addbeh.2021.107162] [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: 03/18/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Tobacco use remains disproportionately common among adults with internalizing problems. The rising prevalence of flavored tobacco use among this population may be a contributing factor. Using data from Wave 4 of the Population Assessment of Tobacco and Health Study, this study examined differences across adult ever tobacco users by severity of internalizing problems, in initiation of tobacco use with a flavored product and past 30-day (current) flavored tobacco use (n = 27,425). Severity of internalizing problems was measured using the Global Appraisal of Individual Needs-Short Screener Internalizing Disorder Screener. Tobacco use variables included initiation with or current use of a flavored product, assessed separately for each product. Weighted chi-square tests and multivariable modified Poisson regression models were used to examine the associations between severity of internalizing problems and each outcome. RESULTS Controlling for covariates, ever users with severe internalizing problems were more likely to have initiated with flavors for cigarettes (adjusted prevalence ratio [aPR]: 1.16, 95% confidence interval [CI]: 1.09,1.24), cigarillos (aPR: 1.09, 95% CI: 1.03, 1.16), electronic nicotine products (aPR: 1.08, 95% CI: 1.03, 1.13) and smokeless tobacco (aPR: 1.15, 95% CI: 1.04, 1.27), relative to those with low internalizing problems. Ever users with severe internalizing problems were more likely to currently use a flavored tobacco product for cigarettes (aPR: 1.15, 95% CI: 1.07, 1.24) and cigarillos (aPR: 1.15, 95% CI: 1.04, 1.28). CONCLUSIONS Flavored tobacco use seems disproportionately common among tobacco users with severe internalizing problems, across a variety of measures.
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23
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Sanford BT, Toll BA, Palmer AM, Foster MG, Cummings KM, Stansell S, Rojewski AM. Tobacco Treatment Outcomes for Hospital Patients With and Without Mental Health Diagnoses. Front Psychiatry 2022; 13:853001. [PMID: 35722554 PMCID: PMC9199856 DOI: 10.3389/fpsyt.2022.853001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The prevalence of mental health conditions is higher in cigarette smokers than nonsmokers. However, those with diagnosed mental health disorders are understudied within general inpatient hospital settings. This study seeks to evaluate how having a mental health diagnosis influences response to a brief opt-out inpatient tobacco treatment intervention. METHODS Data included 4,153 admitted patients who completed a tobacco treatment visit. Post-discharge self-reported abstinence was obtained via response to an automated call 1-month after discharge. Mental health co-morbidities were assessed by reviewing electronic medical records. Logistic regression was used to assess associations between having a mental health diagnosis and patients' smoking history, interest in quitting smoking, and post-discharge abstinence. RESULTS Overall 34.1% of patients were diagnosed with mental health disorders, most commonly depression or substance use disorders. Patients with a diagnosed mental health disorder were more likely to report a history of long-term heavy smoking and were less likely to express an interesting in remaining abstinent from smoking after hospitalization. An intent-to-treat analysis using logistic regression analysis found lower rates of self-reported smoking abstinence in those with a mental health disorder compared to those without (9 vs. 13.2%, p < 0.001). CONCLUSIONS Patients with a history of mental health diagnoses, such as depression or substance use disorders, was associated with lower rates of smoking abstinence in patients after hospitalization. Hospital based opt-out smoking cessation programs have shown to be generally effective and efficient. However, certain subpopulations may require tailored intervention in order to improve treatment outcomes. Future research is needed to develop brief, effective tobacco treatment for hospital patients with comorbid mental health diagnoses.
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Affiliation(s)
- Brandon T Sanford
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Benjamin A Toll
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Amanda M Palmer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Madeline G Foster
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - K Michael Cummings
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Stephanie Stansell
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Alana M Rojewski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
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24
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Parikh NS, Parasram M, White H, Merkler AE, Navi BB, Kamel H. Smoking Cessation in Stroke Survivors in the United States: A Nationwide Analysis. Stroke 2021; 53:1285-1291. [PMID: 34784739 DOI: 10.1161/strokeaha.121.036941] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Continued smoking after stroke is associated with a high risk of stroke recurrence and other cardiovascular disease. We sought to comprehensively understand the epidemiology of smoking cessation in stroke survivors in the United States. Furthermore, we compared smoking cessation in stroke and cancer survivors because cancer is another smoking-related condition in which smoking cessation is prioritized. METHODS We performed a cross-sectional analysis of data from the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System, an annual, nationally representative health survey. Using pooled data from 2013 to 2019, we identified stroke and cancer survivors with a history of smoking. We used survey procedures to estimate frequencies and summarize quit ratios with attention to demographic and geographic (state-wise and rural-urban) factors for stroke survivors. The quit ratio is conventionally defined as the proportion of ever smokers who have quit. Then, we used multivariable logistic regression to compare quit ratios in stroke and cancer survivors while adjusting for demographics and smoking-related comorbidities. RESULTS Among 4 434 604 Americans with a history of stroke and smoking, the median age was 68 years (interquartile range, 59-76), and 45.4% were women. The overall quit ratio was 60.8% (95% CI, 60.1%-61.6%). Quit ratios varied by age group, sex, race and ethnicity, and several geographic factors. There was marked geographic variation in quit ratios, ranging from 48.3% in Kentucky to 71.5% in California. Furthermore, compared with cancer survivors, stroke survivors were less likely to have quit smoking (odds ratio, 0.72 [95% CI, 0.67-0.79]) after accounting for differences in demographics and smoking-related comorbidities. CONCLUSIONS There were considerable demographic and geographic disparities in smoking quit ratios in stroke survivors, who were less likely to have quit smoking than cancer survivors. A targeted initiative is needed to improve smoking cessation for stroke survivors.
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Affiliation(s)
- Neal S Parikh
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Melvin Parasram
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Halina White
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Alexander E Merkler
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Babak B Navi
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY
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25
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Parker MA, Cordoba-Grueso WS, Streck JM, Goodwin RD, Weinberger AH. Intersectionality of serious psychological distress, cigarette smoking, and substance use disorders in the United States: 2008-2018. Drug Alcohol Depend 2021; 228:109095. [PMID: 34601273 PMCID: PMC8595675 DOI: 10.1016/j.drugalcdep.2021.109095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/13/2021] [Accepted: 08/03/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Serious psychological distress (SPD) is common among adults who smoke cigarettes and among adults with substance use disorders (SUD). It is unknown whether the burden of SPD is even greater among individuals with both cigarette smoking and SUDs. This study examined the intersectionality of SPD, cigarette smoking, and SUD over time. METHODS Data came from annual, cross-sectional, nationally representative samples of the United States (US) National Survey on Drug Use and Health (individuals age 12+). Past-month SPD prevalences were estimated each year from 2008 to 2018 for adults age 18+ with current daily, current non-daily, former, and never cigarette smoking by SUD status (combined n = 441,286). Logistic regression models examined linear time trends of SPD. RESULTS In 2018, SPD was significantly more prevalent among adults in each smoking group with SUD versus those without SUD (daily 29.1% vs. 9.0%, non-daily 23.2% vs. 8.6%, former 19.5% vs. 3.2%, never 16.4% vs. 4.3%). After adjusting for sociodemographics, SPD prevalence increased over time across smoking statuses with a larger change for persons with SUD (AOR=1.07; 95% CI: 1.06, 1.09) vs. no SUD (AOR=1.03; 95% CI: 1.02. 1.04). CONCLUSIONS SPD was more than twice as common among adults with SUD who smoke cigarettes compared to those without SUD who do not smoke cigarettes, with the highest prevalence among adults with both SUD and daily smoking. While SPD has increased over time, differences depended on SUD status beyond the effect of cigarette smoking. These results provide further evidence for treating smoking and mental health problems together.
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Affiliation(s)
- Maria A. Parker
- Indiana University School of Public Health, Department of Epidemiology & Biostatistics, Bloomington, IN, USA
| | - Whitney S. Cordoba-Grueso
- Indiana University School of Public Health, Department of Epidemiology & Biostatistics, Bloomington, IN, USA
| | - Joanna M. Streck
- Tobacco Research and Treatment Center, Division of General Internal Medicine Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA,Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Renee D. Goodwin
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York School of Public Health, New York, NY, USA,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Andrea H. Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA,Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
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26
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Kertes J, Stein Reisner O, Grunhaus L, Nezry R, Alcalay T, Azuri J, Neumark Y. Comparison of smoking cessation program registration, participation, smoking cessation medication utilization and abstinence rates between smokers with and without schizophrenia, schizo-affective disorder or bipolar disorder. Nicotine Tob Res 2021; 24:670-678. [PMID: 34626108 DOI: 10.1093/ntr/ntab202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 10/07/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION People with serious mental illness (SMI) are three times more likely to smoke and be heavy smokers than smokers without SMI. Counseling combined with smoking cessation medication (SCM) is the recommended treatment. However until 2017, SCM prescription for SMI smokers was discouraged (FDA black box warning). This study compared use of smoking cessation programs (SCP) and SCM between smokers with and without SMI. METHODS Data regarding SCP and SCM use were extracted from the database of a large HMO that offers free Group and telephone SCP. SCP registration, participation, completion and abstinence rates between July 2013 and December 2019 were compared between smokers with and without SMI, controlling for demographic and health variables. RESULTS 48,000 smokers registered for a SCP during the study period. Smokers with SMI were 1.8 times more likely to register for a SCP than smokers without SMI. Smokers without SMI were, however, 1.2 times more likely to start the SCP, 1.5 times more likely to complete the SCP and 1.6 times more likely to have quit by the end of the program. The strongest factors predicting abstinence were SCP completion and SCM use. Smokers with SMI were less likely to purchase SCM, although their purchase rate increased after the black box warning was lifted. CONCLUSIONS Smoking cessation programs and SCM use should be encouraged in the SMI population. Providing support during the quit attempt and adapting SCP to the needs of smokers with SMI, combined with SCM prescription promotion, should improve abstinence. IMPLICATIONS Smokers with serious mental illness (SMI) were more likely to seek professional help to quit smoking than non-SMI smokers, with over 30% achieving abstinence, discrediting healthcare professional beliefs that SMI smokers don't want to and cannot quit. Smoking cessation program (SCP) completion and smoking cessation medication (SCM) utilization were the strongest predictors of abstinence. SMI smokers were more likely to drop out of SCPs and less likely to use SCMs. Providing support during the quit attempt and adapting SCPs to the needs of smokers with SMI, combined with SCM prescription promotion, should improve abstinence.
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Affiliation(s)
- Jennifer Kertes
- Dept Health Evaluation & Research, Maccabi HealthCare, Hamered 27, Tel Aviv, Israel
| | - Orit Stein Reisner
- Mental Health Services, Maccabi HealthCare Services, Hamered 27, Tel Aviv, Israel
| | | | - Ronit Nezry
- Telephone Quitline Services, Maccabi HealthCare Services, Hamered 27, Tel Aviv, Israel
| | - Tamar Alcalay
- Dept Health Promotion, Maccabi HealthCare Services, Hamered 27, Tel Aviv, Israel
| | - Joseph Azuri
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv Israel, and Maccabi Healthcare Services, Central District
| | - Yehuda Neumark
- Hebrew University-Hadassah Braun School of Public Health & Community Medicine, Jerusalem, Israel
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27
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Kock L, Brown J, Shahab L, Moore G, Horton M, Brose L. Smoking, distress and COVID-19 in England: Cross-sectional population surveys from 2016 to 2020. Prev Med Rep 2021; 23:101420. [PMID: 34150478 PMCID: PMC8193154 DOI: 10.1016/j.pmedr.2021.101420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 05/10/2021] [Accepted: 05/25/2021] [Indexed: 10/29/2022] Open
Abstract
Changes in the prevalence of psychological distress among smokers during the COVID-19 pandemic in England may exacerbate existing health inequalities. This study examined the prevalence of psychological distress among smokers following the onset of the pandemic compared with previous years. Cross-sectional data came from a representative survey of smokers (18+) in England (n = 2,927) between April-July in 2016, 2017 and 2020. Logistic regressions estimated the associations between past-month distress across 2016/2017 and 2020, and age. Weighted proportions, chi-squared statistics and stratified logistic regression models were used to compare the distributions of moderate and severe distress, respectively, within socio-demographic and smoking characteristics in 2016/2017 and 2020. Between the combined April-July 2016 and 2017 sample and April-July 2020 the prevalence of moderate and severe distress among past-year smokers increased (2016/2017: moderate 20.66%, 19.02-22.43; severe 8.23%, 7.16-9.47; 2020: moderate 28.79%, 95%CI 26.11-31.60; OR = 2.08, 95%CI 1.34-3.25; severe 11.04%, 9.30-13.12; OR = 2.16, 1.13-4.07). While there was no overall evidence of an interaction between time period and age, young (16-24 years) and middle-age groups (45-54 years) may have experienced greater increases in moderate distress and older age groups (65+ years) increases in severe distress. There were increases of moderate distress among more disadvantaged social grades and both moderate and severe distress among women and those with low cigarette addiction. Between April-July 2016/2017 and April-July 2020 in England there were increases in both moderate and severe distress among smokers. The distribution of distress among smokers differed between 2016/2017 and 2020 and represents a widening of inequalities.
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Affiliation(s)
- Loren Kock
- Department of Behavioural Science and Health, University College London, WC1E 7HB, United Kingdom
- SPECTRUM Research Consortium, Edinburgh, United Kingdom
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, WC1E 7HB, United Kingdom
- SPECTRUM Research Consortium, Edinburgh, United Kingdom
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, WC1E 7HB, United Kingdom
- SPECTRUM Research Consortium, Edinburgh, United Kingdom
| | - Graham Moore
- SPECTRUM Research Consortium, Edinburgh, United Kingdom
- DECIPHer, School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Marie Horton
- SPECTRUM Research Consortium, Edinburgh, United Kingdom
- Population Health Analysis Team, Public Health England, United Kingdom
| | - Leonie Brose
- SPECTRUM Research Consortium, Edinburgh, United Kingdom
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
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28
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Brown RA, Minami H, Hecht J, Kahler CW, Price LH, Kjome KL, Bloom EL, Levy DE, Carpenter KM, Smith A, Smits JAJ, Rigotti NA. Sustained Care Smoking Cessation Intervention for Individuals Hospitalized for Psychiatric Disorders: The Helping HAND 3 Randomized Clinical Trial. JAMA Psychiatry 2021; 78:839-847. [PMID: 33950156 PMCID: PMC8100915 DOI: 10.1001/jamapsychiatry.2021.0707] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
IMPORTANCE Smoking among individuals with serious mental illness (SMI) represents a major public health problem. Intervening during a psychiatric hospital stay may provide an opportunity to aid engagement in smoking cessation treatment and facilitate success in quitting. OBJECTIVE To examine the effectiveness of a multicomponent, sustained care (SusC) smoking cessation intervention in adults with SMI receiving inpatient psychiatric care. DESIGN, SETTING, AND PARTICIPANTS The Helping HAND 3 randomized clinical trial compared SusC with usual care (UC) among individuals with SMI who smoked daily and were receiving inpatient psychiatric care in Austin, Texas, in a single hospital. The study was conducted from July 2015 through August 2019. INTERVENTIONS The UC intervention involved brief smoking cessation information, self-help materials and advice from the admitting nurse, and an offer to provide nicotine replacement therapy during hospitalization. The SusC intervention included 4 main components designed to facilitate patient engagement with postdischarge smoking cessation resources: (1) inpatient motivational counseling; (2) free transdermal nicotine patches on discharge; (3) an offer of free postdischarge telephone quitline, text-based, and/or web-based smoking cessation counseling, and (4) postdischarge automated interactive voice response calls or text messages. MAIN OUTCOMES AND MEASURES The primary outcome was biochemically verified 7-day point-prevalence abstinence at 6-month follow-up. A secondary outcome was self-reported smoking cessation treatment use at 1, 3, and 6 months after discharge. RESULTS A total of 353 participants were randomized, of whom 342 were included in analyses (mean [SD] age, 35.8 [12.3] years; 268 White individuals [78.4%]; 280 non-Hispanic individuals [81.9%]; 169 women [49.4%]). They reported smoking a mean (SD) of 16.9 (10.4) cigarettes per day. Participants in the SusC group evidenced significantly higher 6-month follow-up point-prevalence abstinence rates than those in the UC group (8.9% vs 3.5%; adjusted odds ratio, 2.95 [95% CI, 1.24-6.99]; P = .01). The number needed to treat was 18.5 (95% CI, 9.6-306.4). A series of sensitivity analyses confirmed effectiveness. Finally, participants in the SusC group were significantly more likely to report using smoking cessation treatment over the 6 months postdischarge compared with participants in the UC group (74.6% vs 40.5%; relative risk, 1.8 [95% CI, 1.51-2.25]; P < .001). CONCLUSIONS AND RELEVANCE The findings of this randomized clinical trial provide evidence for the effectiveness of a scalable, multicomponent intervention in promoting smoking cessation treatment use and smoking abstinence in individuals with SMI following hospital discharge. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02204956.
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Affiliation(s)
| | - Haruka Minami
- Department of Psychology, Fordham University, Bronx, New York
| | - Jacki Hecht
- School of Nursing, University of Texas at Austin, Austin
| | - Christopher W. Kahler
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Lawrence H. Price
- Butler Hospital, Alpert Medical School of Brown University, Providence, Rhode Island,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Kimberly L. Kjome
- Seton Shoal Creek Hospital, Austin, Texas,Department of Psychiatry, Dell Medical School at the University of Texas at Austin, Austin
| | - Erika Litvin Bloom
- Rhode Island Hospital, Providence, Rhode Island,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island,Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Douglas E. Levy
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston,Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts Medical School, Harvard Medical School, Boston
| | | | - Ashleigh Smith
- Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin,Department of Health Social Work, Steve Hicks School of Social Work, University of Texas at Austin, Austin
| | | | - Nancy A. Rigotti
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston
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Viertiö S, Kiviruusu O, Piirtola M, Kaprio J, Korhonen T, Marttunen M, Suvisaari J. Factors contributing to psychological distress in the working population, with a special reference to gender difference. BMC Public Health 2021; 21:611. [PMID: 33781240 PMCID: PMC8006634 DOI: 10.1186/s12889-021-10560-y] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 03/04/2021] [Indexed: 12/12/2022] Open
Abstract
Background Psychological distress refers to non-specific symptoms of stress, anxiety and depression, and it is more common in women. Our aim was to investigate factors contributing to psychological distress in the working population, with a special reference to gender differences. Methods We used questionnaire data from the nationally representative Finnish Regional Health and Well-being Study (ATH) collected in the years 2012–2016 (target population participants aged 20 +, n = 96,668, response rate 53%), restricting the current analysis to those persons who were working full-time and under 65 of age (n = 34,468). Psychological distress was assessed using the Mental Health Inventory-5 (MHI-5) (cut-off value <=52). We studied the following factors potentially associated with psychological distress: sociodemographic factors, living alone, having children under18 years of age, lifestyle-related factors, social support, helping others outside of the home and work-related factors. We used logistic regression analysis to examine association between having work-family conflict with the likelihood for psychological distress. We first performed the models separately for men and women. Then interaction by gender was tested in the combined data for those independent variables where gender differences appeared probable in the analyses conducted separately for men and women. Results Women reported more psychological distress than men (11.0% vs. 8.8%, respectively, p < 0.0001). Loneliness, job dissatisfaction and family-work conflict were associated with the largest risk of psychological distress. Having children, active participation, being able to successfully combine work and family roles, and social support were found to be protective factors. A significant interaction with gender was found in only two variables: ignoring family due to being absorbed in one’s work was associated with distress in women (OR 1.30 (95% CI 1.00–1.70), and mental strain of work in men (OR 2.71 (95% CI 1.66–4.41). Conclusions Satisfying work, family life and being able to successfully combine the two are important sources of psychological well-being for both genders in the working population. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10560-y.
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Affiliation(s)
- Satu Viertiö
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare in Finland (THL), Helsinki, Finland. .,Adolescent Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Olli Kiviruusu
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare in Finland (THL), Helsinki, Finland.,Adolescent Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maarit Piirtola
- University of Helsinki, Institute for Molecular Medicine Finland (FIMM), Helsinki, Finland
| | - Jaakko Kaprio
- University of Helsinki, Institute for Molecular Medicine Finland (FIMM), Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Tellervo Korhonen
- University of Helsinki, Institute for Molecular Medicine Finland (FIMM), Helsinki, Finland
| | - Mauri Marttunen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare in Finland (THL), Helsinki, Finland.,Adolescent Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jaana Suvisaari
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare in Finland (THL), Helsinki, Finland
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Weinberger AH, Zhu J, Barrington-Trimis JL, Wyka K, Goodwin RD. Cigarette Use, E-Cigarette Use, and Dual Product Use Are Higher Among Adults With Serious Psychological Distress in the United States: 2014-2017. Nicotine Tob Res 2021; 22:1875-1882. [PMID: 32285121 DOI: 10.1093/ntr/ntaa061] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 04/27/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Cigarette use is declining yet remains common among adults with mental health conditions. In contrast, e-cigarette use may be on the rise. This study investigated the relationship between serious psychological distress (SPD) and the exclusive and dual use of cigarettes and e-cigarettes among US adults from 2014 to 2017. AIMS AND METHODS Data came from 2014 to 2017 National Health Interview Survey, an annual, cross-sectional survey of nationally representative samples of US adults (total combined analytic sample n = 125 302). Past-month SPD was assessed using the Kessler Psychological Distress Scale (K6) and cigarette and e-cigarette use were assessed at each wave. Logistic regressions examined product use by SPD status in 2017 and trends in product use by SPD status from 2014 to 2017. Analyses adjusted for demographic covariates. RESULTS The prevalence of cigarette use, e-cigarette use, and dual use was higher among adults with SPD than without SPD in each year including the most recent data year 2017 (cigarette use, 39.50% vs. 13.40%, p < .001; e-cigarette use, 7.41% vs. 2.65%, p < .001; dual use, 5.30% vs. 1.26%, p < .001). Among adults with SPD, the prevalence of cigarette, e-cigarette, and dual product use did not change from 2014 to 2017 in contrast to a decreasing prevalence in cigarette, e-cigarette, and dual product use among individuals without SPD. CONCLUSIONS US adults with SPD report higher levels of cigarette, e-cigarette, and dual product use than adults without SPD. Use of these products has not declined over the past several years in contrast to decreasing trends among adults without SPD. IMPLICATIONS These data extend our knowledge of tobacco product use and mental health disparities by showing that in addition to higher levels of cigarette use, US adults with SPD also use e-cigarettes and dual products (cigarette and e-cigarette) more commonly than those without SPD. Furthermore, the use of these products has not declined over the past several years in contrast to continuing declines among adults without SPD. More research is needed to understand the potential positive and negative consequences of e-cigarette use among adults with SPD.
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Affiliation(s)
- Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Jiaqi Zhu
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY
| | - Jessica L Barrington-Trimis
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Katarzyna Wyka
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY
| | - Renee D Goodwin
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
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Quit ratios for cigarette smoking among individuals with opioid misuse and opioid use disorder in the United States. Drug Alcohol Depend 2020; 214:108164. [PMID: 32652375 PMCID: PMC7423737 DOI: 10.1016/j.drugalcdep.2020.108164] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/19/2020] [Accepted: 06/20/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The prevalence of cigarette smoking is more than two times higher among individuals with versus without opioid misuse and/or opioid use disorders (OUD). Overall, smoking cessation has increased over time although it is unknown whether it has similarly increased for those with opioid misuse or OUD. The current study examined cigarette quit ratios from 2002 to 2018 among US individuals with and without opioid misuse or OUD. METHODS Data came from the National Survey on Drug Use and Health, a yearly cross-sectional survey of US civilians 12 years or older. Annual quit ratios (i.e., proportion of former smokers among lifetime-smokers) were estimated from 2002 to 2018. Logistic regression tested time trends in quit ratios by opioid misuse/OUD. RESULTS Past-month smoking prevalence was much higher for persons with versus without opioid misuse (64.6 % versus 25.7 %) and OUD (73.3 % versus 26.0 %). In 2018, quit ratios for individuals with opioid misuse (18.0 %) or OUD (10.0 %) were less than half of those without opioid misuse (48.3 %) or OUD (48.1 %). After adjusting for background characteristics, the quit ratio did not change over time among individuals with opioid misuse or OUD in contrast to an increase in quit ratios for those without opioid misuse or OUD. For those without opioid misuse or OUD, males had higher quit ratios than females. CONCLUSIONS Cigarette quit ratios remain dramatically lower among those with opioid misuse or OUD. Public health and clinical attention are needed to increase cessation and reduce smoking consequences for individuals with opioid misuse and OUD.
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Brose LS, Brown J, Robson D, McNeill A. Mental health, smoking, harm reduction and quit attempts - a population survey in England. BMC Public Health 2020; 20:1237. [PMID: 32795286 PMCID: PMC7427923 DOI: 10.1186/s12889-020-09308-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 07/28/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Tobacco control strategies have engendered overall declines in smoking; however, a large gap remains between people with and without mental health problems, causing substantial health inequalities. Population-level information on barriers and opportunities for improvements is scarce. We aimed to assess mental health status of cigarette smokers and recent ex-smokers ('past-year smokers') in England, and smoking and harm reduction behaviour and quit attempts by mental health status. METHODS Data were collected from 5637 current and 434 recent ex-smokers in 2016/17 in household surveys of representative samples of adults. We calculated weighted prevalence of different indicators of mental health problem: a) ever diagnosis, b) none, moderate, serious past-month distress, c) past-year treatment. We compared weighted smoking status, cigarette type, dependence, motivation to stop smoking, cutting down, use of nicotine replacement therapy or e-cigarettes, short-term abstinence, and quit attempts according to mental health status. RESULTS Among past-year smokers: 35.9% ever had a diagnosis; 24.3% had experienced moderate, an additional 9.7% serious, past-month distress; 21.9% had had past-year treatment. Those with an indication of a mental health problem were more highly dependent and more likely to smoke roll-your-own cigarettes but also more likely to be motivated to stop smoking, to cut down, use nicotine replacement therapy or e-cigarettes and to have attempted to quit in the past year. CONCLUSIONS About a third of cigarette smokers in England have mental health problems. Interventions should address their increased dependence and leverage higher prevalence of harm reduction behaviours, motivation to stop and attempts to stop smoking.
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Affiliation(s)
- Leonie S Brose
- Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, London, SE5 8BB, UK.
- , SPECTRUM Consortium, UK.
| | - Jamie Brown
- , SPECTRUM Consortium, UK
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Debbie Robson
- Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, London, SE5 8BB, UK
- , SPECTRUM Consortium, UK
| | - Ann McNeill
- Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, London, SE5 8BB, UK
- , SPECTRUM Consortium, UK
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Brose LS, Brown J, McNeill A. Mental health and smoking cessation-a population survey in England. BMC Med 2020; 18:161. [PMID: 32580770 PMCID: PMC7315517 DOI: 10.1186/s12916-020-01617-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/06/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND To reduce inequalities between individuals with and without mental health problems, a better understanding is required of triggers and success of quit attempts among the third of smokers with mental health problems. The aim was to assess whether there are differences by mental health status in (i) triggers for quit attempts, (ii) use of evidence-based support (iii) and quit success. METHODS Monthly cross-sectional household surveys of representative samples of the adult population in England. In 2016/2017, 40,831 adults were surveyed; 1956 who had attempted to stop smoking cigarettes in the past year were included. Logistic regressions assessed associations between mental health (ever diagnosis, past-year treatment, past-month distress), triggers, support used and quit success, adjusting for sociodemographic and smoking characteristics. RESULTS Concern about future health, current health problems and expense of smoking were the most common triggers overall. For respondents with an ever diagnosis, past-year treatment or serious past-month distress, quit attempts were more frequently triggered by current health problems. Non-evidence-based support and e-cigarettes were used most often, and this did not differ by mental health status. Respondents with an ever diagnosis and moderate or serious distress were less likely to have used non-prescription nicotine replacement therapy (NRT). Respondents with past-year treatment or serious distress were more likely to have used prescription medication/behavioural support. Quit success did not differ by mental health status. Compared with non-evidence-based support, non-prescription NRT conferred no benefit. There was some evidence that prescription medication/behavioural support was beneficial (depending on outcome and adjustment, ORs ranged from 1.46, 95% CI 0.92-2.31, to 1.69, 1.01-2.86). E-cigarettes were associated with higher success rates after adjustment for different indicators of mental health (ORs ranged from 2.21, 1.64-2.98, to 2.25, 1.59-3.18). CONCLUSIONS Smokers with mental health problems were more likely to have attempted to quit because of health problems and were more likely to have used gold standard support (medication and behavioural support) than other smokers. E-cigarettes were strongly associated with increased success and were used similarly by those with and without mental health problems, indicating that improved uptake of e-cigarettes for smoking cessation among smokers with mental health problems could help address inequalities.
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Affiliation(s)
- Leonie S Brose
- Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, London, SE5 8BB, UK.
- , .
| | - Jamie Brown
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Ann McNeill
- Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, London, SE5 8BB, UK
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Johnson AL, Kaye J, Baker TB, Fiore MC, Cook JW, Piper ME. Psychiatric comorbidities in a comparative effectiveness smoking cessation trial: Relations with cessation success, treatment response, and relapse risk factors. Drug Alcohol Depend 2020; 207:107796. [PMID: 31864163 PMCID: PMC7076564 DOI: 10.1016/j.drugalcdep.2019.107796] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/26/2019] [Accepted: 11/26/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Comorbid psychiatric diagnoses have been shown to predict cessation failure. The relative impact of various diagnoses on cessation and other cessation processes is rarely studied, particularly among a general population. The impact of psychiatric history among primary care patients seeking cessation services on nicotine dependence, cessation outcomes, treatment effects and adherence, and withdrawal symptoms was examined. METHODS Secondary data analysis of a multi-site comparative effectiveness smoking cessation trial was conducted. Adult smokers (n = 1051; 52.5 % Female, 68.1 % white) completed a structured clinical interview at baseline to assess psychiatric diagnostic history (past-year and lifetime). Nicotine dependence was assessed via self-report measures at baseline. Point-prevalence abstinence was assessed at 8 weeks and 6 months post-quit. Withdrawal symptoms were assessed for one week pre- and post-quit using ecological momentary assessment. Treatment adherence was self-reported at 1, 4, 8, and 12 weeks post-quit. RESULTS Past-year substance use disorder, lifetime mood disorder, and > one lifetime diagnosis, were related to lower rates of short-term, but not long-term, cessation. Lifetime psychiatric diagnosis was related to elevated nicotine dependence, particularly to secondary dependence motives associated with instrumental tobacco use. History of psychiatric diagnosis was associated with increased withdrawal-related craving. There was little evidence that psychiatric diagnostic status moderated the effects of the tested pharmacotherapies on long-term abstinence. CONCLUSIONS Psychiatric diagnoses affect risk factors that exert their effects early in the post-quit process and highlight the potential utility of examining transdiagnostic risk factors to better understand the relations between psychiatric vulnerabilities and the smoking cessation process.
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Affiliation(s)
- Adrienne L. Johnson
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Ste. 200, Madison, WI, 53711,William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705,Correspondence concerning this article should be addressed to Megan E. Piper, Ph.D., Center for Tobacco Research and Intervention, University of Wisconsin, Madison, WI, 53711; Tel: 608-265-5472; Fax: 608-265-3102;
| | - Jesse Kaye
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Ste. 200, Madison, WI, 53711,William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705
| | - Timothy B. Baker
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Ste. 200, Madison, WI, 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| | - Michael C. Fiore
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Ste. 200, Madison, WI, 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| | - Jessica W. Cook
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Ste. 200, Madison, WI, 53711,William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705
| | - Megan E. Piper
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Ste. 200, Madison, WI, 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
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Weinberger AH. Advancing Our Knowledge in All Stages of Treatment Research Using a Range of Methodologies. Nicotine Tob Res 2020; 22:1-2. [PMID: 31563957 DOI: 10.1093/ntr/ntz188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 09/25/2019] [Indexed: 11/13/2022]
Affiliation(s)
- Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
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Weinberger AH, Giovenco DP, Zhu J, Lee J, Kashan RS, Goodwin RD. Racial/ethnic differences in daily, nondaily, and menthol cigarette use and smoking quit ratios in the United States: 2002 to 2016. Prev Med 2019; 125:32-39. [PMID: 31004620 DOI: 10.1016/j.ypmed.2019.04.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 04/01/2019] [Accepted: 04/14/2019] [Indexed: 10/27/2022]
Abstract
In the United States (US), racial/ethnic groups differ in cigarette smoking behaviors. We examined changes in cigarette prevalence and quit ratios over 15 years by racial/ethnic group (Non-Hispanic (NH) White, NH Black, Hispanic, NH Other). Data were drawn from the 2002-2016 National Survey on Drug Use and Health (NSDUH) public use data files and analyzed in 2018. Linear time trends of the prevalence of daily, nondaily, and menthol cigarette use and quit ratios (i.e., proportion of former smokers among lifetime smokers) were assessed using logistic regression models. 19.35% of NH White persons were daily smokers in 2016; this prevalence was significantly higher than all other groups (NH Black 10.99%, Hispanic 6.81%, NH Other 9.10%). Menthol use was significantly more common among NH Black individuals than all other groups in every year from 2002 to 2016 (2016: NH Black 23.38%, NH White 14.52%, Hispanic 10.49%, NH Other 8.97%). From 2002 to 2016, daily and nondaily smoking decreased significantly among all groups. The rate of decline of nondaily smoking was more rapid among Hispanic than NH White individuals while the rate of menthol smoking decline was more rapid among NH White than among Hispanic individuals. The quit ratio did not change significantly from 2002 to 2016 among NH Black individuals (31% to 35%) in contrast to a significant increase among NH White (2002, 45%; 2016, 50%) and Hispanic (2002, 33%; 2016, 41%) individuals. Further progress in tobacco control for vulnerable groups may need to include innovative strategies to address these concerning trends.
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Affiliation(s)
- Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA; Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Daniel P Giovenco
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Jiaqi Zhu
- Institute for Implementation Science in Population Health, The City University of New York, New York, NY, USA.
| | - Joun Lee
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA; Department of Clinical Psychology, Teachers College, Columbia University, New York, NY, USA.
| | - Rachel S Kashan
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.
| | - Renee D Goodwin
- Institute for Implementation Science in Population Health, The City University of New York, New York, NY, USA; Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
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Kalkhoran S, Thorndike AN, Rigotti NA, Fung V, Baggett TP. Cigarette Smoking and Quitting-Related Factors Among US Adult Health Center Patients with Serious Mental Illness. J Gen Intern Med 2019; 34:986-991. [PMID: 30783880 PMCID: PMC6544702 DOI: 10.1007/s11606-019-04857-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 12/13/2018] [Accepted: 01/10/2019] [Indexed: 12/31/2022]
Abstract
INTRODUCTION US adults with serious mental illness (SMI), compared to those without SMI, have a higher prevalence of smoking, which contributes to a shorter life expectancy. This study compared current smoking and quitting-related characteristics of low-income US adults with and without SMI who received healthcare at federally funded health centers. METHODS Using cross-sectional data from adults ≥ 18 years old in the nationally representative 2014 Health Center Patient Survey (n = 5592), we compared the prevalence of ever and current smoking among adults with and without SMI and calculated quit ratios as the percentage of ever smokers who have quit smoking. We examined the association between SMI and receiving advice to quit, making quit attempts, and having plans to quit in the next 30 days using multivariable logistic regression. RESULTS A total of 1376 (23%) of participants had SMI. Ever smoking prevalence was 68% in adults with SMI and 41% in adults without SMI, and current smoking prevalence was 48% and 22%, respectively. The quit ratio was 30% and 46% among participants with and without SMI, respectively. Compared to smokers without SMI, more smokers with SMI reported receiving advice to quit in the past 12 months (aOR 2.47, 95% CI 1.20-5.07). Smokers with and without SMI did not differ significantly in their odds of having made a past-12-month quit attempt or plans to quit. CONCLUSIONS Smokers with SMI seen in federally funded health centers were just as likely to have made a quit attempt and to have plans to quit as smokers without SMI. Despite a higher likelihood of receiving clinician advice to quit, the lower quit ratio in this population suggests that advice alone is unlikely to be sufficient. These results underscore the need for augmented strategies to promote smoking cessation and reduce the excess burden of tobacco-related disease in patients with SMI.
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Affiliation(s)
- Sara Kalkhoran
- Tobacco Research and Treatment Center, General Medicine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Anne N Thorndike
- Tobacco Research and Treatment Center, General Medicine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, General Medicine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Vicki Fung
- Harvard Medical School, Boston, MA, USA.,Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Travis P Baggett
- Tobacco Research and Treatment Center, General Medicine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, MA, USA
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Steinberg ML, Weinberger AH, Tidey JW. Non-pharmacological Treatments for Tobacco Users With Mental Health Symptoms. Nicotine Tob Res 2019; 21:557-558. [PMID: 30768202 PMCID: PMC6468122 DOI: 10.1093/ntr/ntz024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 02/11/2019] [Indexed: 11/14/2022]
Affiliation(s)
- Marc L Steinberg
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Jennifer W Tidey
- Department of Behavioral and Social Sciences, Center for Alcohol & Addiction Studies, Brown University School of Public Health, Providence, RI
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