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Asfar T, Schmidt M, Oluwole OJ, Casas A, Friedman L, Ferdous T, Noar SM, Eissenberg T, Maziak W. Building consensus on a set of ENDS-specific pictorial health warnings: a Delphi study among a tobacco control expert panel. Tob Control 2024:tc-2023-058384. [PMID: 38346872 DOI: 10.1136/tc-2023-058384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/30/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND This study reports on the development of pictorial health warning labels for electronic nicotine delivery system (ENDS) using the Delphi approach with a panel of tobacco control experts. Twenty-four evidence-based ENDS-specific warnings corresponding to three themes (toxicity, health risks and specific harm) were developed and used in the Delphi study. METHODS We conducted a three-round online Delphi study among 60 experts (55% female) between June 2022 and April 2023. We balanced the panel in areas of expertise and positions relevant to ENDS (risks, benefits). In round 1, participants rated the warnings on attention, relevance to evidence and perceived effectiveness (harm perception, motivation to quit) and provided suggestions for improvement. In rounds 2 and 3, participants ranked the revised warnings based on importance in each theme. We assessed levels of agreement between participants using interquartile deviations and medians. RESULTS Warnings in theme 1, toxicity, received the highest ratings for perceived effectiveness on harm perception and encouraging quitting ENDS (p<0.05). Experts recommended using clear and affirmative text paired with emotion-provoking pictures and avoiding the rare side effects of ENDS. Most of the top-ranked warnings were from theme 3, ENDS-specific harm, pertained to lung damage, dual use of ENDS and cigarettes, nicotine addiction among youth, anti-ENDS industry sentiment and toxicity. DISCUSSION This study developed 24 evidence-based ENDS health warning labels using a systematic process that included several rounds of expert panel feedback. These warnings can be used to advance ENDS prevention and tobacco control policies and further target different populations.
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Affiliation(s)
- Taghrid Asfar
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael Schmidt
- Department of Art, The University of Memphis, Memphis, Tennessee, USA
| | - Olusanya Joshua Oluwole
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Alejandra Casas
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Lily Friedman
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Tarana Ferdous
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, Florida, USA
| | - Seth M Noar
- Husssman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Thomas Eissenberg
- Psychology and Inst. for Drug/Alc. Studies, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Wasim Maziak
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, Florida, USA
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Pharmacotherapy for the Treatment of Tobacco Dependence. Respir Med 2023. [DOI: 10.1007/978-3-031-24914-3_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
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Hempel-Bruder C, Habfast-Robertson I, Durand MA, Berlin I, Marti J, Khazaal Y, Quinto C, Faouzi M, Selby K. Combining default choices and an encounter decision aid to improve tobacco cessation in primary care patients: protocol for a cluster-randomized trial. BMC PRIMARY CARE 2022; 23:246. [PMID: 36151529 PMCID: PMC9508762 DOI: 10.1186/s12875-022-01859-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND While quitting smoking dramatically decreases overall mortality, general practitioners (GPs) are less likely to prescribe medications for smoking cessation than other cardiovascular risk factors. Guidelines recommend providers first assess patients' "readiness" to quit, an "opt-in" strategy, but only a minority of tobacco users are ready to quit on a given day. An "opt-out" strategy offering treatment as the default choice increased quit attempts in hospital and with pregnant women, but has not been tested in primary care. We will assess the efficacy of training GPs to offer treatment as the default choice using an encounter decision aid with current smokers seen in primary care. METHODS This is a pragmatic cluster-randomized controlled superiority trial with block randomization at the GP level in private practice in French-speaking Switzerland. GPs will be blinded to the arm allocation. The intervention is a half-day training course teaching an 'opt-out' approach to smoking cessation using an encounter decision aid (paper or electronic). GPs in the enhanced usual care group receives a brief refresher training about smoking cessation without changing their behaviour. GPs in both arms will recruit 23 patients each prior to routine primary care visits. The primary outcome is the effect of consulting a GP who received the intervention on the 7-day, point prevalence, smoking abstinence 6 months after the baseline appointment. Secondary outcomes include continuous abstinence; number of quit attempts; use of smoking cessation aids; patient-perceived involvement in discussions; and changes in GP behaviour. Patient outcomes will be collected using paper and telephone questionnaires. Assuming 15% drop-out, recruiting 46 GPs with 23 patients each will give us 80% power to detect an increase in smoking cessation from 4% (control) to 10.5% (intervention), with an alpha < 0.05. DISCUSSION GP visits are an opportunity to administer proven smoking cessation treatments. We hypothesize GPs offering smoking cessation treatment as the default choice using an encounter decision aid will increase the number of patients who quit. This study could significantly change our approach to smoking cessation in primary care. Default choices and the electronic decision aid are low-cost, easily diffusible interventions. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04868474, First Posted May 3, 2021, Last Update Posted October 6, 2021.
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Affiliation(s)
- Christina Hempel-Bruder
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de Berne 113, 1010, Lausanne, Switzerland
| | - Inès Habfast-Robertson
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de Berne 113, 1010, Lausanne, Switzerland
| | - Marie-Anne Durand
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de Berne 113, 1010, Lausanne, Switzerland
- UMR 1295, CERPOP, University Toulouse III Paul Sabatier, Toulouse, France
| | | | - Joachim Marti
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de Berne 113, 1010, Lausanne, Switzerland
| | - Yasser Khazaal
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de Berne 113, 1010, Lausanne, Switzerland
- Department of Addiction Medicine, CHUV, Lausanne, Switzerland
| | | | - Mohamed Faouzi
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de Berne 113, 1010, Lausanne, Switzerland
| | - Kevin Selby
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de Berne 113, 1010, Lausanne, Switzerland.
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Dogar O, Keding A, Gabe R, Marshall AM, Huque R, Barua D, Fatima R, Khan A, Zahid R, Mansoor S, Kotz D, Boeckmann M, Elsey H, Kralikova E, Parrott S, Li J, Readshaw A, Sheikh A, Siddiqi K. Cytisine for smoking cessation in patients with tuberculosis: a multicentre, randomised, double-blind, placebo-controlled phase 3 trial. LANCET GLOBAL HEALTH 2020; 8:e1408-e1417. [DOI: 10.1016/s2214-109x(20)30312-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/19/2020] [Accepted: 06/24/2020] [Indexed: 12/17/2022]
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Steinglass JE, Glasofer DR, Dalack M, Attia E. Between wellness, relapse, and remission: Stages of illness in anorexia nervosa. Int J Eat Disord 2020; 53:1088-1096. [PMID: 32031292 PMCID: PMC7384605 DOI: 10.1002/eat.23237] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/20/2020] [Accepted: 01/20/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Psychiatric illnesses, like medical illnesses, can sometimes be considered as progressing through stages. Understanding these stages can lead to a better understanding of pathophysiology, and clarification of prognosis and treatment needs. Opinions from experts in the field of anorexia nervosa (AN) were sought to create a model of stages of illness. METHOD The Delphi approach was used to achieve consensus from a panel of 31 individuals from a range of disciplines with expertise in AN. Over three iterative rounds, participants rated agreement with statements about an overall staging framework and definitions of specific stages. RESULTS Agreement was reached about a longitudinal progression including Subsyndromal, Full Syndrome, Persistent Illness, and Partial and Full Remission. The panel achieved consensus in defining Subsyndromal AN as characterized by body image disturbance and mild to moderate restrictive eating. Overall, there was consensus that restrictive eating is central to the behavioral features of all stages of AN, and agreement that its absence is essential to any stage of health. There was little consensus about biological markers, other than body mass index, and no consensus about quality of life indices associated with different stages. DISCUSSION This panel discussion yielded an expert-informed staging model for AN. This model now needs to be tested for its validity. The lack of consensus in several areas highlighted other research questions to address in order to develop an empirically valid and scientifically useful model of the progression of AN.
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Affiliation(s)
- Joanna E. Steinglass
- Department of Psychiatry, Columbia University Irving Medical Center & New York State Psychiatric Institute, New York, New York
| | - Deborah R. Glasofer
- Department of Psychiatry, Columbia University Irving Medical Center & New York State Psychiatric Institute, New York, New York
| | - Maya Dalack
- Department of Psychiatry, Columbia University Irving Medical Center & New York State Psychiatric Institute, New York, New York
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Irving Medical Center & New York State Psychiatric Institute, New York, New York,Weill Cornell Medical Center, Presbyterian Hospital, White Plains, New York
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Buchman S, Attia E, Dawson L, Steinglass JE. Steps of care for adolescents with anorexia nervosa-A Delphi study. Int J Eat Disord 2019; 52:777-785. [PMID: 31058331 PMCID: PMC7147487 DOI: 10.1002/eat.23088] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/19/2019] [Accepted: 04/19/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Anorexia nervosa (AN) commonly develops during adolescence. Existing literature offers some treatment guidelines, but clear clinical criteria for initial recommendations and steps of care are needed. The aim of the present study was to develop expert consensus for a stepped-care algorithm for treatment of adolescents with AN. METHOD The Delphi approach was used to identify clinical parameters that guide initial treatment recommendations and recommendations for transitions between levels of care. The Delphi approach provides a useful expert consensus when empirical data are limited. Individuals with at least 10 years of experience in the field of adolescent AN and membership in one of three professional organizations were recruited. Twenty-five panelists participated in three rounds of iterative online questionnaires. RESULTS Consensus was achieved on several features of a treatment algorithm. Hospitalization is recommended when medical instability, suicidality, or acute food refusal are present at any point in treatment. Family-based treatment (FBT) is recommended as the first-line treatment, with a few exceptions. Consensus was not reached on when to transition from a higher level of care to a lower level of care. DISCUSSION Expert opinion was used to develop a consensus-based algorithm for care of adolescents with AN. Future research is needed to test whether these recommendations can be used to optimize outcomes for adolescents with AN.
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Affiliation(s)
- Samantha Buchman
- Weill Cornell Medicine, New York-Presbyterian Hospital, White Plains, New York
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York
| | - Lisa Dawson
- Centre for Family-Based Mental Health Care, St. Vincent's Private Hospital Sydney, Eating Disorder Service, The Children's Hospital at Westmead, Camperdown, New South Wales, Australia
| | - Joanna E. Steinglass
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York
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Asfar T, Schmidt M, Ebrahimi Kalan M, Wu W, Ward KD, Nakkash RT, Thrasher J, Eissenberg T, Ben Romdhane H, Maziak W. Delphi study among international expert panel to develop waterpipe-specific health warning labels. Tob Control 2019; 29:159-167. [PMID: 30696784 DOI: 10.1136/tobaccocontrol-2018-054718] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/20/2018] [Accepted: 12/20/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Waterpipe (WP) smoking is increasing globally. The rise of WP has been fuelled by widespread misperception of reduced-harm compared to cigarettes. Health warning labels (HWLs) are one strategy to communicate smoking-related risks and address reduced-harm misperceptions. Therefore, the development of WP-specific HWLs represents a priority for WP control. METHODS A panel of experts in WP science developed 28 WP-specific HWLs corresponding to five themes (health risks, addiction, harm to others, WP-specific harm, WP harm compared to cigarettes). Subsequently, a three-round Delphi study was conducted among international expert panel to reach consensus on a set of the most effective HWLs for each theme. Levels of agreement between participants were assessed using interquartile deviations, and the rank between the tied HWLs was based on the median. RESULTS Starting with 28 candidate HWLs stratified according to five WP-related themes, our international expert panel reached consensus on the 13 most important WP-specific HWLs. Labels with the highest agreement were related to oral and heart disease, WP's harmful effects on newborn children and the amount of smoke inhaled from WP compared to cigarettes. CONCLUSION This study is the first to systematically develop and evaluate potential WP-specific HWLs based on the scientific evidence about WP's harmful effects, scientific understanding of HWL for cigarettes and the opinions of experts in WP science, tobacco control and health communication. The final selected HWLs can be adapted based on the context and policy landscape of the target country and can be further fine-tuned based on feedback from WP smokers and non-smokers.
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Affiliation(s)
- Taghrid Asfar
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA.,Syrian Center for Tobacco Studies, Aleppo, Syria.,Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, Florida, US
| | - Michael Schmidt
- Department of Art, The University of Memphis, Memphis, Tennessee, USA
| | - Mohammad Ebrahimi Kalan
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, Florida, USA
| | - Wensong Wu
- Department of Mathematics and Statistics, Florida International University, Miami, Florida, USA
| | - Kenneth D Ward
- Syrian Center for Tobacco Studies, Aleppo, Syria.,School of Public Health, The University of Memphis, Miami, Florida, USA
| | - Rima T Nakkash
- Health Behaviour and Education Department, American University of Beirut, Beirut, Lebanon
| | - James Thrasher
- Health Promotion, Education, and Behavior, School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,Department of Tobacco Research, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Thomas Eissenberg
- Syrian Center for Tobacco Studies, Aleppo, Syria.,USA Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Habiba Ben Romdhane
- Cardiovascular Epidemiology and Prevention Research Laboratory, Faculty of Medicine of Tunis-Tunisia, Tunis, Tunisia
| | - Wasim Maziak
- Syrian Center for Tobacco Studies, Aleppo, Syria.,Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, Florida, USA
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Okoli CT, Al-Mrayat YD, Shelton CI, Khara M. A retrospective analysis of the association between providing nicotine replacement therapy at admission and motivation to quit and nicotine withdrawal symptoms during an inpatient psychiatric hospitalization. Addict Behav 2018; 85:131-138. [PMID: 29908433 DOI: 10.1016/j.addbeh.2018.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 06/05/2018] [Accepted: 06/06/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Psychiatric patients have high tobacco use prevalence, dependence, and withdrawal severity. A tobacco-free psychiatric hospitalization necessitates the management of nicotine withdrawal (NW) for tobacco using patients. NW management often requires the provision of approved nicotine replacement therapy (NRT) to patients, which may also motivate tobacco users towards cessation. However, few studies have examined the associations between providing NRT, motivation to quit, and NW among psychiatric patients. OBJECTIVE(S) To examine the associations between providing NRT at admission and motivation to quit smoking and severity of NW symptoms. DESIGN A retrospective review of the medical records of 255 tobacco using patients on whom NW was assessed during their hospital stay. The time when NRT was provided (i.e., at admission vs. not provided vs. on the unit), motivation to quit smoking, and 8-item Minnesota Nicotine Withdrawal Scale were assessed. RESULTS The primary NW symptom was 'craving' (65.1%); reporting of 'anxiety' varied by psychiatric diagnosis. Providing NRT at admission was not associated with motivation to quit. Patients receiving NRT on the unit (i.e., delayed receipt) had significantly higher NW than those who received NRT at admission. In multivariate analyses, receiving NRT on the unit was significantly associated with greater NW severity (β = .19, p = .002). CONCLUSIONS Among psychiatric patients, providing NRT at admission is associated with greater severity of NW. The provision of NRT for NW management may be considered as standard practice during tobacco-free psychiatric stays. Future studies may consider the effect of other tobacco treatment medications (such as varenicline, bupropion) on managing NW.
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Effect of training program regarding smoking cessation counseling for primary health care physicians in Port Said City, Egypt. J Public Health (Oxf) 2018. [DOI: 10.1007/s10389-017-0890-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Hughes JR, Solomon LJ, Peasley-Miklus CE, Callas PW, Fingar JR. Effectiveness of continuing nicotine replacement after a lapse: A randomized trial. Addict Behav 2018; 76:68-81. [PMID: 28756042 DOI: 10.1016/j.addbeh.2017.07.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 07/12/2017] [Accepted: 07/13/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Four post-hoc analyses of prior trials found smokers using nicotine patch following a lapse were less likely to progress to relapse compared to those using a placebo patch following a lapse. We attempted a conceptual replication test of these results via a randomized trial of instructions to continue vs. stop nicotine patch after a lapse. METHODS Smokers trying to quit (n=701) received nicotine patch (21/14/7mg) and brief phone counseling (six 15-min sessions). We randomized smokers to receive instructions for and rationale for stopping vs. continuing patch after a lapse. The messages were repeated before and after cessation and following lapses via counseling, phone and written instructions. RESULTS Among those who lapsed, those told to Continue Patch did not have a greater incidence of 7-day abstinence at 4months (primary outcome) than those told to Discontinue Patch (51% vs. 46%). Most (81%) participants in the Discontinue condition stopped patch for only 1-2days and then resumed abstinence and patch use. Analyses based on all participants randomized were similar. Adverse events were as expected and did not differ between conditions. CONCLUSION Instructions to continue nicotine patch after a lapse did not increase return to abstinence. These negative results may have occurred because actual use of patch after a lapse was similar in the two conditions. Also, allowing patch use while smoking may have reduced motivation to stay abstinent.
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Affiliation(s)
- John R Hughes
- Vermont Center for Behavior and Health, Department of Psychiatry, and Department of Psychological Sciences, University of Vermont, United States.
| | - Laura J Solomon
- Office of Health Promotion Research, University of Vermont, United States
| | - Catherine E Peasley-Miklus
- Vermont Center for Behavior and Health, Department of Psychiatry, and Department of Psychological Sciences, University of Vermont, United States
| | - Peter W Callas
- Department of Medical Biostatistics, University of Vermont, United States
| | - James R Fingar
- Vermont Center for Behavior and Health, Department of Psychiatry, and Department of Psychological Sciences, University of Vermont, United States
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Okoli CTC, Wiggins A, Fallin-Bennett A, Rayens MK. A retrospective analysis of the comparative effectiveness of smoking cessation medication among individuals with mental illness in community-based mental health and addictions treatment settings. J Psychiatr Ment Health Nurs 2017. [PMID: 28635015 DOI: 10.1111/jpm.12408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Persons with different mental illnesses smoke for reasons based on their particular diagnosis. As compared to those without, persons with mental illnesses are less able to quit smoking when using smoking cessation medications. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This paper shows that there may be differences in the ability to quit smoking between persons with different mental illness diagnoses. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Clinicians should be aware that persons with anxiety disorders may find it more difficult to quit smoking as compared to those with other mental illnesses. Clinicians should be aware that of all medications, varenicline seems to help those with mood disorders to quit the best. Clinicians should be aware that persons with psychotic disorders likely need longer treatment durations for smoking cessation as compared to persons with other mental illnesses. ABSTRACT Introduction Individuals with mental illnesses (MI) have diagnosis-specific reasons for smoking and achieve low smoking cessation when using cessation medications. Aim To assess differences in smoking cessation outcomes by MI diagnosis and cessation medications in outpatient mental health and addictions treatment settings in Vancouver, Canada. Method This is a retrospective analysis of tobacco treatment outcomes from 539 participants. The programme consists of cessation pharmacotherapy with 8 to 12 weeks of behavioural counselling and 12 weeks of support group. Smoking cessation was verified by expired carbon monoxide levels. Generalized estimating equations models assessed differences in cessation by type of medication in both total and stratified samples. Results There were no significant differences in cessation by pharmacotherapy in the total sample. Individuals with a mood disorder were two times more likely to achieve cessation as compared to those with an anxiety disorder. Among individuals with mood disorders, receiving varenicline alone resulted in three times the likelihood of cessation as compared to receiving single NRT. Discussion The differences in outcomes by MI diagnosis suggest the need for more diagnosis-specific approaches to optimize cessation. Implications for Practice Compared with other diagnoses, persons with anxiety disorders may have a greater challenge quitting and those with a psychotic disorder may require longer treatment durations.
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Affiliation(s)
- C T C Okoli
- University of Kentucky College of Nursing, Lexington, KY, USA
| | - A Wiggins
- University of Kentucky College of Nursing, Lexington, KY, USA
| | | | - M K Rayens
- University of Kentucky College of Nursing, Lexington, KY, USA
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Heckman BW, Cummings KM, Kasza KA, Borland R, Burris JL, Fong GT, McNeill A, Carpenter MJ. Effectiveness of Switching Smoking-Cessation Medications Following Relapse. Am J Prev Med 2017; 53:e63-e70. [PMID: 28336353 PMCID: PMC5522631 DOI: 10.1016/j.amepre.2017.01.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 12/16/2016] [Accepted: 01/23/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Nicotine dependence is a chronic disorder often characterized by multiple failed quit attempts (QAs). Yet, little is known about the sequence of methods used across multiple QAs or how this may impact future ability to abstain from smoking. This prospective cohort study examines the effectiveness of switching smoking-cessation medications (SCMs) across multiple QAs. METHODS Adult smokers (aged ≥18 years) participating in International Tobacco Control surveys in the United Kingdom, U.S., Canada, and Australia (N=795) who: (1) completed two consecutive surveys between 2006 and 2011; (2) initiated a QA at least 1 month before each survey; and (3) provided data for the primary predictor (SCM use during most recent QA), outcome (1-month point prevalence abstinence), and relevant covariates. Analyses were conducted in 2016. RESULTS Five SCM user classifications were identified: (1) non-users (43.5%); (2) early users (SCM used for initial, but not subsequent QA; 11.4%); (3) later users (SCM used for subsequent, but not initial QA; 18.4%); (4) repeaters (same SCM used for both QAs; 10.7%); and (5) switchers (different SCM used for each QA; 14.2%). Abstinence rates were lower for non-users (15.9%, OR=0.48, p=0.002), early users (16.6%, OR=0.27, p=0.03), and repeaters (12.4%, OR=0.36, p=0.004) relative to switchers (28.5%). CONCLUSIONS Findings suggest smokers will be more successful if they use a SCM in QAs and vary the SCM they use across time. That smokers can increase their odds of quitting by switching SCMs is an important message that could be communicated to smokers.
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Affiliation(s)
- Bryan W Heckman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina; Cancer Control and Prevention, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina.
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina; Cancer Control and Prevention, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
| | - Karin A Kasza
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York
| | - Ron Borland
- Nigel Gray Fellowship Group, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Jessica L Burris
- Department of Psychology, University of Kentucky, Lexington, Kentucky; Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada; School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada; Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Ann McNeill
- UK Centre for Tobacco and Alcohol Studies, King's College London, Strand, London, United Kingdom
| | - Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina; Cancer Control and Prevention, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
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Valera P, McClernon FJ, Burkholder G, Mugavero MJ, Willig J, O'Cleirigh C, Cropsey KL. A Pilot Trial Examining African American and White Responses to Algorithm-Guided Smoking Cessation Medication Selection in Persons Living with HIV. AIDS Behav 2017; 21:1975-1984. [PMID: 27942999 DOI: 10.1007/s10461-016-1634-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Algorithm-based treatments (AT) may be an effective clinical tool to aid HIV clinicians in prescribing pharmacotherapy to increase smoking cessation among people living with HIV (PLWH). Initial results from AT indicated significant increases in abstinence self-efficacy and medication utilization and declines in cigarettes smoked per day across time. Given historical racial disparities, it is unclear if both African Americans and White smokers would benefit equally from this type of intervention. Thus, the aim of this study was to examine racial differences in response to AT guided smoking cessation for African American and White smokers living with HIV. One hundred PLWH smokers (n = 100) were randomized to receive either AT guided smoking cessation or Treatment as Usual (TAU) which consisted of instructing participants to talk to a provider about smoking cessation assistance when ready to make a quit attempt. Participants were African American (75%) and White (25%) and majority men (71%) who had never been married (56%). African Americans smoked fewer cigarettes and were more likely to smoke mentholated cigarettes compared to White smokers at baseline. African Americans increased their use of other tobacco products (cigars/cigarillos) over time relative to White smokers. A significant interaction between race and quit goal was observed, with White smokers who reported complete abstinence as their goal having higher quit rates, while African Americans who reported a goal other than complete abstinence demonstrating higher quit rates. The increased use of cigars/cigarillos during quit attempts as well as having a goal other than complete abstinence should be considered when applying algorithm based interventions for PLWH African American smokers.
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Affiliation(s)
- Pamela Valera
- Division of Social Solutions and Services Research, The Nathan Kline Institute for Psychiatric Research and Department of Psychiatry, New York University School of Medicine, 140 Old Orangeburg Rd, Orangeburg, NY, 10962, USA
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Addiction Division, Duke University School of Medicine, 2628 Erwin Rd, Durham, NC, 27707, USA
| | - Greer Burkholder
- Department of Internal Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, 1900 University Boulevard, THT 229, Birmingham, AL, 35294, USA
| | - Michael J Mugavero
- Department of Internal Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, 1900 University Boulevard, THT 229, Birmingham, AL, 35294, USA
| | - James Willig
- Department of Internal Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, 1900 University Boulevard, THT 229, Birmingham, AL, 35294, USA
| | - Conall O'Cleirigh
- Department of Psychiatry, Behavioral Medicine, Massachusetts General Hospital/Harvard Medical School, 1 Bowdoin Square, Boston, MA, 02114, USA
| | - Karen L Cropsey
- Department of Psychiatry & Behavioral Neurobiology, University of Alabama at Birmingham, 1720 2nd Ave S., Birmingham, AL, 35294-0017, USA.
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Okoli CTC, Anand V, Khara M. A Retrospective Analysis of the Outcomes of Smoking Cessation Pharmacotherapy Among Persons With Mental Health and Substance Use Disorders. J Dual Diagn 2017; 13:21-28. [PMID: 28166473 DOI: 10.1080/15504263.2017.1290860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES It is common practice to individualize smoking cessation pharmacotherapy based on clinical judgment and patient response. However, little has been documented about the use and outcomes of smoking cessation pharmacotherapy in real-world settings. This study examines factors associated with using smoking cessation pharmacotherapy and related outcomes among smokers with psychiatric and/or substance use disorders who completed an intensive tobacco treatment program within mental health and addiction services settings in Vancouver, Canada. METHODS A retrospective analysis was used to examine combined program participation data (N = 889) from two tobacco treatment programs (i.e., the Tobacco Dependence Clinic and the Butt Out group) between September 2007 and July 2013. Changes in smoking cessation pharmacotherapy from the initial to final treatment and seven-day point prevalence of smoking abstinence (verified by expired carbon monoxide) were assessed at the end of treatment. RESULTS During treatment, 60% of participants remained on the initial pharmacotherapy plan, 30% received adjunctive treatment, and 10% had treatment plans that were switched. Those whose pharmacotherapy was switched had higher cigarette consumption and nicotine dependence at baseline and were less likely to have a psychiatric disorder history. When comparing between pharmacotherapy groups, individuals who switched medications were less likely to achieve abstinence at the end of treatment as compared to those whose medication treatment plans remained the same or who received adjunctive treatment (unchanged = 36.8%, adjunctive = 38.1% vs. switched = 20.9%, χ2 = 9.59, df = 2, p = .008). In multivariate regression analysis, switching pharmacotherapy was associated with lower smoking cessation (OR = .33, 95% CI [.17, .63]) and significantly mediated the effectiveness of pharmacotherapy. As there were differences in medication switching rates at the clinical level, there were limitations in assessing the impact of mental illness or substance use disorder variables. CONCLUSIONS At least 40% of individuals may have their smoking cessation pharmacotherapy plan changed during treatment. Switching pharmacotherapy may indicate a subgroup of smokers characterized by greater challenges in smoking cessation. Our findings may enhance algorithms for using smoking cessation pharmacotherapy in clinical practice and provide directions for future research in treating tobacco use disorder among individuals with mental health and substance use disorders.
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Affiliation(s)
| | - Vivek Anand
- b East Carolina University, Brody School of Medicine , Greenville , North Carolina , USA
| | - Milan Khara
- c Tobacco Dependence Clinic, Vancouver Coastal Health Authority , Vancouver , British Columbia , Canada
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Mooney ME, Schmitz JM, Allen S, Grabowski J, Pentel P, Oliver A, Hatsukami DK. Bupropion and naltrexone for smoking cessation: A double-blind randomized placebo-controlled clinical trial. Clin Pharmacol Ther 2016; 100:344-52. [PMID: 27213949 DOI: 10.1002/cpt.402] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 05/12/2016] [Accepted: 05/16/2016] [Indexed: 11/06/2022]
Abstract
Combination of non-nicotine pharmacotherapies has been underexamined for cigarette smoking cessation. A randomized, double-blind, parallel-group double-dummy study evaluated two medications, bupropion (BUP) and naltrexone (NTX), in treatment-seeking cigarette smokers (N = 121) over a 7-week treatment intervention with 6-month follow-up. Smokers were randomized to either BUP (300 mg/day) + placebo (PBO) or BUP (300 mg/day) + NTX (50 mg/day). The primary outcome was biochemically verified (saliva cotinine, carbon monoxide) 7-day, point-prevalence abstinence. BUP + NTX was associated with significantly higher point-prevalence abstinence rates after 7-weeks of treatment (BUP + NTX, 54.1%; BUP + PBO, 33.3%), P = 0.0210, but not at 6-month follow-up (BUP + NTX, 27.9%; BUP + PBO, 15.0%), P = 0.09. Continuous abstinence rates did not differ, P = 0.0740 (BUP + NTX, 26.2%; BUP + PBO, 13.3%). Those receiving BUP + NTX reported reduced nicotine withdrawal, P = 0.0364. The BUP + NTX combination was associated with elevated rates of some side effects, but with no significant difference in retention between the groups.
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Affiliation(s)
- M E Mooney
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA.
| | - J M Schmitz
- Department of Psychiatry and Behavioral Sciences, University of Texas, Houston, Houston, Texas, USA
| | - S Allen
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA
| | - J Grabowski
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA
| | - P Pentel
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA
| | - A Oliver
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA
| | - D K Hatsukami
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA
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16
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Cropsey KL, Jardin B, Burkholder G, Clark CB, Raper JL, Saag M. An Algorithm Approach to Determining Smoking Cessation Treatment for Persons Living With HIV/AIDS: Results of a Pilot Trial. J Acquir Immune Defic Syndr 2015; 69:291-8. [PMID: 26181705 PMCID: PMC4505746 DOI: 10.1097/qai.0000000000000579] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Smoking now represents one of the biggest modifiable risk factors for disease and mortality in people living with HIV (PLHIV). To produce significant changes in smoking rates among this population, treatments will need to be both acceptable to the larger segment of PLHIV smokers and feasible to implement in busy HIV clinics. The purpose of this study was to evaluate the feasibility and effects of a novel proactive algorithm-based intervention in an HIV/AIDS clinic. METHODS PLHIV smokers (N = 100) were proactively identified through their electronic medical records and were subsequently randomized at baseline to receive a 12-week pharmacotherapy-based algorithm treatment or treatment as usual. Participants were tracked in-person for 12 weeks. Participants provided information on smoking behaviors and associated constructs of cessation at each follow-up session. RESULTS The findings revealed that many smokers reported using prescribed medications when provided with a supply of cessation medication as determined by an algorithm. Compared with smokers receiving treatment as usual, PLHIV smokers prescribed these medications reported more quit attempts and greater reduction in smoking. Proxy measures of cessation readiness (eg, motivation, self-efficacy) also favored participants receiving algorithm treatment. CONCLUSIONS This algorithm-derived treatment produced positive changes across a number of important clinical markers associated with smoking cessation. Given these promising findings coupled with the brief nature of this treatment, the overall pattern of results suggests strong potential for dissemination into clinical settings and significant promise for further advancing clinical health outcomes in this population.
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Affiliation(s)
- Karen L. Cropsey
- University of Alabama at Birmingham, Department of Psychiatry and Behavioral Neurobiology
| | | | - Greer Burkholder
- University of Alabama at Birmingham, Department of Internal Medicine, Division of Infectious Diseases
| | - C. Brendan Clark
- University of Alabama at Birmingham, Department of Psychiatry and Behavioral Neurobiology
| | - James L. Raper
- University of Alabama at Birmingham, Department of Internal Medicine, Division of Infectious Diseases
| | - Michael Saag
- University of Alabama at Birmingham, Department of Internal Medicine, Division of Infectious Diseases
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17
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Varenicline-assisted smoking cessation decreases oxidative stress and restores endothelial function. Hypertens Res 2014; 37:655-8. [DOI: 10.1038/hr.2014.52] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 12/19/2013] [Accepted: 01/25/2014] [Indexed: 01/14/2023]
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18
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A Retrospective Review of Pilot Outcomes from an Out-patient Tobacco Treatment Programme Within Cardiology Services. J Smok Cessat 2014. [DOI: 10.1017/jsc.2013.40] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction: Due to the challenging nature of tobacco addiction, individuals with cardiac conditions often continue to smoke at high rates (up to 62%), even after experiencing life-threatening events.Aims: This study examines pilot outcomes of a longitudinal Smoking Cessation Clinic (SCC) within cardiology services.Methods: This study is based on a retrospective review of the charts of 117 participants of the SCC (between September 2010 and May 2012). The main outcome of interest is self-reported 7-day point-prevalence of smoking abstinence verified by expired CO level. A secondary outcome was smoking reduction, defined as consuming 50% (or lower) than the baseline number cigarettes in the past week.Results: Thirty-five per cent of participants achieved smoking cessation, whereas 42.1% reduced their cigarette consumption. In multivariate regression analyses, salient predictors of smoking cessation included being male and a greater length of visiting the smoking cessation clinic.Conclusions: Providing evidence-based approaches to tobacco treatment within cardiology services is feasible and well received by patients with cardiac and other co-morbidity. The modest outcomes from this pilot study support the need for tobacco treatment in hospital cardiology settings. Such interventions may aid in reducing the disproportionate burden of tobacco-related disease among smokers with medical co-morbidity.
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19
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Harrington KF, Bailey WC. Smoking cessation through the utilization of pharmacotherapy. Expert Rev Respir Med 2014; 3:475-85. [DOI: 10.1586/ers.09.42] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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20
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Goel S, Kumar R, Lal P, Sharma D, Singh RJ. Refining compliance surveys to measure the smokefree status of jurisdictions using the Delphi method. Public Health Action 2013; 3:342-5. [PMID: 26393059 PMCID: PMC4463165 DOI: 10.5588/pha.13.0063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 10/22/2013] [Indexed: 11/10/2022] Open
Abstract
SETTING Compliance assessment surveys are cost-effective means of assessing smokefree status in a jurisdiction. Assigning weights to assessment criteria (indicators) can also inform law implementers and policy makers about the effectiveness of the enforcement of smokefree rules. OBJECTIVE To develop a standardised measure for compliance surveys using the Delphi method in India. DESIGN Tobacco control experts from India comprising different constituencies and jurisdictions met for a half-day workshop in August 2012 to deliberate on how weights can be assigned to criteria for smokefree status. Using the Delphi method, the relevance and ranking of criteria from an existing protocol for measuring compliance was evaluated. RESULTS Consensus was reached on all five compliance survey indicators through three rigorous rounds of discussion. The highest priority was assigned to the absence of the act of smoking in public places (33%), followed by the display of no-smoking signage in public places (32%), absence of cigarette butts or bidi stubs (15%), absence of smoking aids (10%) and absence of tobacco smoke and ash (10%). CONCLUSION Tobacco control advocates can effectively inform local policy makers using weights that prioritise directed enforcement and targeted interventions, which in turn will ensure stronger compliance and sustainable smokefree settings.
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Affiliation(s)
- S Goel
- School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Kumar
- International Union Against Tuberculosis and Lung Disease South-East Asia Regional Office, New Delhi, India
| | - P Lal
- International Union Against Tuberculosis and Lung Disease South-East Asia Regional Office, New Delhi, India
| | - D Sharma
- School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R J Singh
- International Union Against Tuberculosis and Lung Disease South-East Asia Regional Office, New Delhi, India
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Rajendiran S, Kashyap MV, Vishwanatha JK. Intersection of Smoking, Human immunodeficiency virus/acquired immunodeficiency syndrome and Cancer: Proceedings of the 8(th) Annual Texas Conference on Health Disparities. J Carcinog 2013; 12:18. [PMID: 24227993 PMCID: PMC3814655 DOI: 10.4103/1477-3163.119388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 07/20/2013] [Indexed: 11/04/2022] Open
Abstract
The Texas Center for Health Disparities, a National Institute on Minority Health and Health Disparities Center of Excellence, presents an annual conference to discuss prevention, awareness education and ongoing research about health disparities both in Texas and among the national population. The 2013 Texas Conference on Health Disparities brought together experts, in research, patient care and community outreach, on the "Intersection of Smoking, Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and Cancer". Smoking, HIV/AIDS and cancer are three individual areas of public health concern, each with its own set of disparities and risk factors based on race, ethnicity, gender, geography and socio-economic status. Disparities among patient populations, in which these issues are found to be comorbid, provide valuable information on goals for patient care. The conference consisted of three sessions addressing "Comorbidities and Treatment", "Public Health Perspectives", and "Best Practices". This article summarizes the basic science, clinical correlates and public health data presented by the speakers.
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Affiliation(s)
- Smrithi Rajendiran
- Texas Center for Health Disparities and The Institute for Cancer Research, UNT Health Science Center, Fort Worth, Texas, USA
| | | | - Jamboor K. Vishwanatha
- Texas Center for Health Disparities and The Institute for Cancer Research, UNT Health Science Center, Fort Worth, Texas, USA,Corresponding author
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Umeda A, Kato T, Yamane T, Yano H, Ieiri T, Miyagawa K, Takeda H, Okada Y. Does smoking cessation with varenicline worsen vascular endothelial function? BMJ Open 2013; 3:bmjopen-2013-003052. [PMID: 23794597 PMCID: PMC3693419 DOI: 10.1136/bmjopen-2013-003052] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES A meta-analysis suggested that the use of varenicline, which is a partial agonist of nicotinic acetylcholine receptors and is effective in smoking cessation, increases the risk of cardiovascular events within 52 weeks of starting treatment. Defining these events as occurring during drug treatment (usually for 12 weeks) or within 30 days of discontinuation, another meta-analysis showed that the risk was statistically insignificant. In the present study, we aimed to clarify the effect of varenicline-assisted smoking cessation on vascular endothelial function assessed by flow-mediated vasodilation (FMD). DESIGN Before-after and time-series. SETTING Tochigi Prefecture, Japan. PARTICIPANTS Data of 85 participants who visited nicotine-dependent outpatient services were reviewed. FMD was repeatedly measured in 33 of the 85 participants. INCLUSION CRITERIA 20 years and older, Brinkman index ≥200, Tobacco Dependence Screener ≥5 and stated motivation to quit smoking. INTERVENTIONS Each participant was treated with varenicline titrated up to 1.0 mg twice daily (for 12 weeks in total). PRIMARY AND SECONDARY OUTCOME MEASURES Participants were evaluated by FMD prior to, and 3 months after, complete smoking cessation. Follow-up FMD measurements were carried out every 3 months if possible. Changes in FMD during varenicline use were also evaluated. RESULTS FMD was significantly increased from 4.0±1.8% to 5.5±2.2% (p<0.01, n=22) 3 months after complete cessation. Although the timecourse of FMD in most of the cases showed an increase with fluctuations, there was an exceptional case where FMD decreased over the 9 months following complete cessation. Although statistically insignificant, FMD also increased during varenicline use (from 3.7±2.7% to 4.3±2.8%, n=11). CONCLUSIONS Our observations suggest that in ceasing smokers, varenicline and smoking cessation do not lead to a worsening of the vascular endothelial function. TRIAL REGISTRATION FK-79 (International University of Health and Welfare).
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Affiliation(s)
- Akira Umeda
- Department of Internal Medicine, International University of Health and Welfare Shioya Hospital, Tochigi, Japan
| | - Toru Kato
- Department of Clinical Research, National Hospital Organization Tochigi Medical Center, Tochigi, Japan
| | - Tateki Yamane
- Department of Internal Medicine, International University of Health and Welfare Shioya Hospital, Tochigi, Japan
| | - Heiichi Yano
- Department of Internal Medicine, International University of Health and Welfare Shioya Hospital, Tochigi, Japan
| | - Tamio Ieiri
- Department of Internal Medicine, International University of Health and Welfare Shioya Hospital, Tochigi, Japan
| | - Kazuya Miyagawa
- Department of Pharmacology, School of Pharmacy, International University of Health and Welfare, Tochigi, Japan
| | - Hiroshi Takeda
- Department of Pharmacology, School of Pharmacy, International University of Health and Welfare, Tochigi, Japan
| | - Yasumasa Okada
- Department of Internal Medicine, National Hospital Organization Murayama Medical Center, Tokyo, Japan
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23
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Hughes JR. An updated algorithm for choosing among smoking cessation treatments. J Subst Abuse Treat 2013; 45:215-21. [PMID: 23518288 DOI: 10.1016/j.jsat.2013.01.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 01/03/2013] [Accepted: 01/28/2013] [Indexed: 10/27/2022]
Abstract
Although meta-analyses have documented the efficacy of treatments for smoking cessation, and guidelines have outlined treatment elements, few algorithms for choosing among treatments have been described. The current algorithm updates the author's prior algorithm. The major decisions in the algorithm are (a) use a motivational treatment if the smoker is not currently interested in quitting, (b) assess factors that influence choice of treatment, (c) consider both gradual and abrupt cessation, (d) use combined patch+gum/inhaler/lozenge or varenicline as first line medications, (e) use individual, group, Internet, and phone counseling as first line psychosocial treatments, and (f) continue treatment after a lapse or relapse. Further research is needed to determine whether algorithms improve treatment outcomes.
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Affiliation(s)
- John R Hughes
- Department of Psychiatry, University of Vermont, Burlington, VT, USA.
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24
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Ward KD, Kedia S, Webb L, Relyea GE. Nicotine dependence among clients receiving publicly funded substance abuse treatment. Drug Alcohol Depend 2012; 125:95-102. [PMID: 22542293 DOI: 10.1016/j.drugalcdep.2012.03.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Revised: 02/26/2012] [Accepted: 03/26/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Smoking and nicotine dependence (ND) are prevalent among substance abusers but little is known about characteristics of ND in this population. This information would help identify those most in need of smoking cessation programs. This study evaluated the associations of socio-demographic, tobacco- and substance use-related, and health/mental health factors to ND in adults receiving publicly funded substance abuse treatment in Tennessee. METHODS All Tennessee residents who received federal block grant-funded substance abuse treatment during July-December, 2004 were invited to participate in a 6 month post-intake telephone follow-up interview. Socio-demographic characteristics, perceived health and mental health, tobacco use history and patterns, and ND, assessed by the Fagerstrom Test of Nicotine Dependence (FTND), were obtained at follow-up. Alcohol and illicit drug use and smoking status prior to treatment were assessed at intake. This paper analyzes data for 855 clients who were current cigarette smokers at both intake and follow-up. RESULTS Sixty three percent of smokers were ND (FTND score ≥ 4). Correlates of ND included older age, poorer self-rated overall health, earlier age of onset of cigarette smoking and substance abuse, fewer smoking quit attempts in past year, single substance use (alcohol or illicit drug, vs. multiple substances) at intake, use of opiates/narcotics and sedatives, and past month self-reported depression. CONCLUSION ND was highly prevalent and correlated with specific types and patterns of substance abuse and depression. These results suggest that intensive smoking cessation interventions, involving behavioral support, pharmacotherapy, and mood management, are needed to effectively assist this population.
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Affiliation(s)
- Kenneth D Ward
- School of Public Health, The University of Memphis, Memphis, TN, United States.
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Abstract
Given the vast health and socioeconomic effects of tobacco use, smoking cessation is no longer a topic reserved for the primary care physician. As a modifiable risk factor that can lead to stroke, dementia, multiple sclerosis, and other neurologic diseases, cigarette smoking should be addressed by all health care providers, including neurologists. Counseling, nicotine replacement therapies, and other medications are the mainstays of treatment. However, even brief advice from a health care professional at the end of a routine office visit can increase a patient's chances of quitting. Armed with a better understanding of smoking's effect on neurologic disease and available resources, such as toll-free quit lines and Web-based interventions, neurologists can help their patients who smoke take the first step to successful cessation.
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Affiliation(s)
- Jinny Tavee
- Neuromuscular Center, Cleveland Clinic Foundation, Cleveland, OH
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26
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Etter JF, Schneider NG. An internet survey of use, opinions and preferences for smoking cessation medications: nicotine, varenicline, and bupropion. Nicotine Tob Res 2012; 15:59-68. [PMID: 22529220 DOI: 10.1093/ntr/nts084] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION We assessed use, compliance and preferences among smoking cessation medications in a "real world" sample of current and former smokers. METHODS Internet survey on a smoking cessation website (French/English, 2008-2010) to assess use of nicotine replacement therapies (NRT), varenicline, and bupropion. RESULTS There were 885 participants (39% current smokers, 61% former smokers), the majority of the sample (70%) was female. The most frequently used medications were, in order: patches (40%), varenicline (23%), nicotine gum (16%), nicotine lozenge/tablet (10%), bupropion (8%), and inhaler (3%). Satisfaction, perceived relief of craving/withdrawal and effectiveness were best for varenicline and lowest for gum. In current users, duration of use was longest for gum (121 days), lozenge/tablet (152 days) and shortest for patch (25 days). Daily use was good for lozenge (9 pieces/day) but less than recommended for gum (6 pieces/day) and inhaler (2 plugs/day). People who tried more than 1 medication found varenicline more effective and satisfactory than NRT or bupropion; and users preferred patch to gum. By smoking status, former smokers had more education, reported greater use of medications (daily, over time) and reported more satisfaction with medications than current smokers. CONCLUSIONS An Internet survey showed smoking cessation medications differed significantly in perceived effectiveness, satisfaction, and smoking status (former vs. current smoking). Except for lozenge/tablet, insufficient daily use remained a problem with acute NRTs. For all medications, improving outcome may require better instruction for proper use, approval of new indications (precessation) or development of new medications that bypass compliance issues that undermine success.
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Affiliation(s)
- Jean-François Etter
- Institute of Social and Preventive Medicine, Faculty of Medicine, University of Geneva, Switzerland.
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27
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Cosci F, Pistelli F, Lazzarini N, Carrozzi L. Nicotine dependence and psychological distress: outcomes and clinical implications in smoking cessation. Psychol Res Behav Manag 2011; 4:119-28. [PMID: 22114542 PMCID: PMC3218785 DOI: 10.2147/prbm.s14243] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Nicotine dependence is characteristically a chronic and relapsing disease. Although 75%-85% of smokers would like to quit, and one-third make at least three serious lifetime attempts, less than 50% of smokers succeed in stopping before the age of 60. Relevant and complex factors contributing to sustained cigarette consumption, and strongly implicated in the clinical management of smokers, are the level of nicotine dependence and psychological distress. In this review of the literature, these two factors will be examined in detail to show how they may affect smoking cessation outcome and to encourage clinicians to assess patients so they can offer tailored support in quitting smoking.
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Affiliation(s)
| | - Francesco Pistelli
- University Unit of Pulmonology and Respiratory Pathophysiology, Cardiothoracic Department, University Hospital of Pisa, Pisa, Italy
| | | | - Laura Carrozzi
- University Unit of Pulmonology and Respiratory Pathophysiology, Cardiothoracic Department, University Hospital of Pisa, Pisa, Italy
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28
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Willemsen MC, van der Meer RM, Schippers GM. Smoking cessation quitlines in Europe: matching services to callers' characteristics. BMC Public Health 2010; 10:770. [PMID: 21167063 PMCID: PMC3020686 DOI: 10.1186/1471-2458-10-770] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 12/18/2010] [Indexed: 11/16/2022] Open
Abstract
Background Telephone quitlines offer a wide range of services to callers, including advice and counsel, and information on pharmacotherapy for smoking cessation. But, little is known about what specific quitline services are offered to smokers and whether these services are appropriately matched to characteristics of smokers. This study examines how quitline services are matched to callers' level of addiction, educational level, stage-of-change with quitting, and whether they are referred by a doctor or other health professional. Methods Between February 2005 and April 2006, 3,585 callers to seven European quitlines responded to our survey. During the course of and immediately after the call, quitline counsellors collected descriptive data on callers' characteristics and the services they used. We then conducted four logistic regression analyses to examine the relationship between quitline services and the four caller characteristics. Results Forty three percent of all callers received information on pharmacotherapy - most often nicotine patches and nicotine gum - from the counsellor. As we predicted, these callers were the heavy smokers. There was a direct correlation between the length of the conversations between the counsellor and the educational level of the smoker: the lower the education of the smoker, the shorter the call. However, we found no significant association between any other type of service and the educational level of caller. We also found a correlation between the smoker's stage of quitting and the type of advice a counsellor gives. Smokers in the action stage of quitting were more likely to receive advice (in two quitlines) or counselling (in two quitlines) than those in the preparation stage, who were less likely to be referred (in three quitlines). Very few of the total number of calls (10.7%) were from referrals by health professionals. Referred callers were more likely to receive counselling, but this was found only in four of seven quitlines. Conclusion Most of the services quitlines offer to smokers favour heavy smokers and those at a more advanced stage of cessation, but not based on their educational level. Thus, we recommend that European quitlines extend and tailor their services to include less-educated smokers.
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Affiliation(s)
- Marc C Willemsen
- STIVORO, Dutch Expert Centre on Tobacco Control, The Hague, The Netherlands.
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Abstract
Cigarette smoking represents the most important source of preventable morbidity and premature mortality worldwide. Approximately 100 million deaths were caused by tobacco use in the 20th century. There are >1 billion smokers worldwide, and globally the use of tobacco products is increasing, with the epidemic shifting to the developing world. Tobacco dependence is a chronic condition that often requires repeated intervention for success. Just informing a patient about health risks, although necessary, is usually not sufficient for a decision to change. Smokers should be provided with counseling when attempting to quit. Pharmacologic smoking cessation aids are recommended for all smokers who are trying to quit, unless contraindicated. Evidence-based guidelines recommend nicotine replacement therapy, bupropion SR, and varenicline as effective alternatives for smoking cessation therapy, especially when combined with behavioral interventions. Combination pharmacotherapy is indicated for highly nicotine-dependent smokers, patients who have failed with monotherapy, and patients with breakthrough cravings. An additional form of nicotine replacement therapy or an addition of a non-nicotine replacement therapy oral medication (bupropion or varenicline) may be helpful. The rate of successful smoking cessation at 1 year is 3% to 5% when the patient simply tries to stop, 7% to 16% if the smoker undergoes behavioral intervention, and up to 24% when receiving pharmacological treatment and behavioral support.
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Schnoll RA, Martinez E, Tatum KL, Glass M, Bernath A, Ferris D, Reynolds P. Nicotine patch vs. nicotine lozenge for smoking cessation: an effectiveness trial coordinated by the Community Clinical Oncology Program. Drug Alcohol Depend 2010; 107:237-43. [PMID: 20004065 PMCID: PMC2834192 DOI: 10.1016/j.drugalcdep.2009.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Revised: 11/02/2009] [Accepted: 11/06/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nicotine replacement therapies are efficacious for treating nicotine dependence. However, limited data exist on benefits of different NRTs and predictors of treatment outcome. This study compared the effectiveness of transdermal nicotine vs. nicotine lozenge for smoking cessation and identified predictors of treatment response. METHODS A randomized, open-label effectiveness trial was conducted at 12 medical sites participating in the National Cancer Institute's Community Clinical Oncology Program. The sample consisted of 642 treatment-seeking smokers randomized to 12 weeks of transdermal nicotine or nicotine lozenge. RESULTS Smoker characteristics were assessed at baseline, and 24-h point prevalence abstinence confirmed with breath carbon monoxide (CO) was evaluated at end of treatment (EOT) and at a 6-month follow-up. There was a trend for higher quit rates for transdermal nicotine vs. nicotine lozenge at EOT (24.3% vs. 18.7%, p=.10) and 6 months (15.6% vs. 10.9%, p=.10). A logistic regression model of EOT quit rates showed smokers who preferred transdermal nicotine, were not reactive to smoking cues, and did not use nicotine to alleviate distress or stimulate cognitive function had higher quit rates on transdermal nicotine. A logistic regression model of 6-month quit rates showed smokers who preferred transdermal nicotine had higher quit rates on transdermal nicotine, and smokers who used nicotine to alleviate distress or stimulate cognitive processes had lower quit rates on nicotine lozenge. CONCLUSIONS Transdermal nicotine may be more effective than nicotine lozenge for smokers who prefer transdermal nicotine and do not smoke to alleviate emotional distress or stimulate cognitive function.
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Affiliation(s)
- Robert A. Schnoll
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 4 Floor, Philadelphia, PA, 19104
| | - Elisa Martinez
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 4 Floor, Philadelphia, PA, 19104
| | - Kristina L. Tatum
- Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111
| | - Marcella Glass
- Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111
| | - Albert Bernath
- Geisinger Medical Center, 100 North Academy Road, Danville, PA 17822
| | - Daron Ferris
- Department of Family Medicine and Obstetrics and Gynecology, Medical College of Georgia, 1120 15 St, HH-105, Augusta GA 30912
| | - Patrick Reynolds
- Mt. Sinai Medical Center, 4306 Alton Road, Mt. Sinai CCC, Miami Beach, FL 33140
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Laniado-Laborín R. Smoking and chronic obstructive pulmonary disease (COPD). Parallel epidemics of the 21 century. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2009; 6:209-24. [PMID: 19440278 PMCID: PMC2672326 DOI: 10.3390/ijerph6010209] [Citation(s) in RCA: 190] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Accepted: 01/07/2009] [Indexed: 11/16/2022]
Abstract
One hundred million deaths were caused by tobacco in the 20(th) century, and it is estimated that there will be up to one billion deaths attributed to tobacco use in the 21(st) century. Chronic obstructive pulmonary disease (COPD) is rapidly becoming a global public health crisis with smoking being recognized as its most important causative factor. The most effective available treatment for COPD is smoking cessation. There is mounting evidence that the rate of progression of COPD can be reduced when patients at risk of developing the disease stop smoking, while lifelong smokers have a 50% probability of developing COPD during their lifetime. More significantly, there is also evidence that the risk of developing COPD falls by about half with smoking cessation. Several pharmacological interventions now exist to aid smokers in cessation; these include nicotine replacement therapy, bupropion, and varenicline. All pharmacotherapies for smoking cessation are more efficacious than placebo, with odds ratios of about 2. Pharmacologic therapy should be combined with nonpharmacologic (behavioral) therapy. Unfortunately, despite the documented efficacy of these agents, the absolute number of patients who are abstinent from smoking at 12 months of follow-up is low.
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