Six-month contingency management effects on smoking cessation in individuals with substance use disorders

Introduction

Persons with substance use disorders (SUD) smoke at strikingly high rates and tobacco use cessation rates are notably low in this population. Contingency Management (CM) is effective to promote substance abstinence, including tobacco, in a large range of populations. CM is scarcely implemented in clinical settings mainly due to barriers at the therapist and organizational levels.

Objectives

The study sought to examine the additive effectiveness of CM on Cognitive-Behavioral Therapy (CBT) over long-term smoking abstinence in persons undergoing SUD treatment.

Methods

A total of 54 smokers (75.9% males, M_age=46.19, SD=9.21) were randomly assigned to CBT (n=30) or to CBT+CM (n=24). Interventions consisted of eight weeks of group-based therapy. Participants were instructed to gradually reduce their nicotine intake by 20% weekly. The CM arm was voucher-based, and the primary outcome was biochemically verified tobacco abstinence (CO≤4ppm, and urine cotinine≤80ng/ml).

Results

A total of 42/54 (77.78%) participants completed the treatment (73.33% in CBT and 83.33% in CBT+CM; p=.380). At the end of treatment, participants in CBT+CM showed higher 24-hour smoking abstinence (50% vs. 20%, p=.032); however, both treatment conditions show equal abstinence rates in the remaining follow-ups (CBT_1month= 13.33% vs. CBT+CM_1month= 25%; CBT_2months= 10% vs. CBT+CM_2months= 16.66%; CBT_3months= 10% vs. CBT+CM_3months= 16.66%; CBT_6months= 10% vs. CBT+CM_6months= 8.33%; all p-values ≥ .244).

Conclusions

CM facilitates early abstinence outcomes in smokers with SUD more than CBT only does. However, no additive effects of CM were observed at long-term, suggesting the convenience to intensify CM schedules or using technology platforms for incentives delivery.

Disclosure

No significant relationships.

Predictors of smoking cessation treatment attrition in individuals with substance use disorders

Introduction

Attrition rates in smoking cessation treatments are high, particularly in persons with substance use disorders. It is estimated that about 55%% disengage prematurely at treatment, meaning that a large portion will not benefit from smoking abstinence. So far, no previous studies have examined predictors of dropouts in a smoking cessation treatment with persons with SUD.

Objectives

The study was two-fold: 1) to analyze the percentage of early-, late-dropouts and completers, and 2) to examine sociodemographic, psychological, and substance-related predictors of dropouts.

Methods

A total of 86 participants (69.8% males; M_age=43.84, SD=9.917) were randomly assigned to two psychological smoking cessation treatment: cognitive-behavioral treatment (CBT) (n=51) or CBT + contingency management (CM) (n=35). Interventions were delivered during eight consecutive weeks

Results

Of the 86 participants who completed the baseline assessment, 21 did not start treatment, 17 dropped out of treatment during treatment, and the remaining 48 completed the treatment. Predictors of early-dropout were younger age (B=-.234; p=.024; OR=.792) and lower number of days in SUD treatment (B= -.005; p=.026; OR=.995). Patients’ primary substance of use was associated with reduced early-dropouts; compared to cocaine users, alcohol (B=-1.827; p=.043; OR=.161) and opioids (B=-3.408; p=.018; OR=.033) related to improved attrition. Late dropout was directly related to higher number of tobacco use cessation attempts (B=.407; p=.039; OR=1.502).

Conclusions

Incorporating strategies to improve attendance and completion rates in SUD populations should be a priority. Mobile reminders, offering online therapies, or CM to reinforce attendance to therapy may be considered.

Disclosure

No significant relationships.

In-treatment behaviors in a multicomponent intervention to promote smoking cessation and prevent weight gain among smokers with obesity: A pilot study

Introduction

Smoking rates are quite high among overweight and obese individuals. Many smokers with excess weight are at increased risk for health complications and report that concern about post-cessation weight gain is a barrier to quitting. It is necessary to perform studies to assess the efficacy of interventions for smoking cessation among individuals with excess weight.

Objectives

To describe in-treatment behaviors, in terms of smoking and weight, in an integrated intervention for smoking cessation and weight gain management.

Methods

A total of 16 smokers (37.5% females, M_age=52.31, SD=9.58) were randomly assigned to one of the two following 8-week smoking cessation conditions: 1) Cognitive-Behavioral Treatment (CBT) for gradual smoking cessation + a Weight Gain Prevention (WGP) module for weight stability (n=7); 2) the same treatment alongside Contingency Management (CM) for smoking abstinence (n=9). Smoking behavior (cigarettes per day, carbon monoxide (CO) in expired air and urine cotinine) and weight were tracked at every visit from baseline through the end of treatment.

Results

Cigarettes per day significantly decreased in both conditions (p≤.028), as well as CO (p≤.018) and cotinine (p≤.043). Regarding body weight gain, participants maintained their body weight (Kg) from baseline to the end of treatment (CBT+WGP: Δ_kg= .671, CBT+WGP+CM: Δ_kg= .667, p≥.058) and their BMI (CBT+WGP: 30.56 vs. 30.85, CBT+WGP+CM: 29.74 vs. 29.85, p≥.139).

Conclusions

Preliminary data indicated that a multicomponent intervention to promote gradual smoking cessation and prevent weight gain facilitates in-treatment tobacco reduction and weight stability. CM procedures improved in-treatment smoking behaviors.

Disclosure

No significant relationships.

Prevalence, Incidence, and Progression of Erosive Tooth Wear and Their Respective Risk Factors Among Schoolchildren in Mexico City

Purpose: To evaluate the cumulative incidence and progression of erosive tooth wear (ETW) and identify risk factors over 18 months in a cohort of 11- to 14-year-old schoolchildren in Mexico. Methods: The study was conducted in public schools located in northern Mexico City. Permanent teeth of 424 schoolchildren were examined using the basic erosive wear examination. The possible risk factors were included in the logistic models: the consumption of acidic food and beverages; habits related to the consumption of beverages; medication; gastroesophageal reflux; frequent vomiting; and characteristics of the saliva. Results: The prevalence of ETW was 62.5 percent (265 out of 424). The cumulative incidence was 35.2 percent (56 out of 159) and the progression was 72.8 percent (193 out of 265). The consumption of acidic beverages increased the relative risk (RR) of both the cumulative incidence (RR equals 1.09; 95 percent confidence interval [95% CI] 1.02 to 1.18; P=0.005) and the progression (RR equals 1.16; 95% CI 1.01 to 1.34; P=0.003). Conclusions: This population has a high risk of the development and progression of ETW, found in approximately one-third and approximately two-thirds of the schoolchildren, respectively. The most important risk factor was the consumption of acidic beverages.

In-treatment cigarette demand among treatment-seeking smokers with depressive symptoms

INTRODUCTION

Despite previous evidence supporting the use of the Cigarette Purchase Task (CPT) as a valid tool for assessing smoking reinforcement, research assessing how environmental changes affect CPT performance is scarce.

AIMS

This study addressed for the first time the differential effect of treatment condition [Cognitive Behavioral Treatment (CBT) + Behavioral Activation (BA) versus CBT + BA + Contingency Management (CM)] on cigarette demand among treatment seeking smokers with depressive symptoms. It also sought to assess whether reductions in smoking consumption arranged over the course of an intervention for smoking cessation impact on in-treatment cigarette demand.

METHOD

Participants were 92 smokers with depressive symptoms from a randomized clinical trial that received eight weeks of either CBT + BA or CBT + BA + CM. Individuals completed the CPT 8 times; the first during the intake visit and the remaining 7 scheduled once a week in midweek sessions. Cotinine samples were collected in each session.

RESULTS

Participants receiving CBT + BA + CM showed higher reduction in cigarette demand across sessions than participants receiving CBT + BA, although this comparison was only significant for the intensity index (p = .004). Cotinine was positively related to cigarette demand (all p values < .001), although this association became less prominent across sessions. In-treatment cotinine decreases were associated with demand reductions (all p values < .001), but this association was not significant for elasticity.

CONCLUSIONS

Reductions in nicotine intake arranged over the course of an intervention for smoking cessation impact in-treatment cigarette demand.

Self-report of gingival problems and periodontitis in indigenous and non-indigenous populations in Chiapas, Mexico

OBJECTIVE

To estimate the prevalence of self-reported gingival and periodontal conditions and their association with smoking, oral hygiene, indigenous origin, diabetes and location (urban or rural) in indigenous and non-indigenous adults in Chiapas, Mexico.

METHODS

A cross-sectional study of 1,749 persons, ≥20 years of age, living in four rural and four urban marginal localities in Comitán (Chiapas, México). The variables investigated were: age; sex; indigenous origin; oral hygiene; halitosis; chewing ability; gingival conditions; periodontitis; smoking; alcoholism; diabetes; and location. Bivariate analysis and a logistic regression model were used to identify the association of periodontitis with the independent variables.

RESULTS

In total, 762 (43.6%) indigenous and 987 (56.4%) non-indigenous persons were interviewed. Their mean age was 41 ± 14 years, 66.7% were women and 43.8% lived in rural locations. Gingival problems were reported by 68.5% and periodontitis by 8.7%. In total, 17.9% had used dental services during the previous year, 28.7% wore a removable partial or a complete dental prosthesis, 63.7% had lost at least one tooth, the prevalence of diabetes was 9.2% and the prevalence of smoking was 12.2%. The logistic regression model showed that age, diabetes and the interaction between rural location and indigenous origin were associated with the presence of periodontitis.

CONCLUSIONS

Indigenous people living in rural areas are more likely to have periodontitis. It is necessary to promote oral health practices in indigenous and marginalised populations with a focus on community-oriented primary care.