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Teixeira RS, Galil AGS, Cupertino AP, Cartujano-Barrera F, Colugnati FAB. Electronic Decision-Making Tool for Smoking Cessation (Pare de Fumar Conosco) Versus Standard of Care: A Cost-Effectiveness Analysis. Value Health Reg Issues 2024; 42:100980. [PMID: 38677062 DOI: 10.1016/j.vhri.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/13/2023] [Accepted: 01/14/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVES The study aimed to evaluate the cost-effectiveness of the Pare de Fumar Conosco software compared with the standard of care adopted in Brazil for the treatment of smoking cessation. METHODS In the cohort of smokers with multiple chronic conditions, we developed an decision tree model for the benefit measures of smoking cessation. We adopted the perspectives of the Brazilian Unified Health System and the service provider. Resources and costs were measured by primary and secondary sources and effectiveness by a randomized clinical trial. The incremental cost-effectiveness ratio (ICER) was calculated, followed by deterministic and probabilistic sensitivity analyses and deterministic and probabilistic sensitivity analyses. No willingness to pay threshold was adopted. RESULTS The software had a lower cost and greater effectiveness than its comparator. The ICER was dominant in all of the benefits examined (-R$2 585 178.29 to -R$325 001.20). The cost of the standard of care followed by that of the electronic tool affected the ICER of the benefit measures. In all probabilistic analyses, the software was superior to the standard of care (53.6%-82.5%). CONCLUSION The Pare de Fumar Conosco software is a technology that results in cost savings in treating smoking cessation.
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Affiliation(s)
- Roberta S Teixeira
- Technical Support Division, National Institute of Cardiology, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Arise G S Galil
- Faculty of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Ana Paula Cupertino
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Fernando A B Colugnati
- Faculty of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil.
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Grech J, Norman IJ, Sammut R. Exploring the smoking cessation needs of individuals with diabetes using the Information-Motivation-Behavior Skills model. Tob Prev Cessat 2024; 10:TPC-10-07. [PMID: 38313659 PMCID: PMC10831727 DOI: 10.18332/tpc/181366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/15/2024] [Accepted: 01/15/2024] [Indexed: 02/06/2024]
Abstract
INTRODUCTION Smoking cessation is an important aspect of diabetes management. Despite the increased risk for diabetes complications when smoking, evidence suggests that people living with type 1 and type 2 diabetes are less likely to quit smoking when compared to those without diabetes. Guided by the Information-Motivation-Behavioral Skills model, this study aimed to identify the needs of individuals living with type 1 and type 2 diabetes to quit smoking. METHODS A qualitative descriptive design was adopted. Semi-structured telephone interviews were held between April and June 2021, with 20 former and current Maltese smokers living with type 1 or type 2 diabetes, recruited from the diabetic clinics within the two main acute public hospitals. The interview transcriptions were analyzed using applied thematic analysis. RESULTS Individuals with diabetes need more information on the effects of smoking on diabetes to encourage cessation. Preventing diabetic complications was reported as a motivator to quit smoking. However, having diabetes was identified as a challenge to quitting. Participants welcomed the provision of health professional support for quitting smoking, identifying the need to provide smoking cessation support within diabetic clinics. The provision of information on tobacco-associated diabetic complications, by using video messages featuring former smokers' stories was also suggested. CONCLUSIONS To promote smoking cessation among individuals with diabetes, they need to be informed about how smoking affects their condition. Utilizing video messages featuring real-life stories of former smokers with diabetes who experienced tobacco-associated diabetic complications may be influential. Additionally, providing diabetes-specific intensive smoking cessation support is crucial to help them quit.
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Affiliation(s)
- Joseph Grech
- Department of Nursing, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Ian J. Norman
- Faculty of Nursing, Midwifery and Palliative Care, King’s College London, United Kingdom
| | - Roberta Sammut
- Department of Nursing, Faculty of Health Sciences, University of Malta, Msida, Malta
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3
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Melzer AC, Reese ZA, Mascarhenas L, Clancy CB, Deepak J, Gogineni H, Gesthalter Y, Hart JL. Education for Tobacco Use Disorder Treatment: Current State, Evidence, and Unmet Needs. ATS Sch 2023; 4:546-566. [PMID: 38196686 PMCID: PMC10773493 DOI: 10.34197/ats-scholar.2022-0131re] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 06/20/2023] [Indexed: 01/11/2024] Open
Abstract
Background Tobacco use is undertreated in the medical setting. One driver may be inadequate tobacco use disorder treatment (TUDT) training for clinicians in specialties treating tobacco-dependent patients. Objective We sought to evaluate the current state of TUDT training for diverse professionals and how these skills are assessed in credentialing exams. Methods We performed a focused review of current educational practices, evidence-based strategies, and accreditation exam contents focused on TUDT. Results Among medical students, participants in reviewed studies reported anywhere from 45 minutes to 3 hours of TUDT training throughout their 4-year programs, most often in the form of didactic sessions. Similarly, little TUDT training was reported at the post-graduate (residency, fellowship, continuing medical education) levels, and reported training was typically delivered as time-based (expected hours of instruction) rather than competency-based (demonstration of mastery) learning. Multiple studies evaluated effective TUDT curricula at varied stages of training. More effective curricula incorporated longitudinal sessions and active learning, such as standardized patient encounters or proctored patient visits. Knowledge of TUDT is minimally evaluated on certification exams. For example, the American Board of Internal Medicine blueprint lists TUDT as <2% of one subtopic on both the internal medicine and pulmonary exams. Conclusion TUDT training for most clinicians is minimal, does not assess competency, and is minimally evaluated on certification exams. Effective, evidence-based TUDT training incorporating active learning should be integrated into medical education at all levels, with attention paid to inclusion on subsequent certifying exams.
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Affiliation(s)
- Anne C. Melzer
- Center for Care Delivery and Outcomes
Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Division of Pulmonary, Allergy, Critical
Care, and Sleep, and
| | - Zachary A. Reese
- Division of Pulmonary, Allergy, and
Critical Care, Department of Medicine
| | - Lorraine Mascarhenas
- Department of Internal Medicine,
University of Minnesota Medical School, Minneapolis, Minnesota
| | - Caitlin B. Clancy
- Division of Pulmonary, Allergy, and
Critical Care, Department of Medicine
| | - Janaki Deepak
- Division of Pulmonary and Critical Care,
Department of Medicine, University of Maryland School of Medicine, Baltimore,
Maryland
| | - Hyma Gogineni
- Department of Pharmacy, Western University
of Health Sciences, Pomona, California
| | - Yaron Gesthalter
- Department of Pulmonary and Critical Care,
University of California San Francisco, San Francisco, California; and
| | - Joanna L. Hart
- Division of Pulmonary, Allergy, and
Critical Care, Department of Medicine
- Palliative and Advanced Illness Research
Center, and
- Department of Medical Ethics and Health
Policy, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Medicine, Corporal Michael
J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia,
Pennsylvania
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4
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Yingst JM, Carrillo M, Chan KH, Choi K, Dao J, Kulkarni P, Bordner C, Goyal N, Foulds J, Bascom R. Effectiveness of smoking cessation interventions among persons with cancer: A systematic review. Psychooncology 2023; 32:1147-1162. [PMID: 37226331 DOI: 10.1002/pon.6171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVES Continued smoking after cancer diagnosis is associated with worse outcomes, however, many persons diagnosed with cancer who smoke are unable to quit successfully. Effective interventions are needed to promote quitting in this population. The purpose of this systematic review is to understand the most effective interventions for smoking cessation among persons with cancer and to identify gaps in knowledge and methodology to suggest directions for future research. METHODS Three electronic databases (The Cochrane Central Register of Controlled trials, MEDLINE, and EMBASE) were searched for studies of smoking cessation interventions among persons with cancer, published up to 1 July 2021. Title and abstract screening, full-text review, and data extraction was completed by two independent reviewers, via Covalence software, with any discordance resolved by a third reviewer. A quality assessment was completed using the Cochrane Risk of Bias Tool Version 2. RESULTS Thirty-six articles were included in the review, including 17 randomized-controlled trials (RCTs) and 19 non-RCT studies. Of the 36 studies, 28 (77.8%) utilized an intervention that included both counseling and medication, with 24 (85.7%) providing medication to participants at no cost. Abstinence rates in the RCT intervention groups (n = 17) ranged from 5.2% to 75%, while the non-RCTs found abstinence rates ranging from 15% to 46%. Overall, studies met a mean of 2.28 out of seven quality items, ranging from 0 to 6. CONCLUSIONS Our study highlights the importance of utilizing intensive combined behavioral and pharmacological interventions for persons with cancer. While combined therapy interventions seem to be the most effective, more research is needed, as current studies have several quality issues, including the lack of biochemical verification for abstinence.
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Affiliation(s)
- Jessica M Yingst
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Penn State Cancer Institute, Hershey, Pennsylvania, USA
| | - Matthew Carrillo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | | | - Karen Choi
- Penn State Cancer Institute, Hershey, Pennsylvania, USA
- Department of Otolaryngology, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Joseph Dao
- Penn State College of Medicine, Hershey, Pennsylvania, USA
| | | | - Candace Bordner
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Neerav Goyal
- Penn State Cancer Institute, Hershey, Pennsylvania, USA
- Department of Otolaryngology, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Jonathan Foulds
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Penn State Cancer Institute, Hershey, Pennsylvania, USA
| | - Rebecca Bascom
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Penn State Cancer Institute, Hershey, Pennsylvania, USA
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
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Kuramoto DAB, Zanin LFS, Flumignan RLG, Flumignan CDQ, Reicher ME, Correia RM, Nakano LCU. Smoking cessation for peripheral arterial disease: systematic review protocol. Rev Col Bras Cir 2023; 50:e20233482. [PMID: 37075468 PMCID: PMC10508677 DOI: 10.1590/0100-6991e-20233482-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/14/2022] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND peripheral arterial disease has smoking as its main avoidable vascular risk factor. However, most studies do not focus on smoking as the main exposure variable. OBJECTIVES to assess the impact of smoking cessation interventions versus active comparator, placebo or no intervention, on peripheral arterial disease outcomes. METHODS we will use the Cochrane Handbook for Systematic Reviews of Interventions to guide whole this review process. We will consider parallel or cluster-randomised controlled trials (RCTs), quasi-RCTs, and cohort studies. We will search CENTRAL, MEDLINE, Embase, PsycINFO, LILACS and IBECS. We will also conduct a search of ClinicalTrials.gov and the ICTRP for ongoing or unpublished trials. Each research step will involve at least two independent reviewers. We will create a table, using GRADE pro GDT software, reporting the pooled effect estimates for the following outcomes: all-cause mortality, lower limb amputation, adverse events, walking distance, clinical severity, vessel or graft secondary patency, and QoL. CONCLUSIONS we will assess these outcomes according to the five GRADE considerations to assess the certainty of the body of evidence for these outcomes, and to draw conclusions about the certainty of the evidence within the review.
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Affiliation(s)
| | - Luiz Fernando Santetti Zanin
- - Universidade Federal de São Paulo, Disciplina de Cirurgia Vascular, Departamento de Cirurgia - São Paulo - SP - Brasil
| | - Ronald Luiz Gomes Flumignan
- - Universidade Federal de São Paulo, Disciplina de Cirurgia Vascular, Departamento de Cirurgia - São Paulo - SP - Brasil
| | | | - Marcello Erich Reicher
- - Universidade Federal de São Paulo, Disciplina de Cirurgia Vascular, Departamento de Cirurgia - São Paulo - SP - Brasil
| | - Rebeca Mangabeira Correia
- - Universidade Federal de São Paulo, Disciplina de Cirurgia Vascular, Departamento de Cirurgia - São Paulo - SP - Brasil
| | - Luís Carlos Uta Nakano
- - Universidade Federal de São Paulo, Disciplina de Cirurgia Vascular, Departamento de Cirurgia - São Paulo - SP - Brasil
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Klemperer EM, Streck JM, Lindson N, West JC, Su A, Hughes JR, Carpenter MJ. A systematic review and meta-analysis of interventions to induce attempts to quit tobacco among adults not ready to quit. Exp Clin Psychopharmacol 2023; 31:541-559. [PMID: 35771496 PMCID: PMC10106992 DOI: 10.1037/pha0000583] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The prevalence of past-year smoking cessation remains below 10% in the U.S. Most who smoke are not ready to quit in the near future. Cessation requires both (a) initiating a quit attempt (QA) and (b) maintaining abstinence. Most research has focused on abstinence among people already motivated to quit. We systematically reviewed interventions to promote QAs among people not motivated to quit tobacco. We searched PubMed, CENTRAL, PsycINFO, Embase, and our personal libraries for randomized trials of tobacco interventions that reported QAs as an outcome among adults not ready to quit. We screened studies and extracted data in duplicate. We pooled findings of the 25 included studies using Mantel-Haenszel random effects meta-analyses when ≥ 2 studies tested the same intervention. Most (24) trials addressed cigarettes and one addressed smokeless tobacco. Substantial heterogeneity among trials resulted in a series of small meta-analyses. Findings indicate varenicline may increase QAs more than no varenicline, n = 320; RR = 1.4, 95% CI [1.1, 1.7]; I² = 0%, and nicotine replacement therapy (NRT) may increase QAs more than no NRT, n = 2,568; RR = 1.1, 95% CI [1.02, 1.3]; I² = 0%. Pooled effects for motivational counseling, reduction counseling, and very low nicotine content cigarettes showed no clear evidence of benefit or harm. The evidence was judged to be of medium to very low certainty due to imprecision, inconsistency, and risk of bias, suggesting that further research is likely to change interpretation of our results. Findings demonstrate the need for more high-quality research on interventions to induce QAs among adults not ready to quit tobacco. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Elias M. Klemperer
- Vermont Center on Behavior & Health, Department of Psychiatry, University of Vermont
- Department of Psychological Science, University of Vermont
| | - Joanna M. Streck
- Tobacco Research & Treatment Center, Division of General Internal Medicine and Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford
| | - Julia C. West
- Vermont Center on Behavior & Health, Department of Psychiatry, University of Vermont
- Department of Psychological Science, University of Vermont
| | - Alan Su
- University of Vermont Medical Center
| | - John R. Hughes
- Vermont Center on Behavior & Health, Department of Psychiatry, University of Vermont
- Department of Psychological Science, University of Vermont
| | - Matthew J. Carpenter
- Department of Psychiatry and Behavioral Sciences & Hollings Cancer Center, Medical University of South Carolina
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Nokovitch L, Kim Y, Zrounba P, Roux PE, Poupart M, Giagnorio R, Triviaux D, Maquet C, Thollin J, Arantes N, Thomas N, Fervers B, Deneuve S. Addictions, Social Deprivation and Cessation Failure in Head and Neck Squamous Cell Carcinoma Survivors. Cancers (Basel) 2023; 15. [PMID: 36831573 DOI: 10.3390/cancers15041231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/24/2023] [Accepted: 02/07/2023] [Indexed: 02/17/2023] Open
Abstract
AIM To evaluate the evolution of addictions (tobacco and alcohol) and social precarity in head and neck squamous cell carcinoma survivors when these factors are addressed from the time of diagnosis. METHODS Addictions and social precarity in patients with a new diagnosis of HNSCC were assessed through the EPICES score, the Fagerström score, and the CAGE questionnaire. When identified as precarious/dependent, patients were referred to relevant addiction/social services. RESULTS One hundred and eighty-two patients were included. At the time of diagnosis, an active tobacco consumption was associated with alcohol drinking (Fisher's exact test, p < 0.001). Active smokers were more socially deprived (mean EPICES score = mES = 36.2 [±22.1]) than former smokers (mES = 22.8 [±17.8]) and never smokers (mES = 18.9 [±14.5]; Kruskal-Wallis, p < 0.001). The EPICES score was correlated to the Fagerström score (Kruskal-Wallis, p < 0.001). Active drinkers (mES = 34.1 [±21.9]) and former drinkers (mES = 32.7 [±21]) were more likely to be socially deprived than those who never drank (mES = 20.8 [±17.1]; Krukal-Wallis, p < 0.001). A Fagerström score improvement at one year was associated to a CAGE score improvement (Fisher's exact test, p < 0.001). Tobacco and alcohol consumption were more than halved one year after treatment. Patients who continued to smoke one year after diagnosis were significantly more likely to continue to drink (Fisher's exact test, p < 0.001) and had a significantly higher initial EPICES score (Kruskal-Wallis, p < 0.001). CONCLUSIONS At one year, addictions and social deprivation tend to improve when taken care of from the diagnosis. The most dependent patients and those with multiple frailties are at highest risk of cessation failure.
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Siddiqi AD, Chen TA, Britton M, Martinez Leal I, Carter BJ, Correa-Fernández V, Rogova A, Kyburz B, Williams T, Casey K, Reitzel LR. Changes in Substance Use Treatment Providers' Delivery of the 5A's for Non-Cigarette Tobacco Use in the Context of a Comprehensive Tobacco-Free Workplace Program Implementation. Int J Environ Res Public Health 2023; 20:2730. [PMID: 36768097 PMCID: PMC9914947 DOI: 10.3390/ijerph20032730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/25/2023] [Accepted: 02/01/2023] [Indexed: 06/16/2023]
Abstract
Tobacco use treatment is not prioritized in substance use treatment centers (SUTCs), leading to tobacco-related health inequities for patients with substance use disorders (SUDs) and necessitating efforts to enhance providers' care provision. Training providers on how to treat tobacco use increases their intervention on patients' smoking, but limited work addresses its effects on their non-cigarette tobacco use intervention provision. This study redressed this gap using data from 15 unaffiliated SUTCs in Texas (serving 82,927 patients/year) participating in a tobacco-free workplace program (TFWP) that included provider education on treating tobacco use, including non-cigarette tobacco use. SUTC providers completed surveys before (n = 259) and after (n = 194) TFWP implementation. Past-month screening/intervention provision for non-cigarette tobacco use (the 5A's; ask, advise, assess, assist, arrange) and provider factors theoretically and practically presumed to underlie change [i.e., beliefs about concurrently treating tobacco use disorder (TUD) and other SUDs, self-efficacy for tobacco use assessment (TUA) delivery, barriers to treating tobacco dependence, receipt of tobacco intervention training] were assessed. Generalized linear or linear mixed models assessed changes over time from before to after TFWP implementation; low vs. high SUTC-level changes in provider factors were examined as moderators of changes in 5A's delivery. Results indicated significant improvement in each provider factor and increases in providers' asking, assisting, and arranging for non-cigarette tobacco use over time (ps < 0.04). Relative to their counterparts, SUTCs with high changes in providers' beliefs in favor of treating patients' tobacco use had greater odds of advising, assessing, assisting, and arranging patients, and SUTCs with greater barrier reductions had greater odds of advising and assisting patients. Results suggest that TFWPs can address training deficits and alter providers' beliefs about treating non-tobacco TUD during SUD care, improve their TUA delivery self-efficacy, and reduce intervention barriers, ultimately increasing intervention provision for patients' non-cigarette tobacco use. SUTCs with the greatest room for improvement in provider beliefs and barriers to care provision seem excellent candidates for TFWP implementation aimed at increasing non-cigarette tobacco use care delivery.
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Affiliation(s)
- Ammar D. Siddiqi
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
- Department of Biosciences, Rice University, 6100 Main St., Houston, TX 77005, USA
| | - Tzuan A. Chen
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- HEALTH Research Institute, The University of Houston, 4349 Martin Luther King Blvd., Houston, TX 77204, USA
| | - Maggie Britton
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
| | - Isabel Martinez Leal
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
| | - Brian J. Carter
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
| | - Virmarie Correa-Fernández
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
| | - Anastasia Rogova
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
| | - Bryce Kyburz
- Integral Care, 1430 Collier St., Austin, TX 78704, USA
| | | | | | - Lorraine R. Reitzel
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
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Khalil S, Ben Abdelaziz A, Zanina Y, Ben Yahia F, Khelil M, Zoghlami C, Ben Rejeb N, Omezzine A, Bouslama A, Ben Abdelaziz A. [Epidemiology of smoking in the male population in Tunisia. HSHS Study 6]. Tunis Med 2022; 100:683-695. [PMID: 36571753 PMCID: PMC9837716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To determine the prevalence of smoking in the male population of Hammam Sousse (Tunisia), to describe its modalities and to analyse its determining factors. METHODS This was a "community-based" study, carried out on a random sample of households, including a population of males aged 20 or over. The data were collected, at home, using a specific support consisting of a lifestyle questionnaire, a physical examination, and a biological assessment, oriented towards cardiovascular risk factors. Smoking behaviour covered both forms of cigarettes and Narghile. "Current smokers" included all men declaring that they smoked at the time of the survey, including "regular smokers", who smoked daily at the time of the survey, and "occasional smokers", less than once a day. The group of "non-smokers" at the time of the survey was the sum of "ex-smokers" and those "who had never smoked". The prevalences were calculated after their weighting according to age and the adjusted odds ratios were measured following a multivariate study by logistic regression. RESULTS The study population was composed of 481 men with an average age of 49.6±16.35 years and a median of 49 years. Mean body mass index and systolic blood pressure were 26.9 kg/m2 ±4.20 and 151.9 mmHg±24.36, respectively. After adjusting for age, the proportions of current users, former users and subjects who had never used tobacco (all forms combined) were respectively 50.4% (95% CI [49.49-51.3]), 17.4% (95% CI [16.71-18.08]) and 30.9% (95% CI [30.06-31.73]). Daily cigarette consumption was characterized by an average onset at age 20.1±6.91 years, an average duration of 27.0±15.22 years and an average amount of 17.6±9.8 cigarettes smoked per day. After adjusting for age, level of education, and socioeconomic level, smoking behaviour was attributed to a single independent risk factor: the presence of a smoker in the family, with an adjusted OR of 45.17 (p (p<10-3) for regular cigarette smokers, and 29.66 for regular tobacco users of all forms. CONCLUSION Smoking would be a real endemic in Tunisia, threatening the cardiovascular health of the country. The national health system is called upon to strengthen its action plan for the prevention and control of smoking, in all living environments: family, school, work, health centre, etc.
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Affiliation(s)
- Sarra Khalil
- Direction des Systèmes d'Information; CHU Sahloul de Sousse (Tunisie)
- Faculté de Médecine de Sousse. Université de Sousse (Tunisie)
| | - Asma Ben Abdelaziz
- Service de Biochimie. CHU Sahloul de Sousse (Tunisie)
- Faculté de Pharmacie de Monastir. Université de Monastir (Tunisie)
| | - Youssef Zanina
- Direction des Systèmes d'Information; CHU Sahloul de Sousse (Tunisie)
- Faculté de Pharmacie de Monastir. Université de Monastir (Tunisie)
- Laboratoire de Recherche LR19SP01 «Mesure et Appui à la Performance des Etablissements de Santé»
| | - Faten Ben Yahia
- Faculté de Médecine de Sousse. Université de Sousse (Tunisie)
- Laboratoire de Recherche LR19SP01 «Mesure et Appui à la Performance des Etablissements de Santé»
| | - Mohamed Khelil
- Direction des Systèmes d'Information; CHU Sahloul de Sousse (Tunisie)
- Laboratoire de Recherche LR19SP01 «Mesure et Appui à la Performance des Etablissements de Santé»
| | - Chokri Zoghlami
- Laboratoire de Recherche LR19SP01 «Mesure et Appui à la Performance des Etablissements de Santé»
| | - Nabila Ben Rejeb
- Service de Biochimie. CHU Sahloul de Sousse (Tunisie)
- Faculté de Pharmacie de Monastir. Université de Monastir (Tunisie)
| | - Asma Omezzine
- Service de Biochimie. CHU Sahloul de Sousse (Tunisie)
- Faculté de Pharmacie de Monastir. Université de Monastir (Tunisie)
| | - Ali Bouslama
- Service de Biochimie. CHU Sahloul de Sousse (Tunisie)
- Faculté de Pharmacie de Monastir. Université de Monastir (Tunisie)
- Faculté de Pharmacie de Monastir. Université de Monastir (Tunisie)
| | - Ahmed Ben Abdelaziz
- Direction des Systèmes d'Information; CHU Sahloul de Sousse (Tunisie)
- Faculté de Médecine de Sousse. Université de Sousse (Tunisie)
- Laboratoire de Recherche LR19SP01 «Mesure et Appui à la Performance des Etablissements de Santé»
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10
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Dark M, Klyushnenkova E, Gaynor A, Kernan C, Khanna N. Tobacco Cessation Champions: Recognizing Physicians Who Ask, Advise, and Refer. Ann Fam Med 2022; 20:579. [PMID: 36443068 PMCID: PMC9705038 DOI: 10.1370/afm.2891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/02/2022] [Accepted: 08/09/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
- Michael Dark
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Elena Klyushnenkova
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Adam Gaynor
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Colleen Kernan
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Niharika Khanna
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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Kumar R, Sahu M, Rodney T. Efficacy of Motivational Interviewing and Brief Interventions on tobacco use among healthy adults: A systematic review of randomized controlled trials. Invest Educ Enferm 2022; 40:e03. [PMID: 36867776 PMCID: PMC10017134 DOI: 10.17533/udea.iee.v40n3e03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 06/06/2022] [Indexed: 06/18/2023]
Abstract
OBJECTIVES To assess the effectiveness of a brief intervention and motivational interviewing in reducing the use of different tobacco-related products in adults. METHODS For this systematic review, PubMed, Web of Science, and PsychINFO databases were electronically searched for randomized controlled trialson the effect of a brief intervention and / or motivational interview on tobacco reduction among healthy adults published between January 1, 2011 to January 1, 2021. Data from eligible studies were extracted and analyzed. CONSORT guidelines were used to assess the quality of the studies by two reviewers for the included studies. The titles and abstracts of the search results were screened and reviewed by two independent reviewers for eligibility criteria per the inclusion and exclusion criteria. Cochrane review criteria were used to assess the risk of bias in included studies. RESULTS A total of 12 studies were included in the final data extraction of 1406 studies. The brief intervention and motivational interviewing showed varied effects on tobacco use reduction among adults at different follow-ups. Seven of the 12 studies (58.3%) reported a beneficial impact on reducing tobacco use. Pieces of evidence on biochemical estimation on tobacco reduction are limited compared to self-reports, and varied results on quitting and tobacco cessation with different follow-ups. CONCLUSIONS The current evidence supports the effectiveness of a brief intervention and motivational interviewing to quit tobacco use. Still, it suggests using more biochemical markers as outcome measures to reach an intervention-specific decision. While more initiatives to train nurses in providing non-pharmacological nursing interventions, including brief interventions, are recommended to help people quit smoking.
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Affiliation(s)
- Rajesh Kumar
- All India Institute of Medical Sciences (AIIMS) Rishikesh Uttarakhand, India. . Corresponding author
| | - Maya Sahu
- College of Nursing Teerthanker Mahaveer University, Moradabad, Uttar Pradesh, India.
| | - Tamar Rodney
- Johns Hopkins School of Nursing, Baltimore MD, USA.
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12
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McBrayer K, Ouyang F, Adams Z, Hulvershorn L, Aalsma MC. Rates of Tobacco Use Disorder, Pharmacologic Treatment, and Associated Mental Health Disorders in a Medicaid Claim Review Among Youth in Indiana, USA. Tob Use Insights 2022; 15:1179173X221119133. [PMID: 36052177 PMCID: PMC9424880 DOI: 10.1177/1179173x221119133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose This study delineates a number of Medicaid youth with tobacco use disorder (TUD), prescribing habits for treatment, and associated externalizing disorders. Methods Youth Medicaid claims from 2007-2017 processed in a large Midwestern city were analyzed for a diagnosis of TUD, related pharmacotherapy, and externalizing mental health and substance use disorders. Results Claims connected 6541 patients with 42 890 visits. Mean age was 16.4 with 40% female. 1232 of the 6541 charts contained a TUD diagnosis equating to 1848 visits. A comorbid diagnosis of ADHD, cannabis use, and conduct disorder were more common in males (3.9% vs 1.3% in females; 3.4% vs .8%; and 2.8% vs .8%; P < .05). 808 scripts were provided to 152 of the 1232 youths, with 4.7% of those scripts a nicotine replacement product. Conclusions Pharmacotherapy is underutilized in this Medicaid claims data set. Certain externalizing factors were associated with males with TUD more than females.
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Affiliation(s)
- Kimberly McBrayer
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Fangqian Ouyang
- Department of Biostatistics, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Zachary Adams
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Leslie Hulvershorn
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Matthew C Aalsma
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
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de Oliveira PPV, Pereira VODM, Stopa SR, de Freitas PC, Szklo AS, Cavalcante TM, de Andrade FMD, Gomes CS, Malta DC. Indicators related to smoking cessation in Brazil, National Health Survey, 2013 and 2019 editions. Epidemiol Serv Saude 2022; 31:e2021388. [PMID: 35792797 PMCID: PMC9897828 DOI: 10.1590/ss2237-9622202200005.especial] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/15/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To describe the indicators of smoking cessation in 2013 and 2019 for Brazil and federative units, according to sociodemographic variables, collected in the National Health Survey (PNS). METHODS Cross-sectional, population-based and descriptive study with data from the 2013 and 2019 PNS, a household survey collected by trained interviewers. The prevalence of ex-smokers and the proportion of smokers who tried to quit smoking in the 12 months prior to the interview, and respective confidence intervals (95%CI) were calculated, according to sociodemographic variables. Additionally, the percentage variation between the years was calculated. RESULTS In 2013, the prevalence of ex-smokers was 17.5% (95%CI 16.9;18.0) and, in 2019, 26.6% (95%CI 26.1;27.2). In 2013, 51.1% tried to quit smoking (95%CI 49.3;52.9) and, in 2019, 46.6% (95%CI 45.0;48.3). CONCLUSION It is important to strengthen and maintain strategies for coping with tobacco use in Brazil, to increase the current smoker's willingness and ability to quit smoking.
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Affiliation(s)
| | | | | | | | - André Salem Szklo
- Instituto Nacional de Câncer José de Alencar Gomes da Silva, Divisão
de Pesquisa Populacional, Rio de Janeiro, RJ, Brazil
| | - Tânia Maria Cavalcante
- Instituto Nacional de Câncer José de Alencar Gomes da Silva,
Secretaria Executiva da Comissão Nacional para a Implementação da Convenção-Quadro
para o Controle do Tabaco, Rio de Janeiro, RJ, Brazil
| | | | - Crizian Saar Gomes
- Universidade Federal de Minas Gerais, Programa de Pós-Graduação em
Saúde Pública, Belo Horizonte, MG, Brazil
| | - Deborah Carvalho Malta
- Universidade Federal de Minas Gerais, Departamento de Enfermagem
Materno-Infantil e Saúde Pública, Belo Horizonte, MG, Brazil
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Creswell PD, McCarthy DE, Trapskin P, Sheehy A, Skora A, Adsit RT, Zehner ME, Baker TB, Fiore MC. Can inpatient pharmacists move the needle on smoking cessation? Evaluating reach and representativeness of a pharmacist-led opt-out smoking cessation intervention protocol for hospital settings. Am J Health Syst Pharm 2022; 79:969-978. [PMID: 34951621 PMCID: PMC9171569 DOI: 10.1093/ajhp/zxab488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Hospitalization affords an opportunity to reduce smoking, but fewer than half of patients who smoke receive evidence-based cessation treatment during inpatient stays. This study evaluated a pharmacist-led, electronic health record (EHR)-facilitated opt-out smoking cessation intervention designed to address this need. METHODS Analyses of EHR records for adult patients who smoked in the past 30 days admitted to an academic medical center in the upper Midwest were conducted using the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. The reach of a pharmacist-led, EHR-facilitated protocol for smoking cessation treatment was assessed by comparing patients' receipt of nicotine replacement therapy (NRT) and tobacco quitline referral before and after implementation. χ2 tests, t tests, and multiple logistic regression models were used to compare reach across patient demographic groups to assess treatment disparities and the representativeness of reach. Adoption of the program by hospital services was also assessed. RESULTS Of the 70 hospital services invited to implement the program, 88.6% adopted it and 78.6% had eligible admissions. Treatment reach increased as rates of delivering NRT rose from 43.6% of eligible patients before implementation to 50.4% after implementation (P < 0.0001) and quitline referral rates rose from 0.9% to 11.9% (P < 0.0001). Representativeness of reach by sex and ethnicity improved after implementation, although disparities by race and age persisted after adjustment for demographics, insurance, and primary diagnosis. Pharmacists addressed tobacco use for eligible patients in 62.5% of cases after protocol implementation. CONCLUSION Smoking cessation treatment reach and representativeness of reach improved after implementation of a proactive, pharmacist-led, EHR-facilitated opt-out smoking cessation treatment protocol in adult inpatient services.
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Affiliation(s)
- Paul D Creswell
- UW Center for Tobacco Research and Intervention (UW-CTRI), University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Danielle E McCarthy
- UW Center for Tobacco Research and Intervention (UW-CTRI), University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Philip Trapskin
- UW Health, University of Wisconsin School of Pharmacy, Madison, WI, USA
| | - Ann Sheehy
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Amy Skora
- UW Center for Tobacco Research and Intervention (UW-CTRI), University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Robert T Adsit
- UW Center for Tobacco Research and Intervention (UW-CTRI), University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Mark E Zehner
- UW Center for Tobacco Research and Intervention (UW-CTRI), University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Timothy B Baker
- UW Center for Tobacco Research and Intervention (UW-CTRI), University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Michael C Fiore
- UW Center for Tobacco Research and Intervention (UW-CTRI), University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Hilts KE, Yeager VA, Kooreman H, Smith R, Busching B, Spitznagle M. Public Health and Health Care Partnerships for Improved Tobacco Cessation. J Public Health Manag Pract 2022; 28:E404-E412. [PMID: 34347652 PMCID: PMC8807793 DOI: 10.1097/phh.0000000000001406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
CONTEXT Tobacco use remains a leading cause of preventable death and disease. While most tobacco users are interested in quitting, few receive professional assistance. PROGRAM This state health department-led project leveraged partnerships to build capacity and support 9 health care organizations in implementing system-level initiatives to improve delivery of tobacco cessation. IMPLEMENTATION Participating organizations' initiatives targeted 3 focus areas: implementing best practices for tobacco cessation; quality improvement; and utilization of the electronic health record. EVALUATION A qualitative study was conducted to examine facilitators and barriers to tobacco cession systems change among participating health care organizations. Common barriers included time constraints, staffing issues, and organizational structure. These factors often differed by organization type (eg, large vs small). Facilitators included leadership buy-in, organizational priority, technical assistance, teams/teamwork, and IT support. DISCUSSION Initial findings suggest that this type of partnership model can be leveraged to gain organizational support, build capacity, address key barriers, and ensure that systems change strategies align with best practices for tobacco cessation across a diverse set of health care organizations. Findings presented in this report provide insights for other public health and health care organizations looking to implement similar initiatives.
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Affiliation(s)
- Katy Ellis Hilts
- Center for Health Policy, Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana (Drs Hilts and Yeager and Mr Kooreman); and Tobacco Prevention and Cessation Commission, Indiana Department of Health, Indianapolis, Indiana (Mss Smith and Spitznagle and Mr Busching)
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Hilts KE, Hudmon KS, Benson AF, Elkhadragy N. Rural-urban disparities in tobacco use and the role of pharmacists in closing the gap. J Rural Health 2022; 38:355-359. [PMID: 34374450 PMCID: PMC8828795 DOI: 10.1111/jrh.12607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Katy Ellis Hilts
- Indiana University School of Nursing, Indianapolis, Indiana, USA
| | - Karen Suchanek Hudmon
- Department of Pharmacy Practice, Purdue University College of Pharmacy, West Lafayette, Indiana, USA
| | - Adam F. Benson
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Nervana Elkhadragy
- Department of Pharmacy Practice, Purdue University College of Pharmacy, West Lafayette, Indiana, USA,University of Wyoming School of Pharmacy, Laramie, Wyoming, USA
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Koka KM, Yadlapalli S, Pillarisetti P, Yasangi MK, Yaragani A, Kummamuru S. The barriers for tobacco cessation counseling in teaching health care institutions: A qualitative data analysis using MAXQDA software. J Family Med Prim Care 2021; 10:3262-3267. [PMID: 34760741 PMCID: PMC8565150 DOI: 10.4103/jfmpc.jfmpc_19_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 06/12/2021] [Accepted: 06/20/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction: Recently, Dental Council of India directed all the teaching dental institutions in the country to set up tobacco cessation centers (TCC). International experiences suggest that there are many barriers for the provision of tobacco cessation counseling at dental clinics. In this context, it is important to understand the dental students’ attitudes toward this initiative of tobacco cessation counseling at dental settings. Materials and Methods: This qualitative study to document the dental students’ perspectives toward the provision of tobacco cessation counseling using focus group interviews was conducted in two teaching dental institutions in the state of Andhra Pradesh, India. 133 house surgeons from two dental institutions participated in the study and were interviewed as 13 focus groups. MAXQDA (version 12, VERBI GmbH, Berlin, Germany) was used for data analysis. All the interviews were audio recorded and the transcripts were open coded by three independent investigators. Results: The response rate in this study was 78.45%. The following themes were extracted from the views and opinions shared by the students: the reluctance of patients to discuss tobacco-related problems; tobacco use among students discouraging them to actively participate in counseling; an opinion that dental clinics are not suitable for the provision of tobacco cessation counseling; belief among students that they are not qualified enough. Conclusion: The directives given by the Ministry of Health and Family Welfare in association with Dental council of India to set up TCC at every teaching dental institution are laudable and demonstrate the commitment at policy level toward bringing down tobacco consumption in the country. However, few reforms need to be made in the curriculum to better execute the delegated responsibilities, which include orientation programs for dental students on the scope of the dental profession and workshops on tobacco cessation counseling.
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Affiliation(s)
- Krishna M Koka
- Conservative Dentistry and Endodontics, KIMS Dental College, Amalapuram, Andhra Pradesh, India
| | - Sravanthi Yadlapalli
- Prosthodontics, Lenora Institute of Dental Sciences, Rajahmundry, Andhra Pradesh, India
| | | | - Manoj Kumar Yasangi
- Prosthodontics, MNR Dental College and Hospital, Sanga Reddy, Telangana, India
| | - Anusha Yaragani
- Orthodontics, KIMS Dental College, Amalapuram, Andhra Pradesh, India
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Hilts KE, Blackburn J, Gibson PJ, Yeager VA, Halverson PK, Menachemi N. Impact of Medicaid expansion on smoking prevalence and quit attempts among those newly eligible, 2011-2019. Tob Prev Cessat 2021; 7:16. [PMID: 34414341 PMCID: PMC8336658 DOI: 10.18332/tpc/139812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/24/2021] [Accepted: 07/03/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Low-income populations have higher rates of smoking and are disproportionately affected by smoking-related illnesses. This study assessed the long-term impact of increased coverage for tobacco cessation through Medicaid expansion on past-year quit attempts and prevalence of cigarette smoking. METHODS Using data from CDC's annual Behavioral Risk Factor Surveillance System 2011-2019, we conducted difference-in-difference regression analyses to compare changes in smoking prevalence and past-year quit attempts in expansion states versus non-expansion states. Our sample included non-pregnant adults (18-64 years old) without dependent children with incomes at or below 100% of the Federal Poverty Level (FPL). RESULTS Regression analyses indicate that Medicaid expansion was associated with reduced smoking prevalence in the first two years post-expansion (β=-0.019, p=0.04), but that this effect was not maintained at longer follow-up periods (β=-0.006, p=0.49). Results of regression analyses also suggest that Medicaid expansion does not significantly impact quit attempts in the short-term (β=-0.013, p=0.52) or at longer term follow-up (β=-0.026, p=0.08). CONCLUSIONS Expanded coverage for tobacco cessation services through Medicaid alone may not be enough to increase quit-attempts or sustain a reduction in overall prevalence of smoking in newly eligible populations over time. Medicaid programs should consider additional strategies, such as public education campaigns and removal of barriers, to support cessation among enrollees.
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Affiliation(s)
- Katy Ellis Hilts
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, United States
| | - Justin Blackburn
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, United States
| | - P Joseph Gibson
- Marion County Public Health Department, Indianapolis, United States
| | - Valerie A Yeager
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, United States
| | - Paul K Halverson
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, United States
| | - Nir Menachemi
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, United States
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Blok AC, Ignacio RV, Geraci MC, Kim HM, Barnett PG, Duffy SA. Provider and clinical setting characteristics associated with tobacco pharmacotherapy dispensed in the Veterans Health Administration. Tob Induc Dis 2021; 19:65. [PMID: 34429727 PMCID: PMC8349177 DOI: 10.18332/tid/140091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/04/2021] [Accepted: 07/08/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION While initiation rates of tobacco cessation pharmacotherapy have improved both inside and outside the Department of Veteran Affairs (VA), prescribing rates remain low. The objective of this study was to examine correlation of the characteristics of providers, clinics, and facilities with initiation of tobacco cessation pharmacotherapy. METHODS This retrospective, observational study used VA outpatient electronic medical record data from federal fiscal year 2011. Logistic regression models estimated the adjusted odds ratio associated with provider characteristics for pharmacotherapy initiation. RESULTS For the 639507 veterans who used tobacco, there were 30388 providers caring for them. Younger (p<0.001) and female (p<0.001) providers were more likely to initiate tobacco cessation pharmacotherapy. Compared to physicians, pharmacists were 74% more likely to initiate pharmacotherapy, while all groups of nurses were 5-8% and physicians' assistants were 12% less likely (p<0.001). Compared to those seen in primary care clinics, patients assessed in substance use treatment clinics were 16% more likely to have pharmacotherapy initiated (p<0.001), while those in psychiatry were 10% less likely (p<0.001), and those in outpatient surgery were 39% less likely to initiate pharmacotherapy (p<0.001). Compared to almost all other classes of VA facilities, patients seen in primary care community-based outpatient clinics (CBOCs) were 7-28% more likely to initiate pharmacotherapy (p<0.0001). CONCLUSIONS While the VA is at the leading edge of providing tobacco cessation pharmacotherapy, targeting quality improvement efforts towards providers, clinics, and facilities with low prescribing rates will be essential to continue the declining rates of tobacco use among VA patients.
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Affiliation(s)
- Amanda C. Blok
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, United States
- Department of Systems, Populations and Leadership, School of Nursing, University of Michigan, Ann Arbor, United States
| | - Rosalinda V. Ignacio
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, United States
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, United States
| | - Mark C. Geraci
- Department of Veterans Affairs Pharmacy Benefits Management Services, United States Department of Veterans Affairs, Hines, United States
| | - Hyungjin Myra Kim
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, United States
- Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, United States
| | - Paul G. Barnett
- Health Economics Resource Center, United States Department of Veterans Affairs, Menlo Park, United States
| | - Sonia A. Duffy
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, United States
- College of Nursing, The Ohio State University, Columbus, United States
- Department of Psychiatry, University of Michigan, Ann Arbor, United States
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Gibson B, Kramer H, Weir C, Fiol G, Borbolla D, Schlechter CR, Lam C, Nelson M, Bohner C, Schulthies S, Sieperas T, Pruhs A, Nahum-Shani I, Fernandez ME, Wetter DW. Workflow analysis for design of an electronic health record-based tobacco cessation intervention in community health centers. JAMIA Open 2021; 4:ooaa070. [PMID: 34514352 PMCID: PMC8423419 DOI: 10.1093/jamiaopen/ooaa070] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/09/2020] [Accepted: 12/22/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Tobacco use is the leading cause of preventable morbidity and mortality in the United States. Quitlines are effective telephone-based tobacco cessation services but are underutilized. The goal of this project was to describe current clinical workflows for Quitline referral and design an optimal electronic health record (EHR)-based workflow for Ask-Advice-Connect (AAC), an evidence-based intervention to increase Quitline referrals. MATERIALS AND METHODS Ten Community Health Center systems (CHC), which use three different EHRs, participated in this study. Methods included: 9 group discussions with CHC leaders; 33 observations/interviews of clinical teams' workflow; surveys with 57 clinical staff; and assessment of the EHR ecosystem in each CHC. Data across these methods were integrated and coded according to the Fit between Individual, Task, Technology and Environment (FITTE) framework. The current and optimal workflow were notated using Business Process Modelling Notation. We compared the requirements of the optimal workflow with EHR capabilities. RESULTS Current workflows are inefficient in data collection, variable in who, how, and when tobacco cessation advice and referral are enacted, and lack communication between referring clinics and the Quitline. In the optimal workflow, medical assistants deliver a standardized AAC intervention during the visit intake. Referrals are submitted electronically, and there is bidirectional communication between the clinic and Quitline. We implemented AAC within all three EHRs; however, deviations from the optimal workflow were necessary. CONCLUSION Current workflows for Quitline referral are inefficient and ineffective. We propose an optimal workflow and discuss improvements in EHR capabilities that would improve the implementation of AAC.
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Affiliation(s)
- Bryan Gibson
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Heidi Kramer
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Charlene Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Guilherme Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Damian Borbolla
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Chelsey R Schlechter
- Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Cho Lam
- Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Marci Nelson
- Tobacco Prevention and Control Program Utah, Department of Health, Salt Lake City, Utah, USA
| | - Claudia Bohner
- Tobacco Prevention and Control Program Utah, Department of Health, Salt Lake City, Utah, USA
| | - Sandra Schulthies
- Tobacco Prevention and Control Program Utah, Department of Health, Salt Lake City, Utah, USA
| | - Tracey Sieperas
- Association for Utah Community Health, Salt Lake City, Utah, USA
| | - Alan Pruhs
- Association for Utah Community Health, Salt Lake City, Utah, USA
| | - Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Maria E Fernandez
- Center for Health Promotion and Prevention Research, University of Texas Health science Center at Houston, Houston, Texas, USA
| | - David W Wetter
- Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
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Abstract
Cigarette use is the leading cause of preventable death in the United
States. Despite the well documented dangers of smoking, nearly 20% of
adults report regular use of tobacco. A majority desire to discontinue
but the long-term cessation success rate remains near 4%. One
challenge to reducing the prevalence of tobacco use is an incomplete
understanding of the individual correlates that reinforce continued
use. Evidence from research on nicotine and tobacco suggests that
Tobacco Use Disorder is a complex, and multifactorial condition.
Personality traits, comorbidities, habits and lifestyle, genetics,
socioeconomic status, and mental and physical health all contribute to
the risk for dependence and to the likelihood of quitting. This
perspective review provides an overview of some common factors that
contribute to liability risk for Tobacco Use Disorder and a framework
for assessing individual tobacco users. The framework includes 5 areas
that research suggests contribute to continued tobacco use: nicotine
addiction, psychological influences, behavioral dependencies,
neurobiological factors, and social reinforcement. Nicotine addiction
includes drug-seeking behavior and the role of withdrawal avoidance.
Psychological and emotional states contribute to a perceived reliance
on tobacco. Behavioral dependence is reinforced by associative and
non-associative learning mechanisms. Neurobiological factors include
genetic variables, variations in neurotransmitters and receptors,
pharmacogenetics, and interaction between psychiatric illnesses and
nicotine use and dependence. Finally, social reinforcement of smoking
behavior is explained by a network phenomenon and consistent visual
cues to smoke. A comprehensive assessment of individual tobacco users
will help better determine appropriate treatment options to achieve
improved efficacy and outcomes.
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Santos CP, Proença M, Gouveia TDS, Soares de Oliveira CB, Tacao GY, Trevisan IB, Ramos EMC, Ramos D. Effectiveness of Aerobic Exercise on Smoking Cessation in Adults: A Systematic Review and Meta-Analysis. J Phys Act Health 2021; 18:230-42. [PMID: 33434887 DOI: 10.1123/jpah.2019-0339] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/19/2020] [Accepted: 10/06/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The specific benefits of aerobic exercises in smoking cessation are unclear, as they have different characteristics, intensities, and durations. The purpose of this systematic review with meta-analysis was to evaluate the effects of aerobic exercise, with or without co-interventions, compared with a control group of cognitive behavior treatment on smoking cessation. METHODS This review was prospectively registered on PROSPERO, and the searches were performed from 2016 to 2018. Randomized controlled trials evaluating the effects of aerobic exercise, with or without nicotine therapy replacement, compared with usual care were included. The primary outcome was smoking cessation defined as the prevalence of those who quit or continuous abstinence. Meta-analysis was calculated using random effects model in the comprehensive meta-analysis software. RESULTS The authors identified 18 trials reporting data for a total of 2815 participants. There was moderate-quality evidence that aerobic exercise was better than usual care in promoting smoking cessation at short term (11 trials, risk ratio 0.79; 95% confidence interval, 0.66-0.94). However, there were no differences between aerobic exercises and usual care at medium- or long-term follow-ups. CONCLUSIONS According to review, aerobic exercise may be effective in promoting smoking cessation at short-term, but not at medium- and long-term follow-ups.
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Abstract
OBJECTIVE To investigate prevalence and correlates of medical use and misuse of psychoactive prescription medications among US youth and young adults. DESIGN Cross-sectional, self-reported surveys from the 2015-2018 National Survey of Drug Use and Health. Sampling was probabilistic and nationally representative. SETTING The target population included individuals from households, non-institutional group quarters (eg, college dormitories) and civilians living on military bases. Questionnaires were completed using computer-assisted self-interview methods. PARTICIPANTS Our analytical sample included youth and young adults aged 12-25 years (n=110 556). Psychoactive prescription medication misuse was a report by the respondent that they had used psychoactive prescription medications in the past year in any way not directed or prescribed for them. Medical use was defined as past-year use without a report of misuse. Because certain variables were assessed only among adults, our multivariable analysis to identify correlates of misuse was restricted to young adults aged 18-25 years (n=55 690). RESULTS Among US youth aged 12-17 years, 25.0% reported use of any psychoactive prescription medication assessed, and 5.7% reported past-year use of at least two psychoactive prescription medications. Among youth who used any psychoactive prescription medications, 20.9% (1.3 million) reported misuse; 3.4% were classified as having substance use disorder. Past-year use of each psychoactive prescription medication was: opioids (19.0%), stimulants (7.2%), tranquillisers (4.3%) and sedatives (2.2%). Among users of each psychoactive prescription medication, the estimated percentage reporting misuse was as follows: opioids (17.6%, 0.8 million), stimulants (24.2%, 0.4 million), tranquillisers (40.1%, 0.4 million) and sedatives (14.2%, 80 000). Among users of each psychoactive prescription medication, the estimated percentage having substance use disorder was as follows: opioids 2.6%, stimulants 3.0%, tranquillisers 7.0% and sedatives 3.6%. Analyses among young adults aged 18-25 years revealed that, compared with never users of non-prescription substances (including alcohol, tobacco, marijuana, cocaine, heroin), opioid misuse increased with: more recent use of non-prescription substances (adjusted prevalence ratios (APRs)=8.26, 2.75 and 2.41 for past ≤30-day, ≤12-month and >12-month use, respectively); and a higher number of substances used (APRs=1.69, 3.44, 6.82, 10.60 and 20.60 for 1, 2, 3, 4 and 5+ substances, respectively) (all p<0.05). Similar patterns were seen for stimulants, tranquillisers and sedatives. CONCLUSIONS It is important to monitor the diversity of medication misuse behaviours among youth and young adults, given their potential for abuse liability. Modifiable risk factors for prescription substance misuse, such as tobacco and other non-prescription substance use, underscore the need for comprehensive approaches towards health promotion among youth and young adults.
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Affiliation(s)
- Israel Agaku
- Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Satomi Odani
- Department of Social Medicine, University of Crete, Rethimno, Crete, Greece
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Ofei-Dodoo S, Wipperman J, Nutting R, Gilchrist K, Kellerman R. Changes in Family Physicians' Perceptions of Electronic Cigarettes in Tobacco Use Counseling Between 2016 and 2019. Kans J Med 2020; 13:311-317. [PMID: 33343825 PMCID: PMC7735429 DOI: 10.17161/kjm.vol13.13877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/10/2020] [Indexed: 11/21/2022] Open
Abstract
Introduction Given the recent reports of e-cigarette, or vaping, product use-associated lung injury (EVALI) and harm of e-cigarettes, the authors evaluated changes in the use and perception of e-cigarettes as tobacco use cessation tools in 2019 relative to 2016. The authors also evaluated the sources family physicians most commonly use to receive information regarding e-cigarettes. Methods A cross-sectional online survey of 248 community family physicians in Kansas was conducted from October 2019 to December 2019. An 11-item questionnaire measured the participants’ perceptions of recommending e-cigarettes to patients for tobacco cessation. A mixed method approach was used to collect, analyze, and interpret the data. Standard descriptive statistics, Likelihood-Ratio/Fisher’s exact tests, and immersion-crystallization methods were used to analyze the data. Results The response rate was 59.3% (147/248). The proportion of the family physicians who did not recommend e-cigarettes for tobacco use cessation was significantly higher in 2019 than in 2016 (86% vs. 82%; χ2 [1, n = 261] = 12.31; p < 0.01). Several reasons regarding respondents’ perceptions of e-cigarettes as tobacco use cessation tools were reported. The medical literature and news media were the top sources where family physicians accessed e-cigarettes information. Conclusion Most family physicians did not recommend e-cigarettes for tobacco cessation. Opinions regarding the efficacy and safety of e-cigarettes were influenced by information sources. Future, larger studies would be beneficial to further determine family physicians’ beliefs and practices regarding e-cigarettes as tobacco use cessation products.
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Affiliation(s)
- Samuel Ofei-Dodoo
- Department of Family and Community Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS.,Family Medicine Residency Program at Ascension Via Christi Hospitals, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Jennifer Wipperman
- Department of Family and Community Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS.,Family Medicine Residency Program at Ascension Via Christi Hospitals, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Ruth Nutting
- Department of Family and Community Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS.,Family Medicine Residency Program at Ascension Via Christi Hospitals, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Karissa Gilchrist
- Family Medicine Residency Program at Ascension Via Christi Hospitals, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Rick Kellerman
- Department of Family and Community Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
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25
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Goel D, Chaudhary PK, Khan A, Patthi B, Singla A, Malhi R, Gambhir RS. Acquaintance and Approach in the Direction of Tobacco Cessation Among Dental Practitioners-A Systematic Review. Int J Prev Med 2020; 11:167. [PMID: 33312476 PMCID: PMC7716613 DOI: 10.4103/ijpvm.ijpvm_316_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 12/13/2019] [Indexed: 11/16/2022] Open
Abstract
Background: Nowadays, tobacco consumption has become one of the major public health problems and is the leading cause of escapable illness and death. A significant role is played by dental professionals in the identification of smokers; they are, thus, in a better position to offer preventive care. The aim of the present study was to systemically review the knowledge and attitude of dental practitioners toward tobacco cessation. Methods: A literature search was performed in PubMed Central and Cochrane Library, Medline—PubMed, Embase, Google Scholar up to 2018 to identify appropriate studies. Full-text original research articles of the cross-sectional design were only included in the study. Our target was to systemically review the knowledge and attitude of dental practitioners toward tobacco cessation. Results: The present review included a total of nine articles (studies) that fulfilled the eligibility criteria. Two articles which were hand searched and one article which was obtained through contact with experts were included. The results of the review revealed that the dental practitioners in most of the included studies lack satisfactory knowledge and were unaware of existing referral pathways to specialist smoking cessation services. At the same time, most of the dentists have a positive attitude toward tobacco cessation. Conclusions: Dental professionals are aware of their obligations toward smoking cessation counseling for patients but certain barriers including lack of time, confidence, and training prevent them from practicing the same in their daily routine. The dental professionals should obtain appropriate training and attain knowledge along with quantifiable skills for the prevention and cessation of tobacco use.
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Affiliation(s)
- Divyangi Goel
- Department of Public Health Dentistry, DJ College of Dental Sciences and Research, Modinagar, Uttar Pradesh, India
| | - Pankaj Kumar Chaudhary
- Department of Public Health Dentistry, DJ College of Dental Sciences and Research, Modinagar, Uttar Pradesh, India
| | - Ambar Khan
- Department of Public Health Dentistry, DJ College of Dental Sciences and Research, Modinagar, Uttar Pradesh, India
| | - Basavaraj Patthi
- Department of Public Health Dentistry, DJ College of Dental Sciences and Research, Modinagar, Uttar Pradesh, India
| | - Ashish Singla
- Department of Public Health Dentistry, DJ College of Dental Sciences and Research, Modinagar, Uttar Pradesh, India
| | - Ravneet Malhi
- Department of Public Health Dentistry, DJ College of Dental Sciences and Research, Modinagar, Uttar Pradesh, India
| | - Ramandeep Singh Gambhir
- Department of Public Health Dentistry, BRS Dental College and Hospital, Panchkula, Haryana, India
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Pallejà-Millán M, Rey-Reñones C, Barrera Uriarte ML, Granado-Font E, Basora J, Flores-Mateo G, Duch J. Evaluation of the Tobbstop Mobile App for Smoking Cessation: Cluster Randomized Controlled Clinical Trial. JMIR Mhealth Uhealth 2020; 8:e15951. [PMID: 32589153 PMCID: PMC7381259 DOI: 10.2196/15951] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 12/09/2019] [Accepted: 03/29/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Mobile apps provide an accessible way to test new health-related methodologies. Tobacco is still the primary preventable cause of death in industrialized countries, constituting an important public health issue. New technologies provide novel opportunities that are effective in the cessation of smoking tobacco. OBJECTIVE This paper aims to evaluate the efficacy and usage of a mobile app for assisting adult smokers to quit smoking. METHODS We conducted a cluster randomized clinical trial. We included smokers older than 18 years who were motivated to stop smoking and used a mobile phone compatible with our mobile app. We carried out follow-up visits at 15, 30, and 45 days, and at 2, 3, 6, and 12 months. Participants of the intervention group had access to the Tobbstop mobile app designed by the research team. The primary outcomes were continuous smoking abstinence at 3 and 12 months. RESULTS A total of 773 participants were included in the trial, of which 602 (77.9%) began the study on their D-Day. Of participants in the intervention group, 34.15% (97/284) did not use the app. The continuous abstention level was significantly larger in the intervention group participants who used the app than in those who did not use the app at both 3 months (72/187, 38.5% vs 13/97, 13.4%; P<.001) and 12 months (39/187, 20.9% vs 8/97, 8.25%; P=.01). Participants in the intervention group who used the app regularly and correctly had a higher probability of not being smokers at 12 months (OR 7.20, 95% CI 2.14-24.20; P=.001) than the participants of the CG. CONCLUSIONS Regular use of an app for smoking cessation is effective in comparison with standard clinical practice. TRIAL REGISTRATION Clinicaltrials.gov NCT01734421; https://clinicaltrials.gov/ct2/show/NCT01734421.
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Affiliation(s)
- Meritxell Pallejà-Millán
- Unitat de Suport a la Recerca Camp de Tarragona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Reus, Spain.,Departament de Ciències Mèdiques Bàsiques, Universitat Rovira i Virgili, Reus, Spain
| | - Cristina Rey-Reñones
- Departament de Ciències Mèdiques Bàsiques, Universitat Rovira i Virgili, Reus, Spain.,Institut Català de la Salut, Unitat de Suport a la Recerca Camp de Tarragona, Reus, Spain
| | - Maria Luisa Barrera Uriarte
- Institut Català de la Salut, Unitat de Suport a la Recerca Camp de Tarragona, Reus, Spain.,Equip d'Atenció Primaria La Granja (Tarragona-2), Direcció d'Atenció Primaria Camp de Tarragona, Institut Català de la Salut, Torreforta, Spain
| | - Esther Granado-Font
- Institut Català de la Salut, Unitat de Suport a la Recerca Camp de Tarragona, Reus, Spain.,Equip d'Atenció Primaria Horts de Miró (Reus-4), Direcció d'Atenció Primaria Camp de Tarragona, Institut Català de la Salut, Reus, Spain
| | - Josep Basora
- Unitat de Suport a la Recerca Camp de Tarragona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Reus, Spain.,Departament de Ciències Mèdiques Bàsiques, Universitat Rovira i Virgili, Reus, Spain
| | - Gemma Flores-Mateo
- Unitat de Suport a la Recerca Camp de Tarragona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Reus, Spain.,Unitat d'Anàlisi i Qualitat, Xarxa Sanitària i Social Santa Tecla, Tarragona, Spain
| | - Jordi Duch
- Departament d'Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Tarragona, Spain
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Fernández-García D, Ordás B, Fernández-Peña R, Bárcena-Calvo C, Ordoñez C, Amo-Setién FJ, Gómez-Salgado J, Martínez-Isasi S. Smoking in nursing students: A prevalence multicenter study. Medicine (Baltimore) 2020; 99:e19414. [PMID: 32243361 PMCID: PMC7220658 DOI: 10.1097/md.0000000000019414] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The role of nursing students as future health promoters of healthy behaviors is influenced by their attitude towards smoking. A cross-sectional study using a self-administered survey was performed to analyze smoking prevalence among undergraduate the nursing students who attend nursing faculties in 2 European countries (Spain and Portugal) during academic period 2015 to 2016. A total of 1469 subjects were surveyed (response rate of 79.8%). An 80% of the students were female with a mean age of 21.9 (4.8) years. The overall prevalence of tobacco use was 18.9%, with an average percentage of 16.2% in Portugal and 18.3% in Spain. Statistical significance was observed in relation to smoke and previous studies (16.4% vs 27.1%; P < .001). Only 1.1% of the students reported using electronic cigarette. 15.8% of smokers started smoking while at university with statistical gender and previous studies differences (P < .001). Fagerström and Richmond test showed low nicotine dependence (2.8 ± 2) and moderate motivation to stop smoking (4.9 ± 3), respectively. Smoking prevalence among nursing students was slightly higher than the general European population. For that reason, measures to reduce tobacco use have to be focused on students and university policies on tobacco control should be a challenge in the future.
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Affiliation(s)
| | - Beatriz Ordás
- Division of Nursing, University Hospital of Leon, León
| | - Rosario Fernández-Peña
- Department of Nursing, University of Cantabria, SALBIS Research Group, Nursing Research Group IDIVAL, Santander
| | | | - César Ordoñez
- Department of Biomedical Science, Area of Toxicology, University of Leon, León
| | - Francisco José Amo-Setién
- Department of Nursing, University of Cantabria, SALBIS Research Group, Nursing Research Group IDIVAL, Santander
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, University of Huelva, Huelva
- Safety and Health Posgrade Program, Espíritu Santo University, Samborondón, Guayaquil, Ecuador
| | - Santiago Martínez-Isasi
- CLINURSID Research Group, Nursing Department, University of Santiago de Compostela, Santiago de Compostela, Galicia
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Abstract
OBJECTIVES California features low smoking prevalence, cautionary electronic cigarette (e-cigarette) public messaging, and legal recreational cannabis: a unique landscape for dental professionals to navigate tobacco cessation promotion. This cross-sectional study assessed California dental professionals' self-reported tobacco patient counseling behaviors and the correlates of providing such assistance. METHODS Statewide surveys of dental hygienists (n = 701) and dentists (n = 725) were distributed electronically. The dentist survey was weighted for sampling and nonresponse. Prevalence of asking patients about use was compared for cigarette and noncigarette products (e.g., e-cigarettes, cannabis). Multivariable models identified independent correlates of providing cessation assistance to tobacco-using patients. RESULTS Respondents reported frequently (often/always) documenting patient tobacco use (hygienists: 80%; dentists: 73%) but less commonly provided forms of assistance (hygienists: 27%-49%; dentists: 10%-31%). Most respondents asked patients about cigarette smoking, but noncigarette product use (cigar, hookah, pipe, e-cigarette, or cannabis) was not commonly assessed. Greater confidence and willingness to assist were positively associated with providing assistance in multivariable models, but perceived barriers (e.g., lack of time and remuneration) were not. Results were robust to model specifications. CONCLUSIONS California dental professionals often ask about smoking but lag in providing cessation assistance and inquiring about noncigarette products. Successful efforts to encourage dental professionals' engagement in tobacco prevention and cessation must enhance providers' self-efficacy and motivation and likely will require system and organizational change. KNOWLEDGE TRANSFER STATEMENT Study findings identify substantial gaps in dental professionals' engagement in patient tobacco cessation. The results identify correlates of providing assistance and of dental professionals' willingness and confidence to do so, which could serve to inform interventions to support and enhance engagement.
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Affiliation(s)
- B.W. Chaffee
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco School of Dentistry, San Francisco, CA, USA
| | - J. Urata
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco School of Dentistry, San Francisco, CA, USA
| | - E.T. Couch
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco School of Dentistry, San Francisco, CA, USA
| | - S. Silverstein
- Division of Oral Epidemiology and Dental Public Health, University of California San Francisco School of Dentistry, San Francisco, CA, USA
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El Tantawi M, Ellakany P, Aly NM, Moussa H. Oral health and tobacco research in the Eastern Mediterranean Region in relation to the Framework Convention on Tobacco Control: a scoping review. East Mediterr Health J 2020; 26:85-93. [PMID: 32043550 DOI: 10.26719/2020.26.1.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 07/31/2019] [Indexed: 11/09/2022]
Abstract
Background Tobacco use is associated with oral diseases. Evaluating research on tobacco use and oral health can provide insight into the prevailing situation and help engage dental personnel in tackling the tobacco problem. Aims This study aimed to map knowledge gaps on tobacco and oral health research in the Eastern Mediterranean Region based on four articles of the Framework Convention on Tobacco Control (FCTC). These were: article 12 - use of communication tools to promote tobacco education and awareness; article 14 - promotion of tobacco cessation; article 20 - exchange of information on determinants and outcomes of tobacco use; and article 22 - international cooperation to transfer expertise to strengthen national tobacco control strategies. Methods A scoping review was conducted that included publications on tobacco use and oral health in the Region. PubMed, Scopus, Web of Science, Google Scholar and Proquest theses were searched. Information extracted included: country, study type, whether more than one country was included and whether the publication addressed FCTC articles 12, 14, 20 or 22. Results In all, 322 publications were included, of which 82.0% were observational studies and 4.3% were clinical trials. Most publications (87.9%) were from the Islamic Republic of Iran, Jordan, Pakistan Saudi Arabia and Yemen. Only 32 (9.9%) publications included participants from more than one country. Of all the publications, 21.5% related to article 12 of the FCTC, 4.3% to article 14, 94.7% to article 20 and 6.5% article 22. Conclusions Research on oral health and tobacco needs to be better aligned with the FCTC articles.
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Affiliation(s)
- Maha El Tantawi
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Passent Ellakany
- Department of Substitutive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Nourhan M Aly
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Hana Moussa
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Huang H, Zhang Y, Cheng J, Wang W, Wen M. Evaluating the Changes of White Matter Microstructures in Tobacco Addicts Based on Diffusion Tensor Imaging. Med Sci Monit 2020; 26:e919105. [PMID: 31899914 PMCID: PMC6977634 DOI: 10.12659/msm.919105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/16/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The tract-based spatial statistics (TBSS) method was used to investigate the changes of white matter microstructure in tobacco addicts, and to analyze its correlation with smoking index, smoking years, and daily smoking amount. MATERIAL AND METHODS Routine magnetic resonance imaging (excluding intracranial lesions) and diffusion tensor imaging (DTI) sequence scanning were performed in 156 nicotine addicts (nicotine dependence group) and 81 non-nicotine addicts (control group) recruited from the study group. TBSS method was used to preprocess DTI data, and age and education level were taken as covariables to statistically analyze relevant parameters between nicotine dependence group and control group, such as fractional anisotropy (FA) value and smoking index. Spearman correlation analysis was performed on smoking status and FA values in brain regions with significant differences between nicotine dependent group and control group, and the test level alpha was 0.05. RESULTS Compared with control group, FA values of white matter in part of the posterior limb of the right inner capsule (r=-0.428, P=0.003), the right superior radiating crown (r=-0.136, P=0.004), the right posterior radiating crown (r=-0.229, P=0.003), the right superior longitudinal bundle (r=-0.474, P=0.002), the right inferior longitudinal bundle (r=-0.354, P=0.003) and the inferior frontal occipital bundle (r=-0.310, P=0.002) were decreased, which were negatively correlated with smoking index (P<0.05). CONCLUSIONS Nicotine can damage the microstructure of white matter in specific brain regions and damage neurons, with cumulative effects.
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Mann N, Nonnemaker J, Davis K, Chapman L, Thompson J, Juster HR. The Potential Impact of the New York State Smokers' Quitline on Population-Level Smoking Rates in New York. Int J Environ Res Public Health 2019; 16:ijerph16224477. [PMID: 31739413 PMCID: PMC6887956 DOI: 10.3390/ijerph16224477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/25/2019] [Accepted: 11/11/2019] [Indexed: 11/16/2022]
Abstract
Receiving smoking cessation services from telephone quitlines significantly increases quit success compared with no intervention or other quitting methods. To affect population-level smoking, quitlines must provide a sufficient proportion of smokers with effective interventions. Nationally, quitlines reach around 1% of adult smokers annually. From 2011 through 2016, the average annual reach of the New York State Smokers' Quitline (NYSSQL) was 2.9%. We used data on the reach and cessation outcomes of NYSSQL to estimate its current impact on population-level smoking prevalence and to estimate how much reach would have to increase to achieve population-level smoking prevalence reductions. We estimate NYSSQL is associated with a 0.02 to 0.04 percentage point reduction in smoking prevalence in New York annually. If NYSSQL achieved the recommended annual reach of 8% (CDC Best Practices) and 16% (NAQC), state-level prevalence would decrease by an estimated 0.07-0.12 and 0.13-0.24 percentage points per year, respectively. To achieve those recommended levels of reach, NYSSQL would need to provide services to approximately 3.5 to 6.9 times more smokers annually. Given their reach, quitlines are limited in their ability to affect population-level smoking. Increasing quitline reach may not be feasible and would likely be cost-prohibitive. It may be necessary to re-think the role of quitlines in tobacco control efforts. In New York, the quitline is being integrated into larger efforts to promote cessation through health systems change.
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Affiliation(s)
- Nathan Mann
- RTI International, Research Triangle Park, NC 27709, USA; (J.N.); (K.D.); (L.C.); (J.T.)
- Correspondence: ; Tel.: +(919)-485-5584; Fax: +(919)-541-6683
| | - James Nonnemaker
- RTI International, Research Triangle Park, NC 27709, USA; (J.N.); (K.D.); (L.C.); (J.T.)
| | - Kevin Davis
- RTI International, Research Triangle Park, NC 27709, USA; (J.N.); (K.D.); (L.C.); (J.T.)
| | - LeTonya Chapman
- RTI International, Research Triangle Park, NC 27709, USA; (J.N.); (K.D.); (L.C.); (J.T.)
| | - Jesse Thompson
- RTI International, Research Triangle Park, NC 27709, USA; (J.N.); (K.D.); (L.C.); (J.T.)
| | - Harlan R. Juster
- Bureau of Tobacco Control, New York State Department of Health, Albany, NY 12242, USA;
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Polinski KJ, Wolfe R, Peterson A, Juhl A, Perraillon MC, Levinson AH, Crume TL. Impact of an incentive-based prenatal smoking cessation program for low-income women in Colorado. Public Health Nurs 2019; 37:39-49. [PMID: 31692104 DOI: 10.1111/phn.12682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/03/2019] [Accepted: 10/17/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess birth outcomes and cost-savings of an incentive-based prenatal smoking cessation program targeting low-income women in Colorado. DESIGN Prospective observational cohort with nonequivalent population control groups. SAMPLE Program participants (n = 2,231) linked to the birth certificate to ascertain birth outcomes compared to two reference populations from Pregnancy Risk Assessment Monitoring System (PRAMS) and Colorado live births based on the birth certificate. MEASUREMENTS Tobacco cessation metrics in the third trimester of pregnancy, neonatal low birth weight (<2,500 g), preterm birth (birth at <37 weeks gestation), neonatal intensive care unit (NICU) admission and maternal gestational hypertension. Cost-savings and return on investment (ROI) were projected using average Medicaid reimbursement. RESULTS Infants of mothers enrolled in the program had a lower risk of low birthweight (RR = 0.86; 95% CI = 0.75, 0.97), preterm birth (PTB) (RR = 0.76; 95% CI = 0.65, 0.88) and neonatal intensive care unit (NICU) admission (RR = 0.76; 95% CI = 0.66, 0.88) compared to the birth certificate population, corresponding to a ROI of $7.73 and an individual cost savings of $6,040. Compared to PRAMS, infants of enrolled mothers had a lower risk of PTB (RR = 0.72; 95% CI = 0.53, 0.99) and NICU admission (RR = 0.45; 95% CI = 0.32, 0.62), corresponding to an ROI of $2.79 and an individual cost savings of $2,182. CONCLUSIONS We found a reduction of adverse birth outcomes, and cost savings.
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Affiliation(s)
- Kristen J Polinski
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Rachel Wolfe
- Department of Health Systems Management and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Anne Peterson
- Colorado Department of Public Health and Environment, Health Surveys and Evaluation Branch, Center for Health and Environmental Data, Denver, CO, USA
| | - Ashley Juhl
- Colorado Department of Public Health and Environment, Health Surveys and Evaluation Branch, Center for Health and Environmental Data, Denver, CO, USA
| | - Marcelo Coca Perraillon
- Department of Health Systems Management and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Arnold H Levinson
- Department of Community and Behavioral Health, Colorado School of Public Health and University of Colorado Cancer Center University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Tessa L Crume
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Ahmadian M, Khami MR, Ahamdi AE, Razeghi S, Yazdani R. Effectiveness of two interactive educational methods to teach tobacco cessation counseling for senior dental students. Eur J Dent 2019; 11:287-292. [PMID: 28932135 PMCID: PMC5594954 DOI: 10.4103/ejd.ejd_352_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective: Nowadays, one of the major health problems in many countries is tobacco use. Dental professionals are in a unique position to promote smoking cessation since they have the opportunity for regular interaction with their patients. The purpose of the present study was to compare the effectiveness of two educational methods to teach tobacco cessation counseling (TCC) in dental practice for senior dental students. Materials and Methods: In this interventional study, 93 eligible senior dental students from two dental schools in Tehran, Iran were randomly divided into two groups. Two educational programs, role play (RP) and problem-based learning (PBL), with the same aim about TCC in dental practice, were developed and implemented for the two groups. The score of knowledge, attitude, and skill were determined in both groups before and after participation in the course using a questionnaire. The changes in the scores from pre- to post-test were statistically analyzed using repeated measure ANOVA test. Results: Total scores of knowledge, attitude, and skill of the participants showed improvements when compared to scores before training (P < 0.001, P = 0.003, and P < 0.001, respectively). However, the differences between the two study methods were statistically insignificant (P > 0.05). Conclusion: The results suggested that TCC training through RP and PBL methods leads to improvement in knowledge, attitude, and skills of dental students in the short-term evaluation.
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Affiliation(s)
- Mina Ahmadian
- Department of Pediatric Dentistry, School of Dentistry, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mohammad Reza Khami
- Research Center for Caries Prevention, Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezoo Ebn Ahamdi
- Department of Community Oral Health, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samaneh Razeghi
- Research Center for Caries Prevention, Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Yazdani
- Research Center for Caries Prevention, Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
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Scheeres A, Xhezo R, Julius R, Coffman R, Frisby J, Weber L, Streeter J, Leone F, Bettigole C, Lawman H. Changes in voluntary admission and restraint use after a comprehensive tobacco-free policy in inpatient psychiatric health facilities. Subst Abus 2019; 41:252-258. [PMID: 31295085 DOI: 10.1080/08897077.2019.1635556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Cardiovascular and respiratory diseases, predominantly due to tobacco use, are the leading causes of death among individuals with serious and persistent mental illness. However, many psychiatric health facilities do not routinely treat tobacco use disorder. The purpose of the current study was to examine the impact of implementing a tobacco-free policy in inpatient psychiatric health facilities in a large, urban setting on behavioral problems, treatment access, and tobacco treatment. Methods: Data on seclusion and restraint incidents, voluntary commitment at admission for each hospitalization episode, and nicotine replacement therapy (NRT) prescriptions were collected through secondary analysis of Medicaid administrative records from baseline in January 2015 (n = 8983) to follow-up in December 2016 (n = 9685) at 14 inpatient psychiatric health facilities. Results: There were no significant changes from baseline to follow-up in odds of seclusion and restraint incidents or voluntary admission status. There was a significant increase in the odds of NRT prescriptions at both 30 and 180 days post discharge (odds ratio [OR] range = 1.58-2.09, P < .01). Conclusions: In a large, urban setting among Medicaid enrollees, implementation of a tobacco-free policy in inpatient psychiatric health facilities had no negative impact on behavioral problems or treatment access and improved access to NRT, although overall NRT use remained low. This study challenges perceptions among some providers that addressing tobacco use disorder will negatively impact treatment outcomes in individuals with serious mental illness. These findings support tobacco-free policies in psychiatric health facilities and the role of psychiatric health providers in treating tobacco use in this population, which is at high risk for tobacco-related mortality.
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Affiliation(s)
- Annaka Scheeres
- Division of Chronic Disease Prevention, Philadelphia Department of Public Health, Philadelphia, Pennsylvania, USA
| | - Regina Xhezo
- Community Behavioral Health, Philadelphia, Pennsylvania, USA
| | - Rose Julius
- Community Behavioral Health, Philadelphia, Pennsylvania, USA
| | - Ryan Coffman
- Division of Chronic Disease Prevention, Philadelphia Department of Public Health, Philadelphia, Pennsylvania, USA
| | - Jarma Frisby
- Division of Chronic Disease Prevention, Philadelphia Department of Public Health, Philadelphia, Pennsylvania, USA
| | - Luise Weber
- Community Behavioral Health, Philadelphia, Pennsylvania, USA
| | | | - Frank Leone
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cheryl Bettigole
- Division of Chronic Disease Prevention, Philadelphia Department of Public Health, Philadelphia, Pennsylvania, USA
| | - Hannah Lawman
- Division of Chronic Disease Prevention, Philadelphia Department of Public Health, Philadelphia, Pennsylvania, USA
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Abstract
Background & objectives: Smokeless tobacco (SLT) consumption is a global health issue with about 350 million users and numerous adverse health consequences like oral cancer and myocardial disorders. Hence, cessation of SLT use is as essential as smoking cessation. An update on the available literature on SLT cessation intervention studies is provided here. Methods: Through an extensive literature search on SLT cessation intervention studies, using keywords such as smokeless tobacco, cessation, interventions, quitlines, brief advice, nicotine replacement therapy, nicotine gum, nicotine lozenge, nicotine patch, bupropion, varenicline, mHealth, etc., 59 eligible studies were selected. Furthermore, efficacy of the interventions was assessed from the reported risk ratios (RRs) [confidence intervals (CIs)] and quit rates. Results: Studies were conducted in Scandinavia, India, United Kingdom, Pakistan and the United States of America, with variable follow up periods of one month to 10 years. Behavioural interventions alone showed high efficacy in SLT cessation; most studies were conducted among adults and showed positive effects, i.e. RR [CI] 0.87 [0.7, 1.09] to 3.84 [2.33, 6.33], quit rate between 9-51.5 per cent, at six months. Regular telephone support/quitlines also proved beneficial. Among pharmacological modalities, nicotine lozenges and varenicline proved efficacious in SLT cessation. Interpretation & conclusions: Globally, there is limited information available on SLT cessation intervention trials, research on which must be encouraged, especially in the low-resource, high SLT burden countries; behavioural interventions are most suitable for such settings. Appropriate training/sensitization of healthcare professionals, and school-based SLT use prevention and cessation programmes need to be encouraged.
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Affiliation(s)
- Suzanne Tanya Nethan
- Division of Clinical Oncology, ICMR-National Institute of Cancer Prevention & Research, Noida, India
| | | | - Kumar Chandan
- WHO FCTC Global Knowledge Hub on Smokeless Tobacco, ICMR-National Institute of Cancer Prevention & Research, Noida, India
| | - Ravi Mehrotra
- WHO FCTC Global Knowledge Hub on Smokeless Tobacco, ICMR-National Institute of Cancer Prevention & Research, Noida, India
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Brown EM, Hayes KA, Olson LT, Battles H, Ortega-Peluso C. Dentist and hygienist smoking cessation counseling and awareness of Medicaid benefits. J Public Health Dent 2019; 79:246-252. [PMID: 31063236 DOI: 10.1111/jphd.12321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 12/11/2018] [Accepted: 03/22/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Integrating smoking cessation interventions into dental care is an efficient way to intervene with smokers. This study of dentists and dental hygienists who provide dental care to Medicaid-insured patients explores awareness of Medicaid smoking cessation benefits, awareness of Quitline resources, beliefs about perceived role in providing tobacco interventions, and behaviors around clinical intervention. METHODS In 2015, we conducted a survey of dentists and hygienists who serve Medicaid patients in New York State. RESULTS A total of 182 dentists and 92 hygienists completed the survey. Ninety percent reported that helping patients quit smoking is part of their role, while 51.0 percent reported feeling confident in their ability to counsel a patient about quitting. Most respondents (73.4 percent) asked patients about tobacco use, 83.7 percent advised smokers to quit, and 49.1 percent assisted with quit attempts. We found that 26.7 percent were aware that dentist smoking cessation counseling is covered by Medicaid, and 15.5 percent were aware that hygienist smoking cessation counseling is covered. A total of 38.9 percent were aware of any Medicaid coverage for smoking cessation. Awareness of the Medicaid smoking cessation benefit was associated with intervention behaviors of asking and assisting. CONCLUSIONS Most dental care providers see smoking cessation as part of their role, but few are aware of the Medicaid benefits available to help patients. Expanding coverage of and promoting Medicaid benefits for smoking cessation have the potential to increase the reach and quality of smoking cessation interventions for Medicaid-insured smokers, a population disproportionately affected by tobacco use.
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Affiliation(s)
- Elizabeth M Brown
- Center for Health Policy Science & Tobacco Research, RTI International, Research Triangle Park, NC, USA
| | - Kim A Hayes
- Center for Health Policy Science & Tobacco Research, RTI International, Research Triangle Park, NC, USA
| | - Lindsay T Olson
- Center for Health Policy Science & Tobacco Research, RTI International, Research Triangle Park, NC, USA
| | - Haven Battles
- Division of Chronic Disease Prevention, New York State Department of Health, Albany, NY, USA
| | - Christina Ortega-Peluso
- Division of Chronic Disease Prevention, New York State Department of Health, Albany, NY, USA
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Joseph AM, Rothman AJ, Almirall D, Begnaud A, Chiles C, Cinciripini PM, Fu SS, Graham AL, Lindgren BR, Melzer AC, Ostroff JS, Seaman EL, Taylor KL, Toll BA, Zeliadt SB, Vock DM. Lung Cancer Screening and Smoking Cessation Clinical Trials. SCALE (Smoking Cessation within the Context of Lung Cancer Screening) Collaboration. Am J Respir Crit Care Med 2019; 197:172-182. [PMID: 28977754 DOI: 10.1164/rccm.201705-0909ci] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
National recommendations for lung cancer screening for former and current smokers aged 55-80 years with a 30-pack-year smoking history create demand to implement efficient and effective systems to offer smoking cessation on a large scale. These older, high-risk smokers differ from participants in past clinical trials of behavioral and pharmacologic interventions for tobacco dependence. There is a gap in knowledge about how best to design systems to extend reach and treatments to maximize smoking cessation in the context of lung cancer screening. Eight clinical trials, seven funded by the National Cancer Institute and one by the Veterans Health Administration, address this gap and form the SCALE (Smoking Cessation within the Context of Lung Cancer Screening) collaboration. This paper describes methodological issues related to the design of these clinical trials: clinical workflow, participant eligibility criteria, screening indication (baseline or annual repeat screen), assessment content, interest in stopping smoking, and treatment delivery method and dose, all of which will affect tobacco treatment outcomes. Tobacco interventions consider the "teachable moment" offered by lung cancer screening, how to incorporate positive and negative screening results, and coordination of smoking cessation treatment with clinical events associated with lung cancer screening. Unique data elements, such as perceived risk of lung cancer and costs of tobacco treatment, are of interest. Lung cancer screening presents a new and promising opportunity to reduce morbidity and mortality resulting from lung cancer that can be amplified by effective smoking cessation treatment. SCALE teamwork and collaboration promise to maximize knowledge gained from the clinical trials.
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Affiliation(s)
| | | | - Daniel Almirall
- 3 Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | | | - Caroline Chiles
- 4 Department of Radiology, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Paul M Cinciripini
- 5 Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Amanda L Graham
- 6 Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC
| | | | | | - Jamie S Ostroff
- 8 Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elizabeth L Seaman
- 9 Tobacco Control Research Branch, National Cancer Institute, Rockville, Maryland
| | - Kathryn L Taylor
- 10 Department of Oncology, Georgetown University Medical Center, Washington, DC
| | - Benjamin A Toll
- 11 Department of Public Health Sciences and Psychiatry, Medical University of South Carolina, Charleston, South Carolina; and
| | - Steven B Zeliadt
- 12 VA Center of Innovation for Veteran-Centered and Value-Driven Care, School of Public Health, University of Washington, Seattle, Washington
| | - David M Vock
- 13 Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota
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Weiss-Gerlach E, McCarthy WJ, Wellmann J, Graunke M, Spies C, Neuner B. Secondary analysis of an RCT on Emergency Department-Initiated Tobacco Control: Repeatedly assessed point-prevalence abstinence up to 12 months and extension of results through a 10-year follow-up. Tob Induc Dis 2019; 17:26. [PMID: 31582937 PMCID: PMC6751984 DOI: 10.18332/tid/105579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/08/2019] [Accepted: 03/12/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Emergency departments (EDs) are opportune places for tobacco control interventions. The ‘Tobacco Control in an Urban Emergency Department’ (TED) study, ISRCTN41527831, originally evaluated the effect of motivational interviewing on-site plus up to four booster telephone calls on 12-month abstinence. This study’s aim was to evaluate the effect of the intervention on 7-day point-prevalence abstinence at 10 years follow-up (primary outcome) as well as on repeated point-prevalence abstinence at 1, 3, 6, 12 months and at 10 years (continual smoking abstinence, secondary outcome). METHODS At the 10 years follow-up and after informed consent, study participants responded to a mailed questionnaire. The primary outcome was analyzed in observed-only and in all-cases analyses. The secondary outcomes were analyzed using a multiple adjusted GLMM for binary outcomes. RESULTS Out of 1012 TED-study participants, 986 (97.4%) were alive and 231 (23.4% of 986) responded to the follow-up at 10 years. For observed-only and all-cases analyses, the effect of the baseline intervention on 7-day point-prevalence abstinence at the 10 years follow-up was statistically non-significant. However, when taking into account all repeated measures, the intervention significantly influenced continual abstinence with odds ratio 1.32 (95% CI: 1.01–1.73; p=0.042). Baseline motivation, perceived self-efficacy to stop smoking, and nicotine dependency were independently associated with long-term continual smoking abstinence (all p<0.05). CONCLUSIONS A conventional analysis failed to confirm a significant effect of the ED-initiated tobacco control intervention on the point-prevalence abstinence at 10 years. Results from a more integrative analysis nonetheless indicated an enduring intervention effect on continual abstinence among smokers first encountered in the emergency department setting 10 years earlier.
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Affiliation(s)
- Edith Weiss-Gerlach
- Department of Anesthesiology and Intensive Care Medicine, Charité- Universitätsmedizin Berlin, Berlin, Germany
| | - William J McCarthy
- Center for Cancer Prevention and Control Research, UCLA Fielding School of Public Health, Los Angeles, United States
| | - Jürgen Wellmann
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Marie Graunke
- Department of Anesthesiology and Intensive Care Medicine, Charité- Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia Spies
- Department of Anesthesiology and Intensive Care Medicine, Charité- Universitätsmedizin Berlin, Berlin, Germany
| | - Bruno Neuner
- Department of Anesthesiology and Intensive Care Medicine, Charité- Universitätsmedizin Berlin, Berlin, Germany
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Hagan J, Kedzior S, Pimentel L, Tran D, Vallabh P, Apollonio DE. A Cross-sectional Survey of California Pharmacists' Knowledge and Perceptions about Electronic Nicotine Delivery Systems (ENDS). Calif J Health Syst Pharm 2019; 31:56-68. [PMID: 35418739 PMCID: PMC9004318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
| | | | | | | | | | - Dorie E Apollonio
- Department of Clinical Pharmacy, at University of California, San Francisco
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Vijayaraghavan M, Apollonio DE. Engaging Adults Experiencing Homelessness in Smoking Cessation Through Large-Scale Community Service Events. Health Promot Pract 2019; 20:325-327. [PMID: 30845844 DOI: 10.1177/1524839919835280] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Cigarette smoking contributes substantially to the increased financial- and health-related burdens among adults experiencing homelessness. We describe findings from a case study of a model to increase access to cessation services among adults experiencing homelessness. In partnership with Project Homeless Connect (PHC), we piloted a unique service delivery model that involved providing brief cessation counseling and pharmacotherapy to smokers from this population attending large-scale service events in San Francisco, with the goal of connecting them to long-term smoking cessation care. We participated in three service events between October 2017 and March 2018. We offered brief smoking cessation counseling to 45 individuals, and smoking cessation counseling and pharmacotherapy to 7 individuals experiencing homelessness. This model could improve public health if expanded to other cities, particularly the 200 other cities in the United States offering PHC service events.
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Neumann AS, Kumar SV, Bangar S, Kookal KK, Spallek H, Tokede B, Simmons K, Even J, Mullins J, Mertz E, Yansane A, Obadan-Udoh E, White JM, Walji MF, Kalenderian E. Tobacco screening and cessation efforts by dental providers: A quality measure evaluation. J Public Health Dent 2019; 79:93-101. [PMID: 30566752 PMCID: PMC6570416 DOI: 10.1111/jphd.12298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 09/12/2018] [Accepted: 10/22/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The purpose of this study was to adapt, test, and evaluate the implementation of a primary care "Preventive care and Screening" meaningful use quality measure for tobacco use, in dental institutions. We determined the percentage of dental patients screened for tobacco use, and the percentage of tobacco users who received cessation counseling. METHODS We implemented the dental quality measure (DQM), in three dental schools and a large dental accountable care organization. An automated electronic health record (EHR) query identified patients 18 years and older who were screened for tobacco use one or more times within 24 months, and who received cessation counseling intervention if identified as a tobacco user. We evaluated EHR query performance with a manual review of a subsample of charts. RESULTS Across all four sites, in the reporting calendar year of 2015, a total of 143,675 patients met the inclusion criteria for the study. Within 24 months, including 2014 and 2015 calendar years, percentages of tobacco screening ranged from 79.7 to 99.9 percent, while cessation intervention percentages varied from 1 to 81 percent among sites. By employing DQM research methodology, we identified intervention gaps in clinical practice. CONCLUSIONS We demonstrated the successful implementation of a DQM to evaluate screening rates for tobacco use and cessation intervention. There is substantial variation in the cessation intervention rates across sites, and these results are a call for action for the dental profession to employ tobacco evidence-based cessation strategies to improve oral health and general health outcomes.
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Affiliation(s)
- Ana S Neumann
- Department of General Dentistry and Dental Public Health. University of Texas Health Science Center, School of Dentistry at Houston, 7500 Cambridge, Houston, TX, 77054
| | - Shwetha V Kumar
- Department of Diagnostic and Biomedical Sciences, Technology Services and Informatics. University of Texas Health Science Center, School of Dentistry at Houston, 7500 Cambridge, Houston, TX, 77054
| | - Suhasini Bangar
- Department of Diagnostic and Biomedical Sciences, Technology Services and Informatics. University of Texas Health Science Center, School of Dentistry at Houston, 7500 Cambridge, Houston, TX, 77054
| | - Krishna K Kookal
- Technology Services and Informatics. University of Texas Health Science Center, School of Dentistry at Houston, 7500 Cambridge, Houston, TX, 77054
| | - Heiko Spallek
- The University of Sydney. Faculty of Dentistry. 1 Mons Road, Westmead, NSW, 2145 Australia
| | - Bunmi Tokede
- Department of Oral Health Policy and Epidemiology. Harvard School of Dental Medicine. 188 Longwood Avenue, Boston, MA 02115
| | - Kristen Simmons
- Willamette Dental Group. 6950 NE Campus Way. Hillsboro, OR 97124
| | - Joshua Even
- Willamette Dental Group. 6950 NE Campus Way. Hillsboro, OR 97124
| | - Joanna Mullins
- Willamette Dental Group. 6950 NE Campus Way. Hillsboro, OR 97124
| | - Elizabeth Mertz
- Department of Preventive & Restorative Dental Sciences University of California San Francisco School of Dentistry. 707 Parnassus Ave., San Francisco, CA 94143
| | - Alfa Yansane
- Department of Preventive & Restorative Dental Sciences University of California San Francisco School of Dentistry. 707 Parnassus Ave., San Francisco, CA 94143
| | - Enihomo Obadan-Udoh
- Department of Preventive & Restorative Dental Sciences University of California San Francisco School of Dentistry. 707 Parnassus Ave., San Francisco, CA 94143
| | - Joel M White
- Department of Preventive & Restorative Dental Sciences University of California San Francisco School of Dentistry. 707 Parnassus Ave., San Francisco, CA 94143
| | - Muhammad F Walji
- Department of Diagnostic and Biomedical Sciences, Technology Services and Informatics. University of Texas Health Science Center, School of Dentistry at Houston, 7500 Cambridge, Houston, TX, 77054
| | - Elsbeth Kalenderian
- Department of Preventive & Restorative Dental Sciences University of California San Francisco School of Dentistry. 707 Parnassus Ave., San Francisco, CA 94143
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Williams LB, McCall A, Joshua TV, Looney SW, Tingen MS. Design of a Community-Based Lung Cancer Education, Prevention, and Screening Program. West J Nurs Res 2019; 41:1152-1169. [PMID: 30698501 DOI: 10.1177/0193945919827261] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Uptake of low-dose computed tomography (LDCT) for lung cancer screening is extremely low. Efforts to promote screening are warranted, especially among disparate groups such as racial/ethnic minorities and those of lower socioeconomic status. This article describes the design and implementation strategies of the ongoing cancer-Community Awareness Access Research and Education (c-CARE) program. The purpose of c-CARE is to increase community awareness of lung cancer screening through education. Community health workers were trained to implement the intervention in 12 community sites. The Health Belief Model guided the evaluation and intervention development methods. Aims include changing participants' knowledge, attitude, and beliefs related to lung cancer and increasing lung cancer early detection and prevention behaviors by identifying and connecting high-risk and/or nicotine-dependent individuals to LDCT screening and/or tobacco cessation services. If effective, these methods could model increased dissemination to other high-risk communities.
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Affiliation(s)
- Lovoria B Williams
- 1 Augusta University, Augusta, GA USA.,2 University of Kentucky, Lexington, KY USA
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Abstract
OBJECTIVE To measure the prevalence of smoking cessation during pregnancy and to identify factors associated with its occurrence. METHODS The present survey included all puerperal women living in the municipality of Rio Grande, RS, whose birth occurred between January 1 and December 31, 2013. A single standardized questionnaire was applied, in the hospital, within 48 hours of delivery. Multivariate analysis was performed using Poisson regression with robust variance. RESULTS The prevalence of smoking cessation among the 598 parturients studied was 24.9% (95%CI 21.5-28.6). After adjusting for confounding factors, mothers aged 13 to 19 years (PR = 1.76; 95%CI 1.13-2.74), who had higher family income (PR = 1.83; 95%CI, 1.23-2.72), higher educational level (PR = 2.79; 95%CI 1.27-6.15), higher number of prenatal appointments (PR = 1.84; 95%CI 1.11-3.05), and who did not smoke in the previous pregnancy (PR = 2.93; 95% CI, 1.95-4.41) presented a higher prevalence ratio of smoking cessation. CONCLUSIONS Although pregnancy is a window of opportunity for smoking cessation, the rate of cessation was low. The prevalence of cessation was higher among mothers with lower risk of complications, suggesting the need for interventions prioritizing pregnant women of lower socioeconomic levels.
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Affiliation(s)
- Josiane Luzia Dias-Damé
- Universidade Federal de Pelotas. Faculdade de Odontologia. Departamento de Odontologia Social e Preventiva. Pelotas, RS, Brasil
| | - Ana Cristina Lindsay
- University of Massachusetts Boston. College of Nursing and Health Sciences. Department of Exercise and Health Sciences. Boston, MA, EUA
- Harvard T.H. Chan School of Public Health. Department of Nutrition. Boston, MA, EUA
| | - Juraci Almeida Cesar
- Universidade Federal de Pelotas. Faculdade de Medicina. Departamento de Medicina Social. Programa de Pós-Graduação em Epidemiología. Pelotas, RS, Brasil
- Universidade Federal do Rio Grande. Faculdade de Medicina. Programa de Pós-Graduação em Saúde Pública. Rio Grande, RS, Brasil
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Abstract
PROBLEM IDENTIFICATION Continued smoking after a cancer diagnosis can lead to development of potential treatment interactions, secondary cancers, and comorbid conditions. The purpose of this article is to examine the prevalence of smoking after diagnosis and present current management strategies.
. LITERATURE SEARCH The terms cancer, survivorship, behavior, smoking, and quitlines were searched in PubMed and CINAHL® from the start of the databases to December 2016. Statistics, guidelines, and background information were obtained from websites of organizations such as the American Cancer Society, National Cancer Institute, National Institutes of Health, and Centers for Disease Control and Prevention.
. DATA EVALUATION Of 17 relevant articles, 12 were analyzed to identify variables among survivors who continued to smoke versus those who successfully quit. Five articles were analyzed to identify characteristics of successful smoking cessation interventions.
. SYNTHESIS Survivors who are younger, female, and not partnered and those who report less socioeconomic and psychosocial support may be at greater risk for continued smoking. Peer counseling, cognitive behavioral therapy exercises, and use of frameworks to guide interventions are unique properties of successful cessation interventions.
. IMPLICATIONS FOR RESEARCH Continued research on cancer-specific tobacco cessation interventions and exploration of why current evidence-based therapies are not working in this population are warranted.
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Puljević C, Coomber R, Kinner SA, de Andrade D, Mitchell C, White A, Cresswell SL, Bowman J. 'Teabacco': Smoking of nicotine-infused tea as an unintended consequence of prison smoking bans. Drug Alcohol Rev 2018; 37:912-921. [PMID: 30051520 DOI: 10.1111/dar.12848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/21/2018] [Accepted: 06/29/2018] [Indexed: 01/15/2023]
Abstract
INTRODUCTION AND AIMS Following the introduction of smoke-free policies in prisons in several countries, there have been anecdotal reports of prisoners creating cigarettes by mixing nicotine patches or lozenges with tea leaves ('teabacco'). Among a sample of people recently released from smoke-free prisons in Queensland, Australia, the aims of this study were to explore the perceived popularity of teabacco use, motivations for its use and describe the process of creating teabacco to identify potential associated health risks. DESIGN AND METHODS This study used a mixed-methods design. Eighty-two people recently released from prison in Queensland, Australia completed surveys at parole offices measuring teabacco use while incarcerated. Twenty-one teabacco smokers took part in follow-up, qualitative interviews to explore survey responses in greater depth. RESULTS The majority of survey participants (57%) reported smoking teabacco while incarcerated, with 37% smoking teabacco frequently (> once per week). Teabacco use was primarily motivated by cigarette cravings. Participants described the perceived inevitability of prisoners finding substitutes for tobacco. Multivariate analyses found that self-rated poor physical health, having been incarcerated five or more times, experiencing cigarette cravings while incarcerated, and use of illicit drugs while incarcerated were positively associated with frequent teabacco use in prison. DISCUSSION AND CONCLUSIONS Our findings suggest that teabacco use has become common practice in Queensland's smoke-free prisons. Correctional smoking bans are an important public health initiative but should be complemented with demand and harm reduction measures cognisant of the risk environment.
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Affiliation(s)
- Cheneal Puljević
- Griffith Criminology Institute, Griffith University, Brisbane, Australia.,Queensland Alcohol and Drug Research and Education Centre, School of Public Health, The University of Queensland, Brisbane, Australia.,The Institute for Social Science Research, The University of Queensland, Brisbane, Australia
| | - Ross Coomber
- Griffith Criminology Institute, Griffith University, Brisbane, Australia.,Department of Sociology, Social Policy and Criminology, University of Liverpool, Liverpool, UK
| | - Stuart A Kinner
- Griffith Criminology Institute, Griffith University, Brisbane, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Mater Research Institute-UQ, University of Queensland, Brisbane, Australia
| | - Dominique de Andrade
- Griffith Criminology Institute, Griffith University, Brisbane, Australia.,School of Psychology, University of Queensland, Brisbane, Australia.,Centre for Youth Substance Abuse Research, School of Psychology and Counselling, Institute of Health and Biomedical Innovation, Centre for Children's Health Research, Queensland University of Technology, Brisbane, Australia
| | - Courtney Mitchell
- School of Environment and Science, Griffith University, Brisbane, Australia
| | - Alan White
- School of Environment and Science, Griffith University, Brisbane, Australia
| | - Sarah L Cresswell
- School of Environment and Science, Griffith University, Brisbane, Australia
| | - Jasper Bowman
- School of Environment and Science, Griffith University, Brisbane, Australia
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Whitehouse E, Lai J, Golub JE, Farley JE. A systematic review of the effectiveness of smoking cessation interventions among patients with tuberculosis. Public Health Action 2018; 8:37-49. [PMID: 29946519 PMCID: PMC6012961 DOI: 10.5588/pha.18.0006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/14/2018] [Indexed: 12/30/2022] Open
Abstract
Smoking is a significant risk factor for morbidity and mortality, particularly among patients with tuberculosis (TB). Although smoking cessation is recommended by the World Health Organization and the International Union Against Tuberculosis and Lung Disease, there has been no published evaluation of smoking cessation interventions among people with TB. The purpose of this review was to synthesize the evidence on interventions and suggest practice, research and policy implications. A systematic review of the literature identified 14 peer-reviewed studies describing 13 smoking cessation interventions between 2007 and 2017. There were five randomized controlled trials, three non-randomized interventions, and five prospective cohort studies. The primary types of interventions were brief advice (n = 9), behavioral counseling (n = 4), medication (n = 3), and community-based care (n = 3). A variety of health care workers (HCWs) implemented interventions, from physicians, nurses, clinic staff, community health workers (CHWs), as did family members. There was significant heterogeneity of design, definition of smoking and smoking abstinence, and implementation, making comparison across studies difficult. Although all smoking interventions increased smoking cessation between 15% and 82%, many studies had a high risk for bias, including six without a control group. The implementing personnel did not make a large difference in cessation results, suggesting that national TB programs may customize according to their needs and limitations. Family members may be important supporters/advocates for cessation. Future research should standardize definitions of smoking and cessation to allow comparisons across studies. Policy makers should encourage collaboration between tobacco and TB initiatives and develop smoking cessation measures to maximize results in low-resource settings.
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Affiliation(s)
- E Whitehouse
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - J Lai
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - J E Golub
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - J E Farley
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
- The REACH Initiative, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
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Abstract
Healthcare providers often do not have the time to counsel patients on how to quit smoking. Consequently, little emphasis is placed on this pursuit, and no behavioral counseling is done. Using medications approved by the U.S. Food and Drug Administration in combination with behavioral counseling has been shown to be effective in smoking cessation programs. Oncology nurses, and advanced practice nurses in particular, can play a significant role in helping patients to quit smoking. This article details how one oncology clinical nurse specialist created a smoking cessation program at her institution.
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Nowlin JP, Lee JGL, Wright WG. Implementation of Recommended Tobacco Cessation Systems in Dental Practices: A Qualitative Exploration in Northeastern North Carolina. J Dent Educ 2018; 82:475-482. [PMID: 29717071 DOI: 10.21815/jde.018.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 11/04/2017] [Indexed: 11/20/2022]
Abstract
Every year, cigarettes and other tobacco products cause nearly one in five deaths in the U.S., but many smokers report not being advised to quit by their health care providers. Dentists have an important role to play in tobacco cessation, but more research is needed about the extent of and barriers to implementation in dental practices. The aims of this study were to assess the extent to which dental practices in northeastern North Carolina were implementing the recommended U.S. Public Health Service (PHS) Clinical Practice Guideline, to understand policies about smoking in dental practice settings, and to identify barriers to implementation of recommended systems. In the 252 telephone area code, which covers northeastern North Carolina, 75 general dentists were identified from the American Dental Association website and purposely selected for geographic, gender, race, and practice size diversity from the sampling frame. The 11 dentists who agreed to participate (seven male, four female) took part in 15-minute semi-structured interviews by phone in January-March 2017. The interview transcripts were thematically coded for adherence to the PHS guideline. The results showed that full implementation of the guideline and the 5As was limited, although asking, advising, and assessing about tobacco use was consistently present in these dental practices. Other recommendations, particularly designation of a staff member as coordinator, were not implemented. In terms of barriers, interviewees reported very limited past or present training for themselves or their staff members. This study found meaningful levels of adherence to the tobacco cessation guideline in this area with high smoking prevalence; but the results suggest room for improvement in training through both dental curricula and continuing education.
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Affiliation(s)
- Jonathan P Nowlin
- Jonathan P. Nowlin, BSPH, is Research Assistant, Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University; Joseph G.L. Lee, PhD, MPH, is Assistant Professor, Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University; and Wanda G. Wright, RN, DDS, MS, MSD, is Assistant Professor, Department of Foundational Sciences and Division Director of Dental Public Health, School of Dental Medicine, East Carolina University
| | - Joseph G L Lee
- Jonathan P. Nowlin, BSPH, is Research Assistant, Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University; Joseph G.L. Lee, PhD, MPH, is Assistant Professor, Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University; and Wanda G. Wright, RN, DDS, MS, MSD, is Assistant Professor, Department of Foundational Sciences and Division Director of Dental Public Health, School of Dental Medicine, East Carolina University.
| | - Wanda G Wright
- Jonathan P. Nowlin, BSPH, is Research Assistant, Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University; Joseph G.L. Lee, PhD, MPH, is Assistant Professor, Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University; and Wanda G. Wright, RN, DDS, MS, MSD, is Assistant Professor, Department of Foundational Sciences and Division Director of Dental Public Health, School of Dental Medicine, East Carolina University
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Bricker JB, Sridharan V, Zhu Y, Mull KE, Heffner JL, Watson NL, McClure JB, Di C. Trajectories of 12-Month Usage Patterns for Two Smoking Cessation Websites: Exploring How Users Engage Over Time. J Med Internet Res 2018; 20:e10143. [PMID: 29678799 PMCID: PMC5935807 DOI: 10.2196/10143] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 03/23/2018] [Accepted: 03/24/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Little is known about how individuals engage with electronic health (eHealth) interventions over time and whether this engagement predicts health outcomes. OBJECTIVE The objectives of this study, by using the example of a specific type of eHealth intervention (ie, websites for smoking cessation), were to determine (1) distinct groups of log-in trajectories over a 12-month period, (2) their association with smoking cessation, and (3) baseline user characteristics that predict trajectory group membership. METHODS We conducted a functional clustering analysis of 365 consecutive days of log-in data from both arms of a large (N=2637) randomized trial of 2 website interventions for smoking cessation (WebQuit and Smokefree), with a primary outcome of 30-day point prevalence smoking abstinence at 12 months. We conducted analyses for each website separately. RESULTS A total of 3 distinct trajectory groups emerged for each website. For WebQuit, participants were clustered into 3 groups: 1-week users (682/1240, 55.00% of the sample), 5-week users (399/1240, 32.18%), and 52-week users (159/1240, 12.82%). Compared with the 1-week users, the 5- and 52-week users had 57% higher odds (odds ratio [OR] 1.57, 95% CI 1.13-2.17; P=.007) and 124% higher odds (OR 2.24, 95% CI 1.45-3.43; P<.001), respectively, of being abstinent at 12 months. Smokefree users were clustered into 3 groups: 1-week users (645/1309, 49.27% of the sample), 4-week users (395/1309, 30.18%), and 5-week users (269/1309, 20.55%). Compared with the 1-week users, 5-week users (but not 4-week users; P=.99) had 48% higher odds (OR 1.48, 95% CI 1.05-2.07; P=.02) of being abstinent at 12 months. In general, the WebQuit intervention had a greater number of weekly log-ins within each of the 3 trajectory groups as compared with those of the Smokefree intervention. Baseline characteristics associated with trajectory group membership varied between websites. CONCLUSIONS Patterns of 1-, 4-, and 5-week usage of websites may be common for how people engage in eHealth interventions. The 5-week usage of either website, and 52-week usage only of WebQuit, predicted a higher odds of quitting smoking. Strategies to increase eHealth intervention engagement for 4 more weeks (ie, from 1 week to 5 weeks) could be highly cost effective. TRIAL REGISTRATION ClinicalTrials.gov NCT01812278; https://www.clinicaltrials.gov/ct2/show/NCT01812278 (Archived by WebCite at http://www.webcitation.org/6yPO2OIKR).
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Affiliation(s)
- Jonathan B Bricker
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States.,Department of Psychology, University of Washington, Seattle, WA, United States
| | - Vasundhara Sridharan
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States.,Department of Psychology, University of Washington, Seattle, WA, United States
| | - Yifan Zhu
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Kristin E Mull
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Jaimee L Heffner
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Noreen L Watson
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Jennifer B McClure
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Chongzhi Di
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
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Brown-Johnson CG, Boeckman LM, White AH, Burbank AD, Paulson S, Beebe LA. Trust in Health Information Sources: Survey Analysis of Variation by Sociodemographic and Tobacco Use Status in Oklahoma. JMIR Public Health Surveill 2018; 4:e8. [PMID: 29434015 PMCID: PMC5826981 DOI: 10.2196/publichealth.6260] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 07/08/2017] [Accepted: 07/27/2017] [Indexed: 01/24/2023] Open
Abstract
Background Modern technology (ie, websites and social media) has significantly changed social mores in health information access and delivery. Although mass media campaigns for health intervention have proven effective and cost-effective in changing health behavior at a population scale, this is best studied in traditional media sources (ie, radio and television). Digital health interventions are options that use short message service/text messaging, social media, and internet technology. Although exposure to these products is becoming ubiquitous, electronic health information is novel, incompletely disseminated, and frequently inaccurate, which decreases public trust. Previous research has shown that audience trust in health care providers significantly moderates health outcomes, demographics significantly influence audience trust in electronic media, and preexisting health behaviors such as smoking status significantly moderate audience receptivity to traditional mass media. Therefore, modern health educators must assess audience trust in all sources, both media (traditional and digital) and interpersonal, to balance pros and cons before structuring multicomponent community health interventions. Objective We aimed to explore current trust and moderators of trust in health information sources given recent changes in digital health information access and delivery to inform design of future health interventions in Oklahoma. Methods We conducted phone surveys of a cross-sectional sample of 1001 Oklahoma adults (age 18-65 years) in spring 2015 to assess trust in seven media sources: traditional (television and radio), electronic (online and social media), and interpersonal (providers, insurers, and family/friends). We also gathered information on known moderators of trust (sociodemographics and tobacco use status). We modeled log odds of a participant rating a source as “trustworthy” (SAS PROC SURVEYLOGISTIC), with subanalysis for confounders (sociodemographics and tobacco use). Results Oklahomans showed the highest trust in interpersonal sources: 81% (808/994) reported providers were trustworthy, 55% (550/999) for friends and family, and 48% (485/998) for health insurers. For media sources, 24% of participants (232/989) rated the internet as trustworthy, followed by 21% of participants for television (225/998), 18% for radio (199/988), and only 11% for social media (110/991). Despite this low self-reported trust in social media, 40% (406/991) of participants reported using social media for tobacco-related health information. Trust in health providers did not vary by subpopulation, but sociodemographic variables (gender, income, and education) and tobacco use status significantly moderated trust in other sources. Women were on the whole more trusting than men, trust in media decreased with income, and trust in friends and family decreased with education. Conclusions Health education interventions should incorporate digital media, particularly when targeting low-income populations. Utilizing health care providers in social media settings could leverage high-trust and low-cost features of providers and social media, respectively.
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Affiliation(s)
- Cati G Brown-Johnson
- Evaluation Sciences Unit, Division of Primary Care and Population Health, Stanford School of Medicine, Stanford, CA, United States
| | - Lindsay M Boeckman
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Ashley H White
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Andrea D Burbank
- Stanford Health for All Alumni, Stanford Prevention Research Center, Stanford School of Medicine, Stanford, CA, United States
| | - Sjonna Paulson
- Oklahoma Tobacco Settlement Endowment Trust, Oklahoma City, OK, United States
| | - Laura A Beebe
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
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