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Chenoweth MJ, Kim YJ, Nollen NL, Hawk LW, Mahoney MC, Lerman C, Knight J, Tyndale RF. Genetic Prediction of Smoking Cessation Medication Side Effects: A Genome-Wide Investigation of Abnormal Dreams on Varenicline. Clin Pharmacol Ther 2024; 115:1277-1281. [PMID: 38369951 DOI: 10.1002/cpt.3210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/26/2024] [Indexed: 02/20/2024]
Abstract
Varenicline, the most efficacious smoking cessation monotherapy, produces abnormal dreams. Although genetic contributions to varenicline-associated nausea and cessation have been identified, the role of genetics in abnormal dreams is unknown. We conducted a genomewide association study (GWAS) of abnormal dreams in 188 European ancestry smokers treated with varenicline (NCT01314001). Additive genetic models examined the likelihood of experiencing abnormal dreams 2 weeks following varenicline initiation. For the top locus, we tested for selectivity to varenicline, effects on cessation, replication, and generalizability to African ancestry (AA) individuals. The top GWAS variant associated with abnormal dreams was rs901886, mapping to intron 2 of ICAM5 on chromosome 19. The prevalence of abnormal dreams in those with rs901886 CC, CT, and TT genotypes was 15%, 36%, and 62%, respectively (odds ratio = 2.94 for T vs. C, 95% confidence interval = 1.92-4.55, P = 2.03e-7; T allele frequency = 52%). This rs901886 association was selective to varenicline (P values > 0.05 on nicotine patch and placebo). There were also positive associations for rs901886 T (vs. C allele, P = 0.03) and for abnormal dreams (P = 0.06) with varenicline-aided cessation. Neither rs901886 (P = 0.40) nor abnormal dreams (P = 0.24) were associated with adherence. A similar direction of effect of rs901886 on abnormal dreams was observed in a second varenicline trial (NCT01836276). In AA individuals (n = 137), rs901886 was not associated with abnormal dreams (P = 0.41), but there was an association for a variant located ~ 74.4 kb 5' of ICAM5 (P = 2.56e-3). Variation in ICAM5 may influence abnormal dreams and cessation on varenicline. These findings provide additional support for genetically optimized smoking cessation approaches.
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Affiliation(s)
- Meghan J Chenoweth
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Yong Jae Kim
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Nikki L Nollen
- Department of Population Health, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Larry W Hawk
- Department of Psychology, University at Buffalo, Buffalo, New York, USA
| | - Martin C Mahoney
- Department of Internal Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Caryn Lerman
- USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jo Knight
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Data Science Institute, Lancaster University Medical School, Lancaster, UK
| | - Rachel F Tyndale
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Cooper RK, Mahoney MC, Tiffany ST, Colder CR, Tyndale RF, Hawk LW. Relationships Between the Nicotine Metabolite Ratio and Laboratory Assessments of Smoking Reinforcement and Craving Among Adults in a Smoking Cessation Trial. Nicotine Tob Res 2024; 26:604-611. [PMID: 37996099 PMCID: PMC11033563 DOI: 10.1093/ntr/ntad232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/10/2023] [Accepted: 11/20/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION People who metabolize nicotine more quickly are generally less successful at quitting smoking. However, the mechanisms that link individual differences in the nicotine metabolite ratio (NMR), a phenotypic biomarker of the rate of nicotine clearance, to smoking outcomes are unclear. We tested the hypotheses that higher NMR is associated with greater smoking reinforcement, general craving, and cue-induced cigarette craving in a treatment-seeking sample. METHODS Participants were 252 adults who smoke cigarettes enrolled in a randomized controlled smoking cessation trial (NCT03262662) conducted in Buffalo, New York, USA. Participants completed the Choice Behavior Under Cued Conditions (CBUCC) paradigm, a laboratory choice procedure, ~1 week before the first cessation treatment visit, at which time a saliva sample was collected for NMR assessment. On each CBUCC trial, participants reported cigarette craving during cue presentation (cigarette, water) and spent $0.01-$0.25 for a chance (5%-95%) to sample the cue (one puff, sip), providing measures of smoking reinforcement (spending for cigarettes vs. water), general cigarette craving (averaged across cigarette and water cues), and cue-specific craving (cigarette craving during cigarette vs. water cues). RESULTS As observed in prior work, the NMR was significantly higher among White and female participants. As expected, both spending and cigarette craving were significantly greater on cigarette compared to water trials. However, contrary to our hypotheses, higher NMR was not associated with greater smoking reinforcement, general craving, or cue-specific craving. CONCLUSIONS The present data do not support that smoking reinforcement or craving is related to nicotine metabolism among individuals seeking to quit smoking. IMPLICATIONS Though greater smoking reinforcement, general craving, and cue-specific craving are hypothesized to be linked to faster nicotine metabolism, there was no evidence of such relationships in the present sample of adults seeking to quit smoking. Further research, including replication and consideration of alternate hypotheses, is warranted to elucidate the mechanisms by which the NMR is related to smoking cessation.
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Affiliation(s)
- Robert K Cooper
- Department of Psychology, University at Buffalo, Buffalo, NY, USA
| | | | | | - Craig R Colder
- Department of Psychology, University at Buffalo, Buffalo, NY, USA
| | - Rachel F Tyndale
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Larry W Hawk
- Department of Psychology, University at Buffalo, Buffalo, NY, USA
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Paulin LM, Halenar MJ, Edwards KC, Lauten K, Taylor K, Brunette M, Tanski S, MacKenzie T, Stanton CA, Hatsukami D, Hyland A, Mahoney MC, Niaura R, Trinidad D, Blanco C, Compton W, Gardner LD, Kimmel HL, Cummings KM, Lauterstein D, Roh EJ, Marshall D, Sargent JD. Relationship Between Tobacco Product Use and Health-Related Quality of Life Among Individuals With COPD in Waves 1-5 (2013-2019) of the Population Assessment of Tobacco and Health Study. Chronic Obstr Pulm Dis 2024; 11:68-82. [PMID: 38113525 PMCID: PMC10913919 DOI: 10.15326/jcopdf.2023.0422] [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] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 12/21/2023]
Abstract
Introduction We examined the association between tobacco product use and health-related quality of life (HRQoL) among individuals with chronic obstructive pulmonary disease (COPD) in Waves 1-5 of the Population Assessment of Tobacco and Health (PATH) Study. Methods Adults ≥40 years with an ever COPD diagnosis were included in cross-sectional (Wave 5) and longitudinal (Waves 1 to 5) analyses. Tobacco use included 13 mutually exclusive categories of past 30-day (P30D) single use and polyuse with P30D exclusive cigarette use and ≥5-year cigarette cessation as reference groups. Multivariable linear regression and generalized estimating equations (GEE) were used to examine the association between tobacco use and HRQoL as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10 questionnaire. Results Of 1670 adults, 79.4% ever used cigarettes; mean (standard error [SE]) pack years was 30.9 (1.1). In cross-sectional analysis, P30D exclusive cigarette use, and e-cigarette/cigarette dual use were associated with worse HRQoL compared to ≥5-year cigarette cessation. Compared to P30D exclusive cigarette use, never tobacco use and ≥5-year cigarette cessation were associated with better HRQoL, while e-cigarette/cigarette dual use had worse HRQoL. Longitudinally (n=686), e-cigarette/cigarette dual use was associated with worsening HRQoL compared to both reference groups. Only never tobacco use was associated with higher HRQoL over time compared to P30D exclusive cigarette use. Conclusions E-cigarette/cigarette dual use was associated with worse HRQoL compared to ≥5-year cigarette cessation and exclusive cigarette use. Never use and ≥5-year cigarette cessation were the only categories associated with higher HRQoL compared to exclusive cigarette use. Findings highlight the importance of complete smoking cessation for individuals with COPD.
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Affiliation(s)
- Laura M. Paulin
- Geisel School of Medicine at Dartmouth, The C. Everett Koop Institute at Dartmouth, Hanover, New Hampshire, United States
| | - Michael J. Halenar
- Behavioral Health and Health Policy Practice, Westat, Rockville, Maryland, United States
| | - Kathryn C. Edwards
- Behavioral Health and Health Policy Practice, Westat, Rockville, Maryland, United States
| | - Kristin Lauten
- Behavioral Health and Health Policy Practice, Westat, Rockville, Maryland, United States
| | - Kristie Taylor
- Behavioral Health and Health Policy Practice, Westat, Rockville, Maryland, United States
| | - Mary Brunette
- Geisel School of Medicine at Dartmouth, The C. Everett Koop Institute at Dartmouth, Hanover, New Hampshire, United States
| | - Susanne Tanski
- Geisel School of Medicine at Dartmouth, The C. Everett Koop Institute at Dartmouth, Hanover, New Hampshire, United States
| | - Todd MacKenzie
- Geisel School of Medicine at Dartmouth, The C. Everett Koop Institute at Dartmouth, Hanover, New Hampshire, United States
| | - Cassandra A. Stanton
- Behavioral Health and Health Policy Practice, Westat, Rockville, Maryland, United States
| | - Dorothy Hatsukami
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, United States
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States
| | - Martin C. Mahoney
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States
| | - Ray Niaura
- School of Global Public Health, New York University, New York, New York, United States
| | - Dennis Trinidad
- University of California at San Diego, La Jolla, California, United States
| | - Carlos Blanco
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, United States
| | - Wilson Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, United States
| | - Lisa D. Gardner
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland, United States
| | - Heather L. Kimmel
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, United States
| | - K. Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Dana Lauterstein
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland, United States
| | - Esther J. Roh
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, Maryland, United States
| | - Daniela Marshall
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, United States
- Axle Informatics, Rockville, Maryland, United States
| | - James D. Sargent
- Geisel School of Medicine at Dartmouth, The C. Everett Koop Institute at Dartmouth, Hanover, New Hampshire, United States
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Gass JC, Tonkin S, Maguin E, Colder CR, Mahoney MC, Tiffany ST, Hawk LW. A preliminary randomized trial of reinforcement contingencies to improve compliance with ecological momentary assessment. Transl Behav Med 2024; 14:60-65. [PMID: 37904628 PMCID: PMC10782908 DOI: 10.1093/tbm/ibad066] [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: 11/01/2023] Open
Abstract
Ecological Momentary Assessment (EMA) methods are increasingly used by translational scientists to study real-world behavior and experience. The ability to draw meaningful conclusions from EMA research depends upon participant compliance with assessment completion. Most EMA studies provide financial compensation for compliance, but little empirical evidence addresses the impact of reinforcement parameters on the level of compliance. The purpose of this study-within-a-trial was to determine the effects of varying the amount and frequency of reinforcement on EMA compliance in a clinical sample of individuals seeking treatment for cigarette smoking. In the parent clinical trial, participants were asked to complete 9 weeks of EMA (1 daily Morning Assessment and 4 daily Random Assessments). Following a 5-week Standard Payment phase for EMA compliance, 61 individuals seeking treatment for cigarette smoking enrolled in the larger clinical trial were randomized to receive Standard ($1 per assessment, paid biweekly), Frequent ($1 per assessment, paid 3 times per week), or Large ($2 per assessment, paid biweekly) payments for EMA compliance during a 4-week Payment Manipulation Phase. Overall, receiving Frequent or Large payments did not improve EMA compliance compared to Standard payments, Ps > .30. Varying frequency and amount of remuneration for EMA compliance did not generally improve compliance in an ongoing clinical trial, raising further questions about the importance of reinforcement parameters in promoting EMA compliance.
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Affiliation(s)
- Julie C Gass
- Center for Integrated Healthcare, Western NY VA Healthcare System, Buffalo, NY, USA
- Department of Psychology, SUNY University at Buffalo, Buffalo, NY, USA
| | - Sarah Tonkin
- TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, USA
| | - Eugene Maguin
- Department of Psychology, SUNY University at Buffalo, Buffalo, NY, USA
| | - Craig R Colder
- Department of Psychology, SUNY University at Buffalo, Buffalo, NY, USA
| | - Martin C Mahoney
- Department of Cancer Prevention & Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Stephen T Tiffany
- Department of Psychology, SUNY University at Buffalo, Buffalo, NY, USA
| | - Larry W Hawk
- Department of Psychology, SUNY University at Buffalo, Buffalo, NY, USA
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Sheffer CE, Shevorykin A, Foulds J, Carl E, Mahoney MC, Bensch L, Liskiewicz A, Vantucci D, McDonough B, Szeliga A, Goniewicz ML, Hyland A. The Roswell eND scale: Brief, valid assessment of nicotine dependence adults seeking to discontinue e-cigarette use. Drug Alcohol Depend 2023; 243:109708. [PMID: 36608485 DOI: 10.1016/j.drugalcdep.2022.109708] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Most adults who regularly use e-cigarettes or Electronic Nicotine Delivery Systems (ENDS) desire to discontinue use. ENDS use can result symptoms of nicotine withdrawal and dependence which can make it more difficult to discontinue use. Brief, valid assessment of nicotine dependence among adults who use ENDS is needed to guide treatment for nicotine dependence in this group. We sought to develop a brief, valid instrument to measure nicotine dependence among adults seeking to discontinue ENDS in a busy Quitline. METHODS In this cross-sectional design, we examined content, construct, and concurrent validity of the Roswell ENDS Nicotine Dependence Scale (Roswell eND Scale) and the Penn State E-Cigarette Dependence Index (Penn State eCDI). Participants who called the New York Quitline from November 2019 to June 2020 seeking to discontinue ENDS use were invited to participate. Construct validity was examined with exploratory and confirmatory factor analyses. Instrument and factor scores were then correlated with cotinine, a biomarker of nicotine exposure. RESULTS All participants (n = 209) were highly dependent and co-used combustible cigarettes to varying degrees. Both instruments demonstrated content validity and construct validity, however only the 5-item Roswell eND Scale demonstrated criterion-related validity by showing a significant positive correlation with salivary cotinine levels. CONCLUSIONS The 5-item Roswell eND Scale can briefly and effectively assess nicotine dependence among treatment-seeking adults who co-use ENDS and cigarettes. These preliminary psychometric findings have the potential to be generalizable to other adults seeking to discontinue ENDS use, many of whom currently or formerly smoked cigarettes.
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Affiliation(s)
- Christine E Sheffer
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA.
| | - Alina Shevorykin
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Jonathan Foulds
- Public Health Sciences & Psychiatry, and Penn State Center for Research on Tobacco and Health, Penn State College of Medicine, Hershey, PA, USA
| | - Ellen Carl
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Martin C Mahoney
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Lindsey Bensch
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Amylynn Liskiewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Darian Vantucci
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Brian McDonough
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Andrew Szeliga
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
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Shevorykin A, Carl E, Liskiewicz A, Hanlon CA, Bickel WK, Mahoney MC, Vantucci D, Bensch L, Thorner H, Marion M, Sheffer CE. Perceived research burden of a novel therapeutic intervention: A study of transcranial magnetic stimulation for smoking cessation. Front Rehabil Sci 2023; 4:1054456. [PMID: 36937103 PMCID: PMC10020334 DOI: 10.3389/fresc.2023.1054456] [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: 09/27/2022] [Accepted: 02/17/2023] [Indexed: 03/06/2023]
Abstract
Background Translating repetitive transcranial magnetic stimulation (rTMS) into evidence-based clinical applications relies on research volunteers with different perspectives on the burden of study participation. Additionally, clinical applications of rTMS require multiple visits over weeks or months, the impact of research burden is an important component for these studies and translation of these findings to clinical practice. High frequency rTMS has significant potential to be developed as an evidence-based treatment for smoking cessation, however, the optimal rTMS dosing strategies have yet to be determined. Participant burden is an important component of determining optimal dosing strategy for rTMS as a treatment for long-term smoking cessation. Methods In this double-blinded, sham-controlled, randomized design, the effects of treatment duration, intensity, and active/sham assignment of rTMS on research burden were examined. Results Overall level of perceived research burden was low. Experienced burden (M = 26.50) was significantly lower than anticipated burden (M = 34.12). Research burden did not vary by race or income. Conclusions Overall research burden was relatively low. Contrary to our hypotheses, we found little evidence of added significant burden for increasing the duration or intensity of rTMS, and we found little evidence for differences in research burden by race or income. Clinical Trial Registration identifier NCT03865472.
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Affiliation(s)
- Alina Shevorykin
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
- Correspondence: Alina Shevorykin
| | - Ellen Carl
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Amylynn Liskiewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Colleen A. Hanlon
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Warren K. Bickel
- Addiction Recovery Research Center, Center for Health Behavior Research, Fralin Biomedical Research Institute at VTC, Roanoke, VA, United States
| | - Martin C. Mahoney
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Darian Vantucci
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Lindsey Bensch
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Hannah Thorner
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Matthew Marion
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Christine E. Sheffer
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
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Ferkin AC, Tonkin SS, Maguin E, Mahoney MC, Colder CR, Tiffany ST, Hawk LW. A Psychometric Evaluation of the Stanford Expectations of Treatment Scale (SETS) in the Context of a Smoking Cessation Trial. Nicotine Tob Res 2022; 24:1914-1920. [PMID: 35906990 PMCID: PMC9653073 DOI: 10.1093/ntr/ntac187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Although treatment outcome expectancies (TOEs) may influence clinical outcomes, TOEs are rarely reported in the smoking cessation literature, in part because of the lack of validated measures. Therefore, we conducted a psychometric evaluation of TOEs scores with the Stanford Expectations of Treatment Scale (SETS) in the context of a smoking cessation clinical trial. METHODS Participants were 320 adults enrolled in a randomized controlled trial of extended versus standard pre-quit varenicline treatment for smoking cessation (clinicaltrials.gov ID: NCT03262662). Across an 8-week treatment period, we examined the nature and stability of the factor structure using confirmatory factor analysis (CFA), evaluated discriminant validity by examining correlations with abstinence self-efficacy and positive/negative affect (PA/NA), and assessed internal consistency and test-retest reliability of SETS scores. RESULTS CFAs supported a 2-factor structure that was stable (ie, invariant) across weeks. Positive and negative TOEs were each reflected in three-item subscales that exhibited acceptable to excellent internal consistency (Cronbach's alphas ≥ .77). Positive and negative TOEs were modestly correlated with PA and NA (all |rs| <.27, p < .05). Positive TOEs, but not negative TOEs, were moderately correlated with abstinence self-efficacy (rs = .45 to .61, p < .01). Both positive and negative TOEs scores demonstrated moderate test-retest reliability between assessments (rs = .54 to .72). CONCLUSIONS SETS scores generally reflect a valid and reliable assessment of positive and negative TOEs in a sample of adults enrolled in a smoking cessation trial. The SETS appears to be a reasonable option for assessing TOEs in future smoking treatment studies. IMPLICATIONS Assessments of treatment outcome expectancies are rarely reported in the smoking cessation literature. The present results support the validity and reliability of the SETS scores among adults seeking treatment for their smoking behavior.
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Affiliation(s)
- Adam C Ferkin
- Department of Psychology, University at Buffalo, Suny, Buffalo, NY, USA
| | - Sarah S Tonkin
- Department of Psychology, University at Buffalo, Suny, Buffalo, NY, USA
| | - Eugene Maguin
- Department of Psychology, University at Buffalo, Suny, Buffalo, NY, USA
| | - Martin C Mahoney
- Department of Internal Medicine and Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Craig R Colder
- Department of Psychology, University at Buffalo, Suny, Buffalo, NY, USA
| | - Stephen T Tiffany
- Department of Psychology, University at Buffalo, Suny, Buffalo, NY, USA
| | - Larry W Hawk
- Department of Psychology, University at Buffalo, Suny, Buffalo, NY, USA
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Hawk LW, Tiffany ST, Colder CR, Ashare RL, Wray JM, Tyndale RF, Brandon TH, Mahoney MC. Effect of Extending the Duration of Prequit Treatment With Varenicline on Smoking Abstinence: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2241731. [PMID: 36367720 PMCID: PMC9652761 DOI: 10.1001/jamanetworkopen.2022.41731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
IMPORTANCE Even with varenicline, the leading monotherapy for tobacco dependence, smoking abstinence rates remain low. Preliminary evidence suggests that extending the duration of varenicline treatment before quitting may increase abstinence. OBJECTIVE To test the hypotheses that, compared with standard run-in varenicline treatment (1 week before quitting), extended run-in varenicline treatment (4 weeks before quitting) reduces smoking exposure before the target quit date (TQD) and enhances abstinence, particularly among women. DESIGN, SETTING, AND PARTICIPANTS This double-blind, randomized, placebo-controlled clinical trial enrolled participants from October 2, 2017, to December 9, 2020, at a single-site research clinic in Buffalo, New York. Of 1385 people screened, 320 adults reporting smoking 5 or more cigarettes per day (CPD) were randomized and followed up for 28 weeks. Data were analyzed from August 2021 to June 2022. INTERVENTIONS In the pre-TQD period (weeks 1-4), the extended run-in group received 4 weeks of varenicline; the standard run-in group received 3 weeks of placebo followed by 1 week of varenicline. Both groups received open-label varenicline during weeks 5 to 15 and brief quit counseling at 6 clinic visits. MAIN OUTCOMES AND MEASURES The primary outcome consisted of cotinine-verified (at end of treatment [EOT]) self-reported continuous abstinence from smoking (in CPD) during the last 4 weeks of treatment. Secondary outcomes included bioverified self-report of continuous abstinence at the 6-month follow-up and percentage of reduction in self-reported smoking rate during the prequit period (week 1 vs week 4). RESULTS A total of 320 participants were randomized, including 179 women (55.9%) and 141 men (44.1%), with a mean (SD) age of 53.7 (10.1) years. Continuous abstinence during the final 4 weeks of treatment (weeks 12-15; EOT) was not greater in the extended run-in group (64 of 163 [39.3%]) compared with the standard run-in group (57 of 157 [36.3%]; odds ratio [OR], 1.13 [95% CI, 0.72-1.78]), nor was the hypothesized group × sex interaction significant (OR, 0.52 [95% CI, 0.21-1.28]). Similar nonsignificant results were obtained for continuous abstinence at the 6-month follow-up. The mean (SE) decrease in self-reported smoking rate during the prequit period was greater in the extended run-in group (-38.8% [2.8%]) compared with the standard run-in group (-17.5% [2.7%]). CONCLUSIONS AND RELEVANCE Among adult daily smokers, extending the duration of prequit varenicline treatment beyond the standard 1-week run-in period reduced prequit smoking exposure but, more importantly, did not significantly improve continuous abstinence rates. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03262662.
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Affiliation(s)
- Larry W. Hawk
- Department of Psychology, University at Buffalo, Buffalo, New York
| | | | - Craig R. Colder
- Department of Psychology, University at Buffalo, Buffalo, New York
| | - Rebecca L. Ashare
- Department of Psychology, University at Buffalo, Buffalo, New York
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jennifer M. Wray
- Department of Psychiatry, Military Sciences Division, Medical University of South Carolina, Charleston
| | - Rachel F. Tyndale
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, The Center for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Thomas H. Brandon
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
- Department of Psychology, University of South Florida, Tampa
- Department of Oncologic Sciences, University of South Florida, Tampa
| | - Martin C. Mahoney
- Department of Internal Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York
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Tonkin SS, Colder C, Mahoney MC, Swan GE, Cinciripini P, Schnoll R, George TP, Tyndale RF, Hawk LW. Evaluating Treatment Mechanisms of Varenicline: Mediation by Affect and Craving. Nicotine Tob Res 2022; 24:1803-1810. [PMID: 35639828 PMCID: PMC9596996 DOI: 10.1093/ntr/ntac138] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/17/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Negative reinforcement models posit that relapse to cigarette smoking is driven in part by changes in affect and craving during the quit attempt. Varenicline may aid cessation by attenuating these changes; however, this mediational pathway has not been formally evaluated in placebo-controlled trials. Thus, trajectories of negative affect (NA), positive affect (PA), and craving were tested as mediators of the effect of varenicline on smoking cessation. AIMS AND METHODS Secondary data analysis was conducted on 828 adults assigned to either varenicline or placebo in a randomized controlled trial for smoking cessation (NCT01314001). Self-reported NA, PA, and craving were assessed 1-week pre-quit, on the target quit day (TQD), and 1 and 4 weeks post-TQD. RESULTS Across time, NA peaked 1-week post-quit, PA did not change, and craving declined. Less steep rises in NA (indirect effect 95% CI: .01 to .30) and lower mean craving at 1-week post-quit (CI: .06 to .50) were mediators of the relationship between varenicline and higher cessation rates at the end of treatment. PA was associated with cessation but was not a significant mediator. CONCLUSIONS These results partially support the hypothesis that varenicline improves smoking cessation rates by attenuating changes in specific psychological processes and supported NA and craving as plausible treatment mechanisms of varenicline. IMPLICATIONS The present research provides the first evidence from a placebo-controlled randomized clinical trial that varenicline's efficacy is due, in part, to post-quit attenuation of NA and craving. Reducing NA across the quit attempt and craving early into the attempt may be important treatment mechanisms for effective interventions. Furthermore, post-quit NA, PA, and craving were all associated with relapse and represent treatment targets for future intervention development.
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Affiliation(s)
- Sarah S Tonkin
- Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY, USA.,Department of Psychiatry, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Craig Colder
- Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Martin C Mahoney
- Departments of Internal Medicine and Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Gary E Swan
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Paul Cinciripini
- Department of Behavioral Science MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Robert Schnoll
- Department of Psychiatry and Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tony P George
- Departments of Psychiatry, Pharmacology & Toxicology, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Rachel F Tyndale
- Departments of Psychiatry, Pharmacology & Toxicology, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Larry W Hawk
- Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY, USA
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10
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Paulin LM, Halenar MJ, Edwards KC, Lauten K, Stanton CA, Taylor K, Hatsukami D, Hyland A, MacKenzie T, Mahoney MC, Niaura R, Trinidad D, Blanco C, Compton WM, Gardner LD, Kimmel HL, Lauterstein D, Marshall D, Sargent JD. Association of tobacco product use with chronic obstructive pulmonary disease (COPD) prevalence and incidence in Waves 1 through 5 (2013-2019) of the Population Assessment of Tobacco and Health (PATH) Study. Respir Res 2022; 23:273. [PMID: 36183112 PMCID: PMC9526897 DOI: 10.1186/s12931-022-02197-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 09/22/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND We examined the association of non-cigarette tobacco use on chronic obstructive pulmonary disease (COPD) risk in the Population Assessment of Tobacco and Health (PATH) Study. METHODS There were 13,752 participants ≥ 40 years with Wave 1 (W1) data for prevalence analyses, including 6945 adults without COPD for incidence analyses; W1-5 (2013-2019) data were analyzed. W1 tobacco use was modeled as 12 mutually-exclusive categories of past 30-day (P30D) single and polyuse, with two reference categories (current exclusive cigarette and never tobacco). Prevalence and incidence ratios of self-reported physician-diagnosed COPD were estimated using weighted multivariable Poisson regression. RESULTS W1 mean (SE) age was 58.1(0.1) years; mean cigarette pack-years was similar for all categories involving cigarettes and exclusive use of e-cigarettes (all > 20), greater than exclusive cigar users (< 10); and COPD prevalence was 7.7%. Compared to P30D cigarette use, never tobacco, former tobacco, and cigar use were associated with lower COPD prevalence (RR = 0.33, (95% confidence interval-CI) [0.26, 0.42]; RR = 0.57, CI [0.47, 0.70]; RR = 0.46, CI [0.28, 0.76], respectively); compared to never tobacco use, all categories except cigar and smokeless tobacco use were associated with higher COPD prevalence (RR former = 1.72, CI [1.33, 2.23]; RR cigarette = 3.00, CI [2.37, 3.80]; RR e-cigarette = 2.22, CI [1.44, 3.42]; RR cigarette + e-cigarette = 3.10, CI [2.39, 4.02]; RR polycombusted = 3.37, CI [2.44, 4.65]; RR polycombusted plus noncombusted = 2.75, CI]1.99, 3.81]). COPD incidence from W2-5 was 5.8%. Never and former tobacco users had lower COPD risk compared to current cigarette smokers (RR = 0.52, CI [0.35, 0.77]; RR = 0.47, CI [0.32, 0.70], respectively). Compared to never use, cigarette, smokeless, cigarette plus e-cigarette, and polycombusted tobacco use were associated with higher COPD incidence (RR = 1.92, CI [1.29, 2.86]; RR = 2.08, CI [1.07, 4.03]; RR = 1.99, CI [1.29, 3.07]; RR = 2.59, CI [1.60, 4.21], respectively); exclusive use of e-cigarettes was not (RR = 1.36, CI [0.55, 3.39]). CONCLUSIONS E-cigarettes and all use categories involving cigarettes were associated with higher COPD prevalence compared to never use, reflecting, in part, the high burden of cigarette exposure in these groups. Cigarette-but not exclusive e-cigarette-use was also strongly associated with higher COPD incidence. Compared to cigarette use, only quitting tobacco was protective against COPD development.
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Affiliation(s)
- Laura M Paulin
- Geisel School of Medicine at Dartmouth, The C. Everett Koop Institute at Dartmouth, Hanover, NH, USA.
| | - Michael J Halenar
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD, USA
| | - Kathryn C Edwards
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD, USA
| | - Kristin Lauten
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD, USA
| | | | - Kristie Taylor
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD, USA
| | - Dorothy Hatsukami
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Todd MacKenzie
- Geisel School of Medicine at Dartmouth, The C. Everett Koop Institute at Dartmouth, Hanover, NH, USA
| | - Martin C Mahoney
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Ray Niaura
- New York University School of Global Public Health, New York, NY, 10012, USA
| | - Dennis Trinidad
- University of California at San Diego, La Jolla, CA, 92037, USA
| | - Carlos Blanco
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | - Wilson M Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | - Lisa D Gardner
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Heather L Kimmel
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | - Dana Lauterstein
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Daniela Marshall
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
- Kelly Government Solutions, Rockville, MD, USA
| | - James D Sargent
- Geisel School of Medicine at Dartmouth, The C. Everett Koop Institute at Dartmouth, Hanover, NH, USA
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11
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Shevorykin A, Carl E, Mahoney MC, Hanlon CA, Liskiewicz A, Rivard C, Alberico R, Belal A, Bensch L, Vantucci D, Thorner H, Marion M, Bickel WK, Sheffer CE. Transcranial Magnetic Stimulation for Long-Term Smoking Cessation: Preliminary Examination of Delay Discounting as a Therapeutic Target and the Effects of Intensity and Duration. Front Hum Neurosci 2022; 16:920383. [PMID: 35874156 PMCID: PMC9300313 DOI: 10.3389/fnhum.2022.920383] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background Repetitive transcranial magnetic stimulation (rTMS) is a novel treatment for smoking cessation and delay discounting rate is novel therapeutic target. Research to determine optimal therapeutic targets and dosing parameters for long-term smoking cessation is needed. Due to potential biases and confounds introduced by the COVID-19 pandemic, we report preliminary results from an ongoing study among participants who reached study end prior to the pandemic. Methods In a 3 × 2 randomized factorial design, participants (n = 23) received 900 pulses of 20 Hz rTMS to the left dorsolateral prefrontal cortex (PFC) in one of three Durations (8, 12, or 16 days of stimulation) and two Intensities (1 or 2 sessions per day). We examined direction and magnitude of the effect sizes on latency to relapse, 6-month point-prevalence abstinence rates, research burden, and delay discounting rates. Results A large effect size was found for Duration and a medium for Intensity for latency to relapse. Increasing Duration increased the odds of abstinence 7–8-fold while increasing Intensity doubled the odds of abstinence. A large effect size was found for Duration, a small for Intensity for delay discounting rate. Increasing Duration and Intensity had a small effect on participant burden. Conclusion Findings provide preliminary support for delay discounting as a therapeutic target and for increasing Duration and Intensity to achieve larger effect sizes for long-term smoking cessation and will provide a pre-pandemic comparison for data collected during the pandemic. Clinical Trial Registration [www.ClinicalTrials.gov], identifier [NCT03865472].
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Affiliation(s)
- Alina Shevorykin
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Ellen Carl
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Martin C Mahoney
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Colleen A Hanlon
- Wake Forest School of Medicine, Winston-Salem, NC, United States
| | | | - Cheryl Rivard
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Ronald Alberico
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Ahmed Belal
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Lindsey Bensch
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Darian Vantucci
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Hannah Thorner
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Matthew Marion
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Warren K Bickel
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, United States
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12
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Mahoney MC, Rivard C, Kimmel HL, Hammad HT, Sharma E, Halenar MJ, Sargent J, Cummings KM, Niaura R, Goniewicz ML, Bansal-Travers M, Hatsukami D, Gaalema D, Fong G, Gravely S, Christensen CH, Haskins R, Silveira ML, Blanco C, Compton W, Stanton CA, Hyland A. Cardiovascular Outcomes among Combustible-Tobacco and Electronic Nicotine Delivery System (ENDS) Users in Waves 1 through 5 of the Population Assessment of Tobacco and Health (PATH) Study, 2013-2019. Int J Environ Res Public Health 2022; 19:4137. [PMID: 35409819 PMCID: PMC8998731 DOI: 10.3390/ijerph19074137] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/30/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prior studies have not clearly established risk of cardiovascular disease (CVD) among smokers who switch to exclusive use of electronic nicotine delivery systems (ENDS). We compared cardiovascular disease incidence in combustible-tobacco users, those who transitioned to ENDS use, and those who quit tobacco with never tobacco users. METHODS This prospective cohort study analyzes five waves of Population Assessment of Tobacco and Health (PATH) Study data, Wave 1 (2013-2014) through Wave 5 (2018-2019). Cardiovascular disease (CVD) incidence was captured over three intervals (Waves 1 to 3, Waves 2 to 4, and Waves 3 to 5). Participants were adults (40+ years old) without a history of CVD for the first two waves of any interval. Change in tobacco use status, from exclusive past 30 day use of any combustible-tobacco product to either exclusive past 30 day ENDS use, dual past 30 day use of ENDS and combustible-tobacco, or no past 30 day use of any tobacco, between the first two waves of an interval was used to predict onset of CVD between the second and third waves in the interval. CVD incidence was defined as a new self-report of being told by a health professional that they had congestive heart failure, stroke, or a myocardial infarction. Generalized estimating equation (GEE) analyses combined 10,548 observations across intervals from 7820 eligible respondents. RESULTS Overall, there were 191 observations of CVD among 10,548 total observations (1.7%, standard error (SE) = 0.2), with 40 among 3014 never users of tobacco (1.5%, SE = 0.3). In multivariable models, CVD incidence was not significantly different for any tobacco user groups compared to never users. There were 126 observations of CVD among 6263 continuing exclusive combustible-tobacco users (adjusted odds ratio [AOR] = 1.44; 95% confidence interval (CI) 0.87-2.39), 15 observations of CVD among 565 who transitioned to dual use (AOR = 1.85; 0.78-4.37), and 10 observations of CVD among 654 who quit using tobacco (AOR = 1.18; 0.33-4.26). There were no observations of CVD among 53 who transitioned to exclusive ENDS use. CONCLUSIONS This study found no difference in CVD incidence by tobacco status over three 3 year intervals, even for tobacco quitters. It is possible that additional waves of PATH Study data, combined with information from other large longitudinal cohorts with careful tracking of ENDS use patterns may help to further clarify this relationship.
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Affiliation(s)
- Martin C. Mahoney
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (M.C.M.); (M.L.G.); (M.B.-T.); (A.H.)
| | - Cheryl Rivard
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (M.C.M.); (M.L.G.); (M.B.-T.); (A.H.)
| | - Heather L. Kimmel
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MS 20892, USA; (H.L.K.); (M.L.S.); (C.B.); (W.C.)
| | - Hoda T. Hammad
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA; (H.T.H.); (C.H.C.); (R.H.)
| | - Eva Sharma
- Westat, Rockville, MD 20850, USA; (E.S.); (M.J.H.); (C.A.S.)
| | | | - Jim Sargent
- The C. Everette Koop Institute at Dartmouth, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA;
| | | | - Ray Niaura
- NYU School of Global Public Health, New York, NY 10003, USA;
| | - Maciej L. Goniewicz
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (M.C.M.); (M.L.G.); (M.B.-T.); (A.H.)
| | - Maansi Bansal-Travers
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (M.C.M.); (M.L.G.); (M.B.-T.); (A.H.)
| | | | | | - Geoffrey Fong
- University of Waterloo, Waterloo, ON N2L 3G1, Canada; (G.F.); (S.G.)
| | - Shannon Gravely
- University of Waterloo, Waterloo, ON N2L 3G1, Canada; (G.F.); (S.G.)
| | - Carol H. Christensen
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA; (H.T.H.); (C.H.C.); (R.H.)
| | - Ryan Haskins
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA; (H.T.H.); (C.H.C.); (R.H.)
| | - Marushka L. Silveira
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MS 20892, USA; (H.L.K.); (M.L.S.); (C.B.); (W.C.)
- Kelly Government Solutions, Troy, MI 48084, USA
| | - Carlos Blanco
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MS 20892, USA; (H.L.K.); (M.L.S.); (C.B.); (W.C.)
| | - Wilson Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MS 20892, USA; (H.L.K.); (M.L.S.); (C.B.); (W.C.)
| | | | - Andrew Hyland
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (M.C.M.); (M.L.G.); (M.B.-T.); (A.H.)
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13
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Mahoney MC, Rivard C, Hammad HT, Blanco C, Sargent J, Kimmel HL, Wang B, Halenar MJ, Kang JC, Borek N, Cummings KM, Lauten K, Goniewicz ML, Hatsukami D, Sharma E, Taylor K, Hyland A. Cardiovascular Risk Factor and Disease Measures from the Population Assessment of Tobacco and Health (PATH) Study. Int J Environ Res Public Health 2021; 18:7692. [PMID: 34300159 PMCID: PMC8305887 DOI: 10.3390/ijerph18147692] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 06/08/2021] [Revised: 07/14/2021] [Accepted: 07/17/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Cardiovascular disease is a key health condition associated with tobacco use; however, clinical measures are not typically possible in population-based studies. In this paper, we assess the reliability and validity of self-reported cardiovascular risk factors and diseases in a large nationally representative study of tobacco use and health outcomes. METHODS This paper analyzes self-reported cardiovascular risk factors and disease among adults age 40 years and older based on U.S. nationally representative data from the Population Assessment of Tobacco and Health (PATH) Study. Prevalence of cardiovascular risk factors (self-reported high blood pressure, high cholesterol, diabetes and family history of premature heart disease, BMI ≥ 35, and tobacco use) and cardiovascular disease (self-reported heart attack, stroke and/or congestive heart failure (CHF)) were considered along with ratings of physical functioning, fatigue, and general health. RESULTS Self-reported cardiovascular disease was found to be associated with functional health measures (walking up a flight of stairs) and general ratings of health. Prospective analyses found strong correlations between sequential data collection waves for history of hypertension, elevated cholesterol and CHF, while more modest correlations were noted for stroke and heart attack. The overall prevalence of cardiovascular disease and hypertension was comparable to those from the National Health and Nutrition Examination Survey (NHANES). CONCLUSIONS These analyses suggest reliability and concurrent validity regarding self-reported cardiovascular risk factors and disease assessed in the PATH Study.
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Affiliation(s)
- Martin C. Mahoney
- Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY 14263, USA; (M.C.M.); (M.L.G.); (A.H.)
| | - Cheryl Rivard
- Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY 14263, USA; (M.C.M.); (M.L.G.); (A.H.)
| | - Hoda T. Hammad
- U.S. Food and Drug Administration, Center for Tobacco Products, Silver Spring, MD 20993, USA; (H.T.H.); (B.W.); (J.C.K.); (N.B.)
| | - Carlos Blanco
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA; (C.B.); (H.L.K.)
| | - James Sargent
- Geisel School of Medicine at Dartmouth, The C. Everette Koop Institute at Dartmouth, Lebanon, NH 03756, USA;
| | - Heather L. Kimmel
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA; (C.B.); (H.L.K.)
| | - Baoguang Wang
- U.S. Food and Drug Administration, Center for Tobacco Products, Silver Spring, MD 20993, USA; (H.T.H.); (B.W.); (J.C.K.); (N.B.)
| | | | - Jueichuan Connie Kang
- U.S. Food and Drug Administration, Center for Tobacco Products, Silver Spring, MD 20993, USA; (H.T.H.); (B.W.); (J.C.K.); (N.B.)
- US Public Health Service Commissioned Corps, Silver Spring, MD 20993, USA
| | - Nicolette Borek
- U.S. Food and Drug Administration, Center for Tobacco Products, Silver Spring, MD 20993, USA; (H.T.H.); (B.W.); (J.C.K.); (N.B.)
| | - K. Michael Cummings
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Kristin Lauten
- Westat, Rockville, MD 20850, USA; (M.J.H.); (K.L.); (E.S.); (K.T.)
| | - Maciej L. Goniewicz
- Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY 14263, USA; (M.C.M.); (M.L.G.); (A.H.)
| | - Dorothy Hatsukami
- Medical School, University of Minnesota, Minneapolis, MN 55414, USA;
| | - Eva Sharma
- Westat, Rockville, MD 20850, USA; (M.J.H.); (K.L.); (E.S.); (K.T.)
| | - Kristie Taylor
- Westat, Rockville, MD 20850, USA; (M.J.H.); (K.L.); (E.S.); (K.T.)
| | - Andrew Hyland
- Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY 14263, USA; (M.C.M.); (M.L.G.); (A.H.)
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14
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Lawson SC, Gass JC, Cooper RK, Tonkin SS, Colder CR, Mahoney MC, Tiffany ST, Hawk LW. The impact of three weeks of pre-quit varenicline on reinforcing value and craving for cigarettes in a laboratory choice procedure. Psychopharmacology (Berl) 2021; 238:599-609. [PMID: 33219852 PMCID: PMC10031567 DOI: 10.1007/s00213-020-05713-7] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/10/2020] [Indexed: 12/16/2022]
Abstract
RATIONALE Varenicline, a partial nicotinic agonist, is theorized to attenuate pre-quit smoking reinforcement and post-quit withdrawal and craving. However, the mechanisms of action have not been fully characterized, as most studies employ only retrospective self-report measures, hypothetical indices of reinforcing value, and/or nontreatment-seeking samples. OBJECTIVES The current research examined the impact of pre-quit varenicline (vs. placebo) on laboratory measures of smoking and food (vs. water) reinforcement and craving. METHODS Participants were 162 treatment-seeking smokers enrolled in a randomized controlled trial of smoking cessation ( clinicaltrials.gov ID: NCT03262662). Participants completed two laboratory sessions: a pre-treatment session, ~ 1 week prior to beginning varenicline or placebo, and an active treatment session, after ~ 3 weeks of treatment. At each session, participants completed a laboratory choice procedure; on each of 36 trials, a lit cigarette, food item, or cup of water was randomly presented. Participants reported level of craving and spent $0.01-0.25 to have a corresponding 5-95% chance to sample the cue. RESULTS As predicted, spending was significantly higher on cigarette trials than water trials, and varenicline resulted in a greater between-session decline in spending on cigarette trials (but not water) than did placebo. Cigarette craving was enhanced in the presence of smoking cues compared to water, but neither average (tonic) cigarette craving nor cue-specific cigarette craving was significantly influenced by varenicline. Food spending and craving were generally unaffected by varenicline treatment. CONCLUSIONS These laboratory data from treatment-seeking smokers provide the strongest evidence to date that varenicline selectively attenuates smoking reinforcement prior to quitting.
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Affiliation(s)
- Schuyler C Lawson
- Department of Psychology, University at Buffalo (The State University of New York), Main Street, Buffalo, NY, 14214, USA
| | - Julie C Gass
- Department of Psychology, University at Buffalo (The State University of New York), Main Street, Buffalo, NY, 14214, USA
- Center for Integrated Healthcare, VA Western New York Healthcare System, 3495 Bailey Ave, Buffalo, NY, 14215, USA
| | - Robert K Cooper
- Department of Psychology, University at Buffalo (The State University of New York), Main Street, Buffalo, NY, 14214, USA
| | - Sarah S Tonkin
- Department of Psychology, University at Buffalo (The State University of New York), Main Street, Buffalo, NY, 14214, USA
| | - Craig R Colder
- Department of Psychology, University at Buffalo (The State University of New York), Main Street, Buffalo, NY, 14214, USA
| | - Martin C Mahoney
- Department of Psychology, University at Buffalo (The State University of New York), Main Street, Buffalo, NY, 14214, USA
- Department of Internal Medicine, Roswell Park Cancer Institute, Buffalo, NY, 14263, USA
| | - Stephen T Tiffany
- Department of Psychology, University at Buffalo (The State University of New York), Main Street, Buffalo, NY, 14214, USA
| | - Larry W Hawk
- Department of Psychology, University at Buffalo (The State University of New York), Main Street, Buffalo, NY, 14214, USA.
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15
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Rokitka D, Heffler J, Zevon M, Kitcho C, Schweitzer J, Rodriguez EM, Mahoney MC. Designing an exercise intervention for adult survivors of childhood cancers. BMC Cancer 2021; 21:1. [PMID: 33397301 PMCID: PMC7784286 DOI: 10.1186/s12885-020-07763-8] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 12/22/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This study examined current physical activity levels and preferences for exercise settings and activities among adult survivors of childhood cancers as a strategy to inform the feasibility and design of such programs. METHODS A mixed-methods design was used to investigate current activity levels as well as barriers to and preferences for physical activity among 20 adult survivors of pediatric cancer. RESULTS One-half of participants reported engaging in regular physical activity, although the frequency, intensity, and duration varied. Overall, 17 of the 20 participants (85%) stated they would be interested in participating in a structured exercise intervention, and they expressed a strong interest in walking (76%), bicycling (53%), and weight training (53%). Common barriers to participation in a potential structured exercise program were insufficient time, current health issues, and program location/distance. Nearly all participants agreed that information on nutrition and diet should be included as part of an exercise intervention. CONCLUSIONS These findings will help inform the design and implementation of future exercise programs to enhance physical activity among this high-risk group of cancer survivors.
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Affiliation(s)
- Denise Rokitka
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center, Buffalo, New York, 14263, USA.
| | - Jennifer Heffler
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center, Buffalo, New York, 14263, USA
| | - Michael Zevon
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center, Buffalo, New York, 14263, USA
| | - Caleb Kitcho
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center, Buffalo, New York, 14263, USA
| | - Jennifer Schweitzer
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center, Buffalo, New York, 14263, USA
| | - Elisa M Rodriguez
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York, 14263, USA
| | - Martin C Mahoney
- Department of Internal Medicine and Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, 14263, USA
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Lyons D, Wahab RA, Vijapura C, Mahoney MC. The nipple-areolar complex: comprehensive imaging review. Clin Radiol 2020; 76:172-184. [PMID: 33077158 DOI: 10.1016/j.crad.2020.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
Abstract
The nipple-areolar complex can be affected by a variety of benign and malignant entities that can present with non-specific symptoms. Benign pathologies commonly affecting the nipple-areolar complex include nipple calcifications, nipple adenoma, abscess of Montgomery tubercles, ductal ectasia, periductal mastitis, and papilloma. Malignant pathologies that affect the nipple-areolar complex include Paget's disease of the breast, ductal carcinoma in-situ, and invasive ductal carcinoma. Clinical history and examination, imaging, and tissue sampling when appropriate are co-dependent factors that guide the assessment of nipple-areolar pathologies. This article provides a review of the normal anatomy, common anatomical variants, benign and malignant pathologies, and imaging techniques to guide the diagnostic assessment of the nipple-areolar complex.
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Affiliation(s)
- D Lyons
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, ML 0772, Cincinnati, OH, 45219-0772, USA.
| | - R A Wahab
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, ML 0772, Cincinnati, OH, 45219-0772, USA
| | - C Vijapura
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, ML 0772, Cincinnati, OH, 45219-0772, USA
| | - M C Mahoney
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, ML 0772, Cincinnati, OH, 45219-0772, USA
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Mahoney MC, Ashare R, Schlienz N, Duerr C, Hawk LW. Making lemonade from SARS coronavirus-2 lemons: Transitioning a smoking cessation trial to a virtual platform. J Subst Abuse Treat 2020; 117:108100. [PMID: 32811627 PMCID: PMC7403863 DOI: 10.1016/j.jsat.2020.108100] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/16/2020] [Accepted: 07/25/2020] [Indexed: 11/28/2022]
Abstract
Clinical trials represent an essential component of improving treatment for substance use disorders (SUD). The SARS coronavirus-2 pandemic disrupted our ongoing clinical trial of smoking cessation and forced us to rapidly implement changes to assure participants access to ongoing counseling and monitoring via telephone calls and/or video chat sessions. Our experiences suggest that this pandemic will lead to changes for both future clinical trial participants and project staff. While challenges remain, it will be important to assessing the impact of these changes with regard to participant experiences and treatment outcomes.
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Affiliation(s)
- Martin C Mahoney
- Department of Internal Medicine, Roswell Park Cancer Institute, Buffalo, NY 14623, United States of America.
| | - Rebecca Ashare
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, United States of America.
| | - Nicolas Schlienz
- Department of Psychology, University at Buffalo, Buffalo, NY 14214, United States of America.
| | - CeCe Duerr
- Department of Psychology, University at Buffalo, Buffalo, NY 14214, United States of America.
| | - Larry W Hawk
- Department of Psychology, University at Buffalo, Buffalo, NY 14214, United States of America.
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18
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Sheffer CE, Stein JS, Petrucci C, Mahoney MC, Johnson S, Giesie P, Carl E, Krupski L, Tegge AN, Reid ME, Bickel WK, Hyland A. Tobacco Dependence Treatment in Oncology: Initial Patient Clinical Characteristics and Outcomes from Roswell Park Comprehensive Cancer Center. Int J Environ Res Public Health 2020; 17:E3907. [PMID: 32486463 PMCID: PMC7312979 DOI: 10.3390/ijerph17113907] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 04/06/2020] [Revised: 05/11/2020] [Accepted: 05/22/2020] [Indexed: 01/28/2023]
Abstract
Despite the importance of smoking cessation to cancer care treatment, historically, few cancer centers have provided treatment for tobacco dependence. To address this gap, the National Cancer Institute (NCI) launched the Cancer Center Cessation Initiative (C3i). As part of this effort, this study examined implementation outcomes in a cohort of cancer survivors (CSs) who smoked cigarettes in the first year of an ongoing process to develop and implement a robust Tobacco Treatment Service at Roswell Park Comprehensive Cancer Center. We provide a comprehensive description of the new tobacco use assessment and referral process, and of the characteristics of cancer survivors who agreed to treatment including traditional tobacco-related psychosocial and cancer treatment-related characteristics and novel characteristics such as delay discounting rates. We also examine characteristic differences among those who agreed to treatment between those who attended and those who did not attend treatment. As the new tobacco assessment was implemented, the number of referrals increased dramatically. The mean number of treatment sessions attended was 4.45 (SD = 2.98) and the six-month point prevalence intention to treat abstinence rate among those who attended was 22.7%. However, only 6.4% agreed to treatment and 4% attended at least one treatment session. A large proportion of cancer survivors who agreed to treatment were women, of older age, of lower socioeconomic status (SES), and who had high levels of depressive symptomology. The findings demonstrate that the implementation of system changes can significantly improve the identification of cancer survivors who use tobacco and are referred to tobacco use treatment. Among those who attend, treatment is effective. However, the findings also suggest that a systematic assessment of barriers to engagement is needed and that cancer survivors may benefit from additional treatment tailoring. We present plans to address these implementation challenges. Systematic electronic medical record (EMR)-sourced referral to tobacco treatment is a powerful tool for reaching cancer survivors who smoke, but more research is needed to determine how to enhance engagement and tailor treatment processes.
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Affiliation(s)
- Christine E. Sheffer
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.P.); (M.C.M.); (S.J.); (P.G.); (E.C.); (L.K.); (M.E.R.); (A.H.)
| | - Jeffrey S. Stein
- Fralin Biomedical Research Institute at VTC, Roanoke, VA 24016, USA; (J.S.S.); (A.N.T.); (W.K.B.)
| | - Cara Petrucci
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.P.); (M.C.M.); (S.J.); (P.G.); (E.C.); (L.K.); (M.E.R.); (A.H.)
| | - Martin C. Mahoney
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.P.); (M.C.M.); (S.J.); (P.G.); (E.C.); (L.K.); (M.E.R.); (A.H.)
| | - Shirley Johnson
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.P.); (M.C.M.); (S.J.); (P.G.); (E.C.); (L.K.); (M.E.R.); (A.H.)
| | - Pamela Giesie
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.P.); (M.C.M.); (S.J.); (P.G.); (E.C.); (L.K.); (M.E.R.); (A.H.)
| | - Ellen Carl
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.P.); (M.C.M.); (S.J.); (P.G.); (E.C.); (L.K.); (M.E.R.); (A.H.)
| | - Laurie Krupski
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.P.); (M.C.M.); (S.J.); (P.G.); (E.C.); (L.K.); (M.E.R.); (A.H.)
| | - Allison N. Tegge
- Fralin Biomedical Research Institute at VTC, Roanoke, VA 24016, USA; (J.S.S.); (A.N.T.); (W.K.B.)
| | - Mary E. Reid
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.P.); (M.C.M.); (S.J.); (P.G.); (E.C.); (L.K.); (M.E.R.); (A.H.)
| | - Warren K. Bickel
- Fralin Biomedical Research Institute at VTC, Roanoke, VA 24016, USA; (J.S.S.); (A.N.T.); (W.K.B.)
| | - Andrew Hyland
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.P.); (M.C.M.); (S.J.); (P.G.); (E.C.); (L.K.); (M.E.R.); (A.H.)
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Carl E, Liskiewicz A, Rivard C, Alberico R, Belal A, Mahoney MC, Quisenberry AJ, Bickel WK, Sheffer CE. Dosing parameters for the effects of high-frequency transcranial magnetic stimulation on smoking cessation: study protocol for a randomized factorial sham-controlled clinical trial. BMC Psychol 2020; 8:42. [PMID: 32357940 PMCID: PMC7193364 DOI: 10.1186/s40359-020-00403-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/05/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Despite the considerable success of comprehensive tobacco control efforts, tobacco use remains one of the greatest preventable causes of death and disease today. Over half of all smokers in the US make quit attempts every year, but over 90% relapse within 12 months, choosing the immediate reinforcement of smoking over the long-term benefits of quitting. Conceptual and empirical evidence supports continued investigation of high frequency repetitive transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex in reducing relapse and decreasing cigarette consumption. While this evidence is compelling, an optimal dosing strategy must be determined before a long-term efficacy trial can be conducted. The goal of this study is to determine a dosing strategy for 20 Hz rTMS that will produce the best long-term abstinence outcomes with the fewest undesirable effects. METHODS This is a fully crossed, double-blinded, sham-controlled, 3x2x2 randomized factorial study. The three factors are duration (stimulation days: 8, 12, and 16); intensity (900 or 1800 pulses per day); and sham control. Participants (n = 258) will consist of adults (18-65) who are motivated to quit smoking cigarettes and who will be followed for 6 months post-quit. Outcomes include latency to relapse, point prevalence abstinence rates, delay discounting rates, cognitive-behavioral skills acquisition, and multiple measures of potential undesirable effects that impact participant compliance. DISCUSSION This study integrates existing theoretical concepts and methodologies from neuropsychology, behavioral economics, brain stimulation, clinical psychology, and the evidence-based treatment of tobacco dependence in the development of a promising and innovative approach to treat tobacco dependence. This study will establish an optimal dosing regimen for efficacy testing. Findings are expected to have a significant influence on advancing this approach as well as informing future research on clinical approaches that combine rTMS with other evidence-based treatments for tobacco dependence and perhaps other addictions. TRIAL REGISTRATION Clinical Trials NCT03865472 (retrospectively registered). The first participant was fully enrolled on November 26, 2018. Registration was posted on March 7, 2019.
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Affiliation(s)
- Ellen Carl
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14203, USA.
| | | | - Cheryl Rivard
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14203, USA
| | - Ronald Alberico
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14203, USA
| | - Ahmed Belal
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14203, USA
| | - Martin C Mahoney
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14203, USA
| | | | - Warren K Bickel
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, 24016, USA
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Tonkin SS, Williams TF, Simms LJ, Tiffany ST, Mahoney MC, Schnoll RA, Cinciripini PM, Hawk LW. Withdrawal Symptom, Treatment Mechanism, and/or Side Effect? Developing an Explicit Measurement Model for Smoking Cessation Research. Nicotine Tob Res 2020; 22:482-491. [PMID: 30535357 PMCID: PMC7164574 DOI: 10.1093/ntr/nty262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 12/06/2018] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Assessment of withdrawal symptoms, treatment mechanisms, and side effects is central to understanding and improving smoking cessation interventions. Though each domain is typically assessed separately with widely used questionnaires to separately assess each domain (eg, Minnesota Nicotine Withdrawal Scale = withdrawal; Questionnaire of Smoking Urges-Brief = craving; Positive and Negative Affect Schedule = affect; symptom checklist = side effects), there are substantial problems with this implicit "one questionnaire equals one construct" measurement model, including item overlap across questionnaires. This study sought to clarify the number and nature of constructs assessed during smoking cessation by developing an explicit measurement model. METHODS Two subsamples were randomly created from 1246 smokers in a clinical trial. Exploratory and confirmatory factor analyses were conducted to identify and select a model that best represented the data. Measurement invariance was assessed to determine if the factors and their content were consistent prior to and during the quit. Improvement in construct overlap within this model was compared against the implicit measurement model using correlational analyses. RESULTS A 5-factor measurement model composed of negative affect, somatic symptoms, sleep problems, positive affect, and craving fits the data well prior to and during quitting. All factor content except somatic symptoms was consistent over time. Correlational analyses indicated that the 5-factor model attenuated construct overlap compared to the implicit model. CONCLUSIONS The models generated from data-driven approaches (eg, the 5-factor model) reduced overlap and better represented the constructs underlying these measures. This approach created distinct, stable constructs that span over measures of side effects and potential treatment mechanisms. IMPLICATIONS This study demonstrated that measures assessing treatment mechanisms, withdrawal symptoms, and side effects contain problematic overlap that reduces the clarity of these key constructs. The use of data-driven approaches showed that these measures do not map on to their posited latent constructs (eg, the Minnesota Nicotine Withdrawal Scale does not yield a withdrawal factor). Rather, these measures form distinct, basic processes that may represent more meaningful constructs for future research on cessation and treatment. Assessments designed to individually examine these processes may improve the study of treatment mechanisms.
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Affiliation(s)
- Sarah S Tonkin
- Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY
| | - Trevor F Williams
- Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY
| | - Leonard J Simms
- Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY
| | - Stephen T Tiffany
- Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY
| | - Martin C Mahoney
- Department of Internal Medicine, Roswell Park Cancer Institute, Buffalo, NY.,Department of Social and Preventive Medicine, Department of Community Health and Health Behavior, University at Buffalo, State University of New York, Buffalo, NY
| | - Robert A Schnoll
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Paul M Cinciripini
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Larry W Hawk
- Department of Psychology, University at Buffalo, State University of New York, Buffalo, NY
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21
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Abstract
Objectives: In this study, we identified differences in cessation, nicotine dependence, and quit attempts between smokers using non-menthol cigarettes and smokers using menthol cigarettes differing in menthol delivery method (eg, menthol in the tobacco only, crushable capsules only or both). Methods: We analyzed data from the Population Assessment of Tobacco and Health Study, Waves 1 and 2 (W1 and W2), to determine associations of delivery method of menthol with cessation, nicotine dependence, and quit attempts among current adult cigarette smokers. Results: Nearly 40% of US smokers reported using a mentholated cigarette product with most using a product mentholated in the tobacco only. Smokers included in this analysis had a moderate to low heaviness of smoking index score. The lowest average score was among those using products mentholated in a filter capsule only (1.3, SE = .10), and the highest among those using non-mentholated products (2.4, SE = .03). About 12% of smokers quit between W1 and W2. Cessation, nicotine dependence, and quit attempts at W2 were not associated with delivery method of menthol at W1. Conclusions: Method of menthol delivery did not impact cessation, nicotine dependence, and quit attempts.
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Affiliation(s)
- Liane M Schneller
- Postdoctoral Fellow, Clinical and Translational Science Institute, University of Rochester, Rochester, NY.,
| | - Maansi Bansal-Travers
- Associate Professor and Richard J. O'Connor, Professor of Oncology, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Martin C Mahoney
- Professor of Oncology, Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Susan E McCann
- Professor of Oncology, Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Richard J O'Connor
- Professor of Oncology, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY
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Amato KA, Reid ME, Ochs-Balcom HM, Giovino GA, Bansal-Travers M, Warren GW, Mahoney MC, Hyland AJ. Evaluation of a Dedicated Tobacco Cessation Support Service for Thoracic Cancer Center Patients. J Public Health Manag Pract 2019; 24:E12-E19. [PMID: 29278577 PMCID: PMC6014867 DOI: 10.1097/phh.0000000000000674] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Cancer patients' continued tobacco use results in poorer therapeutic outcomes including decreased quality of life and survival. OBJECTIVE To assess reach and impact of a free, opt-out, telephone-based tobacco cessation program for thoracic cancer center patients. DESIGN Observational study. SETTING Comprehensive Cancer Center in Western New York. PARTICIPANTS Current or recent (within past 30 days) tobacco-using thoracic cancer center patients referred to a tobacco cessation support service between October 2010 and October 2012 at a Comprehensive Cancer Center (n = 942/1313 referrals were eligible for cessation support). INTERVENTION A free, opt-out, telephone-based cessation service that was implemented as standard of care. Cessation specialists had patient-guided conversations that assessed readiness to quit; methods used in the past provided cessation strategies and worked to set up a quit date. There was an average of 35.9 days between referral and first contact. MAIN OUTCOME MEASURES Program reach (referral and participation rates) and impact (as self-reported cessation outcomes measured twice after referral). RESULTS Of 942 patients, 730 (77.5%) referred to and called by a tobacco cessation service participated in at least 1 cessation support call, of which 440 of 730 (60.3%) were called for follow-up and 89.5% (394/440) participated. In total, 20.2% (69/342) of current smokers at referral reported at least 7-day abstinence at follow-up. Among current smokers at referral and first contact, being married (odds ratio [OR] = 2.05; 95% confidence interval [CI], 1.01-4.18) and having a lower Eastern Cooperative Oncology Group (ECOG) performance score (OR = 4.05; 95% CI, 1.58-10.39) were associated with quitting at follow-up, after controlling for demographic, clinical, and health behavior characteristics. CONCLUSIONS Our results demonstrate that 78% of thoracic cancer center patients, if contacted, participated at least once in this cessation support service; for current smokers at referral and first contact, being married and having a lower ECOG performance score were associated with self-reported quitting at follow-up. Other organizations may find our results useful while implementing a systematic way to identify tobacco-using patients as part of routine care and to improve available cessation support services.
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Affiliation(s)
- Katharine A. Amato
- Department of Health Behavior, Roswell Park Cancer Institute,
Buffalo, NY
- Department of Epidemiology and Environmental Health, University at
Buffalo, Buffalo, NY
- Primary Care Research Institute, Department of Family Medicine,
University at Buffalo, Buffalo, NY
| | - Mary E. Reid
- Department of Medicine, Roswell Park Cancer Institute, Buffalo,
NY
| | | | - Gary A. Giovino
- Department of Community Health and Health Behavior, University at
Buffalo, Buffalo, NY
| | | | - Graham W. Warren
- Department of Radiation Oncology, Medical University of South
Carolina, Charleston, SC
| | | | - Andrew J. Hyland
- Department of Health Behavior, Roswell Park Cancer Institute,
Buffalo, NY
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Voos N, Kaiser L, Mahoney MC, Bradizza CM, Kozlowski LT, Benowitz NL, O'Connor RJ, Goniewicz ML. Randomized within-subject trial to evaluate smokers' initial perceptions, subjective effects and nicotine delivery across six vaporized nicotine products. Addiction 2019; 114:1236-1248. [PMID: 30851137 PMCID: PMC6646880 DOI: 10.1111/add.14602] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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] [Received: 10/26/2018] [Revised: 01/08/2019] [Accepted: 03/04/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Vaporized nicotine products (VNPs) can vary in important characteristics including size, shape, flavor and nicotine yield. We examined whether complex interactions among these characteristics could affect smokers' VNP perceptions and usage patterns. DESIGN A within-subject randomized cross-over trial. SETTING Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA. PARTICIPANTS Eighteen daily cigarette smokers. MEASUREMENTS Participants attended eight weekly visits during which they sampled six different VNPs (disposable, rechargeable, eGO, mod, e-Cigar and e-Pipe) with tobacco-flavored e-liquid. Prior to device use, participants completed product-ranking questionnaires. Participants completed controlled puffing sessions during each of the six trials, after which satisfaction questionnaires were completed and blood samples were taken. FINDINGS Initial perceptions showed that the smallest device (disposable) was ranked as safer compared with a larger device (e-Pipe) (P < 0.05). Participants rated the eGO and mod devices higher on satisfaction and enjoyment from use, taste, pleasantness, harshness ('throat hit') and speed of effect, but lower on perceived health risk and embarrassment from use (P < 0.05). All devices had a lower Cmax than the combustible cigarette (P < 0.05), but there were differences among devices (P < 0.05). The mod, e-Pipe and eGO provided the highest amount of perceived smoking urge relief, and this correlated strongly with Cmax across all devices (R2 = 0.8614, P = 0.007). The perceived speed of urge relief was not correlated with Tmax (R2 = 0.0035, P = 0.911) CONCLUSIONS: Daily cigarette smokers testing six types of vaporized nicotine products (VNPs) reported that they varied in taste, amount of withdrawal relief, harshness, embarrassment from use, perceived health risk and subjective and objective nicotine delivery. The eGO and mod models have properties that may make them most effective for cigarette substitution among smokers who intend to switch to a VNP.
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Affiliation(s)
- Natalie Voos
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, USA
| | - Lisa Kaiser
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, USA
| | - Martin C Mahoney
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, USA
| | | | - Lynn T Kozlowski
- School of Public Health and Health Professions, University at Buffalo, NY, USA
| | - Neal L Benowitz
- Division of Clinical Pharmacology, Department of Medicine and Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, USA
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, USA
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Ashare RL, Thompson M, Leone F, Metzger D, Gross R, Mounzer K, Tyndale RF, Lerman C, Mahoney MC, Cinciripini P, George TP, Collman RG, Schnoll R. Differences in the rate of nicotine metabolism among smokers with and without HIV. AIDS 2019; 33:1083-1088. [PMID: 30946162 DOI: 10.1097/qad.0000000000002127] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE HIV-infected smokers lose more life years to tobacco use than to HIV infection. The nicotine metabolite ratio (NMR), a biomarker of CYP2A6, represents individual variation in the rate at which nicotine is metabolized and is associated with response to smoking cessation treatments. We evaluated whether HIV-infected smokers metabolize nicotine faster than HIV-uninfected smokers, which may contribute to the disproportionate smoking burden and may have important treatment implications. DESIGN We analysed baseline data from two clinical trials (NCT01710137; NCT01314001) to compare the NMR in HIV-infected smokers (N = 131) to HIV-uninfected smokers (N = 199). METHODS Propensity scores were used to match the groups 2 : 1 on characteristics that influence NMR: sex, race, BMI and smoking rate. Nicotine metabolites were assessed via liquid chromatography-tandem mass spectrometry methods and the ratio of 3-hydroxycotinine:cotinine was used to compute the NMR. RESULTS HIV-infected smokers had significantly higher NMR (mean = 0.47, SEM = 0.02) and were more likely to be in the highest NMR quartile compared with HIV-uninfected smokers (mean = 0.34, SEM = 0.02; Ps < 0.001). CONCLUSION The higher NMR observed among HIV-infected smokers may partially explain higher smoking rates and lower response to transdermal nicotine therapy. Understanding the mechanisms by which HIV and/or ART contribute to faster nicotine metabolism may guide the use of the NMR to personalize tobacco cessation strategies in this underserved population.
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Abstract
BACKGROUND Limited data exist on what young adults report as their first-ever nicotine product; some evidence suggests that they report hookah as their first product smoked. OBJECTIVES This study reports on the first nicotine product used among undergraduates who had ever tried tobacco, and explores correlates of hookah as that first product. METHODS Participants included a convenience sample of undergraduate students (n = 1538) at four universities in upstate New York during fall 2013. Descriptive statistics assessed first nicotine product used and prevalence of current use. Logistic regression was used to examine correlates of hookah as the first nicotine product used. RESULTS Among the 832 students who reported ever use of any nicotine product, 25.4% reported hookah as their first product smoked; only combustible cigarettes (39.5%) were reported more frequently. Among students who ever smoked cigarettes, most reported cigarettes as their introductory product. Among students who never smoked cigarettes, nearly half reported hookah as their introductory product. Among ever nicotine users, current hookah smoking was common (34.9%), and greater than current e-cigarette (25.9%) and current combustible cigarette (26.4%) use. Never users of cigarettes, females, and non-Hispanic African Americans, had higher adjusted odds of reporting hookah as their introductory product. CONCLUSIONS The results of this study have implications for the identification of risk factors for tobacco initiation, the assessment of tobacco use patterns and behaviors, and the tailoring of tobacco prevention initiatives among youth. Our findings suggest that broadening prevention efforts beyond a focus on combustible cigarettes may be warranted.
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Affiliation(s)
- Jessica A Kulak
- a Primary Care Research Institute, Department of Family Medicine , University at Buffalo , Buffalo , New York , USA
| | | | - Mark J Travers
- c Department of Health Behavior and Aerosol Pollution Exposure Research Laboratory , Roswell Park Cancer Institute , Buffalo , New York , USA
| | - Maansi Bansal-Travers
- c Department of Health Behavior and Aerosol Pollution Exposure Research Laboratory , Roswell Park Cancer Institute , Buffalo , New York , USA
| | - Gregory G Homish
- d Department of Community Health and Health Behavior, School of Public Health and Health Professions , University at Buffalo, The State University of New York , Buffalo , New York , USA
| | - Martin C Mahoney
- d Department of Community Health and Health Behavior, School of Public Health and Health Professions , University at Buffalo, The State University of New York , Buffalo , New York , USA.,e Division of Cancer Prevention and Population Sciences , Roswell Park Cancer Institute , Buffalo , New York , USA
| | - Gary A Giovino
- d Department of Community Health and Health Behavior, School of Public Health and Health Professions , University at Buffalo, The State University of New York , Buffalo , New York , USA
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Mahoney MC, Erwin DO, Twarozek AM, Saad-Harfouche FG, Rodriguez EM, Sun X, Underwood W, Fox C. Leveraging technology to promote smoking cessation in urban and rural primary care medical offices. Prev Med 2018; 114:102-106. [PMID: 29953897 PMCID: PMC6082685 DOI: 10.1016/j.ypmed.2018.06.016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/04/2018] [Accepted: 06/24/2018] [Indexed: 10/28/2022]
Abstract
We examined the use of automated voice recognition (AVR) messages targeting smokers from primary care practices located in underserved urban and rural communities to promote smoking cessation. We partnered with urban and rural primary care medical offices (n = 7) interested in offering this service to patients. Current smokers, 18 years and older, who had completed an office visit within the previous 12 months, from these sites were used to create a smoker's registry. Smokers were recruited within an eight county region of western New York State between June 2012 and August 2013. Participants were contacted over six month intervals using the AVR system. Among 5812 smokers accrued 1899 (32%) were reached through the AVR system and 55% (n = 1049) continued to receive calls. Smokers with race other than white or African American were less likely to be reached (OR = 0.71, 0.57-0.90), while smokers ages 40 and over were more likely to be reached. Females (OR = 0.78, 0.65-0.95) and persons over age 40 years were less likely to opt out, while rural smokers were more likely to opt out (OR = 3.84, 3.01-4.90). Among those receiving AVR calls, 30% reported smoke free (self-reported abstinence over a 24 h period) at last contact; smokers from rural areas were more likely to report being smoke free (OR = 1.41, 1.01-1.97). An AVR-based smoking cessation intervention provided added value beyond typical tobacco cessation efforts available in these primary care offices. This intervention required no additional clinical staff time and served to satisfy a component of patient center medical home requirements for practices.
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Affiliation(s)
- Martin C Mahoney
- Department of Medicine, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA.
| | - Deborah O Erwin
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | | | - Frances G Saad-Harfouche
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Elisa M Rodriguez
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Xiaoxi Sun
- State University of New York at Buffalo, Department of Biostatistics, Buffalo, New York, USA
| | - Willie Underwood
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Chester Fox
- State University of New York at Buffalo, Department of Family Medicine, Buffalo, New York, USA
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Lollier A, Rodriguez EM, Saad-Harfouche FG, Widman CA, Mahoney MC. HPV vaccination: Pilot study assessing characteristics of high and low performing primary care offices. Prev Med Rep 2018; 10:157-161. [PMID: 29868360 PMCID: PMC5984216 DOI: 10.1016/j.pmedr.2018.03.002] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 02/13/2018] [Accepted: 03/09/2018] [Indexed: 10/26/2022] Open
Abstract
This pilot study was undertaken to identify characteristics and approaches (e.g., social, behavioral, and/or systems factors) which differentiate primary care medical offices achieving higher rates of HPV vaccination. Eligible primary care practice sites providing care to adolescent patients were recruited within an eight county region of western New York State between June 2016 and July 2016. Practice sites were categorized as higher (n = 3) or lower performing (n = 2) based on three dose series completion rates for HPV vaccinations among females aged 13-17 years. Interviewer administered surveys were completed with office staff (n = 37) and focused on understanding approaches to adolescent vaccination. Results were summarized using basic descriptive statistics. Higher performing offices reported more full-time clinical staff (median = 25 vs. 9.5 in lower performing clinics), larger panels of patients ages 11-17 years (median = 3541 vs. 925) and completion of NYSIIS data entry within two weeks of vaccination. (less than a month vs. two). Staff in higher performing offices reviewed medical charts prior to scheduled visits (100% vs. 50) and identified their office vaccine champion as a physician and/or a nurse manager (75% vs. 22%). Also, staffs from higher performing offices were more likely to report the combination of having an office vaccine champion, previewing charts and using standing orders. These preliminary findings support future research examining implementation of organizational processes including identifying a vaccine champion, using standing orders and previewing medical charts prior to office visits as strategies to increase rates of HPV vaccination in primary care offices.
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Affiliation(s)
- Allison Lollier
- School of Public Health & Health Professions, State University of New York at Buffalo, 401 Kimball Tower, Buffalo, NY, USA.,School of Pharmacy and Pharmaceutical Sciences, State University of New York at Buffalo, 285 Kapoor Hall, Buffalo, NY, USA
| | - Elisa M Rodriguez
- Department of Cancer Prevention and Control, Office of Community Outreach and Engagement, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, USA
| | - Frances G Saad-Harfouche
- Department of Cancer Prevention and Control, Office of Community Outreach and Engagement, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, USA
| | - Christy A Widman
- Department of Cancer Prevention and Control, Office of Community Outreach and Engagement, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, USA
| | - Martin C Mahoney
- School of Public Health & Health Professions, State University of New York at Buffalo, 401 Kimball Tower, Buffalo, NY, USA.,Department of Medicine, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, USA.,Department of Family Medicine, State University of New York at Buffalo, Buffalo, NY, USA
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Abstract
Although there is both a need and a desire to critically evaluate data from community-based clinical practices, many clinicians are inadequately prepared for this undertaking. This paper illustrates the process of establishing a computerized research data base in a community-based medical practice by highlighting issues of design, data collection, enrollment, and data management. In addition, a practical illustration of implementing such a data base system to perform community-based outcomes research among patients with chronic sinusitis is presented. Data bases established for community-based outcomes research can serve as a means for a single medical practice to examine patient outcomes or can serve as a component of a collaborative multi-site research effort.
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Affiliation(s)
- Sanford R. Hoffman
- The Buffalo Otolaryngology Group, Buffalo, New York
- Department of Otolaryngology, School of Medicine and Biomedical Sciences, Buffalo, New York
| | | | | | - Gerald D. Stinziano
- The Buffalo Otolaryngology Group, Buffalo, New York
- Department of Otolaryngology, School of Medicine and Biomedical Sciences, Buffalo, New York
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Widman CA, Rodriguez EM, Saad-Harfouche F, Twarozek AM, Erwin DO, Mahoney MC. Clinician and Parent Perspectives on Educational Needs for Increasing Adolescent HPV Vaccination. J Cancer Educ 2018; 33:332-339. [PMID: 27640203 PMCID: PMC5357204 DOI: 10.1007/s13187-016-1105-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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] [Indexed: 06/06/2023]
Abstract
Human papillomavirus (HPV)-related morbidity and mortality remain a significant public health burden despite the availability of HPV vaccines for cancer prevention. We engaged clinicians and parents to identify barriers and opportunities related to adolescent HPV vaccination within a focused geographic region. This mixed-method study design used an interviewer-administered semi-structured interview with clinicians (n = 52) and a written self-administered survey with similar items completed by parents (n = 54). Items focused on experiences, opinions, and ideas about HPV vaccine utilization in the clinical setting, family, and patient perceptions about HPV vaccination and potential future efforts to increase vaccine utilization. Quantitative items were analyzed using descriptive statistics, while qualitative content was analyzed thematically. Suggested solutions for achieving higher rates of HPV vaccination noted by clinicians included public health education, the removal of stigma associated with vaccines, media endorsements, and targeting parents as the primary focus of educational messages. Parents expressed the need for more information about HPV-related disease, HPV vaccines, vaccine safety, sexual concerns, and countering misinformation on social media. Results from this mixed-method study affirm that educational campaigns targeting both health care professionals and parents represent a key facilitator for promoting HPV vaccination; disease burden and cancer prevention emerged as key themes for this messaging.
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Affiliation(s)
- Christy A Widman
- Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Street, Buffalo, NY, 14263, USA
| | - Elisa M Rodriguez
- Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Street, Buffalo, NY, 14263, USA
| | - Frances Saad-Harfouche
- Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Street, Buffalo, NY, 14263, USA
| | - Annamaria Masucci Twarozek
- Department of Health Behavior, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, 14263, USA
| | - Deborah O Erwin
- Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Street, Buffalo, NY, 14263, USA
| | - Martin C Mahoney
- Department of Health Behavior, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, 14263, USA.
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Ray AD, Williams BT, Mahoney MC. Respiratory Muscle Training Improves Exercise Performance and Quality of Life in Cancer Survivors: A Pilot Study. Rehabilitation Oncology 2017. [DOI: 10.1097/01.reo.0000000000000064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Saad-Harfouche FG, Rodriguez EM, Twarozek AM, Widman CA, Erwin DO, Underwood W, Fox C, Mahoney MC. Abstract A08: Leveraging technology to promote smoking cessation in primary care medical offices. Cancer Epidemiol Biomarkers Prev 2017. [DOI: 10.1158/1538-7755.disp16-a08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Purpose of the Study: While smoking represents the leading preventable cause of premature morbidity and mortality in the U.S., research has demonstrated that only a limited scope of cessation services are delivered to patients in many medical offices. We examined the use of an automated voice recognition (AVR) messaging intervention among smokers from primary care practices located in underserved urban and rural communities as a strategy to promote smoking cessation.
Methods: We utilized community-based participatory research (CBPR) involving smokers as a foundation for creating AVR messaging and partnered with urban and rural primary care medical office sites (n=7), including community clinics and federally qualified health centers. Current smokers, 18 years and older, who had an office visit within the previous 12 months, from these sites were used to create a smoker's registry (n=5,872). Between 2012 and 2014 participants were contacted over six month intervals using the AVR system. Smoker's registry data including demographic variables, medical office, and phone contact information. AVR results from each practice were aggregated and analyzed to assess cessation outcomes.
Results: Of the seven practice sites, a total of 5,872 smokers were accrued of whom 1,899 (32%) were reached through the AVR system. The average number of calls to smokers was 44 (median 51). 28% of the smokers reached were African American, 79% were age 40 and over, and 57% were female. Self-reported quit rates among reached smokers were 30%; quit rates were variable across selected variables.
Conclusions: An AVR based smoking cessation intervention provided added value beyond typical tobacco cessation efforts available in these primary care offices. This intervention required no additional clinical staff time and served to satisfy a component of patient center medical home requirements for many of these practices. Building partnerships with primary care medical offices can aid in the development and testing of community-based interventions such as smoking cessation delivered to medically underserved and diverse patient populations.
Citation Format: Frances G. Saad-Harfouche, Elisa M. Rodriguez, Annamaria Masucci Twarozek, Christy A. Widman, Deborah O. Erwin, Willie Underwood, III, Chester Fox, Martin C. Mahoney. Leveraging technology to promote smoking cessation in primary care medical offices. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A08.
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Affiliation(s)
| | | | | | | | | | | | - Chester Fox
- 2State University of New York at Buffalo, Buffalo, New York
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Rodriguez EM, Twarozek AM, Erwin DO, Widman C, Saad-Harfouche FG, Fox CH, Underwood W, Mahoney MC. Perspectives on Smoking Cessation in Northern Appalachia. J Community Health 2017; 41:211-9. [PMID: 26318743 DOI: 10.1007/s10900-015-0084-3] [Citation(s) in RCA: 5] [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] [Indexed: 10/23/2022]
Abstract
This study applies qualitative research methods to explore perspectives on cessation among smokers/former smokers recruited from an area of Northern Appalachia. Six focus groups, stratified by age group (18-39 years old and 40 years and older), were conducted among participants (n = 54) recruited from community settings. Participants described varied interest in and challenges with quitting smoking. Smokers 40 years and older more readily endorsed the health risks of smoking and had greater interest in quitting assistance. Participants expressed frustration with the US government for allowing a harmful product (e.g., cigarettes) to be promoted with minimal regulation. Use of social media was robust among both age groups; participants expressed limited interest in various social media/technology platforms for promoting smoking cessation. Findings from this understudied area of northern Appalachia reflect the heterogeneity of this region and contribute novel information about the beliefs, attitudes, and experiences of current and formers smokers with regard to cessation.
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Affiliation(s)
- Elisa M Rodriguez
- Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA.
| | - Annamaria Masucci Twarozek
- Department of Health Behavior, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Deborah O Erwin
- Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Christy Widman
- Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Frances G Saad-Harfouche
- Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Chester H Fox
- Department of Family Medicine, State University of New York at Buffalo, 240 Goodell Street, Buffalo, NY, 14208, USA
| | - Willie Underwood
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, 14263, USA
| | - Martin C Mahoney
- Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA
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Rokitka DA, Curtin C, Heffler JE, Zevon MA, Attwood K, Mahoney MC. Patterns of Loss to Follow-Up Care Among Childhood Cancer Survivors. J Adolesc Young Adult Oncol 2016; 6:67-73. [PMID: 27529650 DOI: 10.1089/jayao.2016.0023] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [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: 12/31/2022] Open
Abstract
PURPOSE Surveillance for long-term complications related to previous cancer therapy can help diagnose/manage chronic health conditions in childhood cancer survivors and improve survivor quality of life. However, a challenge to delivering long-term care to childhood cancer survivors is loss to follow-up; many patients discontinue care at specialized survivor care centers. The purpose of this study was to examine patterns of loss to follow-up among a cohort of childhood cancer survivors. METHODS This retrospective study examined follow-up patterns among a nonrandom representative sample of 370 childhood cancer survivors among 1116 patients from a single institution. The median age of patients at diagnosis was 10.2 years (range <1-21). Factors potentially related to follow-up were utilized to evaluate patterns of follow-up across 5-year intervals following completion of active therapy. The association between patient characteristics and follow-up was evaluated using univariate and multivariate binomial regression models. RESULTS The probability of follow-up 1-5 years post-treatment was 91.2% (89.7%-92.5%) but dropped to 68.5% (66.2%-70.8%) during years 6-10, 47.7% (45.0%-50.3%) during years 11-15, and continued to steadily decrease over time. Overall, white race, diagnoses at younger ages, patients with lymphomas/leukemias, and decade of diagnosis were each associated with somewhat better rates of follow-up. CONCLUSIONS These findings highlight the lack of follow-up by adult survivors of childhood cancer with only approximately one-half of patients returning for follow-up 10 years after completion of therapy. Interventions focused on educating both patients and primary care physicians may help to increase long-term follow-up care among this at-risk population.
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Affiliation(s)
- Denise A Rokitka
- 1 Department of Pediatric Oncology, Roswell Park Cancer Institute , Buffalo, New York
| | - Colleen Curtin
- 2 Jacobs School of Medicine and Biomedical Sciences, State University at Buffalo , Buffalo, New York
| | - Jennifer E Heffler
- 1 Department of Pediatric Oncology, Roswell Park Cancer Institute , Buffalo, New York
| | - Michael A Zevon
- 3 Department of Health Behavior, Roswell Park Cancer Institute , Buffalo, New York
| | - Kris Attwood
- 4 Department of Biostatistics and Bioinformatics, Roswell Park Cancer Institute , Buffalo, New York
| | - Martin C Mahoney
- 5 Department of Medicine, Roswell Park Cancer Institute , Buffalo, New York.,6 Department of Family Medicine, State University of New York at Buffalo , Buffalo, New York
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Rodriguez EM, Saad-Harfouche FG, Miller A, Mahoney MC, Ambrosone CB, Morrison CD, Underwood W, Erwin DO. Engaging diverse populations in biospecimen donation: results from the Hoy y Mañana study. J Community Genet 2016; 7:271-277. [PMID: 27488840 DOI: 10.1007/s12687-016-0275-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 01/13/2016] [Accepted: 07/27/2016] [Indexed: 10/21/2022] Open
Abstract
The disproportionately lower number of certain subpopulations participating in clinical and prevention research has a significant impact on the representativeness of scientific outcomes. The Hoy y Mañana program (Today and Tomorrow) was developed as a culturally and linguistically appropriate education program to engage diverse medically underserved populations without a cancer diagnosis in biospecimen donation for cancer genomic research. Participants were recruited to in-depth community-based educational programs (∼45-60-min duration) or during open events in the community based on a convenience sampling. Programs were offered in English and Spanish. An on-site mobile lab along with phlebotomy services was provided at all programs and events to collect participant biospecimen (blood) samples to be stored at the cancer center's Data Bank and BioRepository (DBBR). The distributions for education, race/ethnicity, and gender were similar across the event types. Most of the participants were women. The analysis sample had a total of 311 participants, including 231 from the education programs and 80 participants from open events. Those with a higher education (college or more) were more likely to donate than those with a lower level of education (high school or less) (45 vs 28 %, p = 0.007). Actual donation status was not associated with age or race. Willingness to donate a biospecimen and biospecimen donation rates followed the same pattern with respect to participants with higher levels of education being more willing to donate and giving a blood donation. Prior to outreach efforts, less than 6 % of specimens donated to DBBR from healthy/non-cancer patients were from minority participants.
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Affiliation(s)
- Elisa M Rodriguez
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA.
| | - Frances G Saad-Harfouche
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Austin Miller
- Department of Biostatistics and Bioinformatics, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Martin C Mahoney
- Department of Medicine, Department of Health Behavior, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Christine B Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Carl D Morrison
- Center for Personalized Medicine, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Willie Underwood
- Department of Urology, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Deborah O Erwin
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA
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Saddleson ML, Kozlowski LT, Giovino GA, Homish GG, Mahoney MC, Goniewicz ML. Assessing 30-day quantity-frequency of U.S. adolescent cigarette smoking as a predictor of adult smoking 14 years later. Drug Alcohol Depend 2016; 162:92-8. [PMID: 26987520 PMCID: PMC6119624 DOI: 10.1016/j.drugalcdep.2016.02.043] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [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] [Received: 10/19/2015] [Revised: 02/01/2016] [Accepted: 02/22/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND To improve measures of monthly tobacco cigarette smoking among non-daily smokers, predictive of future non-daily monthly and daily smoking. METHODS Data from United States National Longitudinal Study of Adolescent to Adult Health, tracking adolescents, ages 12-21, over 14 years were analyzed. At baseline, 6501 adolescents were assessed; 5114 individuals provided data at waves 1 and 4. Baseline past 30-day non-daily smokers were classified using quantity-frequency measures: cigarettes smoked/day by number of days smoked in the past 30 days. RESULTS Three categories of past 30-day non-daily smokers emerged using cigarettes/month (low:1-5, moderate: 6-60, high: 61+) and predicted past 30-day smoking at follow-up (low: 44.5%, moderate: 60.0%, high: 77.0%, versus 74.2% daily smokers; rτ=-0.2319, p<0.001). Two categories of non-smokers plus low, moderate and high categories of non-daily smokers made up a five-category non-daily smoking index (NDSI). High NDSI (61+ cigs/mo.) and daily smokers were equally likely to be smoking 14 years later (High NDSI OR=0.97, 95% CI=0.53-1.80 [daily as reference]). Low (1-5 cigs/mo.) and moderate (6-60 cigs/mo.) NDSI were distinctly different from high NDSI, but similar to one another (OR=0.21, 95% CI=0.15-0.29 and OR=0.22, 95% CI=0.14-0.34, respectively) when estimating future monthly smoking. Among those smoking at both waves, wave 1 non-daily smokers, overall, were less likely than wave 1 daily smokers to be smoking daily 14 years later. CONCLUSIONS Non-daily smokers smoking over three packs/month were as likely as daily smokers to be smoking 14-years later. Lower levels of non-daily smoking (at ages 12-21) predicted lower likelihood of future monthly smoking. In terms of surveillance and cessation interventions, high NDSI smokers might be treated similar to daily smokers.
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Affiliation(s)
- M L Saddleson
- University at Buffalo, State University of New York, School of Public Health and Health Professions, Department of Community Health and Health Behavior, Buffalo, NY, USA.
| | - L T Kozlowski
- University at Buffalo, State University of New York, School of Public Health and Health Professions, Department of Community Health and Health Behavior, Buffalo, NY, USA
| | - G A Giovino
- University at Buffalo, State University of New York, School of Public Health and Health Professions, Department of Community Health and Health Behavior, Buffalo, NY, USA
| | - G G Homish
- University at Buffalo, State University of New York, School of Public Health and Health Professions, Department of Community Health and Health Behavior, Buffalo, NY, USA
| | - M C Mahoney
- University at Buffalo, State University of New York, School of Public Health and Health Professions, Department of Community Health and Health Behavior, Buffalo, NY, USA; Roswell Park Cancer Institute, Department of Medicine and Department of Health Behavior, Buffalo, NY, USA
| | - M L Goniewicz
- Roswell Park Cancer Institute, Department of Health Behavior, Buffalo, NY, USA
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Twarozek AM, Eggert T, Puca ZG, DuPont N, Erwin DO, Fox CH, Mahoney MC. Promoting Tobacco Cessation in a Community-Based Women's Health Centre. J Womens Health Care 2016; 4. [PMID: 27127729 PMCID: PMC4846304 DOI: 10.4172/2167-0420.1000225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Objective This report assesses the impact of a series of education sessions delivered to office staff on the delivery of smoking cessation services among patients seeking care at a community-based women’s health center. Methods A quasi-experimental design was used to examine the delivery of smoking cessation services to patients in a medical office before and after office staff attended a series of 3 educational sessions intended to increase their knowledge and self-efficacy to address cessation. Delivery of smoking cessation services was documented through a systematic review of medical records using a structured abstraction form. Results While nearly all smokers (93%) were asked about smoking status at their last office visit, few smokers at baseline or follow-up were assessed for interest in setting a quit date or offered pharmacotherapy. Referrals to the smokers quit line increased from <1% at baseline to 8% at follow-up (p<0.001) and “any assistance” also showed a modest but significant increase (<1% baseline, 9% follow-up, p<0.001). Conclusion This evaluation failed to identify clinical meaningful changes in the delivery of smoking cessation services in this women’s health office before and after completion of a series of educational interventions for office staff. It is anticipated that the implementation of patient centered medical homes, and EMR systems, will help to enhance the delivery of smoking cessation services to women seeking medical care.
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Affiliation(s)
| | - Thomas Eggert
- State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Zachary G Puca
- State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Nefertiti DuPont
- Doctor of Oncology, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, New York
| | - Deborah O Erwin
- Director, Office of Cancer Health Disparities Research, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, New York
| | - Chester H Fox
- Department of Family Medicine, State University of New York at Buffalo, 77 Goodell Street, Buffalo New York
| | - Martin C Mahoney
- Departments of Medicine & Health Behaviour, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, New York
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duPont NC, Mahoney MC, Kahn LS, Vest BM, Widman CA, Clark-Hargrave NS, Erwin DO. Developing a Smoking Cessation Intervention for Low Income and Minority Women. ACTA ACUST UNITED AC 2016; 5. [PMID: 28824830 PMCID: PMC5558895 DOI: 10.4172/2167-0420.1000309] [Citation(s) in RCA: 4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective of this qualitative pilot study was to elicit patient and provider feedback on how to develop a smoking cessation program for low income women with cervical dysplasia in an urban Women's Health Center. METHODS A community-based participatory research project incorporating a focus group and structured interviews was utilized to elicit feedback on how to develop a culturally appropriate smoking cessation program appealing to low-income and minority women smokers. RESULTS Qualitative data from 13 patients, 4 nurses, and 6 staff members collected between January 2012-August 2012 described the challenges of finding effective mechanisms for cessation interventions that met the schedules and needs of low income and minority patients. Input from office staff indicated insufficient educational resources to offer patients, limited skills to assist patients and the importance of perceived patient readiness to quit as barriers to creating an effective smoking cessation program. CONCLUSION Smoking cessation services targeting low-income and minority female smokers can be enhanced by providing clinic staff with patient education materials and smoking cessation training.
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Affiliation(s)
- Nefertiti C duPont
- Department of Gynecologic Oncology, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Martin C Mahoney
- Departments of Medicine and Health Behavior, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, New York, USA
| | - Linda S Kahn
- Department of Family Medicine, University at Buffalo, The State University of New York at Buffalo, Buffalo, New York, USA
| | - Bonnie M Vest
- Department of Family Medicine, University at Buffalo, The State University of New York at Buffalo, Buffalo, New York, USA
| | - Christy A Widman
- Division of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, New York, USA
| | - Nikia S Clark-Hargrave
- Division of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, New York, USA
| | - Deborah O Erwin
- Division of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, New York, USA
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Mahoney MC, Saad-Harfouche FG, Widman CA, Twarozek AM, Erwin DO, Rodriguez EM. Clinician Misperceptions about the Importance of Adolescent HPV Vaccination. World J Vaccines 2016; 6. [PMID: 29795800 PMCID: PMC5962284 DOI: 10.4236/wjv.2016.61002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction Adolescent HPV vaccination rates remain suboptimal. The purpose of the study was to investigate attitudes about HPV vaccine relative to other adolescent vaccines among clinical staff from primary care offices and school based clinics. Methods We interviewed clinicians in primary care offices and school-based clinics regarding their attitudes about HPV vaccine relative to Tdap and MCV4. Results Respondents (n = 36) included clinical staff in family medicine (47%), pediatrics (25%), obstetrics/gynecology (19%) and school-based health clinics (8%). Only 3% strongly agreed and 17% agreed that completion of HPV vaccine was more important than completion of pertussis vaccine (Tdap), while 6% strongly agreed and 33% agreed that completion of HPV vaccine was more important than completion of meningitis vaccine (MCV4). Discussion Providing clinicians with additional information about the cancer prevention benefits of the HPV vaccine and the greater risk for HPV infection/disease relative to other vaccine preventable adolescent diseases may help to increase HPV vaccination rates among adolescents.
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Affiliation(s)
- Martin C Mahoney
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Frances G Saad-Harfouche
- Department of Cancer Prevention and Control, Office of Cancer Health Disparities Research, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Christy A Widman
- Department of Cancer Prevention and Control, Office of Cancer Health Disparities Research, Roswell Park Cancer Institute, Buffalo, NY, USA
| | | | - Deborah O Erwin
- Department of Cancer Prevention and Control, Office of Cancer Health Disparities Research, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Elisa M Rodriguez
- Department of Cancer Prevention and Control, Office of Cancer Health Disparities Research, Roswell Park Cancer Institute, Buffalo, NY, USA
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Hawk LW, Ashare RL, Rhodes JD, Oliver JA, Cummings KM, Mahoney MC. Does Extended Pre Quit Bupropion Aid in Extinguishing Smoking Behavior? Nicotine Tob Res 2015; 17:1377-84. [PMID: 25589680 PMCID: PMC4612343 DOI: 10.1093/ntr/ntu347] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 12/24/2014] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Understanding the mechanisms by which bupropion promotes smoking cessation may lead to more effective treatment. To the extent that reduced smoking reinforcement is one such mechanism, a longer duration of pre quit bupropion treatment should promote extinction of smoking behavior. We evaluated whether 4 weeks of pre quit bupropion (extended run-in) results in greater pre quit reductions in smoking rate and cotinine and, secondarily, greater short-term abstinence, than standard 1 week of pre quit bupropion (standard run-in). METHODS Adult smokers (n = 95; 48 females) were randomized to a standard run-in group (n = 48; 3-week placebo, then 1-week bupropion pre quit) or an extended run-in group (4-week pre quit bupropion; n = 47). Both groups received group behavioral counseling and 7 weeks of post quit bupropion. Smoking rate (and craving, withdrawal, and subjective effects) was collected daily during the pre quit period; biochemical data (cotinine and carbon monoxide) were collected at study visits. RESULTS During the pre quit period, the extended run-in group exhibited a greater decrease in smoking rate, compared to the standard run-in group, interaction p = .03. Cigarette craving and salivary cotinine followed a similar pattern, though the latter was evident only among women. Biochemically verified 4-week continuous abstinence rates were higher in the extended run-in group (53%) than the standard run-in group (31%), p = .033. CONCLUSIONS The extended use of bupropion prior to a quit attempt reduces smoking behavior during the pre quit period and improved short-term abstinence rates. The data are consistent with an extinction-of-reinforcement model and support further investigation of extended run-in bupropion therapy for smoking cessation.
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Affiliation(s)
- Larry W Hawk
- Department of Psychology, State University of New York at Buffalo, Buffalo, NY; Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY;
| | - Rebecca L Ashare
- Department of Psychology, State University of New York at Buffalo, Buffalo, NY; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jessica D Rhodes
- Department of Psychology, State University of New York at Buffalo, Buffalo, NY; Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Jason A Oliver
- Department of Psychology, State University of New York at Buffalo, Buffalo, NY; Department of Psychiatry, Yale University, New Haven, CT
| | - Kenneth Michael Cummings
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Martin C Mahoney
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY
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Gondek M, Shogan M, Saad-Harfouche FG, Rodriguez EM, Erwin DO, Griswold K, Mahoney MC. Engaging Immigrant and Refugee Women in Breast Health Education. J Cancer Educ 2015; 30:593-598. [PMID: 25385693 PMCID: PMC4745125 DOI: 10.1007/s13187-014-0751-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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] [Indexed: 06/03/2023]
Abstract
This project assessed the impact of a community-based educational program on breast cancer knowledge and screening among Buffalo (NY) immigrant and refugee females. Program participants completed language-matched pre- and post-test assessments during a single session educational program; breast cancer screening information was obtained from the mobile mammography unit to which participants were referred. Pre- and post-test knowledge scores were compared to assess changes in responses to each of the six individual knowledge items, as well as overall. Mammogram records were reviewed to identify Breast Imaging Reporting and Data System (BI-RADS) scores. The proportion of correct responses to each of the six knowledge items increased significantly on the post-program assessments; 33 % of women >40 years old completed mammograms. The findings suggest that a health education program for immigrant and refugee women, delivered in community-based settings and involving interpreters, can enhance breast cancer knowledge and lead to improvements in mammography completion.
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Affiliation(s)
- Matthew Gondek
- Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, 14263, USA
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Burstein GR, Blank J, Chalmers TF, Mahar T, Mahoney MC. Snowstorm-Related Mortality - Erie County, New York, November 2014. MMWR Morb Mortal Wkly Rep 2015; 64:920-1. [PMID: 26313476 DOI: 10.15585/mmwr.mm6433a7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
During November 18-21, 2014, a narrow band of central and southern Erie County in New York received unprecedented amounts of snowfall. The duration of the storm and amount of snowfall rapidly exceeded weather service forecasts, with some areas receiving 60-84 inches (1.5-2.1 meters) of snow. The rapid accumulation resulted in stranded drivers, travel bans, and logistical challenges associated with snow removal. Sporadic power outages affected a limited number of households. Eleven deaths were linked to the snowstorm, including one that was directly related, nine that were indirectly related, and one that was classified as possibly storm-related.
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Bevers TB, Ward JH, Arun BK, Colditz GA, Cowan KH, Daly MB, Garber JE, Gemignani ML, Gradishar WJ, Jordan JA, Korde LA, Kounalakis N, Krontiras H, Kumar S, Kurian A, Laronga C, Layman RM, Loftus LS, Mahoney MC, Merajver SD, Meszoely IM, Mortimer J, Newman L, Pritchard E, Pruthi S, Seewaldt V, Specht MC, Visvanathan K, Wallace A, Bergman MA, Kumar R. Breast Cancer Risk Reduction, Version 2.2015. J Natl Compr Canc Netw 2015; 13:880-915. [PMID: 26150582 DOI: 10.6004/jnccn.2015.0105] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Breast cancer is the most frequently diagnosed malignancy in women in the United States and is second only to lung cancer as a cause of cancer death. To assist women who are at increased risk of developing breast cancer and their physicians in the application of individualized strategies to reduce breast cancer risk, NCCN has developed these guidelines for breast cancer risk reduction.
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Mahoney MC, Masucci Twarozek A, Saad-Harfouche F, Widman C, Erwin DO, Underwood W, Fox CH. Assessing the delivery of cessation services to smokers in urban, safety-net clinics. J Community Health 2015; 39:879-85. [PMID: 24557716 DOI: 10.1007/s10900-014-9843-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Inequities in smoking behaviors continue to exist with higher rates among persons with limited formal education and for those living below the poverty level. This report describes the scope of tobacco cessation services delivered to low socio-economic status (SES) patients in several primary care medical offices, considered as "safety-net" sources of health care. Using a cross-sectional design, a random sample of records were reviewed for 922 smokers from 4 medical offices. The primary outcome variable was the delivery of smoking cessation services as documented in medical records; information on patient demographics and number of visits during the past 12 months was also abstracted. Smoking status was assessed during the last office visit for 65 % of smokers, 59 % were advised to quit, readiness to quit was assessed for 24 %, 2 % indicated a willingness to quit within the next 30 days and a quit date was established for 1 %. Among smokers not yet ready to quit, few were counseled on the "5 R's" (Relevance, Risks, Rewards, Roadblocks, Repetition). These results expand our understanding of the unfortunately limited scope of cessation services delivered to persons seen in safety-net medical offices and call attention to the need to redouble efforts to more effectively address smoking cessation among diverse, low SES patients served by safety-net primary care clinics.
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Affiliation(s)
- Martin C Mahoney
- Department of Medicine, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA,
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Toll BA, Martino S, O'Malley SS, Fucito LM, McKee SA, Kahler CW, Rojewski AM, Mahoney MC, Wu R, Celestino P, Seshadri S, Koutsky J, Hyland A, Cummings KM. A randomized trial for hazardous drinking and smoking cessation for callers to a quitline. J Consult Clin Psychol 2015; 83:445-54. [PMID: 25419583 PMCID: PMC5996380 DOI: 10.1037/a0038183] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [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: 12/20/2022]
Abstract
OBJECTIVE This study evaluated whether tobacco quitline telephone coaches can be trained to counsel hazardous-drinking smokers to improve smoking cessation success and to limit or abstain from alcohol use. METHOD Smokers (N = 1,948) who called the New York State Smokers' Quitline and reported hazardous drinking (exceeding sex-specific weekly limits [14 drinks for men, 7 drinks for women] or meeting/exceeding daily drinking limits [5 drinks for men, 4 drinks for women] at least once in the past year) were randomized to receive either brief motivational counseling to limit or abstain from alcohol plus an alcohol reduction booklet added to standard care (Alcohol + Tobacco Counseling; ATC), or only smoking cessation counseling plus a smoking cessation booklet added to standard care (Tobacco-Only Counseling; TOC). RESULTS Acceptable coach adherence was achieved. The intention-to-treat (ITT) analysis showed that ATC was associated with a significantly higher rate of smoking abstinence at 7-month follow-up (13.5%) compared with TOC (10.3%; p = .03). The respondent analysis (ATC= 26.2%; TOC = 20.4%) paralleled the ITT findings. When controlling for treatment condition, participants who did not report any heavy drinking were significantly more likely to quit smoking than those who reported any heavy drinking (OR = 1.87, 95% CI [1.29, 2.71]; p = .001). CONCLUSIONS A brief alcohol intervention plus standard care via a telephone quitline resulted in significantly higher smoking cessation rates for hazardous-drinking callers. Given that quitline coaches were trained to provide the intervention with acceptable adherence, the potential to extend this intervention for wide-scale implementation and impact is promising.
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Affiliation(s)
| | - Steve Martino
- Department of Psychiatry, Yale University School of Medicine, VA Connecticut Healthcare Center
| | | | | | | | - Christopher W Kahler
- Center for Alcohol and Addiction Studies, Department of Behavior and Social Sciences, Brown University School of Public Health
| | | | | | | | - Paula Celestino
- Department of Health Behavior, Roswell Park Cancer Institute
| | | | - James Koutsky
- Department of Health Behavior, Roswell Park Cancer Institute
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Cancer Institute
| | - K Michael Cummings
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina
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Ray AD, Williams BT, Cook JL, Maxwell N, Mahoney MC. Respiratory Muscle Training Improves Dyspnea and Exercise Performance in Cancer Survivors. Med Sci Sports Exerc 2015. [DOI: 10.1249/01.mss.0000478806.98407.d9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
PURPOSE This article examines the association between measures of respiratory muscle function and fatigue in individuals with mild-to-moderate disability multiple sclerosis (MS). METHODS This was a cross-sectional study of 37 ambulatory volunteers with MS (28 F/9 M, 52.7 ± 10.2 years, Expanded Disability Status Scale [EDSS] = 3.5 ± 1.9). No patients withdrew from the study. Primary outcome variables included measures of respiratory function: maximal inspiratory (MIP) and expiratory pressures (MEP), forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), maximal voluntary ventilation (MVV12); and a self-reported measure of fatigue: the Modified Fatigue Impact Scale (MFIS). Secondary measures included 6-min walking test (6MWT), a timed stair climb, the Short Form (SF)-36, the Epworth Sleepiness Scale and the Physical Activity and Disability Scale (PADS). RESULTS Significant correlations were shown between expiratory muscle strength (MEP) and the MFIS total (p < 0.03, r = -0.362) and between MEP and physical fatigue scores (p < 0.03, r = -0.360), as well as between MVV12 percent predicted (respiratory muscle endurance) and both the 6MWT (p = 0.045, r = 0.346) and the Epworth Sleepiness Scale (p = 0.006, r = 0.447). CONCLUSIONS Respiratory muscle performance is correlated with perceived fatigue (MFIS), whereas respiratory endurance correlated to reductions in physical function and sleep quality among individuals with mild-to-moderate severity MS. Implications for Rehabilitation Multiple sclerosis (MS) results in peripheral and respiratory muscle weakness and affected individuals report fatigue as one of their most disabling symptoms. Expiratory muscle strength was correlated with self-reported physical fatigue, while respiratory muscle endurance was correlated with functional performance and sleepiness. Respiratory muscle strength was not correlated with lung spirometry testing. These findings highlight the importance of considering the effects of respiratory muscle weakness when evaluating causes of fatigue among individuals with mild-to-moderate MS.
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Affiliation(s)
| | - Martin C Mahoney
- b Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, State University of New York at Buffalo , Buffalo , NY , USA
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Saddleson ML, Kozlowski LT, Giovino GA, Hawk LW, Murphy JM, MacLean MG, Goniewicz ML, Homish GG, Wrotniak BH, Mahoney MC. Risky behaviors, e-cigarette use and susceptibility of use among college students. Drug Alcohol Depend 2015; 149:25-30. [PMID: 25666362 DOI: 10.1016/j.drugalcdep.2015.01.001] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 12/11/2014] [Accepted: 01/02/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Since 2007, there has been a rise in the use of electronic cigarettes (e-cigarettes). The present study uses cross-sectional data (2013) to examine prevalence, correlates and susceptibility to e-cigarettes among young adults. METHODS Data were collected using an Internet survey from a convenience sample of 1437, 18-23 year olds attending four colleges/universities in Upstate New York. Results were summarized using descriptive statistics; logistic regression models were analyzed to identify correlates of e-cigarette use and susceptibility to using e-cigarettes. RESULTS Nearly all respondents (95.5%) reported awareness of e-cigarettes; 29.9% were ever users and 14.9% were current users. Younger students, males, non-Hispanic Whites, respondents reporting average/below average school ability, ever smokers and experimenters of tobacco cigarettes, and those with lower perceptions of harm regarding e-cigarettes demonstrated higher odds of ever use or current use. Risky behaviors (i.e., tobacco, marijuana or alcohol use) were associated with using e-cigarettes. Among never e-cigarette users, individuals involved in risky behaviors or, with lower harm perceptions for e-cigarettes, were more susceptible to future e-cigarette use. CONCLUSIONS More e-cigarette users report use of another nicotine product besides e-cigarettes as the first nicotine product used; this should be considered when examining whether e-cigarette use is related to cigarette susceptibility. Involvement in risky behaviors is related to e-cigarette use and susceptibility to e-cigarette use. Among college students, e-cigarette use is more likely to occur in those who have also used other tobacco products, marijuana, and/or alcohol.
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Affiliation(s)
- M L Saddleson
- University at Buffalo, State University of New York, School of Public Health and Health Professions, Department of Community Health and Health Behavior, Buffalo, NY, USA.
| | - L T Kozlowski
- University at Buffalo, State University of New York, School of Public Health and Health Professions, Department of Community Health and Health Behavior, Buffalo, NY, USA
| | - G A Giovino
- University at Buffalo, State University of New York, School of Public Health and Health Professions, Department of Community Health and Health Behavior, Buffalo, NY, USA
| | - L W Hawk
- University at Buffalo, State University of New York; Department of Psychology, Buffalo, NY, USA
| | - J M Murphy
- State University of New York, at Cortland, Health Department, Cortland, NY, USA
| | - M G MacLean
- State University of New York, Buffalo State, Department of Psychology, Buffalo, NY, USA
| | - M L Goniewicz
- Roswell Park Cancer Institute, Division of Cancer Prevention and Population Sciences, Buffalo, NY, USA
| | - G G Homish
- University at Buffalo, State University of New York, School of Public Health and Health Professions, Department of Community Health and Health Behavior, Buffalo, NY, USA
| | - B H Wrotniak
- D'Youville College, Center for Health Behavior Research, Buffalo, NY, USA
| | - M C Mahoney
- University at Buffalo, State University of New York, School of Public Health and Health Professions, Department of Community Health and Health Behavior, Buffalo, NY, USA; Roswell Park Cancer Institute, Department of Medicine and Department of Health Behavior, Buffalo, NY, USA
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Hamilton DA, Mahoney MC, Novalen M, Chenoweth MJ, Heitjan DF, Lerman C, Tyndale RF, Hawk LW. Test-Retest Reliability and Stability of the Nicotine Metabolite Ratio Among Treatment-Seeking Smokers. Nicotine Tob Res 2015; 17:1505-9. [PMID: 25732567 DOI: 10.1093/ntr/ntv031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 01/26/2015] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The nicotine metabolite ratio (NMR), the ratio of 3-hydroxycotinine to cotinine, is a biomarker used in smoking cessation research, with several retrospective studies suggesting that NMR predicts treatment outcome. To be maximally useful in tailoring treatment, estimates of NMR should be stable over time. The present study is the first to examine the short-term test-retest reliability of NMR among treatment-seeking smokers. METHODS Blood NMR was assessed at two time points, approximately 2-3 weeks apart and prior to intervention, among 72 healthy adult smokers (49% female; 35% non-White) enrolled in a cessation trial (http://ClinicalTrials.gov ID: NCT01314001). RESULTS Mean NMR was stable from Time-1 to Time-2, with no significant change between assessments; test-retest reliability for NMR values was excellent (ICC[2,1] = 0.87). Test-retest reliability remained acceptable to high when NMR was categorized, as in recent clinical trials. Classification of participants as slow (quartile 1, NMR ≤ 0.24) or normal/fast NMR (quartiles 2-4, NMR ≥ 0.25) was consistent from Time-1 to Time-2 for 96% of participants (κ = 0.89). Though classification of participants into NMR quartiles was less consistent from Time-1 to Time-2 (67% agreement; weighted κ = 0.73), all reclassifications occurred between adjacent quartiles. CONCLUSIONS Overall, these data support the use of a single NMR assessment for association studies with smoking phenotypes and in smokers seeking to quit, and they encourage large-scale efforts to determine optimal NMR cutpoints for tailoring treatment selection.
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Affiliation(s)
- Diana A Hamilton
- Department of Psychology, University at Buffalo, SUNY, Buffalo, NY
| | - Martin C Mahoney
- School of Public Health and Health Professions, University at Buffalo, SUNY, Buffalo, NY; Departments of Medicine and Health Behavior, Roswell Park Cancer Institute, Buffalo, NY
| | - Maria Novalen
- Departments of Pharmacology and Toxicology, and Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Meghan J Chenoweth
- Departments of Pharmacology and Toxicology, and Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Daniel F Heitjan
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA
| | - Caryn Lerman
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Rachel F Tyndale
- Departments of Pharmacology and Toxicology, and Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Larry W Hawk
- Department of Psychology, University at Buffalo, SUNY, Buffalo, NY;
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Beshers SC, Murphy JM, Fix BV, Mahoney MC. Sex differences among college students in awareness of the human papillomavirus vaccine and vaccine options. J Am Coll Health 2015; 63:144-147. [PMID: 25337670 DOI: 10.1080/07448481.2014.975720] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 09/21/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To explore awareness of human papillomavirus (HPV) and use of HPV vaccines (Gardasil and Cervarix) by college students. PARTICIPANTS The sample was composed of 817 undergraduates at 2 northeastern US universities; they participated between February and May 2010. METHODS Students were provided with a link to an anonymous, self-administered, Web-based survey comprised of 76 questions. The survey included questions about health behaviors, awareness, and knowledge of HPV and the 2 HPV vaccines, and vaccine uptake. RESULTS Results indicate high levels of awareness of HPV as well as marked sex differences related to vaccine awareness and uptake. Both sexes are largely unaware of Cervarix and the differences between Cervarix and Gardasil. CONCLUSION The study affirms the importance of a clinician's recommendation for HPV vaccination. Public health messaging should become more inclusive of adolescent and young adult males. College students' awareness of HPV vaccine options mirrors Gardasil's market dominance in the United States.
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Affiliation(s)
- Sarah C Beshers
- a Health Department, State University of New York at Cortland , Cortland , New York
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Schlienz NJ, Hawk LW, Tiffany ST, O'Connor RJ, Mahoney MC. The impact of pre-cessation varenicline on behavioral economic indices of smoking reinforcement. Addict Behav 2014; 39:1484-90. [PMID: 24949949 PMCID: PMC4109268 DOI: 10.1016/j.addbeh.2014.05.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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: 11/20/2013] [Revised: 04/19/2014] [Accepted: 05/21/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Varenicline was developed to aid smoking cessation by reducing smoking reinforcement. The present study tests this reinforcement-reduction hypothesis among smokers preparing to quit. METHOD After a one-week baseline, treatment-seeking smokers were randomized to receive three weeks of varenicline or placebo (Weeks 2-4). During each of the four weeks of the study, smokers completed a hypothetical cigarette purchase task (CPT) via handheld devices in their natural environment. Behavioral economic measures of simulated smoking if cigarettes were free (demand intensity), sensitivity of consumption to increasing price (elasticity), and price at which purchases would drop to 0 (breakpoint) were estimated. RESULTS The exponential demand equation fit the purchase task data well across subjects and time. As predicted, demand intensity decreased and sensitivity to price (elasticity) increased over time. However, changes in demand intensity did not differ by treatment group. Contrary to our hypothesis that varenicline would increase sensitivity to price, the placebo group tended to become more elastic in their purchases during Weeks 2 and 3; the groups did not differ in elasticity at Week 4. Breakpoint did not vary by group, time, or their interaction. CONCLUSION Simulated smoking demand can be validly assessed in the natural environment of treatment-seeking smokers. Simulated demand indices of smoking reinforcement diminished as smokers approached their target quit date. However, there was no evidence that varenicline facilitated these changes over a three-week period, leaving open the mechanisms by which varenicline reduces smoking rate prior to cessation and improves long-term abstinence.
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Affiliation(s)
- Nicolas J Schlienz
- Department of Psychology, State University of New York at Buffalo, Buffalo, NY, United States.
| | - Larry W Hawk
- Department of Psychology, State University of New York at Buffalo, Buffalo, NY, United States; Center for Children and Families, State University of New York at Buffalo, Buffalo, NY, United States
| | - Stephen T Tiffany
- Department of Psychology, State University of New York at Buffalo, Buffalo, NY, United States
| | - Richard J O'Connor
- Departments of Medicine and Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, United States
| | - Martin C Mahoney
- Departments of Medicine and Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, United States
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