Recently Completed Studies (Study completed, data under analysis for dissemination)


Advancing Tobacco Research by Integrating Systems Science and Mixture Models
. This project advanced knowledge of how different smoking-cessation treatments worked, for whom, and when. Dr. Stephanie Lanza of Penn State was the lead investigator and Dr. Megan Piper, UW-CTRI associate director of research, was a co-investigator on this R01 grant from the National Cancer Institute. Researchers from The Methodology Center at Penn State integrated time-varying effect models and latent class analysis in order to identify subgroups of smokers who experienced the process of nicotine withdrawal differently. Latent class analysis allowed researchers to gauge the impact of exposure to patterns of multiple risks, as well as the antecedents and consequences of complex behaviors, so that interventions could be tailored to target the subgroups that will benefit most. Results from the project informed the construction of interventions that (1) are tailored to the individual and that (2) adapt to participant response over time. Importantly, the overall impact of this project extended far beyond the proposed analysis; the project’s full potential for accelerating the pace of smoking-cessation research was realized as a result of programmatic dissemination efforts of important new analytic methods to tobacco researchers. Sept. 2013-Aug 2015, $63,000. Funded by NCI. Dr. Stephanie Lanza, PI. Dr.
Megan Piper, co-I.

Primary Care Research Fellowship. Dr. Tanya Schlam was a Primary Care Research Fellow, supported by a National Research Service Award (T32 Postdoctoral Training Grant) from the Health Resources and Services Administration to the University of Wisconsin Department of Family Medicine. July 2012-June 2015. Funded by the Health Resources and Services Administration. Dr. Bruce Barrett, PI.

 

Veterans and Smoking Studies. Dr. Jessica Cook led this study at the William S. Middleton Memorial VA Hospital in Madison. The study tested the hypothesis that smokers with posttraumatic stress disorder (PTSD) and depression smoked cigarettes to improve aversive mood states and other mental health symptoms. The effect Dr. Cook was most interested in was whether smoking regulates anhedonia, a common feature of both PTSD and depression characterized by an inability to respond to pleasurable events. The first part of the study examined how nicotine influenced mood responses to positive and negative stimuli. The second part of the study was done at a critical point, 24 and 48 hours after being deprived of nicotine, which can be the peak of withdrawal. The team explored whether veterans with PTSD and depression had a more difficult time experiencing pleasure in response to rewarding events and whether they experienced more withdrawal-related negative affect. 2007-2014. Funded by NIDA. Dr. Jessica Cook, PI.

 

Tobacco Interventions Delivered by Community Agencies to Those Living in Poverty. UW-CTRI received a $332,000 NIH grant to train staff at four Salvation Army centers (in Green Bay, Appleton, La Crosse and Wausau) to provide a brief intervention with clients who smoked. UW-CTRI Researcher Dr. Bruce Christiansen led this project, which sprouted from pilot data collected via an ICTR grant awarded to Dr. Christiansen. More than 37 million Americans live in poverty, and they smoke at twice the rate of other Americans. As a result, they bear a disproportionate burden from tobacco-related diseases. Research also shows many people who are homeless or very poor have either mental-health or substance-abuse issues. Both of these groups tend to smoke at high rates and struggle to make quit attempts using evidence-based methods. This grant tested a brief intervention that challenged smokers’ beliefs that discouraged quit attempts. These beliefs included:


1) Smoking is both normal and acceptable.

2) Willpower is sufficient to quit, rendering outside help unnecessary and irrelevant.

3) Evidenced-based treatments are not more effective than other methods.

4) Stop-smoking medicines are ineffective, dangerous, addictive and/or too expensive.

5) Help in quitting is not available, hard to access and/or too expensive.


The goal of the intervention was to correct these misconceptions so they would consider quitting smoking. As a control, researchers randomized another 140 clients into a 15-minute intervention wherein a Salvation Army counselor read them a booklet on smoking and health, but without any behavioral or motivational interviewing. Another control group, consisting of 140 clients, received a booklet to peruse by themselves. All three groups were compared with 100 participants who were already set to quit smoking. Researchers made follow-up phone calls after three months. September 2011-September 2014, $332,000. Funded by NCI. Dr. Bruce Christiansen, PI.

UW Partnership to Assist and Serve Smokers (UW-PASS). A $9 million P-50 grant from the National Cancer Institute provided five years of funding for UW-CTRI to study various quit-smoking treatments in primary-care clinics throughout Wisconsin. In this study, led by Dr. Michael Fiore and Dr. Tim Baker, UW-CTRI delivered seamless, cutting-edge treatments for all smokers, including those who were ready to quit and those who weren’t. Beginning in the summer of 2010, UW-CTRI offered participation to patients who smoked and visited select primary-care clinics within two health-care systems—Dean Health System and Aurora Health Care. Medical assistants at partnering clinics identified smokers and asked if they were interested in being contacted about a study. They invited all smokers whether they were willing to quit or not. If the patient was interested, an e-mail was generated from the electronic medical record to UW-PASS staff, employed by UW-CTRI, who conducted screening, orientation, patient visits and follow up. The electronic medical records were supported by Epic Systems Corp. and Cerner. All participants have completed treatment. UW-PASS included three projects:

  • Project 1 focused on increasing the smoker’s motivation to quit. This project offered treatment strategies for smokers who weren’t ready to quit now but were willing to participate in treatment to help them get ready to quit. The hope was to increase their motivation to quit smoking as well as to make actual quit attempts. Treatments included behavioral coaching, motivational interviewing, nicotine patches, and nicotine gum.
  • Project 2 examined whether use of nicotine-replacement medication and behavioral coaching—before actually quitting smoking—helped the patient remain smoke-free. Typically, those who use nicotine-replacement medications (such as the nicotine patch or lozenge) quit smoking first, then use medications to stave off cravings and remain smoke free. Project 2 also tested coaching types and lengths, including in-person coaching vs. telephone coaching.
  • Project 3 studied ways to increase the number of patients who take quit-smoking medication at the proper dosage for the prescribed duration. Most smokers don’t use enough medication or use it the right way. The goal was to see what happened when a patient took medication as prescribed vs. skipping doses or ceasing treatment prematurely. Adherence treatments included automated-adherence phone prompts, electronic monitoring/feedback and a cognitive-adherence intervention. Project 3 also examined the outcomes of long-term coaching and medication.

September 2009-August 2014. NCI P-50 grant. Dr. Tim Baker and Dr. Michael Fiore, PIs.


Dual Use of E-Cigarettes and Traditional Cigarettes in Primary Care and Community Settings
. The National Institutes of Health awarded UW-CTRI a $1.8 million supplement to its NCI-funded center grant. With this supplement, researchers investigated questions of importance to the FDA in its role of regulating tobacco products:

 

  • How dual use of tobacco products (both smoking cigarettes and vaping e-cigarettes) is related to outcomes of public health importance, such as cessation attempts and success.

  • Mechanisms by which dual use affects such outcomes, for instance showing how dual use affects cigarette withdrawal symptoms, smoking reward, and cigarette dependence.

In the NCI Center Grant Primary Care study, UW-CTRI researchers added new measures and analyses to the parent study to see how dual use may (or may not) affect the user’s dependence on cigarettes, withdrawal severity, perception of harm, treatment engagement, and smoking outcomes (smoking reduction and cessation). Participants in the parent grant were recruited through primary-care visits. Dr. Tanya Schlam led this primary care component.

In the Community Sample sub-study, researchers used measures and analyses that elucidated the mechanisms responsible for the associations observed in the Primary Care sub-study. Dr. Doug Jorenby led this community sample component, which recruited 150 daily smokers via advertisements (e.g., convenience stores, TV, social media) throughout the Milwaukee and Madison areas, half of whom also used e-cigarettes.


These participants generated real-time data (using an innovative smartphone app) to determine how dual users and exclusive smokers compared on hedonic ratings of cigarettes, cigarette use, daytime tobacco use, mood, suppression of cigarette withdrawal, contexts of use, and exposure. Moreover, data from dual users revealed how recent use of other tobacco products (OTP) affected cigarette use and reward, especially during periods of reduced cigarette intake. Researchers used the data to compare risk profiles and determine how to improve cessation. September 2012-August 2014. Funded by NIH and FDA. Dr. Tim Baker and Dr. Michael Fiore, PIs.