UW-CTRI researchers presented 14 times at the 2018 annual meeting of the Society for Research on Nicotine and Tobacco (SRNT) at the Baltimore Hilton February 21-24. In addition to six podium presentations, there will be eight posters presented by UW-CTRI experts. Here is a brief summary of the findings.
1. Referral to Randomized Smoking Reduction and Cessation Treatments in Primary Care Clinics: Electronic vs. Fax Referral. By Madeline Oguss, Danielle McCarthy, Dave Fraser, Megan Piper, Jessica Cook, Tanya Schlam, Timothy Baker, Michael Fiore. Oguss said this research compared: 1) a system that referred patients via electronic health records (EHR) to a smoking-treatment study with 2) a quit line fax referral system in various primary care clinics. Whereas 42.8% of smokers were referred by EHR, only 2.1% were referred via fax. Just 12.2% from the EHR referrals enrolled, and 1% via fax. When comparing the health care systems’ use of the EHR invitation, the health system which implemented a hard-stop invitation reported more invitations documented, and reported more invitation declines than the system with the invitation visible to clinicians but not required as a hard stop. However, the health system with just the visible invitation ultimately had a slightly higher proportion of smokers referred and enrolled to the smoking-treatment study.
2. Can We Increase Smoking Cessation Medication Adherence and Does It Matter? Tanya Schlam, Timothy Baker, Jessica Cook, Todd Hayes-Birchler, Daniel Bolt, Stevens Smith, Michael Fiore, and Megan Piper. Schlam discussed what are, to the best of the team’s knowledge, the most comprehensive data collected to date on adherence to nicotine replacement therapy. The study found low adherence overall. Adherence to the patch and nicotine gum was strongly related to abstinence, but the causal basis of this relation is unclear. The study also found that e-Monitoring Counseling slightly increased gum use but did not increase abstinence. Extended-length medication (8 months) increased abstinence, compared to standard-length medication (2 months).
3. Relations of Distress Tolerance and Anxiety Sensitivity to Smoking Cessation, Withdrawal, and Pharmacotherapy Response. Tanya Schlam, Jessica Cook, Stevens Smith, Timothy Baker, Megan Piper. This study found that stronger distress tolerance was related to a greater likelihood of quitting smoking. Distress tolerance is the ability to tolerate aversive feelings. The study also found that both low distress tolerance and high anxiety sensitivity (i.e. the fear of anxious feelings), are associated with stronger tobacco dependence and withdrawal.
4. Engagement in Smoking Reduction Treatment in Primary Care Among Smokers Initially Unwilling to Quit. Jessica Cook, Timothy Baker, Tanya Schlam, Megan Piper, Robin Mermelstein. Schlam presented this research, which found that a 6-12 week smoking-reduction treatment promoted increased engagement when compared to a year-long treatment plan. Researchers compared rates of treatment engagement among smokers unwilling to quit but willing to reduce their smoking. The results suggest that briefer, front-loaded reduction treatments could be an efficient strategy for engaging smokers initially unwilling to quit and motivating them to make aided quit attempts. About 20% made an aided quit attempt.
5. Optimizing Smoking Treatment on Both Effectiveness and Cost as Part of the Multiphase Optimization Strategy (MOST). Megan Piper, Stevens Smith, Linda Collins, Daniel Bolt, David Fraser, Marlon Mundt, Michael Fiore and Timothy Baker. SRNT Secretary-Treasurer and UW-CTRI Associate Director of Research Megan Piper presented this research on how to select the best treatment package based on cost-effectiveness. This approach was contrasted with effectiveness-based optimization or just providing the most intensive treatment package possible. By using the Multiphase Optimization Strategy (MOST), researchers found that cost-effectiveness optimization holds promise for identifying treatments that are attractive to health care systems and appropriate for primary care in terms of effectiveness and overall cost. Piper said the “kitchen sink” approach of combining lots of treatments together is neither more effective nor cost-effective. “It may be that all that contact might be overwhelming to smokers, that quitting smoking becomes like a job and is anxiety-inducing.” Giving smokers medications before their quit date to prepare them for quitting was more cost-effective than extending their medication treatments after the quit date.
6. Smokers and Dual Users: Dependence and Cessation Motivation. Megan Piper, Timothy Baker, Michael Fiore, Stevens Smith, Kate Kobinsky, Neal Benowitz, and Douglas Jorenby. This research presented by Piper explored the risks and benefits posed by electronic cigarettes by examining the habits of smokers and those who both vape and smoke (dual users). The results showed that dual users are supplementing their smoking with electronic cigarette use. Additionally, while dual users may smoke fewer cigarettes per day and delay their first cigarette, it appears to neither influence their carbon monoxide levels nor their plans to quit smoking. So while dual users seemed to have less exposure to carcinogens, it’s unclear whether that’s enough to make a significant difference in health risk. Dual users were more likely to self-report a history of a psychological disorder (e.g., depression, anxiety or ADHD).
1. An Examination of Candidate Mediators of Maintenance Counseling and Adherence-Focused Interventions Effects on Abstinence in Adult Daily Smokers. Nayoung Kim, Danielle McCarthy, Tanya Schlam. Researchers examined the effects of adherence- and maintenance-focused interventions on candidate mediators (e.g., medication fear, cessation fatigue, gum and patch use) at 4 weeks and relations between these candidate mediators and point-prevalence abstinence at 8 weeks. Feedback and counseling about electronically monitored nicotine gum increased the number of days gum was used by 2 days in the first 4 weeks, on average. The combination of maintenance counseling and automated adherence reminders appeared to reduce medication fear and improve gum use in a synergistic manner. However, combining adherence-focused reminder calls with either counseling focused on medication beliefs or feedback about electronically monitored gum use appeared to increase cessation fatigue. More treatment may not be better and may sap quitting motivation. Although feedback about e-monitored gum use enhanced gum use, such feedback was associated with lower patch use unless accompanied by maintenance counseling. None of the targets affected by the interventions were predictive of changes in abstinence, which suggests that the intervention model may need revision.
2. Primary Care Clinic Staff Attitudes Addressing Tobacco Use Before and After Implementing a Smoking Treatment Referral Program. Madeline Oguss, Danielle McCarthy, Dave Fraser, Megan Piper, Jessica Cook, Tanya Schlam, Timothy Baker, Michael Fiore. Oguss said this research analyzed primary care staff attitudes toward treating tobacco use before and after implementing either Fax to Quit or referral via electronic health records (EHR) to a smoking-treatment study. The results suggested that health care staff believe that treating tobacco use is important. Researchers found that providers were more confident about patient reception and referral efficiency and success after the launch than before it. Perceived clinic support for addressing tobacco use may predict clinic implementation success. Clinics varied markedly in staff responses. Ongoing qualitative research will identify key factors associated with staff attitudes and implementation. EHR and Fax Referral clinics did not differ in terms of their survey answers, despite very different referral processes, burden, and reach.
3. Helping Women Veterans Quit Smoking: Back to Basics. Kristin Berg, Stephanie Gruber, Douglas Jorenby. Researchers conducted interviews with 15 women Veterans who were current or former smokers. These women Veterans revealed their requirements for successful quit smoking attempts. Researchers found in these interviews that addressing the women Veterans’ overall health and well-being may be an important aspect in successful quit smoking attempts. A multidisciplinary approach may be most effective, with an individualized approach in targeting the barriers to quitting smoking. Allowing the woman Veteran to explore how smoking is connected with her stressors, mental health, and physical health can avail opportunities for planning and coping strategies. Discussing failed past attempts and developing effective coping strategies may impact the woman Veteran’s optimism about the quit attempt. Improved optimism can impact her resilience to the anxiety and negative stigmatization of slipping or failing to quit, enabling a faster return to quitting.
4. Does Dual Use of Electronic Cigarettes and Conventional Cigarettes Confer a Pulmonary Health Advantage? A Baseline Cohort Analysis. Will Bringgold, Kristin Berg, Megan Piper, Douglas Jorenby. Researchers examined whether the dual use of e-cigarettes and conventional cigarettes is associated with improved pulmonary health compared to using just regular cigarettes. In the sample studied, dual use was associated with fewer cigarettes smoked per day and modestly lower nicotine-dependence scores. However, the results found that dual use did not appear to have any significant pulmonary health benefits.
5. Distinct Behavioral Treatment Fidelity in a Smoking Cessation Treatment Study. Doug Jorenby, Megan Piper, Stevens Smith, Linda Collins, Michael Fiore, Timothy Baker. Researchers examined fidelity rates when health counselors deliver two distinct behavioral smoking-cessation treatments in a cessation experiment. The results showed that multiple bachelor’s-level health counselors were able to deliver the treatments with fidelity rates of 94.8 percent or better. Researchers concluded that health counselors can achieve high levels of behavioral treatment fidelity in an efficient research design with appropriate treatment development and training.
6. Playing Around With Quitting Smoking: A Randomized Pilot Trial of Mobile Games As an Urge Response Strategy. Tanya Schlam and Timothy Baker. Researchers examined whether mobile games can help smokers trying to quit decrease their cravings and increase their chances of quitting. Due to the small sample size, no effects were statistically significant. However, participants in the study who played games showed modest pre- to post-game decreases in urges to smoke. Those randomized to games versus no games were modestly more likely to report being continuously abstinent through 1 month after their target quit day. The results indicate that mobile games may help smokers respond to urges to smoke, and encourage more research on this intervention strategy.
7. Automating a Motivational Intervention for Low Income Smokers: A Pilot Feasibility Study. Bruce Christiansen, Kevin Reeder, Timothy Baker, and Michael Fiore. This pilot study examined the feasibility of using tablet computers in brief motivational interventions with low-income smokers. The results showed that Salvation Army clients could use the tablet easily and preferred to receive the intervention manually. Further, Salvation Army staff successfully used the tablet and found it to be helpful and easy to understand. The study found that a brief tobacco intervention guided by a tablet computer is: 1) acceptable to Salvation Army staff; 2) feasible for Salvation Army clients; and 3) may increase delivery fidelity while reducing staff burden and increasing scalability.
8. Seizing Electronic Health Record Technology to Promote Tobacco Cessation—A Randomized Trial of Primary Care Closed-Loop Referral (“EReferral”) to a State Quitline. Michael Fiore, Danielle McCarthy, Robert Adsit, Mark Zehner, Allison Gorrilla, Kristine Hayden, Amy Skora, Timothy Baker. This study evaluated EHR-enabled electronic referrals in primary care clinics. The results indicated that clinics were more likely to make referrals to a quitline if they were using electronic health records than if they used Fax-to-Quit referral. These results show that eReferrals may be a feasible way to get more patients engaged in evidence-based tobacco treatment during their primary care visits.