As news of COVID-19 was just starting to break, some UW-CTRI staff were in New Orleans to present their research on tobacco use at the annual conference of the Society for Research on Nicotine & Tobacco (SRNT) March 12-14. Others stayed home due to concerns about the spreading coronavirus, canceling travel and sending posters or recordings of their presentations for conference attendees to view.
UW-CTRI’s Katrina Bundy coordinated logistics for all of these SRNT presenters, dexterously keeping all the flights, posters, and logistics updated and on schedule.
“I appreciate the efforts of Katrina, and of all of our staff who have been working hard to adjust our research and outreach efforts during this difficult time,” said UW-CTRI Director Dr. Michael Fiore. “We are getting through this together.”
Fortunately, all UW-CTRI presenters who attended SRNT returned and are healthy as of press time, more than the 14-day incubation period for COVID-19.
Here’s a brief summary of all 15 SRNT presentations of UW-CTRI research results:
Dr. Jessica Cook (presenting author) and Dr. Tanya Schlam (symposium chair and presenting author) did not attend out of caution from COVID-19, but colleagues Elana Brubaker and Kirsten Webster hosted the symposium and played recordings of the talks, and Dr. Megan Piper nimbly served as a discussant on short notice, deftly handling questions from attendees at the symposium, New Approaches to Chronic Care for Smoking.
- Dr. Tanya Schlam. Schlam presented on how to optimize treatment for smokers who have recently relapsed. In this study, 80 percent who relapsed agreed to engage in relapse recovery treatment. Researchers found it best to encourage quitting ASAP after a relapse to increase the likelihood of the patient making a new attempt. They learned that chronic care was feasible. Tanya Schlam, Megan Piper, Jessica Cook, Stevens Smith, Michael Fiore, Timothy Baker. Strike Again While the Iron Is Hot: A SMART (Sequential, Multiple Assignment, Randomized Trial) of Chronic Care.
- Dr. Jessica Cook. Cook presented on her team’s effort to identify Motivation Phase intervention components that yield especially promising effects on quit attempts and abstinence when used among primary-care patients who were initially unwilling to quit. Results showed that the nicotine mini-lozenge increased abstinence in smokers initially unwilling to quit. However, Reduction Counseling undermined the beneficial effects of the mini-lozenge and decreased the likelihood of making a serious quit attempt, casting doubt on its effectiveness during the Motivation Phase of smoking treatment. Jessica Cook, Timothy Baker, Linda Collins, Michael Fiore, Megan Piper, Tanya Schlam, Daniel Bolt, Stevens Smith, Deejay Zwaga, Douglas Jorenby, Robin Mermelstein. Effects of Motivation Phase Intervention Components on Quit Attempts and Abstinence in Smokers Unwilling to Quit: A Factorial Experiment.
- Dr. Megan Piper. Before UW-CTRI Associate Director of Research Dr. Megan Piper transitioned roles from SRNT Treasurer to SRNT President Elect, Piper delivered the SRNT Treasurer’s Report. She reported the financial position of the Society is strong and allows the Society to engage in activities and initiatives to promote tobacco science and support its members.
- Mark Zehner. Zehner presented on electronic referrals (aka eReferral) to tobacco quitlines. Researchers surveyed staff from 23 clinics and amassed a 65-percent response rate. Staff using eReferral reported greater clinic support, a more efficient and well designed tobacco workflow, and higher agreement that the EHR helps address patients’ tobacco use than site staff who used fax referral. eReferral rates were 3-4 times better than fax referral rates. Clinical staff who used eReferral rated all 15 treatment delivery survey items at least as positively as staff who used fax referral. Mark Zehner, Stevens Smith, Rob Adsit, Marika Rosenblum, Danielle McCarthy, Timothy Baker, Michael Fiore. Addressing Tobacco Use in Primary Care – Clinicians’ Perceptions of Referral to a State Quitline.
- Dr. Nayoung Kim. Kim said researchers set out to evaluate how and when an Abstinence Optimized Treatment (AOT) affects craving, negative mood, and anhedonia (the inability to enjoy activities as one normally would) in a randomized control trial versus usual care. They found that as-needed use of mini-lozenges is significantly related to symptom ratings in time-dependent ways, such as worse craving and mood after quitting, but also to reduced anhedonia in the second week after quitting. Danielle McCarthy, Jessica Cook, Megan Piper, Tanya Schlam, Michael Fiore, Timothy Baker. Time-varying Relations of Optimized Smoking Treatment with Pericessation Withdrawal Symptoms. Part of the symposium titled, Back to Basics: Craving, Stress, Withdrawal, and Reward.
- Dr. Megan Piper. Dual users (those who smoke and vape) who were not interested in quitting were recruited via TV and social media advertisements to participate in a longitudinal observational study. Morning use patterns powerfully predicted overall vaping frequency and dependence. For instance, those who vaped before they smoked in the morning had significantly higher vaping—and lower smoking—dependence scores. They also were more likely to continue vaping one year later. Dependence appears to be product-specific. Megan Piper, Tim Baker, Deejay Zwaga, Doug Jorenby. The Relations Between E-Cigarette and Combustible Cigarette Dependence and Daily Use Patterns Among Dual Users. Part of the paper session Dependence, Demand, and Cigarette Use in Youth and Adult Vapers.
- Dr. Bruce Christiansen. This poster addressed the HUD smoke-free housing rule that took effect July 1, 2018. The co-authors found that most Milwaukee HUD residents are knowledgeable about the policy. Still, continued educational efforts are needed to reach a significant minority who are not knowledgeable. The policy has been effective, but tobacco smoke remains in Milwaukee HUD housing. Some residents would like greater enforcement. Attitudes about the policy are polarized. The policy has motivated change. Yet residents desire more help, especially on-site cessation programs and incentives. Lorraine Lathen, Monique Plears, Emile Shartle, Karen Doster-Conner, Michael Fiore, Bruce Christiansen. Residents’ Perceptions of the HUD Smoke-Free Rule Post-Implementation.
- Dr. Megan Piper. Dual users (who both smoke and vape) exhibit differential daily use patterns for smoking versus vaping, with a spike in use in the late afternoon for e-cigarette use. E-cigarette use among dual users is fairly consistent across days of the week, but spikes on Saturday. Combustible cigarette use is also higher on Friday and Saturday. Which product is used first thing in the morning is related to product-specific dependence and continued product use. Megan Piper, Deejay Zwaga, Timothy Baker, Douglas Jorenby. Examining Daily Patterns of E-Cigarette and Combustible Cigarette Use and Changes Over Time in Dual Users.
- Dr. Michael Fiore. Cancer Center Cessation Initiative (C3I) Centers integrated tobacco treatment into clinical care, primarily using the electronic health record (EHR) to connect smokers to treatment. Reach varies by Center, and by program type, but has increased overall since C3I funding was awarded. The population-based approach in C3I has improved the reach of smokers at NCI-Designated Cancer Centers and shows promise for helping smokers to quit. Heather D’Angelo, Betsy Rolland, Rob Adsit, Danielle Pauk, Marika Rosenblum, Timothy Baker, Michael Fiore. Reach and Effectiveness of Tobacco Dependence Treatment Programs Implemented at NCI-Designated Cancer Centers in the Cancer Center Cessation Initiative.
- Rose Millevolte. Millevolte, a former UW-CTRI employee, submitted this poster in collaboration with current UW-CTRI colleagues. EHR-based eReferral to intense smoking treatment had better reach than did fax referral to a quitline. It also had relatively greater reach among groups at elevated risk for difficulty quitting, such as women, African Americans, and Medicaid-eligible or uninsured people who smoke. Rosina Millevolte, Nayoung Kim, Danielle McCarthy, Madeline Oguss, Tim Baker, Michael Fiore. Reach and Representativeness of Electronic Referral of Primary Care Patients to an Evidence-Based Smoking Treatment.
- Dr. Nayoung Kim. Using a complicated algorithm, researchers found that participants who received 26-week extended medication (nicotine patch plus nicotine gum), maintenance counseling and e-monitoring for gum use with feedback and counseling showed higher abstinence rates a year after quitting than those who did not receive such interventions. Maintenance counseling designed to prevent relapse and encourage quit attempts may significantly increase long-term quit rates, especially for adult smokers with high secondary-dependence motive scores (eg. social cues, smoking for buzz, weight control, etc). Nayoung Kim, Danielle McCarthy, Wei-Yin Loh, Tanya Schlam, Megan Piper, Jessica Cook, Michael Fiore, Timothy Baker. Machine Learning Identifies Interactions Among Intervention Components and Individual Differences In Models of Abstinence 1 Year After a Target Quit Day.
- Deejay Zwaga. Researchers found that users who believed in vaping as a way to quit smoking showed the following trends: more vape episodes per day, fewer conventional cigarettes per day, and statistically higher baseline primary dependence measures for vaping. After one year, a high proportion were still smoking and vaping. Deejay Zwaga, Tim Baker, Megan Piper, Douglas Jorenby. Understanding the Influence of Initial E-Cigarette Use Motivation on Combustible and E-cigarettes Among Sustained Dual Users.
- Dr. Michael Fiore. A total of 331 cancer survivors tried to quit in the past year (57%). Among them, 50 percent reported unassisted attempts, 23 percent used medication only, 13 percent use e-cigarettes only, and seven percent used medications and e-cigarettes. Among the 45 who quit smoking, 56 percent had unassisted attempts, 18 percent used medication only, 11 percent used e-cigarettes only, and nine percent used both medications and e-cigarettes. Those who used approved cessation medications had higher odds of success. Approved cessation medications should be considered when offering tobacco treatment to cancer survivors. Ramzi Salloum, Heather D’Angelo, Li-Shiun Chen, Adam Goldstein, Deborah Hudson, Arnold Levinson, Sara Mitra, Kathryn Taylor, Janet Thomas, Hilary Tindle, Graham Warren, Michael Fiore. Costs of Implementing Tobacco Treatment Programs in NCI’s Cancer Center Cessation Initiative (C3I).
- Dr. Marlon Mundt. Mundt reported that providing financial incentives to low-income pregnant women who smoke is a cost-effective means to help women quit smoking during the postpartum period. Total cost was $740 per incentive group participant and $559 per control. The incremental cost-effectiveness ratio was $1,090 per additional smoker who quit. Marlon Mundt, Rob Adsit, Tim Baker, Kate Kobinsky, Michael Fiore. Cost-Effectiveness of Financial Incentives for Low-Income Expectant Mothers Who Smoke to Engage in Tobacco Cessation Treatment.
- Dr. Nayoung Kim. Researchers used a novel algorithm to gauge youth smoking and susceptibility worldwide. Among those aged 13-15 years old, approximately eight percent smoked and 13 percent were susceptible. The study confirmed that exposure to tobacco marketing, anti-tobacco education, secondhand smoke, and support for smoke-free air policies were predictive of both smoking and susceptibility among tweens. Nayoung Kim, Danielle McCarthy, Wei-Yin Loh. Susceptibility to Smoking and Current Smoking among Adolescents Worldwide: Evidence from 95 Countries in the Global Youth Tobacco Survey, 2013-2017.
- Dr. Danielle McCarthy. Proactive outreach can engage more than 1 in 7 adult patients who smoke in planning a quit attempt with the help of a clinician or tobacco-outreach specialist. Tobacco-cessation specialists were able to set a quit date and help set a quit plan for 10.8 percent of the adults who smoked who had not been seen in clinic for more than a year that they attempted to reach. Among all patients who set a quit date, outreach specialists were able to counsel about half. At the 4-6 week post-quit follow-up, 21.4 percent of patients reported that they were no longer smoking. Danielle McCarthy, Mark Zehner, Deejay Zwaga, Rob Adsit, Amy Skora, Michael Fiore. Analysis of the Reach of a Proactive Approach to Offering Smoking Cessation Treatment to Adult Primary Care Patients.