UW-CTRI
UW Center for Tobacco Research and Intervention

2019 Report

OVERVIEW: UW-CTRI releases a research update in January and July of each year. This report summarizes manuscripts, presentations, grants, and financials of the Center. Archived reports are available online at: https://ctri.wisc.edu/researchers/published-research/

SUMMARY: In 2019, UW-CTRI produced:

  • 33 published papers
  • 2 papers in press
  • 68 presentations and posters
  • 4 new studies
  • 5 active studies
  • 4 studies recently completed

Published Papers

Note: Names in bold are current UW-CTRI employees.

  1. Adams D, Bolt D, Deng S, Smith S, Baker T. Using Multidimensional IRT to Evaluate How Response Styles Impact Measurement. British Journal of Mathematical and Statistical Psychology. 2019.

Summary: The paper involves examining a measurement issue that has been the focus of much recent attention in the psychometrics literature. When people fill out self-report surveys involving rating scales, they often display stylistic differences in how they respond, for example some tend to respond with extreme answers while others avoid the extremes. Understanding and measuring these differences can contribute to how people interpret scores and to efforts to further improve item and test development.

  1. Alaniz K, Christiansen B, Sullivan TT, Khalil L, Fiore MC. Helping Low Income Pregnant Women Quit Smoking: Improving the First Breath Program. Wisconsin Medical Journal. 2019;118(3):120-125.

Summary: The Wisconsin Women’s Health program developed the First Breath program to address and minimize the challenges faced by women who smoke during pregnancy, specifically targeting low-income women. To help improve the program, various methods of implementation science were used, including focus groups and a randomized control trial to test new postpartum services. The authors concluded that sustaining this community-based tobacco intervention requires continuous improvement built on measured outcomes and response to changes in the health care delivery system.

  1. Alaniz K, Christiansen B, Sullivan, TT, Khalil L, Fiore MC. Addressing Postpartum Smoking Relapse Among Low Income Women; A Randomized Controlled Trial. Journal of Patient-Centered Research and Reviews. 2019;6(4):233-242.

Summary: Among low-income women who quit smoking during pregnancy, postpartum relapse is likely. Participants were assigned to either the standard First Breath program or an enhanced form of the program. The standard First Breath program provided cessation care at every prenatal visit, but the enhanced program provided more than that, including some in-home counseling, three postpartum counseling calls, and gift cards. More than twice the amount in the enhanced program quit than in the control program. Postpartum intervention may prevent smoking relapse.

  1. Barrett JR, Cherney-Stafford L, Alagoz E, Piper ME, Cook JW, Campbell-Flohr S, Weber SM, Winslow ER, Ronnkleiv-Kelly SM, Abbott DE. Smoking and Gastrointestinal Cancer Patients—Is Smoking Cessation an Attainable Goal? Journal of Surgical Oncology. 2019;120(8):1335-1340.

Summary: Participant interviews revealed three consistent themes: (a) Smoking cessation is not necessarily desired by many patients who have received a cancer diagnosis; (b) Failure in past quit attempts may lead to feelings of hopelessness about future attempts, especially during cancer treatment; (c) Patients perceived little to no access to quit-smoking treatment at the time of their cancer diagnosis. The authors recommend that oncology teams offer patients ready, free access to treatments to quit smoking.

  1. Benowitz N, Bernert J, Foulds J, Hecht S, Jacob P, Jarvis M. Joseph A, Oncken C, Piper M. Biochemical Verification of Tobacco Use and Abstinence: 2019 Update. Nicotine & Tobacco Research.

Summary: This paper discusses whether and how to use biochemical verification of tobacco use and abstinence. The authors share guidelines on which biomarkers to use, which biospecimens to use, optimal cutpoints, time windows to detection, and methodology for biochemical verifications. Use of combinations of biomarkers is recommended for assessment of vaping. Biochemical verification increases scientific rigor, but there are drawbacks that need to be assessed to determine whether the benefits of biochemical verification outweigh the scientific challenges and monetary costs.

  1. Croyle RT, Morgan GD, Fiore MC. Addressing a Core Gap in Cancer Care – the NCI Moonshot Program to Help Oncology Patients Stop Smoking. New England Journal of Medicine. 2019;380(6):512-515.

Summary: Only about half of cancer patients who smoke are offered help to quit by their oncology teams. That’s a lost opportunity, wrote experts in this commentary. Research shows quitting smoking after a cancer diagnosis is associated with longer survival and a reduced risk of new cancers. A 2009 survey of 58 cancer centers in America designated by the National Cancer Institute (NCI) revealed that 21 percent offered no tobacco-use treatment services. This manuscript describes a new NCI initiative to improve cessation treatment delivery in 42 NCI-funded cancer centers.

  1. Culverhouse RC, Chen L-S, Saccone NL, Ma Y, Piper ME, Baker TB, Bierut LJ. Variants in the CHRNA5-CHRNA3-CHRNB4 Region of Chromosome 15 Predict Gastrointestinal Adverse Events in the TTURC Smoking Cessation Trial. Nicotine & Tobacco Research. 2019.

Summary: Variants in the CHRNA5-CHRNA3-CHRNB4 region of chromosome 15 are associated with gastrointestinal adverse events while taking medications to quit smoking. Adherence to medication in this study was a strong predictor of successful smoking cessation. However, neither adverse events nor the genetic variants associated with them predicted adherence or successful cessation in this study.

  1. D’Angelo H, Rolland B, Adsit R, Baker T, Rosenblum M, Pauk D, Morgan GD, Fiore MC. Tobacco Treatment Program Implementation at NCI Cancer Centers: Progress of the NCI Cancer Moonshot-Funded Cancer Center Cessation Initiative. Cancer Prevention and Research.

Summary: The Cancer Center Cessation Initiative (C3I) supports NCI-Designated Cancer Centers in taking a population-based approach to providing tobacco treatment services for all patients with cancer who smoke. The first cohort of C3I-funded centers demonstrated progress over a single year of funding. While the average patient reach rate was modest (about 25%), it should be interpreted in light of the fact that reach rates for tobacco treatment in primary care settings are typically 15% or much lower.

  1. Engle J, Mermelstein R, Baker T, Smith S, Schlam T, Piper M, Jorenby D, Collins L, Cook J. Effects of Motivation Phase Intervention Components on Quit Attempts in Smokers Unwilling to Quit; A Factorial Experiment. Drug and Alcohol Dependence. 2019;197:149-157.

Summary: Nicotine gum significantly increased the likelihood of making a quit attempt by six weeks (23% vs. 15% without gum). Conversely, nicotine patch reduced quit attempts when used with Behavioral Reduction Counseling. Nicotine gum is a promising motivation-phase intervention that may spur quit attempts amongst smokers initially unwilling to quit.

  1. Fiore MC, Adsit R, Zehner M, McCarthy DE, Lundsten S, Hartlaub P, Mahr T, Gorrilla A, Skora A, Baker TB. An EHR-based Interoperable eReferral System to Enhance Quitline Smoking Treatment in Primary Care. Journal of the American Medical Informatics Association. 2019;26(8-9):778-786.

Summary: Twenty-three primary care clinics from two healthcare systems in Wisconsin were randomized to one of two referral methods to connect patients who smoke with tobacco quitlines: either paper-based fax-to-quit or electronic referral via medical records, aka eReferral. Electronic health record-based eReferral provided an effective, closed-loop, interoperable means of referring patients who smoke to telephone quitline services, producing referral rates three to four times higher than the current standard of care (fax referral), including especially high rates of referral of underserved individuals.

  1. Fiore MC, D’Angelo H, Baker TB. Effective Cessation Treatment for Patients with Cancer Who Smoke – The Fourth Pillar of Cancer Care. JAMA Network Open. 2019;2(9):e1912264.

Summary:  Until recently, there have only been three primary pillars of cancer care: surgery, radiotherapy, and chemotherapy. A report issued by the Surgeon General in 2014, however, stated that continued smoking after cancer diagnosis makes things worse for the patient and increases patient mortality. The Cancer Care Cessation Initiative (C3I), funded by the National Cancer Institute, is designed to help cancer centers seamlessly incorporate tobacco treatment into their standard care.

  1. Fletcher TL, Johnson AL, Kim B, Yusuf Z, Benzer J, Smith T. Provider Perspectives on a Clinical Demonstration Project to Transition Patients with Stable Mental Health Conditions to Primary Care. Tranlational Behavioral Medicine. 2019 December 3.

Summary: Practitioners in this study perceived that transitioning stabilized mental health patients back to primary care resulted in increased access to specialty mental healthcare for patients in acute need, that transitioning to a lower level of care indicated patients’ mental health status was improving, and that specialized mental health providers felt less stress related to caseloads and increased ability to offer evidence-based psychotherapy.

  1. Garey L, Manning K, McCarthy DE, Gallagher MW, Shepherd JM, Orr MF, Schmidt NB, Rodic B, Zvolensky MJ. Understanding Quit Patterns from a Randomized Clinical Trial: Latent Classes, Predictors, and Long-Term Abstinence. Addictive Behaviors. 2019;95:16-23.

Summary: Results suggest that there are four relevant classes of quit behavior, each with specific predictor variables, including: age, motivation to quit, smoking urges, and number of quit attempts. These classes relate to long-term abstinence. These results have the potential to inform manualized smoking cessation treatment interventions based on relevant subgroups of quit behavior.

  1. Johnson AL, McLeish AC, Shear PK, Sheth A, Privitera M. The Role of Cigarette Smoking in Epilepsy Severity and Epilepsy-Related Quality of Life. Epilepsy and Behavior. 2019;93:38-42.

Summary: Smokers with epilepsy, compared with nonsmokers with epilepsy, were at increased risk to have seizures in the past year after controlling for the effect of Medicaid status. Smoking with epilepsy was also associated with lower quality of life; however, this finding did not remain significant when Medicaid status was taken into consideration. Contrary to the hypotheses, smokers with epilepsy were not at an increased risk of having refractory epilepsy compared with nonsmokers with epilepsy. Nevertheless, patients with epilepsy should be advised of the dangers of smoking specific to epilepsy.

  1. Johnson AL, Kaye J, Baker TB, Fiore MC, Cook JW, Piper ME. Psychiatric Comorbidities In a Comparative Effectiveness Smoking Cessation Trial: Relations with Cessation Success, Treatment Response, and Relapse Risk Factors. Drug and Alcohol Dependence. Online 2019.

Summary: Psychiatric diagnosis was significantly related to lower likelihood of short-term smoking cessation, but not significantly to long-term cessation likelihood. Lifetime psychiatric diagnosis was related to elevated nicotine dependence. History of psychiatric diagnosis was related to increased craving related to withdrawal. There was little evidence that mental illness moderated the effects of quit-smoking medications (varenicline or nicotine patch plus lozenge) on long-term abstinence.

  1. Kaye JT, Fronk GE, Zgierska AE, Cruz MR, Rabago D, Curtin JJ. Acute Prazosin Administration Does Not Reduce Stressor Reactivity In Healthy Adults. Psychopharmacology. 2019;236(11):3371-3382.

Summary: Prazosin is a medication primarily used to treat high blood pressure, symptoms of an enlarged prostate, and posttraumatic stress disorder (PTSD). A single acute dose (2 mg) of prazosin did not reduce stress reactivity in a healthy adult sample. Neither startle potentiation nor self-reported anxiety was reduced by prazosin (vs. placebo) during unpredictable (vs. predictable) stressors.

  1. Kim N, McCarthy DE, Loh W-Y, Cook JW, Piper ME, Schlam TR, Baker TB. Predictors of Adherence to Nicotine Replacement Therapy: Machine Learning Evidence that Perceived Need Predicts Medication Use. Drug and Alcohol Dependence. 2019;205:107668.

Summary: To address the problem of nonadherence to smoking cessation medication, it may be useful to identify pre-quit risk factors for nonadherence that could be targeted for intervention prior to quitting. Researchers identified subgroups of smokers and characterized them based on their adherence to nicotine replacement therapy. Those who believed the medication was safe and easy to use had greater adherence, and adherence was especially high in those who were more dependent and more exposed to smoking triggers.

  1. Matheny JD, Stevens EM, Chen S, Christiansen BA, Kowitt SD, Osman A, Vidrine D. The RICO Verdict and Corrective Statements as Catalysts for Public Policy. Tobacco Regulatory Science. 2019;5(3):206-228. 2019.

Summary: A federal court ruled tobacco companies violated racketeering laws and ordered them to publish corrective statements. This study assessed effects of exposure to the statements. People who saw the statements were less likely to think lawmakers should trust tobacco companies as much as other companies or that lawmakers should trust tobacco company lobbyists to provide accurate information, compared to the unexposed group. The exposed group also was more likely to support requiring graphic warning labels and point-of-sale quitline signs.

  1. McCarthy DE, Adsit R, Zehner M, Skora A, Kim N, Baker TB, Fiore MC. Closed-Loop Electronic Referral to SmokeFreeTXT for Smoking Cessation Support; A Demonstration Project in Outpatient Care. Translational Behavioral Medicine. 2019 Jun 7.

Summary: Electronic referral (eReferral) to SmokefreeTXT for adult patients who smoke was implemented in two clinics in a health system. Interoperable, HIPAA-compliant eReferral returned referral outcomes to the EHR. During clinician implementation, 43 of 299 adult smokers (14.4%) were eReferred. During medical assistant (MA) implementation, 36 of 401 adult smokers (9.0%) were eReferred. Overall, among those eReferred, 25.7% completed SmokefreeTXT enrollment (3.1% of patients eligible for eReferral). Staff survey responses indicated that eReferral was efficient and easy.

  1. Mitchell C, Piper ME, Smith SS, Korcarz C, Fiore MC, Baker TB, Stein J. Changes In Carotid Artery Structure With Smoking Cessation. Vascular Medicine. 2019;24(6):493-500.

Summary: Carotid artery grayscale ultrasound results can predict cardiovascular disease events. The authors evaluated the longitudinal effects of quitting smoking on four grayscale ultrasound measures. They found that changes in carotid ultrasound results during a smoking cessation attempt are modest and mostly related to weight gain.

  1. Mundt MP, Baker TB, Fraser DL, Smith SS, Piper ME, Fiore MC. Paying Low-Income Smokers to Quit? The Cost-Effectiveness of Incentivizing Tobacco Quit Line Engagement for Medicaid Recipients Who Smoke. Value in Health. 2019;22(2):177-184. 2019.

Summary: The incentive treatment produced higher six-month CO-confirmed seven-day point-prevalence abstinence than did the control treatment (21.6 vs. 13.8%). The incremental cost-effectiveness ratio (ICER) of the financial-incentive intervention was $2316 per additional person who quit. The study ICER compares favorably with other treatments, such as varenicline combined with proactive telephone counseling, whose ICER has been estimated at $2600 per additional smoker who quits. Use of financial incentives to engage with tobacco quitline treatment was cost-effective.

  1. Mundt MP, Baker TB, Piper ME, Smith SS, Fraser DL, Fiore MC. Financial Incentives to Medicaid Smokers for Engaging Tobacco Quit Line Treatment: Maximizing Return on Investment. Tobacco Control. 2019 May 30.

Summary: This study offered financial incentives for smokers to engage with the Wisconsin Tobacco Quit Line to quit smoking. The minimal cost per additional smoker who quit was $2125 when incentives for the first four calls to the Quit Line were set at $20 and the financial payment for the fifth call was set at $70. Modelling suggests that financial incentives at these levels maximize return on investment to engage low-income smokers with evidence-based smoking cessation treatment.

  1. Piper ME, Baker TB, Benowitz NL, Jorenby DE. Changes in Use Patterns Over One Year Among Smokers and Dual Users of Combustible and Electronic Cigarettes. Nicotine & Tobacco Research. 2019.

Summary: In this community sample, the majority of dual users transitioned to exclusive smoking. After a year, a higher percentage of dual users (8.0%) quit smoking than smokers (1.9%), but attrition and baseline differences between the groups compromise strong conclusions. Sustained e-cigarette use was related to baseline e-cigarette dependence. This research suggests that dual use of combustible and electronic cigarettes is not a sustained pattern for the majority of dual users, but it is more likely to be a continued pattern if the user is more dependent on e-cigarettes.

  1. Piper ME, Baker TB, Benowitz NL, Jorenby DE. E-cigarette Dependence Measures in Dual Users; Reliability and Relations with Dependence Criteria and E-cigarette Cessation. Nicotine & Tobacco Research. 2019.

Summary: This research provides empirical support for three e-cigarette dependence measures: the e-cigarette Fagerström Test of Cigarette Dependence (e-FTCD), the Penn State Electronic Cigarette Dependence Index (PS-ECDI), and the e-cigarette Wisconsin Inventory of Smoking Dependence Motives (e-WISDM) among dual users of e-cigarettes and combustible cigarettes. The PS-ECDI and e-WISDM are more reliable, but all three measures were strongly correlated with key dependence constructs such as heavy use and continued use over time.

  1. Piper ME, Bullen C, Krishnan-Sarin S, Ossip DJ, Rigotti NA, Steinberg ML, Streck JM, Joseph AM. Defining and Measuring Abstinence in Clinical Trials of Smoking Cessation Interventions: An Updated Review. Nicotine & Tobacco Research. 2019.

Summary: Changes in tobacco products, use patterns, and assessment technology in the last 15 years led the SRNT Treatment Research Network to call for an update to the 2003 SRNT recommendations for assessing abstinence in clinical trials of smoking cessation interventions. Defining abstinence requires specification of which products a user must abstain from using, the type of abstinence (i.e., point-prevalence, continuous), and the duration of abstinence.

  1. Piper ME, Drobes DJ, Walker N. Behavioral and Subjective Effects of Reducing Nicotine in Cigarettes: A Cessation Commentary. Nicotine & Tobacco Research. Online December 2019;21(Suppl 1): S19-S21.

Summary: This commentary addresses the impact of the use of reduced nicotine cigarettes (RNC). There is moderate evidence RNCs increase the likelihood of making a quit attempt among smokers unmotivated to quit and among smokers motivated to quit who also used nicotine replacement therapy (NRT). There was limited evidence that RNC combined with NRT increased smoking abstinence, regardless of motivation to quit. The data suggest that abrupt reduction in the level of nicotine in combustible cigarettes could increase quit attempts and eventual smoking cessation.

  1. Piper ME, Mermelstein R, Baker TB. Progress in Treating Youth Smoking: Imperative, Difficult, Slow. JAMA Pediatrics. 2019;173(12):1131-1132.

Summary: Helping teens quit smoking is daunting, even with the state-of-the science treatment for adult smokers—varenicline plus intensive counseling—proving ineffective with youth because most didn’t come in for treatment. The authors suggest further research and different tactics could help, such as using texting or other phone-based technologies. Interventions that address dual addictions and/or adverse childhood events could also help.

  1. Ramsey AT, Chiu A, Baker TB, Smock N, Chen U, Lester T, Jorenby D, Bierut LJ, Chen L-S. Care-Paradigm Shift Promoting Smoking Cessation Treatment Among Cancer Center Patients Via a Low-Burden Strategy, Electronic Health Record-Enabled Evidence-Based Smoking Cessation Treatment. Translational Behavioral Medicine.

Summary: In this study, the Electronic Health Record-Enabled Evidence-Based Smoking Cessation Treatment program was implemented in the cancer center clinics. Five-month pre- and post-implementation data from the electronic health record (EHR) were analyzed. The percentage of cancer patients assessed for tobacco use significantly increased from 48% to 90%, the percentage of smokers referred for cessation counseling increased from 0.72% to 1.91%, and the percentage of smokers with cessation medication significantly increased from 3% to 17%.

  1. Rojewski AM, Bailey SR, Bernstein SL, Cooperman NA, Gritz ER, Karam-Hage MA, Piper ME, Rigotti NA, Warren GW. Considering Systematic Barriers to Treating Tobacco Use in Clinical Settings in the United States. Nicotine & Tobacco Research, 21, 1453-1461.

Summary: Three vignettes highlighted in this article illustrate some systemic barriers to providing tobacco treatment for patients being treated for comorbid conditions. The authors explore the barriers to tobacco treatment and offer suggestions for changes in training, health care systems, clinical workflow, and payment systems that could enhance the reach and the quality of tobacco treatment within the US health care system.

  1. Schlam TR, Baker TB, Smith SS, Cook JW, Piper ME. Anxiety Sensitivity and Distress Tolerance in Smokers: Relations with Tobacco Dependence, Withdrawal, and Quitting Success. Nicotine & Tobacco Research. 2019.

Summary: Those with a high ability to tolerate distress may be more likely to quit smoking and remain smoke-free a year later. Anxiety sensitivity (the fear of feelings associated with anxiety) was found to be unrelated to abstinence from cigarettes. However, the study found that a greater ability to tolerate distress was associated with higher quit rates and early abstinence, regardless of nicotine dependence or withdrawal symptoms that participants experienced.

  1. Schlam TR, Baker TB. Playing Around With Quitting Smoking: A Randomized Pilot Trial of Mobile Games As a Craving Response Strategy. Games for Health. 2019.

Summary: In this study, 30 smokers interested in quitting were offered 4 weeks of nicotine patch plus counseling and randomized to quit with or without access to mobile games. Of those randomized to quit using nicotine patches plus mobile games, 31 percent quit smoking the entire month. This intervention may provide a helpful distraction from cravings. The authors recommend a fully powered trial of this intervention.

  1. Schmidt KM, Hansen KM, Johnson AL, Gepner AD, Korcarz CE, Fiore MC, Baker TB, Piper ME, Stein JH. Longitudinal Effects of Cigarette Smoking and Smoking Cessation on Aortic Wave Reflections, Pulse Wave Velocity, and Carotid Artery Distensibility. Journal of the American Heart Association. 2019;8(24):e013939.

Summary: Arterial wave reflection and stiffness measures were associated more strongly with age, blood pressure, and waist circumference than smoking heaviness. Smoking cessation was associated with weight gain and increased insulin resistance. Changes in arterial measures were predicted by changes in blood pressure, highlighting the need to address weight gain and blood pressure changes during a quit attempt.

  1. Wattiaux A, Bettendorf M, Block L, Gilmore-Bykovskyi A, Ramley E, Piper ME, Rosenthal A, Sadusky J, Cox E, Chewning B, Bartels CM. Patient Perspective on Smoking Cessation and Interventions in Rheumatology Clinics. Arthritis Care & Research. 2019.

Summary: Participant-reported barriers included viewing smoking as “a crutch” amid rheumatic disease, rarely receiving cessation counseling in rheumatology, and very limited awareness that smoking can worsen rheumatic diseases or reduce efficacy of some rheumatology medications. Participants endorsed the cessation protocol with rheumatology-specific education and accessible resources like the quitline. Beyond quitting, participants valued knowing why and how to quit. Emphasizing rheumatologic health benefits and cessation resources are essential for rheumatology patients who smoke.

In Press

  1. Fronk GE, Sant’Ana SJ, Kaye JT, & Curtin JJ. Stress Allostasis in Substance Use Disorders: Promise, Progress, and Emerging Priorities in Clinical Research. Annual Review of Clinical Psychology.
  2. Piper ME, Brown DC, Hendershot TP, Swan GE. Social Cognitive Measures for Tobacco Regulatory Research. Tobacco Control.

Research Presentations and Posters

  1. Adsit R, DiGuilio A. Tobacco Cessation Performance Quality Measures in Health Care. National Conference on Tobacco or Health. Presentation. Minneapolis, MN. August 2019.
  2. Adsit R. Electronic Health Record-Based Referral (eReferral) to a Tobacco Quitline: Health System Implementation Strategies. National Conference on Tobacco or Health. Poster. Minneapolis, MN. August 2019.
  3. Alaniz K, Christiansen B, Sullivan T, Khalil L, Fiore MC. A Pilot Study Addressing Postpartum Smoking. Relapse Among Low-Income Women; A Randomized Controlled Trial. Society for Research on Nicotine & Tobacco Annual Conference. Poster. San Francisco, CA. February 2019.
  4. Alaniz K, Christiansen B, Sullivan T, Khalil L, Fiore MC. Eighteen Years of Helping Low Income Pregnant Women Quit Smoking. Society for Research on Nicotine & Tobacco Annual Conference. Poster. San Francisco, CA. February 2019.
  5. Alaniz K, Runge C, Rupp K, Christiansen B. Addressing Cessation in Maternal/Child Health. National Conference on Tobacco or Health. Poster. Minneapolis, MN. August 2019.
  6. Barrett JR, Cherney-Stafford L, Alazoe E, Piper ME, Cook JW, Campbell-Flohr S, Weber SM, Winslow ER, Ronnkleiv-Kelly SM, Abbott DE. Smoking and GI Cancer Patients—Is Smoking Cessation an Attainable Goal? Academic Surgical Congress Conference. Presentation/poster. Houston, TX. February 2019.
  7. Bringgold WR, Berg KM, Smith SS, Piper ME, Jorenby DE. Does Dual Use of Electronic Cigarettes and Conventional Cigarettes Confer a Pulmonary Health Advantage? A Baseline & 12 Month Prospective Cohort Analysis. General Internal Medicine Scholars Showcase. Poster. Madison, WI. June 2019.
  8. Christiansen B, Riemer Donna, Doster K. The “Bucket Approach”: Tobacco Dependence Interventions Based on Evidence-based Practice and Tailored to Those with Significant Mental Illness. National Conference on Tobacco or Health. Poster. Minneapolis, MN. August 2019.
  9. Coffman DL, Dziak JJ, Li R, Piper ME. A New Approach to Functional Regression Mediation Analysis with Application to a Smoking Cessation Intervention. Joint Statistical Meetings. Presentation. Denver, CO. July 2019.
  10. Cook J, Kaye JT, Baker TB. Withdrawal Symptoms During 48-hour Nicotine Deprivation in Smokers with PTSD, Depression, and Non-diagnosed Controls. Society for Research on Nicotine & Tobacco Annual Conference. Poster. San Francisco, CA. February 2019.
  11. Cook J, Kaye JT, Baker TB. Withdrawal Symptoms During 48-hour Nicotine Deprivation in Smokers with PTSD, Depression, and Non-diagnosed Controls. University of Wisconsin Department of Medicine Research Day 2019. Poster. Madison, WI. June 2019.
  12. D’Angelo H, Adsit R, Morgan G, Rolland B, Rosenblum M, Fiore MC. The National Cancer Institute Cancer Cessation Initiative (C3I): Characteristics and Reach of Tobacco Treatment Programs among NCI-Designated Cancer Centers in the First Year of C3I. American Society of Preventive Oncology Annual Conference. Poster. Tampa, FL. March 2019.
  13. D’Angelo H, Rolland B, Adsit R, Pauk D, Rosenblum M, Baker TB, Fiore MC. A Pragmatic Application of the RE-AIM Framework to Evaluate the Implementation of Tobacco Cessation Services Within NCI-Designated Cancer Centers. Annual Conference on The Science of Dissemination and Implementation. Poster. Washington, D.C. December 2019.
  14. Fiore MC. GHC Smoking Cessation Program. Group Health Cooperative of South Central Wisconsin All Staff Meeting, Alliant Energy Center. Presentation. Madison, WI. January 2019.
  15. Fiore MC. Achieving the End Game for Tobacco Use in the United States. Pediatric Cardiology Group Grand Rounds. Presentation. Madison, WI. January 2019.
  16. Fiore MC. Smoking Cessation: An Evidence-Based 2019 Update. Santa Barbara’s Cottage Hospital Grand Rounds. Presentation. Santa Barbara, CA. January 2019.
  17. Fiore MC. Policy Change to Eliminate the Health Effects of Tobacco: Fifty Years of Progress and Challenges. Viterbo University Legislative Gathering. Presentation. La Crosse, WI. March 2019.
  18. Fiore MC. Tobacco Cessation: Inpatient Pharmacist Intervention. UW Health Pharmacist Staff Meeting. Presentation. Madison, WI. April 2019.
  19. Fiore MC. The NCI’s Moonshot Cancer Center Cessation Initiative (C3I): Implementation for Veterans. VA Hospital Tobacco Cessation Clinical Update. Audioconference presentation. Madison, WI. April 2019.
  20. Fiore MC. Cancer Center Cessation Initiative (C3I) (P30 Supplements). NCI Cancer Center Directors Meeting. Presentation. Washington, DC. April 2019.
  21. Fiore MC. Smoking Among Medicaid Recipients: Individual and Societal Costs. HHS Cessation Workgroup. Presentation. Washington, DC. May 2019.
  22. Fiore MC. Smoking Cessation Among Cancer Patients: Evidence, Benefits, Challenges. MCW Oncology Grand Rounds. Presentation. Milwaukee, WI. August 2019.
  23. Fiore MC. Using the Electronic Health Record to Support Delivery of Tobacco Dependence Treatment in Oncology Health Care Settings. National Conference on Tobacco or Health. Presentation. Minneapolis, MN. August 2019.
  24. Fiore MC. Tobacco Use: The Leading Cause of Preventable Illness and Death in Wisconsin. University of Wisconsin School of Medicine and Public Health meeting with Wisconsin Health Services Secretary Designate. Presentation. Madison, WI. September 2019.
  25. Fiore MC. Tobacco 21. Wisconsin Assembly Public Hearing Committee on Substance Abuse and Prevention. Presentation/testimony. Madison, WI. November 2019.
  26. Fiore MC. Tobacco Cessation. University of Vermont Medical Center Grand Rounds. Presentation. Burlington, Vermont. December 2019.
  27. Gardner AL, Jorenby DE. The Impacts of Smoking Cessation Therapies (Varenicline and Nicotine Patch) on Sleep Patterns in Users. University of Wisconsin Biology 152 Event. Poster. Madison, WI. May 2019.
  28. Gorrilla A, Skora A, Adsit R, McCarthy D, Fiore MC. EHR-Based Referral (eReferral) to a State Tobacco Quitline: Health System Implementation Strategies. National Conference on Tobacco or Health. Poster. Minneapolis, MN. August 2019.
  29. Johnson AL and Kaye J, Dermody S, McKee S. The Relative Impact of Alcohol, Substance, and Comorbid Use Disorders on Smoking Cessation Success and Related Constructs. Society for Research on Nicotine & Tobacco Annual Conference. Symposium. San Francisco, CA. February 2019.
  30. Johnson AL, Nystrom NC, Piper ME, Cook J, Norton DL, Zuelsdorff M, Wyman MF, Benton SF, Lambrou NH, O’Hara J, Chin NA, Asthana S, Carlsson C, Gleason CE. Examining the Role of Cigarette Smoking and Cessation on Combined Risk of Incident Dementia, Nursing Home Placement, and Death in Cognitively Healthy and Mildly Cognitively Impaired Adults. University of Wisconsin Department of Medicine Research Day 2019. Poster. Madison, WI. June 2019.
  31. Johnson AL, Nystrom NC, Piper ME, Cook J, Norton DL, Zuelsdorff M, Wyman MF, Benton SF, Lambrou NH, O’Hara J, Chin NA, Asthana S, Carlsson C, Gleason CE. Examining the Role of Cigarette Smoking and Cessation on Combined Risk of Incident Dementia, Nursing Home Placement, and Death in Cognitively Healthy and Mildly Cognitively Impaired Adults. Alzheimer’s Association International Conference. Poster. Los Angeles, CA. July 2019.
  32. Jorenby D. JUUL In the Crown? Emerging Nicotine Delivery Systems. Presentation. Madison, WI. February 2019.
  33. Jorenby D. 50 ml of Prevention: What Works for Smoking Cessation in 2019. Presentation. Milwaukee, WI. March 2019.
  34. Jorenby D. Moving Targets: Recent Developments in Nicotine Use. Wisconsin Health and Physical Education Conference. Presentation. Wisconsin Dells, WI. October 2019.
  35. Kaye JT. Smoking Cessation Outcomes for Heavy Drinking Smokers Using Varenicline, Nicotine Patch, or Combination Nicotine Replacement Therapy. Society for Research on Nicotine & Tobacco Annual Conference. Symposium. San Francisco, CA. February 2019.
  36. Kaye JT, Cook JW. Tobacco Withdrawal Symptoms Before and After Nicotine Deprivation in Smokers with PTSD and Depression. Durham VA Medical Center. Presentation. Durham, NC. November 2019.
  37. Kaye JT, Fronk GE, Zgierska AE, Cruz MR, Rabago D, Curtin JJ. Acute Prazosin Administration Does Not Reduce Stressor Reactivity in Healthy Adults. Society of Biological Psychiatry Annual Meeting. Poster. Chicago, IL. May 2019.
  38. Kaye JT. Smoking Cessation Outcomes for Heavy Drinking Smokers Using Varenicline, Nicotine Patch, or Combination Nicotine Replacement Therapy. General Internal Medicine Scholars Showcase. Poster. Madison, WI. June 2019.
  39. Kaye JT, Piper ME, Baker TB, Cook JW. Searching for Personalized Medicine for Heavy Drinking Smokers: Smoking Cessation Using Varenicline, Nicotine Patch, or Combination Nicotine Replacement Therapy. Research Society on Alcoholism Annual Meeting. Poster. Minneapolis, MN. June 2019.
  40. Keller P, Boyle R, Lien B, Christiansen B, Kobinsky K. Engaging Tobacco Users in Population-Based Cessation Services: Findings from an Observational Study. National Conference on Tobacco or Health. Presentation. Minneapolis, MN. August 2019.
  41. Kim N, McCarthy DE, Piper ME, Baker TB. Comparative Effects of Combination Nicotine Replacement Therapy or Varenicline Versus Patch Monotherapy on Candidate Mediators of Early Abstinence. Society for Research on Nicotine & Tobacco Annual Conference. Poster. San Francisco, CA. February 2019.
  42. Kim N, McCarthy DE, Loh WY, Piper ME, Baker, TB. Predictors of Adherence to Nicotine Replacement Therapy in Recommended Usual Care and Enhanced Treatment in Primary Care Settings. Society for Research on Nicotine & Tobacco Annual Conference. Poster. San Francisco, CA. February 2019.
  43. Kim N, McCarthy DE, Zehner ME, Adsit R, Augustson E, Baker TB, Fiore MC. A Pilot Study of Closed Loop Electronic Referral to SmokefreeTXT in Adult Outpatient Settings. Society for Research on Nicotine & Tobacco Annual Conference. Poster. San Francisco, CA. February 2019.
  44. Kim N, McCarthy DE, Loh WY, Piper ME, Baker, TB. Predictors of Adherence to Nicotine Replacement Therapy: Machine Learning Evidence that Perceived Need Predicts Medication Use. University of Wisconsin Department of Medicine Research Day 2019. Poster. Madison, WI. June 2019.
  45. Kobinsky K. Evolving Approaches to the Management of Quit Lines. North American Quitline Consortium 2019 Meeting, a pre-conference to the National Conference on Tobacco or Health. Presentation. Minneapolis, MN. August 2019.
  46. McCarthy DE, Zehner ME, Adsit RT, Skora A, Baker TB, Fiore MC. Evaluation of an Electronic-Health-Record-Enabled Comprehensive Chronic Care Smoking Treatment System for Primary Care. Society for Research on Nicotine & Tobacco Annual Conference. Poster. San Francisco, CA. February 2019.
  47. Mundt MP, Zakletskaia LI, Baker TB, Fraser DL, Smith SS, Fiore MC. Paying Low-Income Smokers to Engage in Quit Line Treatment: Maximizing Return on Investment. International Health Economics Association (iHEA) Conference. Poster. Basel, Switzerland, July 2019.
  48. Oguss M, McCarthy DE, Fraser DL, et al. Electronic Health Record Based Smoking Treatment Referral: Clinic Staff Attitudes and Referral Success. In Symposium, Boeckmann M and Oguss M (Chairs). New Strategies to Increase the Delivery of Effective Tobacco Cessation Treatment in Primary Care. Society for Research on Nicotine & Tobacco Annual Conference. Symposium. San Francisco, CA. February 2019.
  49. O’Hara, JB, Norton D, Koscik RL, Jonaitis EM, Lambrou N, Wyman MF, Zuelsdorff M, Johnson AL, Flowers Benton S, Carlsson CM, Johnson SC, Asthana S, Gleason CE. Baseline Dispersion Intra-Individual Cognitive Variability in a Young Pre-Clinical Cohort. University of Wisconsin Alzheimer’s Disease & Related Disorders Research Day 2019. Presentation. Madison, WI. March 2019.
  50. Piirtola M, Kaprio J, Piper ME, Korhonen T. The Associations of Smoking Dependence Motives with Depression Among Current Cigarettes Smokers. Society for Research on Nicotine & Tobacco Annual Conference. Poster. San Francisco, CA. February 2019.
  51. Piper M. An Update to the Basics: Current Approaches for Measuring and Understanding Key Individual Differences and Cessation Outcomes. Society for Research on Nicotine & Tobacco Annual Conference. Pre-conference workshop. San Francisco, CA. February 2019.
  52. Piper M, Braymiller J, Barrington-Trimis J. Innovative Methods for Research on E-cigarettes. Society for Research on Nicotine & Tobacco Annual Conference. Symposium. San Francisco, CA. February 2019.
  53. Piper ME, Mermelstein R, Baker TB, Hedeker D, Benowitz NL, Jorenby DE. Assessments of E-cigarette Dependence in Adult Dual Users: Psychometrics and Validity of Three Measures. Society for Research on Nicotine & Tobacco Annual Conference. Poster. San Francisco, CA. February 2019.
  54. Piper M. Changes in Use Patterns Among Smokers and Dual Users. Society for Research on Nicotine & Tobacco Annual Conference. Poster. San Francisco, CA. February 2019.
  55. Piper M. Changes in Use Patterns Among Smokers and Dual Users. General Internal Medicine Scholars Showcase. Poster. Madison, WI. June 2019.
  56. Piper M. Changes in Use Patterns Among Smokers and Dual Users. University of Wisconsin Department of Medicine Research Day 2019. Poster. Madison, WI. June 2019.
  57. Piper ME, Baker TB, Zwaga D, Jorenby DE. Examining Daily E-Cigarette and Combustible Cigarette Use Patterns Among Dual Users Using Ecological Momentary Assessment Data. NIH Tobacco Regulatory Science. Presentation. Bethesda, MD. October 2019.
  58. Piirtola M, Kaprio J, Piper ME, Korhonen T. The Associations of Smoking Dependence Motives With Depression Among Current Cigarettes Smokers. Society for Research on Nicotine & Tobacco Annual Conference. Poster. San Francisco, CA. February 2019.
  59. Schlam TR, Baker TB, Bolt DM, Smith SS, McCarthy DE, Cook JW, Hayes-Birchler T, Fiore MC, Piper ME. Which Comes First in a Quit Attempt? Temporal Relations Between Smoking and Non-Adherence to Nicotine Replacement Therapy. Society for Research on Nicotine & Tobacco Annual Conference. Poster. San Francisco, CA. February 2019.
  60. Schlam TR, Piper ME, Cook JW, Fiore MC, Baker TB. Will Smokers Continue in Chronic Care Once They Relapse? In M. Boeckmann and M. Oguss (Chairs), New Strategies to Increase the Delivery of Effective Tobacco Cessation Treatment in Primary Care. Society for Research on Nicotine & Tobacco Annual Conference. Symposium. San Francisco, CA. February 2019.
  61. Schlam TR, Baker TB, Bolt DM, Smith SS, McCarthy DE, Cook JW, Hayes-Birchler T, Fiore MC, Piper ME. Which Comes First in a Quit Attempt? Temporal Relations Between Smoking and Non-Adherence to Nicotine Replacement Therapy. General Internal Medicine Scholars Showcase. Poster. Madison, WI. June 2019.
  62. Schlam TR, Baker TB, Bolt DM, Smith SS, McCarthy DE, Cook JW, Hayes-Birchler T, Fiore MC, Piper ME. Which Comes First in a Quit Attempt? Temporal Relations Between Smoking and Non-Adherence to Nicotine Replacement Therapy. University of Wisconsin Department of Medicine Research Day 2019. Poster. Madison, WI. June 2019.
  63. Schmidt KMT, Hansen KM, Johnson AL, Korcarz CE, Fiore MC, Baker T, Piper ME, Stein JH. Longitudinal Effects of Cigarette Smoking and Smoking Cessation on Global, Regional, and Local Arterial Stiffness. University of Wisconsin Department of Medicine Research Day 2019. Poster. Madison, WI. June 2019.
  64. Wyman MF, Voils CI, Trivedi R, Boyle L, Goldman D, Umucu E, Zuelsdorff M, Johnson AL, Gleason CE. Perspectives of Mental Health Providers on Working with Persons with Dementia and their Caregivers. University of Wisconsin Alzheimer’s Disease & Related Disorders Research Day 2019. Poster. Madison, WI. March 2019.
  65. VanFrank B, Graff K, Adsit R, Schauer G, McCarthy D, Babb S, Owens L, Schecter A, Wall H. Building Capacity & Increasing Access to Tobacco Cessation Services for Patients with Co-Morbidities. National Conference on Tobacco or Health. Presentation. Minneapolis, MN. August 2019.
  66. Zehner M, Adsit RT, McCarthy D, Baker TB, Gorrilla A, Skora A, Fiore MC. Connection to a Tobacco Quit Line from Primary Care Clinics: EHR-Based vs. Fax-Based Referral. Society for Research on Nicotine & Tobacco Annual Conference. Poster. San Francisco, CA. February 2019.
  67. Zehner M, Adsit RT, McCarthy D, Baker TB, Gorrilla A, Skora A, Fiore MC. Connection to a Tobacco Quit Line from Primary Care Clinics: EHR-Based vs. Fax-Based Referral. University of Wisconsin Department of Medicine Research Day 2019. Poster. Madison, WI. June 2019.
  68. Zehner M, Berg K, Adsit R, Skora A, McCarthy D, Baker T, Fiore MC. Exploring Adoption of EHR Enhancements for Evidence-Based Treatment Engagement. Conference on the Science of Dissemination and Implementation in Health. Poster. Arlington, VA. December 2019.

New Studies

1) Breaking Addiction to Tobacco for Health 2 (BREATHE 2). (Status: Will begin recruiting in 2020) In a first, researchers at the University of Wisconsin will compare the most effective treatments to help people quit smoking in real-world clinics, with a goal of tailoring and optimizing help to individual smokers. This $12.5 million grant from the National Cancer Institute will be the fifth consecutive “center grant” for lead researchers Dr. Tim Baker and Dr. Michael Fiore, research director and director of the University of Wisconsin Center for Tobacco Research and Intervention (UW-CTRI), and their staff. UW-CTRI will partner with health systems to treat more than 4,000 clinic patients. They will reach out to patients listed as smokers in electronic health records to help those who are ready to quit and motivate those who aren’t. The innovative experiment will be the first to experimentally compare the two most effective interventions available—varenicline (Chantix) vs. combination nicotine-replacement medications—and determine whether they are enhanced by type of counseling (in-person vs. phone), or by extra medication before quitting or after the standard treatment. About 25 million smokers in America make a primary care visit each year, but only about five percent of smokers who try to quit use the cessation counseling and medication we know can help. In this study, the research team will reach out to them and offer these treatments. May 2019-May 2024, $12.5 million. Funded by NCI. Drs. Timothy Baker and Michael Fiore, PIs.

2) VA Merit Grant. (Status: Recruiting participants) The US Department of Veterans Affairs has awarded a new grant to UW-CTRI Researcher Dr. Jessica Cook and the William S. Middleton Memorial Veterans Hospital (VA) in Madison to be the first ever to evaluate a chronic care system designed to help veterans who are both ready and not ready to quit smoking. Many veterans become addicted to tobacco during their military service. Led by Cook, the team will implement the grant at the VA, offering telemedicine visits for all veterans who smoke, including rural veterans who cannot afford to drive into Madison for visits. It’s a way of giving back to veterans who have sacrificed so much for our country by assisting those who need it most. The Enhanced Chronic Care system will provide ongoing motivational interventions and interpersonal support to veterans who use tobacco but are not ready to quit. The treatment is designed to encourage veterans to use evidence-based tobacco treatment and to ultimately help them quit. Cook will work with UW-CTRI colleagues Elana Brubaker and Kirsten Webster to recruit 250 veterans who smoke to receive the Enhanced Chronic Care intervention, and another 250 to receive the Standard Care (brief advice to quit once per year). The researchers hope this study will help identify an effective smoking treatment strategy for VA clinical practice. January 2019-December 2023, $1 million. Funded by the VA. Dr. Jess Cook, PI. 

3) Options Study. (Status: Will recruit in early 2020) People in the Madison and Milwaukee areas who want to see what it’s like to temporarily switch from just smoking to alternative products—like Juul e-cigarettes or cigarettes with very low nicotine content—can give it a try in a new research study. They can even get paid up to $380 for doing it. All study participants will be smokers who are willing to try quitting smoking for a week and also try something new for just that week. They will:

  • Be randomly assigned to switch to either vaping or smoking low-nicotine cigarettes (LNC) for a week, or to using no alternative product.
  • Then they go back smoking for a week.
  • Next, they switch from smoking to Juul, or LNC or no alternative product.
  • During the two switch weeks, all participants will be given patches. During one week, the patches will have active nicotine and, during the other switch week, the patches will be placebo (no nicotine).

Researchers will examine how well Juul or low-nicotine cigarettes can substitute for regular smoking, and how nicotine patches factor into it and why. The landscape of tobacco products is changing and we need to understand how people use these products in the real world and how they compare to their regular cigarettes. The researchers hope that this information will help inform the FDA as they try to make rules about tobacco products. May 2019-April 2022, $1.4 million. Funded by NCI and FDA. Dr. Megan Piper, PI.

4) Evaluation of Wisconsin Tobacco Quit Line eReferral Implementation, Reach, and Maintenance. (Status: Active and collecting data via EHR) This new grant from the UW Institute for Clinical and Translational Research (UW-ICTR) will evaluate electronic referrals from primary-care clinics to the Wisconsin Tobacco Quit Line. The study focuses on implementation and dissemination and will identify key factors that influence when and how clinic staff refer patients to the Quit Line via eReferral. Researchers hope to learn how to increase the number of patients referred and promote eReferral to help underserved patients who smoke access treatment to quit. UW-CTRI researchers will analyze data from the electronic health records (EHR) at Gundersen and Ascension health systems, observe their clinic staff at work, and conduct in-depth interviews with clinic staff about offering eReferral to patients who smoke. The goal is to identify ways to encourage clinic staff to consistently offer eReferral to smokers. To do this, UW-CTRI will work with participating clinics to develop and evaluate the use of timely feedback and incentives (e.g., small payments to clinics) to enhance the rates at which clinic staff refer patients via EHR to the Quit Line. November 2019-March 2021, $150,000. Funded by UW-ICTR. Danielle McCarthy, PI.

Active Studies

1) Quitting Using Intensive Treatments Study (QUITS). (Status: Recruitment complete, seeing patients in follow-up) UW-CTRI is partnering with the UW Department of Medicine Cardiology Division on the study. Participants in Madison and Milwaukee get free medication and coaching. All patients get three months of varenicline pills and coaching; some patients also get nicotine patches and extended medications regimens. The study is designed to answer two key questions: 1) whether adding the nicotine patch to varenicline (Chantix) can boost quit rates; and 2) whether extending varenicline or varenicline + nicotine patch treatment for six months (rather than the standard three months) can boost quit rates. Researchers expect both treatment enhancements (either adding the nicotine patch or extending treatment for 6 months) will yield higher cessation rates among people trying to quit. Smokers and their clinicians are calling for cessation treatment options that can substantially increase current modest quit rates, and the goal of this study is to produce such an enhancement. June 2017-May 2021, $7 million. Funded by NHLBI. Drs. Timothy Baker and James Stein, PIs.

2) Transforming the Treatment of Tobacco Use in Health Care: Seizing the Potential of the Electronic Health Record (EHR) to Deliver Comprehensive Chronic Care Treatment for Smoking. (Status: Several projects ongoing) This R35 grant to Dr. Michael Fiore is designed to offer flexibility to researchers in the quest to overcome barriers in helping primary-care patients quit smoking. In other words, it sparks innovation to translate efficacious treatments into clinical use. Projects have included:

  • Tobacco Cessation Quitline eReferral. (Status: Primary outcomes paper published; secondary outcomes under analyses) This study is a two-group, non-blinded, randomized, controlled trial to assess the impact of an EHR-based eReferral system relative to the current standard fax referral method. UW-CTRI partnered with Ascension WI-Wheaton Franciscan Healthcare and Gundersen Health System on the clinical trial to test eReferrals versus fax referrals. The trial, known as the Quit Line Referral Method Study, included 23 clinics, a dozen from Wheaton Franciscan Healthcare and 11 from Gundersen Health System. In each system, half of the clinics tested the closed-loop, HIPAA-compliant eReferral to the Quit Line, while the others operated the Fax to Quit program. Across both healthcare systems, eReferral produced referral rates that were 3-4 times higher than those produced by Fax to Quit. While the rates improved, challenges include increasing enrollment rates as well as sustaining use outside of a research study.
  • SmokefreeTXT Pilot. (Status: Primary outcomes paper published) This pilot project integrates NCI’s SmokefreeTXT program that sends text messages to participants’ phone to inspire and support an attempt to quit smoking. At two participating Gundersen Health System clinics, if a patient was ready to quit smoking, the “best practice alert” in the EHR prompted clinicians to refer the patient to SmokefreeTXT via an eReferral order. Data from this small pilot study indicated feasibility of the approach and information on which members of a care team may be best suited to intervene with this approach.
  • Tolerability of 3 Medications for Smoking Cessation. (Status: Primary outcomes paper published) A single-group, open-label, pilot study of 37 patients explored the tolerability and feasibility of combining varenicline with combination nicotine-replacement medications. An innovative “triple therapy” of three FDA-approved medications taken together—along with coaching on how to quit smoking—appears safe and shows promise, according to a UW-CTRI research paper published in the Journal of Smoking Cessation.
  • Comprehensive Chronic Care Smoking Treatment System. (Status: intervention ongoing; intermediate analyses underway) Given that only about half of smokers in America are advised to quit during clinic visits, UW-CTRI has teamed with Epic and GHC-SCW in a program designed to reach out to all GHC patients who smoke. EHR tools prompted physicians to talk to their patients about quitting smoking. It also facilitated referrals to follow-up support by GHC Tobacco Cessation Outreach Specialists Katherine Coates, Hannah Wallenkamp and Maggie Nolan. The aim was to ensure patients have the tools they need to quit smoking for good. All six GHC primary-care sites are actively participating in this project in which every GHC-SCW patient with a history of current smoking in their health record is offered treatment through routine care, follow-up care, or annual telephone outreach. Additionally, the program has promoted program awareness and quit readiness through quarterly, mailed promotions/communications direct to the patients’ home/EHR patient portal. All clinics have adopted the program for more than a year. The first wave of clinics have done so for nearly two years. Preliminary data suggest that more than 1,000 patients have quit smoking.
  • Learn, Connect, & Quit Pilot. (Status: project complete) UW-CTRI researchers partnered with app developers to create and pilot a tablet app for tobacco users sitting in clinic waiting rooms. Patients watched educational videos regarding how to quit tobacco use, treatment options, and modifiable plans. Patients could discuss clear action steps with providers. While patients liked the app, clinical implementation was a challenge.
  • Tablet Technology Pilot Project with Low-Income Smokers. (Status: project complete) UW-CTRI researchers designed a tablet-based smoking-cessation intervention for clients and piloted it at two Salvation Army sites. This project was intended to continue testing the integration and scalability of technology-assisted interventions and to reach out to potential treatment-delivery sites that serve populations who smoke at higher rate. After clients received the information about quitting tobacco use via a tablet, researchers interviewed these patients as well as clinic staff about their experiences. They unanimously endorsed it.

August 2015-July 2022. $6.1 million. Funded by the National Cancer Institute of the National Institutes of Health. Dr. Michael Fiore, PI.

3) Exhale Study. (Status: Retention and long-term follow-up) As the federal government considers how to regulate electronic cigarettes (e-cigs), the University of Wisconsin was awarded a $3.7 million, 5-year grant from the National Cancer Institute as well as the Food and Drug Administration to study them over five years. This research is providing in-depth, longitudinal information, based on real-time reports, which addresses key priorities that may inform regulatory and health concerns, including understanding the relations between vaping and nicotine dependence; changes in rates of smoking conventional cigarettes; health outcomes such as evidence of exposure to carcinogens, as well as acute and long-term pulmonary health; attempts to quit smoking and the success of those attempts. Specifically, researchers have identified and are tracking over time 150 participants who exclusively smoke cigarettes and 250 participants who both smoke and vape. Researchers have used smart phones and other tools to collect information on patterns of use of these products, levels of addiction, withdrawal symptoms, success quitting versus relapse, lifestyle factors, carcinogen exposure, and how one group of participants compares to the other over time. This research is providing essential information to inform regulatory bodies, as well as researchers, clinicians, and tobacco users, about the patterns of real-world e-cig use and how such use is related to conventional smoking and the health risks caused by it. March 2015–February 2020, $3.7 million. Funded by the National Cancer Institute of the National Institutes of Health, and the Food and Drug Administration. Dr. Megan Piper and Dr. Douglas Jorenby, PIs.

4) Improving Quitline Support Study (IQS). (Status: Recruiting participants) This project will evaluate promising strategies to enhance quit-smoking success among low-income smokers. Researchers are enrolling 1,408 Medicaid-eligible or uninsured smokers who continued smoking four months after engaging in standard services from the Wisconsin Tobacco Quit Line. These smokers are invited to participate in an experiment to evaluate the value of augmenting standard Quit Line treatment with more intensive counseling, more intensive nicotine replacement, NCI’s SmokefreeTXT text support program, and/or financial incentives for using Quit Line and SmokefreeTXT support. Analyses will examine the main and interactive effects of these four treatment components at 26 weeks, as well as other quit-smoking outcomes in this at-risk population. August 2017-July 2022, $3 million. Funded by the National Cancer Institute of the National Institutes of Health. Drs. Danielle McCarthy and Michael Fiore, PIs.

5) First Breath Families: Helping Low-Income Moms Quit Smoking and Babies Grow Up Smoke-Free. (Status: Assisting with implementation) The Wisconsin Women’s Health Foundation (WWHF) has received a $1 million grant from the Wisconsin Partnership Program to significantly expand efforts to bring quit-smoking services to high-risk individuals, families and communities across Wisconsin. UW-CTRI is collaborating with WWHF on this project, to be provided during five years to First Breath Families. The group will also seek systems changes that will provide sustainable funding for these services. The First Breath Families team will collaborate with local agencies that serve pregnant and postpartum women and their families, provide statewide access to local WWHF Quit Coaches, and develop participant-informed services. January 2018-December 2022. $1,000,000. Funded by the Wisconsin Partnership Program/Oversight & Advisory Committee (WPP/OAC). Drs. Bruce Christiansen and Michael Fiore, Academic Partners. Lisette Kahlil, Wisconsin Women’s Health Foundation Community Lead.

Recently Completed Studies

1) Genetically Informed Smoking Cessation Trial. (Primary outcomes paper under review) This randomized clinical trial was the first genetic study to look at nicotine-replacement therapy (NRT) vs. varenicline head-to-head, and how participants with different genetics respond to the medications. Led by Li-Shiun Chen with collaboration from UW-CTRI Research Director Dr. Tim Baker and UW-CTRI Director of Clinical Services Dr. Doug Jorenby, the researchers hoped to determine whether genetic markers can be used to optimize smoking cessation pharmacotherapy to enhance efficacy, medication adherence, and reduce side effects. The researchers’ recent work, which suggested that the nicotinic receptor gene CHRNA5 alters the response to NRT, has been replicated in a meta-analysis. This study of 720 smokers used a stratified randomization trial design based on a subject’s pertinent genotype for smoking cessation. Specifically, in Aim 1, researchers determined if CHRNA5 genotype moderates the effect of medication (combination NRT, varenicline, vs. placebo) on abstinence. In Aim 2, researchers determined if CHRNA5 genotype predicts medication adherence and side effects. In Aim 3, researchers incorporated multiple genotypes and other predictors in order to develop a clinical treatment assignment algorithm for cessation success. This work could result in improved physician care of patients who smoke, overall smoking cessation success, and prevention of cancer, heart, and lung disease. Sept. 2014-July 2019, $90,000. Funded by the National Institutes of Health. Li-Shiun Chen, PI. Douglas Jorenby, co-PI.

2) Breaking Addiction to Tobacco for Health (BREATHE). (Status: Long-term follow-up, analyzing data) This project tests new phased-based treatments to help patients in the Milwaukee and Madison areas quit smoking. Partners in this research include colleagues from Penn State University and the University of Illinois-Chicago, as well as Aurora Health Care, Dean Health System, and Epic. Under the BREATHE project, any smoker who visits a participating clinic, regardless of the initial reason for the visit, is invited to get treatment through BREATHE. This study has implemented both an electronic health records (EHR) system that increases smokers’ recruitment into treatment as well as a highly effective chronic-care treatment with intervention components for all smokers. First, the EHR system was implemented in 18 clinics in two health-care systems and experimentally evaluated on its ability to increase the recruitment of smokers into chronic-care treatment (Project 1). Then, using highly efficient research methods, researchers have experimentally compared multiple intervention components and identified especially effective interventions for every phase of smoking treatment. This includes motivating smokers initially unwilling to quit and preparing them for cessation (Project 2), enhancing quitting success and preventing relapse when smokers are ready to quit (Project 3), and re-engaging relapsed smokers in treatment and restoring their abstinence (Project 4). BREATHE researchers hope this will produce an optimized, comprehensive, chronic-care treatment for smoking that can be readily implemented in primary care settings by project end. June 2014-July 2019, $12 million. Funded by the National Cancer Institute of the National Institutes of Health. Michael Fiore and Tim Baker, PIs.

3) Smoking Cessation – Bucket Approach Training Module Development. (Status: Online training is active) UW-CTRI Researcher Dr. Bruce Christiansen is collaborating with UW-CTRI colleagues to create videos for an online training based on his brief “Bucket Approach” to help patients with serious or significant mental illness to quit smoking. This online training will offer continuing education credits via the same UW training site that already offers a general training for behavioral health providers on how to help behavioral health patients quit smoking. The focus for the new training is on reaching out to Wisconsin Community Support Programs (CSP) and Comprehensive Community Services (CCS) Systems. CSPs work with patients with serious mental illness typically at discrete treatment sites. CCSs generally treat patients with less-serious but still significant mental illness using network models. Both types of programs are county-based. The Bucket Approach is designed to tailor the intervention to various motivational statuses of patients with serious mental illness. October 2018-September 2019. $112,000. Funded by the State of Wisconsin Department of Health Services. Dr. Bruce Christiansen, PI.

4) PTSD and Veterans Merit Award. (Status: Analyzing data) UW-CTRI Researcher Dr. Jessica Cook had led this merit award research at the William S. Middleton Memorial Veterans Hospital in Madison, Wisconsin. The primary objective of this research has been to produce an empirically validated treatment that increases smoking cessation in veterans with posttraumatic stress disorder (PTSD), one that can be easily integrated into smoking cessation clinics and/or mental health clinics within VA facilities. Recent evidence shows that behavioral activation therapy (BA), a behavioral treatment that increases engagement in reinforcing activities, significantly reduces PTSD symptoms and may aid in quitting smoking. The research was designed to determine whether BA, as an adjunct to standard smoking-cessation treatment, (ST+BA) is superior to a comparably intense combination of standard smoking cessation treatment + health and smoking education (ST+HSE) in improving smoking cessation outcomes among veterans with PTSD. The HSE intervention is intended to constitute a credible intervention that controls for contact time. Secondary objectives are to determine if BA improves PTSD symptomatology and associated affective distress, and to identify potential mediators of BA on smoking outcomes. A total of 120 veterans with PTSD who were motivated to quit smoking have attended an initial diagnostic and baseline assessment session. All participants will receive 8 weeks of the nicotine patch. Smoking-cessation outcomes are being assessed 2, 4, 8, 16, and 26 weeks after the quit date. Jan. 2014-Sept. 2019, $770,500. Funded by the United States Department of Veterans Affairs. Jessica Cook, PI.