UW-CTRI
UW Center for Tobacco Research and Intervention

2020 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 2020, UW-CTRI produced:

  • 39 published papers
  • 6 papers in press
  • 37 presentations and posters
  • 1 new study
  • 9 active studies
  • 4 studies recently completed

THANK YOU: UW-CTRI is grateful to its partners, including the US National Institutes of Health, Centers for Disease Control, Centers for Medicare and Medicaid Services, US Food and Drug Administration, US Health Resources and Services Administration, US Department of Veterans Affairs, UW Atherosclerosis Imaging Research Program, UW Comprehensive Cancer Center, UW Department of Family Medicine, UW Institute for Clinical and Translational Research, UW Department of Medicine, UW School of Medicine and Public Health, Wisconsin Department of Health Services, the Wisconsin Partnership Program and the Wisconsin Women’s Health Foundation.

Published Papers

Notes:  Names in bold are current UW-CTRI or C3I faculty or staff.

Click on the article title to view the full paper online.

  1. Akhtar WZ, Mundt MP, Koepke R, Krechel S, Fiore MC, Seal DW, Westergaard R. (2020) Prevalence of Tobacco Use Among People Who Inject Drugs in Rural Communities. JAMA Network Open. Online March 10, 2020. 3(3):e200493.

Summary: Among this large sample of rural-dwelling individuals who were actively injecting opioids and/or stimulants, an extremely high proportion reported that they currently smoked cigarettes. The smoking rate of more than 90 percent is among the highest reported among any subpopulation and exceeds that of many other groups with a high prevalence of smoking, including adults with schizophrenia. In contrast, the overall adult smoking prevalence rate in the US in 2018 was 13.8 percent. Novel approaches to eliminating tobacco use among this population are needed.

  1. Baker TB, Fiore MC. (2020) What We Do Not Know About E-cigarettes Is a Lot. JAMA Network Open. 2020;3(6):e204850.

Summary: The authors warn against jumping to conclusions about vaping before we know answers to questions like: What will be the fate(s) of the dual users of vaping and smoking and what are the long-term health consequences? How will legal restrictions affect youth vaping? How will youth vaping relate to future harms, including cigarette prevalence? To what degree can vaping help people quit smoking? How does that compare with the most effective FDA-approved medications? How will vape products evolve? How does COVID-19 impact vaping? Much more research is needed.

  1. Berg K, Gruber SJ, Jorenby D. (2020) Helping Women Veterans Quit Smoking: A Qualitative Analysis of Successful and Unsuccessful Attempts. BMC Women’s Health. 2020 Mar 30;20(1):63.

Summary: Women Veterans’ quit smoking attempts demonstrate four main themes: baseline health, acknowledgment of addiction, optimism towards quitting, and resilience. Patterns were observed within themes with respect to whether the individual currently smoked or had experienced a prolonged quit attempt in the past. Further research is needed to help women Veterans quit smoking.

  1. Bray MJ, Chen L-S, Fox L, Hancock DB, Culverhouse RC, Hartz SM, Johnson EO, Liu M, McKay JD, Saccone NL, Hokanson JE, Vrieze SI, Tyndale RF, Baker TB, Bierut LJ. (2020) Dissecting the Genetic Overlap of Smoking Behaviors, Lung Cancer, and Chronic Obstructive Pulmonary Disease: A Focus on Nicotinic Receptors and Nicotine Metabolizing Enzyme. Genetic Epidemiology. 2020 Oct;44(7):748-758.

Summary: Overall, heavier smoking and decreased smoking cessation showed genetic associations with increased lung cancer and COPD risk. The chromosomal region 19q13.2, however, showed a different pattern. For example, the effect allele-C within CYP2A6 was associated with an increased risk of heavier smoking, lung cancer, and COPD. Surprisingly, this allele-C was associated with increased smoking cessation. This inverse relationship highlights the need for more research on how CYP2A6 variation could increase quitting while also increasing disease risk (likely through increased smoking).

  1. Buu A, Cai Z, Li R, Wong SW, Lin HC, Su WC, Jorenby DE, Piper ME. (2020) The Association Between Short-Term Emotion Dynamics and Cigarette Dependence: A Comprehensive Examination of Dynamic Measures. Drug and Alcohol Dependence.

Summary: Among those who both smoked and vaped, a higher average level of negative emotion, less sustained negative emotion, and higher instability of positive emotions were associated with higher cigarette dependence. The patterns of associations among those who only smoked were, however, different. Higher inertia of negative emotion, lower instability of positive emotion, and higher variability of negative emotion were associated with higher cigarette dependence.

  1. Chen LS, Baker TB, Miller J, Bray M, Smock N, Chen J, Stoneking F, Culverhouse R, Saccone N, Amos C, Carney R, Jorenby DE, Bierut. (2020) Genetic Variant in CHRNA5 and Response to Varenicline and Combination Nicotine Replacement in a Randomized Placebo-controlled Trial. Clinical Pharmacology and Therapeutics. June 29, 2020.

Summary: Among African American smokers, combo-nicotine medication is more effective in smokers with GG genotypes, whereas varenicline is more effective for smokers with GA/AA genotypes. These findings enhance our ability to improve smoking treatment effectiveness for African American smokers.

  1. Culverhouse RC, Chen L-S, Saccone NL, Ma Y, Piper ME, Baker TB, Bierut LJ. (2020) Variants in the CHRNA5-CHRNA3-CHRNB4 Region of Chromosome 15 Predict Gastrointestinal Adverse Events in the TTURC Smoking Cessation Trial. Nicotine & Tobacco Research. 2020.

Summary: Reducing adverse events from pharmacologic treatment is an important goal of precision medicine and identifying genetic predictors of adverse events is a step toward this goal. The UW Transdisciplinary Tobacco Use Research Center (TTURC) conducted a multiarmed, placebo-controlled smoking cessation trial of bupropion and nicotine replacement therapy that included 985 genotyped participants. Variants in the CHRNA5-CHRNA3-CHRNB4 region of chromosome 15 are associated with gastrointestinal adverse events in smoking cessation, reflecting biological response to the meds.

  1. D’Angelo H, Ramsey AT, Rolland B, Chen LS, Bernstein SL, Fucito LM, Webb HM, Adsit R, Pauk D, Rosenblum MS, Cinciripini PM, Joseph A, Ostroff JS, Warren GW, Fiore MC, Baker TB. (2020)Pragmatic Application of the RE-AIM Framework to Evaluate the Implementation of Tobacco Cessation Programs Within NCI-Designated Cancer Centers. Frontiers in Public Health. 8;221.

Summary: The authors examined a pragmatic application of the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance) to evaluate tobacco treatment programs at three cancer centers. The RE-AIM measures are flexible enough to work in different settings and for different types of tobacco treatment programs but are robust enough to evaluate. The measures can be applied across different healthcare systems and EHR platforms. Delivering tobacco treatment to cancer patients who smoke should be a routine and integrated part of cancer care.

  1. Dindo L, Johnson AL, Lang B, Rodriguez M, Martin L, Jorge R. (2020) Development and Evaluation of an 1-Day Acceptance and Commitment Therapy (ACT) Workshop for Veterans with Comorbid Chronic Pain, TBI, and Psychological Distress: Outcomes from a Pilot Study. Contemporary Clinical Trials. Mar (90), 105954.

Summary: Researchers developed and implemented a 1-day, transdiagnostic workshop for military Veterans with mild traumatic brain injury, stress-based psychopathology, and pain. Preliminary results support the feasibility, acceptability, and promising effects on psychological distress and community reintegration for Veterans. Future research examining the effectiveness of this workshop with a larger sample size is necessary.

  1. Evans-Hudnall G, Odafe MO, Johnson AL, Armenti N, O’Neil J, Lawson E, Trahan LH, Rassu FS. (2020) Using an Adjunctive Treatment to Address Psychological Distress in a National Weight Management Program: Results of an Integrated Pilot Study. Military Medicine. Volume 185, Issue 9-10, September-October 2020, Pages e1662–e1670.

Summary: Thirty-four obese veterans with a diagnosis of PTSD, depression, and/or anxiety who were attending the MOVE! fitness program were assigned to the 8-session HERO group or the usual care (UC) group. At 8 weeks after treatment, participants in the HERO group had significantly higher step counts per day than those in UC. Similarly, at 16 weeks post-treatment, participants in the HERO group continued to experience a significant increase in daily steps taken per day, as well as statistically and clinically significantly lower scores on the depression symptom and PTSD symptom severity.

  1. Fiore MC, Adsit R, Baker TB. (2020) Clinical-, System-, and Population-level Strategies that Promote Smoking Cessation. In: Smoking cessation – A Report of the Surgeon General.Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention, Office on Smoking and Health; 2020:577-640, Chapter 7.

Summary: The evidence is sufficient to infer that the clinical practice guidelines, insurance coverage, quality measures with payments to clinicians, tobacco quitlines, EHRs, price increases, smoke-free policies, mass-media campaigns, comprehensive state tobacco-control programs, and large, pictorial health warnings reduce tobacco use.

  1. Freytag J, Dindo L, Catic A, Johnson AL, Bush Amspoker A, Gravier A, Dawson DB, Tinetti ME, Naik AD. Feasibility of Clinicians Aligning Health Care with Patient Priorities in Geriatrics Ambulatory Care. Journal of American Geriatric Science. 2020 Sep;68(9):2112-2116. Online July 20, 2020.

Summary: This review of charts from the Veterans Administration Medical Center Geriatrics Clinic suggest that clinicians use patient priorities in recommending care. Compared with patients in the usual care group, those in the Patient Priorities Care group had, on average, fewer medications added, more referrals to community services and supports, and more tasks assigned to the patients that were specific to their personal priorities of self-management.

  1. Fronk GE, Sant’Ana SJ, Kaye JT, Curtin JJ. (2020) Stress Allostasis in Substance Use Disorders: Promise, Progress, and Emerging Priorities in Clinical Research. Annual Review of Clinical Psychology. Online February 10, 2020. Print volume 16, 2020, 401-430.

Summary: Biological systems that mediate stress allostasis (the process by which the body responds to stressors over time in order to ‘reset’) are highly interactive, but distinct patterns of stressor allostasis are possible across systems among individuals with substance use disorders (SUDs). For instance, people with SUDS generally display decreased stress allostasis in the peripheral nervous system, but increased stress allostasis in the central nervous system. Stressors cause craving in the laboratory, but at this point there is insufficient evidence of stressor-induced use in humans. Understanding the role of stressor characteristics (such as predictability, controllability, intensity) should be a high research priority.

  1. Johnson AL, Kaye JT, Baker TB, Fiore MC, Cook JW, Piper ME. (2020) 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, print February 2020.

Summary: Psychiatric diagnosis was significantly related to lower likelihood of quitting smoking in the short term, but not the long term, in the Wisconsin Smokers’ Health Study. Lifetime psychiatric diagnosis was related to elevated nicotine dependence. History of psychiatric diagnosis was related to increased craving. There was little evidence that psychiatric diagnostic status moderated the effects of varenicline or combination nicotine-replacement medication on long-term cessation.

  1. Kaye JT, Johnson AL, Baker TB, Piper ME, Cook JW. (2020) Searching for Personalized Medicine for Binge Drinking Smokers: Smoking Cessation Using Varenicline, Nicotine Patch, or Combination Nicotine Replacement Therapy. Journal of Studies on Alcohol and Drugs. 2020;81(4):426-435.

Summary: Varenicline did not yield higher rates of quitting smoking or reduce alcohol use among binge drinkers. Varenicline did reduce alcohol-related cigarette craving, but this did not translate to meaningful differences in quitting smoking.

  1. Kaye JT, Baker TB, Beckham JC, Cook JW. (2020) Tobacco Withdrawal Symptoms Before and After Nicotine Withdrawal in Veteran Smokers with Posttraumatic Stress Disorder and with Major Depressive Disorder. Nicotine and Tobacco Research.

Summary: Contrary to hypotheses, nicotine deprivation produced greater increases in most withdrawal symptoms amongst controls than in those with psychiatric diagnoses. Compared with controls, those with posttraumatic stress disorder (PTSD) or major depressive disorder (MDD) reported elevated symptom levels both before and after tobacco deprivation for most withdrawal symptoms. These findings suggest that chronically high levels of distress and craving may account for the quitting difficulties of those with comorbid conditions such as PTSD and MDD.

  1. Kim N, McCarthy DE, Cook JW, Piper ME, Schlam TR, Baker TB. (2020) Time‐Varying Effects of ‘Optimized Smoking Treatment’ On Craving, Negative Affect and Anhedonia. Addiction.

Summary: A novel model, the Phase-Based Model of Cessation developed by UW-CTRI Research Director Dr. Tim Baker, suggests the process of quitting smoking can be divided into phases, each with different opportunities for intervention to suppress withdrawal. Starting treatment while preparing to quit, and intensifying treatment during a quit attempt, may help more people quit. The innovation, tested in the UW-PASS Study in Aurora and Dean clinics, also showed that the optimized, multi-component intervention reduced craving (both before and after the target quit day) and anhedonia (after quitting).

  1. Kim N, McCarthy DE, Piper ME, Baker TB. (2020) Comparative Effects of Varenicline or Combination Nicotine Replacement Therapy Versus Patch Monotherapy on Candidate Mediators of Early Abstinence in a Smoking Cessation Attempt. September 4, 2020.

Summary: Among adult smokers seeking to quit, varenicline seems to work through its effects on suppression of craving and smoking expectancies pre‐cessation. Combination nicotine-replacement medication seems to work through cessation‐related reduction in craving and changes in smoking expectancies.

  1. Kim SC, Hawkins RP, Shah DV, Gustafson DH, Baker TB. (2020) Understanding How E-Health Intervention Meets Psychosocial Needs of Breast Cancer Patients: The Pathways of Influence on Quality of Life and Cancer Concerns. Psycho-oncology. Epub ahead of print. 2020.

Summary: Using e-health interventions like Comprehensive Health Enhancement Support System (CHESS) can help cancer patients improve their information-management skills and emotional functioning, contributing to better short-term health outcomes. The CHESS-IS program enhanced proximal outcomes at three months through improved information competence. The CHESS with mentor intervention reduced breast cancer concerns at six months, mediated mainly by emotional-social competence and emotional functioning. Adding a human mentor can enhance the benefits of CHESS.

  1. Klemperer EM, Mermelstein R, Baker TB, Hughes JR, Fiore MC, Piper ME, Schlam TR, Jorenby DE, Collins LM, Cook JW. (2020) Predictors of Smoking Cessation Attempts and Success Following Motivation-Phase Interventions Among People Initially Unwilling to Quit Smoking. Nicotine & Tobacco Research. Online April 2020.

Summary: What leads smokers who are unwilling to try to quit smoking to change their minds and then try to quit? Researchers explored this question in a new paper based on UW-CTRI data which showed that increases in two factors—the time before smokers light up their first cigarette each morning, and the belief they can quit—predicted which unwilling smokers would change their minds and try to quit. In simple terms, smokers were more likely to try to quit if they were less dependent on nicotine, that is, go later in the day before lighting up, and if they were rather confident that they could quit.

  1. Klemperer EM, Hughes JR, Peasley-Miklus CE, Callas PW, Cook JW, Streck JM, Morley NE. (2020) Possible New Symptoms of Tobacco Withdrawal III: Positive Affect- A Meta-Analysis. Nicotine and Tobacco Research.

Summary: Abstinence from cigarettes is associated with a decrease in Positive Affect (PA). Whether low PA should be added to withdrawal measures and diagnostic criteria requires replication of the time-course of change in PA and tests of whether abstinence-induced changes in PA and negative affect occur independently. The findings suggest that (1) abstinence from cigarettes decreases positive affect and (2) this decrease may represent a withdrawal effect (vs. an offset effect). However, it is unclear whether abstinence-induced losses in positive affect are independent from increased negative affect.

  1. Lathen LS, Plears ML, Shartle EL, Conner KL, Fiore MC, Christiansen BA. (2020) The HUD Smoke-Free Rule: Perceptions of Residents Post-Implementation. Preventive Medicine Reports. 2020:101159.

Summary: More than 80 percent of smokers living in spaces supported by Housing and Urban Development (HUD) in Milwaukee reported they made at least one positive change to their tobacco use thanks to the 2018 rule prohibiting smoking within 25 feet of HUD housing. The survey of 574 HUD residents in 2019 also showed that nearly half tried to quit or cut down, and 6.4 percent successfully quit. A third took their smokes 25 feet away from the building, while a fifth made no change.

  1. Lydon-Staley DM, Leventhal AM, Piper ME, Schnoll RA, Bassett DS. (2020) Temporal Networks of Tobacco Withdrawal Symptoms During Smoking Cessation Treatment. Journal of Abnormal Psychology. November 2020.

Summary: Here, the authors construct and examine temporal tobacco withdrawal networks. Results indicate substantial moment-to-moment associations among tobacco withdrawal symptoms, substantial differences between people in withdrawal network structure, and reductions in the interplay among withdrawal symptoms during combination treatment to quit smoking. Overall, findings suggest the utility of a network perspective. This also highlights challenges associated with the network approach, stemming from vast differences between people in symptom networks.

  1. Mundt MP, Baker TB, Piper ME, Smith SS, Fraser DL, Fiore MC. (2020) Financial Incentives to Medicaid Smokers for Engaging Tobacco Quit Line Treatment: Maximising Return on Investment. Tobacco Control. 29:320-325.

Summary: Offering $20 per call to smokers for taking the first four quitline calls and $70 for taking a fifth quitline call maximizes ROI to engage low-income smokers with evidence-based treatments to quit smoking. Using variable payments, the minimal cost per additional smoker who quit was $2125 when incentives for the first four calls to the Wisconsin Tobacco Quit Line were set at $20, and the financial payment for the fifth call was set at $70.

  1. Nolan MB, Zwaga D, McCarthy DE, Kastman C, Baker TB, Zehner M, Smith SS, Fiore MC. (2020) Who are We Missing with EHR-Based Smoking Cessation Treatments; a Descriptive Study of Patients Who Smoke and Do Not Regularly Visit Primary Care Clinics. Journal of Smoking Cessation. September 2020.

Summary: Of 3,407 patients identified as smokers in a health system registry, 565 (16.6%) had not seen any primary care provider in the past year. Among 271 of those called, 143 (53%) were successfully reached and 33 (23%) set a quit date. Those without visits tended to be younger, male, some-day versus every-day smokers, and less active on the EHR patient portal. Many are receptive to offers to help them quit smoking.

  1. Piper ME, Bullen C, Krishnan-Sarin S, Ossip DJ, Rigotti NL. Steinberg ML, Streck JM, Jospeh AM. (2020) Defining and Measuring Abstinence in Clinical Trials of Smoking Cessation Interventions: An Updated Review.Nicotine & Tobacco Research. 1-9.

Summary: Defining abstinence requires specification of which products a user must abstain from using, the type of abstinence (ie, point prevalence or continuous), and the duration of abstinence. These recommendations are intended to serve as guidelines for investigators as they collect the necessary data to accurately describe participants’ abstinence during smoking-cessation clinical trials. The authors recommend continuing to define it as: no use of smoking, vaping, or smokeless products.

  1. Piper ME, Brown DC, Hendershot TP, Swan GE. (2020) PhenX Host: Social/Cognitive Measures for Tobacco Regulatory Research. Tobacco Control. 2020;29:s5-s12.

Summary: A working group of experts recommended 11 social/cognitive measures for a toolkit of measures for biomedical research on tobacco use. Of these, 10 were self-administered measures: frequency of communication with parents about smoking, quality of communication with parents about smoking, susceptibility to tobacco use, behavior economics/purchase behavior, motivation to quit (both single and multi-item measures), hedonic tone or response to pleasurable situations, multigroup ethnic identity, peer and family influence on smoking, attentional control and house rules about tobacco use.

  1. Piper ME, Baker TB, Mermelstein R, Benowitz N, Jorenby DE. (2020) Relations Among Cigarette Dependence, E-cigarette Dependence, and Key Dependence Criteria Among Dual Users of Combustible and E-cigarettes. Psychology of Addictive Behaviors. Online September 21, 2020.

Summary: The aim of this study was to examine dependence on smoking and vaping among those who do both (dual users), which may provide important insights into long-term use patterns. Among dual users, measures of e-cigarette and cigarette dependence tended to be unrelated to one another, but dual users tended to use both products for the same instrumental motives. Which product is used first in the morning may serve as a valuable measure of relative dependence on the two products.

  1. Quach B, Bray M, Gaddis N, Liu M, Palviainen T, Minica C, Zellers S, Sherva R, Aliev F, Nothnagel M, Young Y, Marks J, Young H, Carnes M, Guo Y, Waldrop A, Sey N, Landi MT, McNeil D, Drichel D, Farrer L, Markunas C, Vink J, Hottenga J-J, Ionaco W, Kranzler H, Saccone N, Neale M, Madden P, Rietschel M, Marazita M, McGue M, Won H, Winterer G, Grucza R, Dick D, Gelernter J, Caporaso N, Baker TB, Boomsma D, Kaprio J, Hokanson J, Vrieze S, Bierut L, Johnson E, Hancock D. (2020) Expanding the Genetic Architecture of Nicotine Dependence and its Shared Genetics with Multiple Traits: Findings from the Nicotine Dependence GenOmics (iNDiGO) Consortium. Nature Communications. Online January 15, 2020.

Summary: Knowledge is evolving on genetics underlying smoking initiation, regular smoking, nicotine dependence (ND), and cessation. Researchers performed a genome-wide association study using the Fagerström Test for ND (FTND) in 58,000 smokers of European or African ancestry. Five genome-wide significant loci were identified, and loci reported for other smoking traits were extended to ND. SNP-based heritability of ND was 8.6%, and ND was genetically correlated with 13 other smoking traits and co-morbid diseases. The results emphasize the FTND as a composite phenotype that expands genetic knowledge of smoking, including loci specific to ND.

  1. Ramsey AT, Baker TB, Pham G, Stoneking F, Smock N, Colditz GA, James AS, Liu J, Bierut LJ, Chen LS. (2020) Low Burden Strategies are Needed to Reduce Smoking in Rural Healthcare Settings: A Lesson from Cancer Clinics.International Journal of Environmental Research and Public Health. 17(5): 1-11.

Summary: Smoking prevalence was particularly high and treatment engagement was particularly low among patients seen in rural clinics, where quit-smoking programs are inconsistent. In the cancer care setting, patients were more likely to receive smoking treatment in clinics that implemented the EHR-based ELEVATE module versus clinics that didn’t. The point-of-care treatment approach supported by ELEVATE offers a promising solution for rural settings, for general and cancer care. Including decision support within EHR systems offers potential to extend reach.

  1. Rosenblum MS, Engle JL, Piper ME, Kaye JT, Cook JW. (2020) Motives for Smoking in Those with PTSD, Depression, and no Psychiatric Disorder. Journal of Dual Diagnosis. Jul-Sep 2020;16(3):285-291.

Summary: Results suggest that both Primary Dependence Motives (such as automatic smoking, loss of control, craving, or tolerance) and Secondary Dependence Motives (such as smoking to improve mood, or when exposed to smoking-related cues) play a meaningful role in motivation to smoke among those with post-traumatic stress disorder. Smoking dependence in those with major depressive disorder may be primarily influenced by Secondary Dependence Motives. These groups of smokers could benefit from quit-smoking treatment that teaches them to regulate their distressing mood states.

  1. Sarna L, Fiore MC, Schroeder SA. (2020) Tobacco Dependence Treatment is Critical to Excellence in Healthcare. JAMA Internal Medicine. September 2020;180(11):1413-1414.

Summary: The authors point out a weakness in the high-profile “Best Hospitals Honor Roll” published annually by U.S. News and World Report. Namely, that these hospitals aren’t reporting on how they treat the leading preventable cause of disease and death: Tobacco use. For the 2020–21 U.S. News rankings, none of the Top 20 hospitals reported to the Joint Commission on how they deliver treatment for tobacco dependence. Reporting on tobacco treatment should be a required measure, not an elective one, for accreditation and recognition, the authors assert.

  1. Schlam TR, Baker TB, Smith SS, Bolt DM, McCarthy DE, Cook JW, Hayes-Birchler T, Fiore MC, Piper ME. (2020) Electronically Monitored Nicotine Gum Use Before and After Smoking Lapses: Relations with Lapse and Relapse. Nicotine and Tobacco Research. Online June 2020.

Summary: In a smoking cessation attempt using nicotine patch plus gum, lapsers versus matched non-lapsers used less gum immediately preceding and following their first lapse. Lower mean gum use, before and after lapses, predicted a more rapid escalation to relapse. Decreased nicotine gum use both precedes and follows returns to smoking during cessation attempts.

  1. Schlam TR, Cook JW, Smith SS, Baker TB, Piper ME. (2020) Anxiety Sensitivity and Distress Tolerance in Smokers: Relations with Tobacco Dependence, Withdrawal, and Quitting Success. Nicotine and Tobacco Research. 2020;22(1):58-65.

Summary: Researchers looked at distress tolerance (a measure of how much an individual can withstand difficult situations and emotions) as well as anxiety sensitivity (the fear of feelings associated with anxiety) to see whether these emotional vulnerabilities were associated with quitting smoking in a stop-smoking study. Those who reported a greater ability to tolerate distress were more likely to quit smoking and remain smoke-free a year later.

  1. Schletzbaum M, Wang X, Greenlee R, Piper ME, Bartels CM. (2020) Predictors of Smoking Cessation in Patients with Rheumatoid Arthritis in Two Cohorts; Health Care Factors Most Predictive. Arthritis Care and Research. March 2020.

Summary: Healthcare factors—including their particular health system and being new to rheumatology care, were more predictive of smoking cessation in patients with rheumatoid arthritis (RA) than patient sociodemographic factors, suggesting an important role for quit-smoking treatment for patients with RA. RA patients were 43% less likely to quit smoking and may particularly benefit from support to quit smoking. Emphasizing smoking cessation with RA patients and leveraging health-system interventions could improve smoking cessation and outcomes in RA.

  1. Smits JA, Kauffman BY, Lee-Furman E, Zvolensky MJ, Otto MW, Piper ME, Powers MB, Rosenfield D. (2020) Enhancing Panic and Smoking Reduction Treatment with D-Cycloserine: A Pilot Randomized Controlled Trial. Drug and Alcohol Dependence. 2020.

Summary: D-cycloserine (DCS) facilitated greater reductions in anxiety sensitivity which in turn predicted better smoking outcomes early on. However, long-term, there was no evidence DCS made a significant difference in helping participants to quit smoking.

  1. Stein JH, Smith SS, Hanson KM, Korcarz CE, Piper ME, Fiore MC, Baker TB. (2020) Longitudinal Efects of Smoking Cessation on Carotid Artery Atherosclerosis in Contemporary Smokers: the Wisconsin Smoker’s Health Study. Atherosclerosis. 2020.

Summary: Smoking cessation is associated with less progression of carotid plaque, but not intima-media thickness (a measurement of the innermost two layers of the artery wall).

  1. Williams BS, Smith SS, Marbin JN, Huang MZ, Garell CL, Kosack AS, Ulfat Shaikh U, Tebb KP, Fiore MC. (2020) Addressing Environmental Smoke Exposure During Pediatric Hospitalization: Attitudes and Practices of Pediatric Nurses versus Respiratory Therapists. Respiratory Care.

Summary: Compared to in-patient pediatric RNs, respiratory therapists reported higher rates of confidence in providing cessation interventions, screening for smoke exposure, and counseling on reducing smoke exposure, suggesting that they may be better positioned for intervening. These results can inform the design of an in-patient cessation intervention for caregivers of hospitalized children.

  1. Wyman MF, Voils CI, Gleason CE, Trivedi R, Umucu E, Johnson AL, Zuelsdorff M. (2020) Perspectives of Veterans Affairs Mental Health Providers on Working with Older Adults with Dementia and Their Caregivers. Gerontology & Geriatrics Research. Online May 18, 2020.

Summary: Researchers surveyed 65 mental health (MH) providers at a Veterans Affairs medical center on working with older persons with dementia (PwD) and informal caregivers. Respondents believed PwD can benefit from MH treatments, yet identified several barriers to providing care, including time and staffing. Interest in geriatric training topics was high. Findings demonstrate that MH providers at this site value care provision to PwD and caregivers and desire additional training to serve this population. System-level barriers to MH care for PwD should also be identified and addressed.

In Press

  1. Baker TB, Berg KM, Adsit RT, Skora AD, Swedlund MP, Zehner ME, McCarthy ME, Glasgow R, Fiore MC. Closed-loop eReferral from Primary Care Clinics to a State Tobacco Cessation Quitline; Effects Using Real World Implementation Training. American Journal of Preventive Medicine.
  2. Baker TB, McCarthy DE. Smoking Treatment: A Report Card on Progress and Challenges. Annual Review of Clinical Psychology.
  3. Fiore MC, Baker TB. Quitline Commentary: 10 Million Calls and Counting: Progress and Promise of Tobacco Quitlines in the United States. American Journal of Preventive Medicine.
  4. Hammond D, Reid JL, Rynard VL, O’Connor R, Goniewicz ML, McNeill A, Piper ME, Bansal-Travers M.  Indicators of Dependence and Efforts to Quit Vaping and Smoking Among Youth in Canada, England, and the United States. Tobacco Control.
  5. Piirtola M, Kaprio J, Baker TB, Piasecki TM, Piper ME, Korhonen T. The Associations of Smoking Dependence Motives with Depression Among Daily Smokers. Addiction.
  6. Smith SS, Piper ME, Bolt DM, Kaye JT, Fiore MC, Baker TB. Revision of the Wisconsin Smoking Withdrawal Scale: Development of Brief and Long Forms. Psychological Assessment.

Research Presentations and Posters

  1. Bouges S, Norton DL, Wyman MF, Lambrou NH, Zuelsdorff M, Van Hulle CA, Ennis GE, James T, Johnson AL, Clark L, Carlsson CM, Gleason CE. Effect of Metabolic Syndrome Risk Factors on Processing Speed In 3 Racial Groups. Abstract Presented at University of Wisconsin 2020 Alzheimer’s Disease & Related Disorders Research Day. Presentation. Madison, WI. February 2020.
  2. Conlon A. Applying the Science and Art of Project Management to Public Health Initiatives. Wisconsin Public Health Association’s Virtual Statewide Conference. Presentation. Madison, WI. August 2020.
  3. Cook J, Baker TB, Collins L, Fiore MC, Piper ME, Schlam T, Bolt D, Smith S, Zwaga D, Jorenby D, Mermelstein R. Effects of Motivation Phase Intervention Components on Quit Attempts and Abstinence in Smokers Unwilling to Quit: A Factorial Experiment. Society for Research on Nicotine or Tobacco Annual Conference 2020. Symposium. New Orleans, LA. March 2020.
  4. D’Angelo H, Rolland B, Adsit R, Pauk D, Rosenblum M, Baker TB, Fiore MC. Reach and Effectiveness of Tobacco Dependence Treatment Programs Implemented at NCI-Designated Cancer Centers in the Cancer Center Cessation Initiative. Society for Research on Nicotine or Tobacco Annual Conference 2020. Poster. New Orleans, LA. March 2020.
  5. D’Angelo H, Rolland B, Adsit R, Pauk D, Rosenblum M, Baker TB, Fiore MC. Reaching Cancer Center Patients Who Smoke with Tobacco Treatment Integrated into Clinical Cancer Care: Examining the Reach and Effectiveness of Tobacco Treatment Programs Implemented in the NCI Cancer Center Cessation Initiative. 44th Annual Conference for the American Society of Preventative Oncology (ASPO). Online presentation. March 2020.
  6. D’Angelo H, Rolland B, Adsit R, Pauk D, Salloum R, Hohl S, Fiore MC, Baker TB. Sustainability Capacity of Smoking Cessation Programs Implemented within NCI-designated Cancer Centers in the Cancer Center Cessation Initiative. 13th Annual Conference on the Science of Dissemination and Implementation in Health. Online poster. December 2020.
  7. Fiore MC. GHC-SCW Smoking Cessation Program: Update 2020. GHC Primary Care Conference. Presentation. Madison WI. February 2020.
  8. Fiore MC. BREATHE 2 Clinic Staff Training. Advocate Aurora Health St. Luke’s Family Clinic. Presentation. Milwaukee, WI. March 2020.
  9. Fiore MC. Summary of the 2020 U.S. Surgeon General’s Report on Smoking Cessation. North American Quitline Consortium Meeting. Online presentation. April 2020.
  10. Fiore MC. Cancer Center Cessation Initiative (C3I) Coordinating Center: Updates on Enhancement Funds for Current Grantees, Overview on C3I and COVID-19 Data Report–Through June 2019. C3I Biannual Grantees Meeting. Online presentation. April 2020.
  11. Fiore MC. Using Both Varenicline and NRT to Help Smokers Quit: Time for a Recommendation Update? XV International Symposium on Smoking Cessation. Online presentation. October 2020.
  1. Fiore MC. Treatment of Smoking in Special Situations. XV International Symposium on Smoking Cessation. Online presentation. October 2020.
  2. Fiore MC. Smoking Cessation in Oncology: The 4th Pillar of Cancer Care. XV International Symposium on Smoking Cessation. Online presentation. October 2020.
  3. Fiore MC. Discussion of the C3I COVID Project – overview of data analysis process for NCI Leadership. Online presentation. October 2020.
  4. Fiore MC. Treating Tobacco Dependence in Youth and Adolescents. UW-CTRI Outreach statewide webinar. Online presentation. November 2020.
  5. 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 in the Interrelated Outcomes of Incident Dementia, Nursing Home Placement, Death In Cognitively Healthy and Mild Cognitively Impaired Adults. Society for Research on Nicotine or Tobacco Annual Conference 2020. Poster. New Orleans, LA. March 2020.
  6. Kaye JT. Translational Implications of Preclinical Research On Stress and Alcohol Use. Discussant for symposium, Interactions Between Vulnerability To Stress And Alcohol Drinking Behaviors. Midwestern Psychological Association. Symposium. Chicago, IL. April 2020. (Conference canceled due to COVID-19.)
  1. Kim N, McCarthy D, Loh WY. Susceptibility to Smoking and Current Smoking among Adolescents Worldwide: Evidence from 95 Countries in the Global Youth Tobacco Survey, 2013-2017. Society for Research on Nicotine or Tobacco Annual Conference 2020. Poster. New Orleans, LA. March 2020.
  1. Kim N, McCarthy D, Loh WY, Schlam T, Piper ME, Cook J, Fiore MC, Baker TB. Machine Learning Identifies Interactions Among Intervention Components and Individual Differences in Models of Abstinence 1 Year After a Target Quit Day. Society for Research on Nicotine or Tobacco Annual Conference 2020. Poster. New Orleans, LA. March 2020.
  1. Kim N, McCarthy D, Cook JW, Piper ME, Schlam T, Fiore MC, Baker TB. Presented via video by Nayoung Kim. Time-varying Relations of Optimized Smoking Treatment with Pericessation Withdrawal Symptoms. Society for Research on Nicotine or Tobacco Annual Conference 2020. New Orleans, LA. March 2020.
  1. Lathen L, Plears M, Shartle E, Doster-Conner K, Fiore ME, Christiansen B. Residents’ Perceptions of the HUD Smoke-Free Rule Post-Implementation. Society for Research on Nicotine or Tobacco Annual Conference 2020. Poster. New Orleans, LA. March 2020.
  1. McCarthy D, Zehner M, Zwaga DJ, Adsit R, Skora A, Fiore MC. Analysis of the Reach of a Proactive Approach to Offering Smoking Cessation Treatment to Adult Primary Care Patients. Society for Research on Nicotine or Tobacco Annual Conference 2020. Poster. New Orleans, LA. March 2020.
  1. Millevolte R, Kim N, McCarthy D, Oguss M, Baker TB, Fiore MC.Reach and Representativeness of Electronic Referral of Primary Care Patients to an Evidence-Based Smoking Treatment. Society for Research on Nicotine or Tobacco Annual Conference 2020. Poster. New Orleans, LA. March 2020.
  1. Minami H, Nahvi S, Arnsten J, Brinkman HR, Donnelly R, Stockmal C, Rivera-Mindt M, Wetter DW, Bloom EL, Price LH, Vieira C, McClain LM, Kennedy K, Fine M, McCarthy DE, Thomas JG, Hecht J, Brown RA. Smartphone-Assisted Mindfulness-Based Intervention with Contingency Management for Smokers with Mood Disorders Receiving Outpatient Psychiatric Treatment: A Pilot Randomized Controlled Trial. Poster. Society for Research on Nicotine or Tobacco Annual Conference 2020. Poster. New Orleans, LA. March 2020.
  1. Mundt M, Adsit R, Baker TB, Kobinsky K, Fiore MC. Cost-Effectiveness of Financial Incentives for Low-Income Expectant Mothers Who Smoke to Engage in Tobacco Cessation Treatment. Society for Research on Nicotine or Tobacco Annual Conference 2020. Poster. New Orleans, LA. March 2020.
  1. Piper ME. SRNT Treasurer’s Report. Society for Research on Nicotine or Tobacco Annual Conference 2020. Presentation. New Orleans, LA. March 2020.
  1. Piper ME, Baker TB, Zwaga D, Jorenby D. The Relations Between E-Cigarette and Combustible Cigarette Dependence and Daily Use Patterns Among Dual Users. Society for Research on Nicotine or Tobacco Annual Conference 2020. Presentation. New Orleans, LA. March 2020.
  1. Piper M, Zwaga D, Baker TB, Jorenby D. Examining Daily Patterns of E-Cigarette and Combustible Cigarette Use and Changes Over Time in Dual Users. Society for Research on Nicotine or Tobacco Annual Conference 2020. Poster. New Orleans, LA. March 2020.
  1. Rolland B. 2020 Cancer Center Cessation Initiative Overview. Introducing the Initiative as pre-work for the NCI 2020 Implementation Science Consortium in Cancer Meeting. Online presentation. September 2020.
  1. Rolland B. 2020 Cancer Center Cessation Initiative (C3I). Synergies, Gaps and Opportunities in IS Panel. NCI 2020 Implementation Science Consortium in Cancer Meeting. Online presentation. September 2020.
  1. Salloum R, D’Angelo H, Chen LS, Goldstein A, Hudson D, Levinson A, Mitra S, Taylor K, Thomas J, Tindle H, Warren G, Fiore MC. Costs of Implementing Tobacco Treatment Programs in NCI’s Cancer Center Cessation Initiative (C3I). Society for Research on Nicotine or Tobacco Annual Conference 2020. Poster. New Orleans, LA. March 2020.
  1. Salloum R, D’Angelo H, Theis R, LeLaurin J, Pauk D, Chen L-S, Day A, Goldstein A, Histman B, Hudson D, King A, Lam C, Levinson A, Prochaska J, Tanski S, Taylor K, Thomas J, Tindle H, Tong E, Warren G, Baker TB, Fiore MC. Mixed-Methods Economic Evaluation of the Implementation of Tobacco Treatment Programs within NCI-Designated Cancer Centers. 13th Annual Conference on the Science of Dissemination and Implementation. Presentation. December 2020.
  1. Schlam T, Piper ME, Cook JW, Smith SS, Fiore MC, Baker TB. Strike Again While the Iron Is Hot: A SMART (Sequential, Multiple Assignment, Randomized Trial) of Chronic Care Intervention for Smoking. Society for Research on Nicotine or Tobacco Annual Conference 2020. Symposium. Elana Brubaker served as Acting Chair and Megan Piper as Discussant. New Orleans, LA. March 2020.
  1. VanFrank B, Adsit R, Prochaska J. Treating Tobacco Use and Dependence in an Evolving Environment. The American Society of Addiction Medicine Annual Conference. Presentation. April 2020.
  1. Zehner M, Smith S, Adsit R, Rosenblum M, McCarthy D, Baker TB, Fiore MC. Addressing Tobacco Use in Primary Care – Clinicians’ Perceptions of Referral to a State Quitline. Society for Research on Nicotine or Tobacco Annual Conference 2020. Presentation. New Orleans, LA. March 2020.
  1. Zehner M, Nolan M, McCarthy D, Zwaga D, Fiore M. Utilizing a Patient Registry for Extending Smoking Cessation Outreach Beyond the Primary Care Clinic. Virtual Conference of the Science of Dissemination and Implementation. Poster. December 2020.
  1. Zwaga D, Baker TB, Piper ME, Jorenby D. Understanding the Influence of Initial E-Cigarette Use Motivation on Combustible and E-cigarettes Among Sustained Dual Users. Society for Research on Nicotine or Tobacco Annual Conference 2020. Poster. New Orleans, LA. March 2020.

New Study

COVID EHR Cohort at the University of Wisconsin (CEC-UW). UW-CTRI has joined the quest to better understand COVID-19. The National Cancer Institute has asked UW-CTRI researchers to reach out to health systems associated with the Cancer Center Cessation Initiative (C3I), coordinated at UW. The goal is to explore whether patient demographic and other electronic health record (EHR) variables —including smoking status and cancer —in patients diagnosed with COVID-19 are associated with disease severity, complications and/or mortality. The CEC-UW initiative is led by Principal Investigator Dr. Michael Fiore and includes other

UW-CTRI and C3I Coordinating Center staff including Rob Adsit, Karen Conner, Stevens Smith, Betsy Rolland, Julie Kirsch, Todd Hayes-Birchler, Kari Giacolone, Douglas Jorenby, Wendy Theobald, Brian Williams, Katie Greiber, Jonah Stankovsky, Danielle Pauk, and Lisa Rogers. Tim Baker is serving as Senior Scientist on the CEC-UW project. Twenty-one health systems across the nation are participating in the project, most of which are also C3I sites. By the end of 2020, the project had collected EHR data on more than 400,000 total inpatients and outpatients who test positive for, or are diagnosed with, COVID-19. May 2020-Sept 2021, $1 million. Funded by NCI. Dr. Michael Fiore, PI.

Active Studies

  1. Breaking Addiction to Tobacco for Health 2 (BREATHE 2). (Status: Recruiting) In a first, researchers at the University of Wisconsin are comparing the most effective treatments to help people quit smoking in real-world clinics, with a goal of tailoring and optimizing help to individual smokers. Under the direction of Drs. Timothy Baker and Michael Fiore, UW-CTRI is partnering with health systems to treat more than 4,000 clinic patients. They’re reaching 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. Cardiac and LUng E-cigarette smoking Study (CLUES). The UW Atherosclerosis Imaging Research Program (UW AIRP) and UW-CTRI are collaborating on a study on the acute and chronic effects of vaping and dual use of cigarettes and e-cigarettes. UW-CTRI is collaborating on the project. The project is led by UW AIRP Director and Cardiologist Dr. James Stein and UW-CTRI Director of Research Dr. Tim Baker. The study is enrolling 440 participants representing four groups: vapers, smokers, dual users, and never users. Participants receive $200 for two study visits. The study uses an array of tests to explore relations between:
  • Acute smoking and/or vaping with possible cardiovascular and pulmonary disease mechanisms.
  • Longer-term patterns of smoking and/or vaping with measures of cardiovascular and pulmonary dysfunction and injury.

These outcome biomarkers will predict future disease risk and measure injury to arteries and lungs. For cardiovascular disease (CVD), the primary biomarkers are brachial artery flow-mediated dilation (FMD, a measure of endothelial function that predicts CVD) and carotid intima-media thickness (IMT, a measure of subclinical arterial injury and atherosclerosis that also predicts CVD events). For pulmonary disease, the primary biomarkers are predicted lung volumes and flow rates obtained by spirometry. In secondary analyses, researchers will:

  1. Characterize carotid artery echogenicity (a novel measure of arterial injury).
  2. Perform treadmill exercise stress testing (to measure exercise capacity, heart rate recovery, heart rate reserve, and rate-pressure product).
  3. Electrocardiography (to measure heart rate variability).
  4. Measure blood pressure, fasting lipids, HbA1c, markers of inflammation and oxidation (leukocyte count, C-reactive protein, F2 isoprostanes), and exhaled nitric oxide. These tests index the degree of dysfunction, injury mechanisms, and future risks of cardiovascular and pulmonary disease.

UW-AIRP Manager Dr. Claudia Korcarz coordinates the study and UW-CTRI Director of Clinical Services Dr. Doug Jorenby serves as the on-site and operational scientific lead. Dr. Nathan Sando is overseeing all pulmonary measurements. UW-AIRP Research Specialist Kristin Hansen will assist with tests. Holly Prince of UW-CTRI is managing study visits in Madison. September 2018-August 2022, $1.8 million. Funded by NIH. Drs. Timothy Baker and James Stein, PIs.

  1. VA Merit Grant. (Status: Recruiting) The US Department of Veterans Affairs awarded a 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 is implementing 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 provides 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 works 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. Jessica Cook, PI.
  2. Options Study. (Status: Recruiting) 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 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 cigs can substitute for regular smoking, and how nicotine patches factor into it and why. The landscape of tobacco products is changing and researchers want to understand how people use these products 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.

  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. 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. A main outcomes paper was published in the Journal of the American Medical Informatics Association.
  • SmokefreeTXT Pilot. 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 Gundersen Health System clinics, if a patient was ready to quit smoking, the “best practice alert” in electronic health records (EHR) prompted clinicians to refer to SmokefreeTXT via an eReferral order. Data from this small pilot study indicated feasibility of the approach, and present questions on which members of a care team may be best suited to intervene with this approach. Based on study findings, researchers reported in a paper in Translational Behavioral Medicine that interoperable eReferral via outpatient EHR to SmokefreeTXT was feasible and acceptable to clinic staff, enrolled roughly 3% of smokers, and the individual clinic context and implementation approach may influence reach.
  • Tolerability of 3 Medications for Smoking Cessation. 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. 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. GHC Tobacco Cessation Outreach Specialists Katherine Coates and Hannah Wallenkamp are ensuring their patients have the tools they need to quit smoking for good. All six GHC primary-care sites are actively participating in this project.
  • Tablet Technology Pilot Project with Low-Income Smokers. A tablet-based smoking-cessation intervention for clients was pilot tested at two Salvation Army sites. The goals were to gauge integration and scalability of technology-assisted interventions and to reach out to potential treatment-delivery sites that serve populations who smoke at a higher rate. Following the intervention, researchers interviewed staff and clients about their experiences, affirming acceptability of the tablet intervention.
  • Learn, Connect, and Quit. Researchers conducted a pilot of a tablet app featuring videos for smokers visiting one primary-care clinic. Unfortunately, clinic staff gave the tablet to patients much less frequently than researchers anticipated. Of the 30 patients who engaged with the app, 15 watched at least 1 video: 10 watched 1 video, 3 watched 2 videos and 2 watched 3 videos.
  • Financial Incentives for Smoking Treatment Engagement. Building upon the robust treatment program implemented at Group Health Cooperative-South Central Wisconsin (GHC), this project will evaluate modest financial incentives to smokers who engage in quit planning with the GHC Tobacco Cessation Outreach Specialists. Five-hundred fifty smokers will be randomized to three different incentive levels to encourage engagement in quit-smoking treatment planning over the phone.

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

  1. 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.
  2. 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.
  3. Smoking Cessation for those with Mental Illness – the Bucket Approach Training. (Status: Dissemination) UW-CTRI Researcher Dr. Bruce Christiansen collaborated with UW-CTRI colleagues to create an online training based on the “Bucket Approach” to help patients with serious or significant mental illness to quit smoking. This online training is offering free 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 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. Currently activities are supporting the implementation of the Bucket Approach in treatment programs. These activities include: dissemination by the UW-CTRI outreach staff; Bucket Approach Integration Awards to treatment programs to implement the Bucket Approach; videos of clients and therapists talking about the quitting journey; and the creation of rolls for Certified Peer Specialists to help peers reduce and quit. October 2018-September 2021, $456,000. Funded by the State of Wisconsin Department of Health Services. Dr. Bruce Christiansen, PI.

Recently Completed Studies

  1. Exhale Study. 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 provided 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 identified and tracked over time 150 participants who exclusively smoke cigarettes and 250 participants who both smoke and vape. Researchers 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 provided 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.
  2. PTSD and Veterans Merit Award. UW-CTRI Researcher Dr. Jessica Cook led this merit award research at the William S. Middleton Memorial Veterans Hospital in Madison, Wisconsin. The primary objective of this research was 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. 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 was intended to constitute a credible intervention that controls for contact time. Secondary objectives were to determine if BA improves PTSD symptomatology and associated affective distress, and to identify potential mediators of BA on smoking outcomes. A total of 124 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.
  3. Breaking Addiction to Tobacco for Health (BREATHE). This project tested new phased-based treatments to help patients in the Milwaukee and Madison areas quit smoking. Partners in this research included 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 visited a participating clinic, regardless of the initial reason for the visit, was invited to get treatment through BREATHE. This study implemented both an electronic health records (EHR) system that increased 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 experimentally compared multiple intervention components and identified especially effective interventions for every phase of smoking treatment. This included 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 have been formulating 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.
  4. Genetically Informed Smoking Cessation Trial. 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.