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 the first half of 2022, UW-CTRI has produced:
- 22 published papers or chapters (p. 1)
- 2 papers in press (p. 6)
- 32 presentations and posters (p. 6)
- 10 active studies (p. 9)
- 3 studies recently completed (p. 12)
- Financials (p. 15)
THANK YOU: UW-CTRI is grateful to its partners, including the Centers for Disease Control, Department of Veterans Affairs, Food and Drug Administration, Health Resources and Services Administration, National Heart, Lung, and Blood Institute, National Institute on Aging, Centers for Medicare and Medicaid Services, National Institutes of Health, UW Department of Family Medicine, UW Institute for Clinical and Translational Research, UW Comprehensive Cancer Center, UW Department of Medicine, UW School of Medicine and Public Health, Wisconsin Alzheimer’s Disease Research Center, Wisconsin Department of Health Services, Wisconsin Division of Care and Treatment, Wisconsin Partnership Program and Wisconsin Women’s Health Foundation.
Note: Names in bold are current UW-CTRI employees.
- Baker TB, Burris JL, Fiore MC. (2022) Helping African American Individuals Quit Smoking: Finally, Some Progress.2022;327(22):2192-2194.
Summary: The researchers applauded a new study, also published in JAMA, of 500 African Americans that shows that active varenicline plus culturally appropriate counseling more than doubled quit rates, even though they were people who mostly smoked fewer cigarettes per day. They urged healthcare providers to use electronic health records to reach out to every patient who smokes and offer this combination treatment to Black patients. They encouraged the FDA to officially ban menthols.
- Baker TB, Fiore MC. (2022) Combined Varenicline With Nicotine Patch and Extended Duration of Therapy for Smoking Cessation—Reply. 327(4):391-392.
Summary: In this reply, the authors assert that it remains important that standardized smoking treatments are identified that can be delivered routinely in busy health-care settings and can yield strong benefits. After all, the greatest constraint to helping patients quit smoking is almost certainly the low rates of smoking treatment delivery and engagement that occur in health care.
- Bray M, Chang Y, Baker TB, Jorenby DE, Carney RM, Fox L, Pham G, Stoneking F, Smock N, Amos CI, Bierut L, Chen L-S. (2022) The Promise of Polygenic Risk Prediction in Smoking Cessation: Evidence from Two Treatment Trials. Nicotine & Tobacco Research. Online February 16, 2022, ntac043.
Summary: There is a potential for polygenic risk scores to inform future clinical medicine, and a great need for evidence on whether these scores predict clinically meaningful outcomes. This meta-analysis provides early evidence for the potential utility of using them to predict the outcomes of attempts to quit smoking.
- Burris JL, Borger TN, Baker TB, Bernstein SL, Ostroff JS, Rigotti NA, Joseph AM. (2022) Proposing a Model of Proactive Outreach to Advance Clinical Research and Care Delivery for Patients Who Use Tobacco. Journal of General Internal Medicine.
Summary: This commentary introduces a comprehensive yet flexible model of proactive outreach and describes how proactive outreach can optimize clinical research and care delivery in these domains: (1) identifying the population, (2) offering treatment, and (3) delivering treatment. Adoption of the proposed proactive outreach model could improve the precision and rigor with which tobacco cessation research and tobacco treatment programs report data, which could have a positive effect on patient care.
- Buu A, Tong Z, Cai Z, Li R, Yang JJ, Jorenby DE, Piper ME. (2022) Subtypes of Dual Users of Combustible and Electronic Cigarettes: Longitudinal Changes in Product Use and Dependence Symptomatology. Nicotine & Tobacco Research. Online June 23, 2022.
Summary: This study characterizes subtypes of people who both smoke and vape, based on the dynamic interactions between cigarette use and e-cigarette use, as well as product-specific trajectories of dependence. People who predominantly vape appeared to engage in substitution, as they decreased their smoking and increased their e-cigarette dependence. Smoking bans may promote substitution of cigarettes with e-cigarettes.
- Cai X, Coffman DL, Piper ME, Runze L. (2022) Estimation and Inference for the Mediation Effect in a Time-Varying Mediation Model. BMC Medical Research Methodology. 2022;22:113.
Summary: We developed a new analytic approach, using time-varying mediation analyses, that allows us to study mediation when the outcome and mediators both vary over time. We share the analytic code in the R package of statistical programming so others can analyze time-varying outcomes and mediators.
- Chakraborti Y, Coffman DL, Piper ME. (2022) Time-Varying Mediation of Pharmacological Smoking Cessation Treatments on Smoking Lapse Via Craving, Cessation Fatigue and Negative Mood. Nicotine & Tobacco Research.
Summary: Researchers reported a statistically significant time-varying mediation effect of varenicline on smoking status through craving. They didn’t find significant time-varying mediation effects through negative mood and cessation fatigue. This study supports the importance of craving suppression in order to quit smoking. They identified specific time points when withdrawal symptoms increased that would likely benefit from targeted interventions.
- Cox CM, Westrick J, McCarthy DE, Carpenter MJ, Mathew AR. (2022) Practice Quit Attempts: Scoping Review of a Novel Intervention Strategy. Journal of Studies on Alcohol and Drugs. January 2022, 83(1), 115-125.
Summary: Researchers conducted a systematic literature search of 3,879 articles on practice quit attempts. They found that fostering practice quit attempts for people trying to quit smoking, through behavioral and pharmacological interventions, offers a promising technique for cessation induction that warrants future research.
- D’Angelo H, Hohl SD, Rolland B, Adsit RT, Pauk D, Fiore MC, Baker TB. (2022) Reach and Effectiveness of the NCI Cancer Moonshot-funded Cancer Center Cessation Initiative. Translational Behavioral Medicine. Online February 23, 2022.
Summary: Researchers found that engagement by leadership at cancer centers had a favorable impact on the reach of those centers to help cancer patients quit smoking. Investment in technology may also help cancer centers reach more patients to help them quit smoking. Understanding which implementation and intervention strategies facilitate greater cessation treatment reach and effectiveness could lead to improved outcomes among cancer patients who smoke.
- Heiden BT, Smock N, Pham G, Chen J, Baker TB, Bierut LJ, Chen L-S. (2022) Assessment of Formal Tobacco Treatment and Smoking Cessation in Dual Users of Cigarettes and E-Cigarettes. Thorax. Online July 20, 2022;0:1–7.
Summary: The researchers found that dual users of cigarettes and e-cigarettes benefit from formal tobacco treatment. Clinicians should consider offering formal tobacco treatment to such patients, though future trials are needed.
- Hohl SD, Bird JE, Nguyen CVT, Pauk D, D’Angelo H, Minion M, Adsit RT, Fiore MC, Nolan MB, Rolland B. (2022) Operationalizing Leadership and Clinician Buy-In to Implement Evidence-Based Tobacco Treatment Programs in Routine Oncology Care: A Mixed-Method Study of the U.S. Cancer Center Cessation Initiative. Current Oncology. 29(4), c. March 29, 2022.
Summary: At least 75 percent of participating cancer centers secured administrative, clinical, and IT leadership buy-in and support. Six themes emerged from interviews on what factors facilitated their efforts to help cancer patients quit smoking: engaging leadership, access to resources, leveraging federal funding support to build leadership interest, designating champions, identifying training needs, and ensuring staff roles and IT workflows.
- Hohl SD, Shoenbill KA, Taylor KL, Minion M, Bates-Pappas GE, Hayes RB, Nolan MB, Simmons VN, Steinberg MB, Park ER, Ashing K, Beneventi D, Sanderson Cox L, Goldstein O, King A, Kotsen C, Presant CA, Sherman SE, Sheffer CE, Warren GW, Adsit RT, Bird JE, D’Angelo H, Fiore MC, Nguyen CVT, Pauk D, Rolland B, Rigotti NA. (2022) The Impact of the COVID-19 Pandemic on Tobacco Treatment Program Implementation at NCI-Designated Cancer Centers. Nicotine & Tobacco Research.
Summary: This work describes how NCI-designated cancer centers participating in the Cancer Center Cessation Initiative (C3I) adapted to challenges to sustain evidence-based tobacco use treatment programs during the COVID-19 pandemic. This work offers a model for resilience and rapid transition to remote tobacco treatment services delivery and proposes a policy and research agenda for telehealth services as an approach to sustaining evidence-based tobacco treatment programs.
- Ives K, Christiansen BA, Nolan MB, Kaye JT, Fiore MC. (2022) Nine Years of Smoking Data from Incarcerated Men: A Call to Action for Tobacco Dependence Interventions. Preventive Medicine Reports.
Summary: Nearly all people in prison return to smoking shortly after release. Smoking prevalence prior to prison remains very high and is not changing. Most prison survey respondents do not consider themselves addicted. Prison survey respondents have become less interested in help to stay tobacco free. Survey results suggest possible elements for tobacco interventions.
- Johnson AL, Schlam TR, Baker TB, Piper ME. (2022) Understanding What Changes Adults in a Smoking Cessation Study Believe They Need to Make to Quit Smoking: A Qualitative Analysis of Pre- and Post-Quit Perceptions. Psychology of Addictive Behaviors. Online June 23, 2022.
Summary: Prior to quitting, more than a third of participants were unable to identify changes to increase cessation success. The others said they focused on triggers and cues for smoking. Participants who quit reported using the strategies they learned from counselors—such as the 4 D strategies (delay, drink water, deep breathing, distract), avoiding cues to smoke, changing routine, and getting support. Using FDA-approved medications was the least-reported theme.
- Kohen CB, Cofresí RU, Bartholow BD, Piasecki TM. (2022) Alcohol Craving in the Natural Environment: Moderating Roles of Cue Exposure, Drinking, and Alcohol Sensitivity. Experimental and Clinical Psychopharmacology.
Summary: Craving during drinking episodes in the natural environment is magnified by the presence of alcohol cues, potentially contributing to the maintenance or acceleration of drinking episodes. Moreover, people who drink with lower sensitivity may be particularly susceptible to the combined effects of cue exposure and post-drinking status on alcohol craving.
- LeFoll B, Piper ME, Fowler CD. (2022) Tobacco and Nicotine Use. Nature Reviews Disease Primer. 8(19).
Summary: Given that the majority of people who smoke ultimately relapse, the researchers asserted that it’s important to enhance the reach of available interventions and to continue to develop novel interventions. These efforts associated with innovative policy regulations (aimed at reducing nicotine content or eliminating tobacco products) have the potential to reduce the prevalence of tobacco and nicotine use and their enormous adverse impact on population health.
- McCarthy DE, Baker TB, Zehner ME, Adsit RA, Kim N, Zwaga D, Coates K, Wallenkamp H, Nolan M, Steiner M, Skora A, Kastman C, Fiore MC. (2022) A Comprehensive Electronic Health Record-Enabled Smoking Treatment Program: Evaluating Reach and Effectiveness in Primary Care in a Multiple Baseline Design. Preventive Medicine. Online May 28, 2022.
Summary: Implementation of a comprehensive, opt-out, chronic-care program aimed at all patients who smoke was associated with increases in the rates of pharmacotherapy and counseling delivery and quitting smoking. Proactive outreach may help reduce disparities in treatment access. Telephone treatment reach was particularly high in historically underserved groups, including African American, Hispanic, and Medicaid-eligible patients.
- Nuako A, Liu J, Pham G, Smock N, James A, Baker TB, Bierut L, Colditz G, Chen L-S. (2022) Quantifying Rural Disparity in Healthcare Utilization in the United States: Analysis of a Large Midwestern Healthcare System. PLOS One. Online February 10, 2022.
Summary: Within the large healthcare system, patients in rural clinics had lower outpatient healthcare utilization compared to their urban counterparts despite having potentially elevated health needs reflected by a higher number of unique health diagnoses documented in their electronic health records after adjusting for multiple factors.
- Piper ME, Maddox R, Castro Y, Hinds JT, Henderson PN, Clark H, Guy MC, Choi K. (2022) Lessons Learned on Addressing Racism: Recommendations from The Society for Research on Nicotine & Tobacco’s Racial Equity Task Force. Online June 25, 2022.
Summary: In this editorial, the authors review the recommendations of the Society for Research on Nicotine and Tobacco’s Racial Equity Task Force on how to address individual and institutional racism within academia in general and within the field of commercial tobacco and nicotine science.
- Ramsey AT, Baker TB, Stoneking F, Smock N, Chen J, Pham G, James AS, Colditz GA, Govindan R, Bierut LJ, Chen L-S. (2022) Increased Reach and Effectiveness With a Low-Burden Point-of-Care Tobacco Treatment Program in Cancer Clinics. Journal of the National Comprehensive Cancer Network. Online May 17, 2022.
Summary: This study of 13,651 oncology patients examined whether a health system could leverage their electronic health system to identify patients who smoke and offer help to quit. It worked. The system had a low burden on oncology staff and was delivered at point-of-care. This improved access to (and the impact of) evidence-based treatment to quit smoking. It could be implemented at cancer centers across the country to bolster reach to patients who smoke to help them quit, improving cancer outcomes.
- Slutske WS, Davis CN, Lynskey MT, Heath AC, Martin NG. (2022) An Epidemiologic, Longitudinal, and Discordant-Twin Study of the Association Between Gambling Disorder and Suicidal Behaviors. Clinical Psychological Science. Online January 10, 2022.
Summary: The association of suicidal thoughts with disordered gambling was non-causally explained by common genetic influences among women but not men. Conversely, there was evidence consistent with a potentially causal influence of disordered gambling on suicide attempts among men only. This might have been related to gambling-related financial problems. The causes of the association with disordered gambling differed for suicidal ideation, plan, and attempt (and differed by gender).
- Yang J, Kuo J, Su W-C, Jorenby DE, Piper ME, Buu A. (2022) A New Statistical Model for Longitudinal Ecological Momentary Assessment Data on Dual Use of Electronic and Combustible Cigarettes. Methods in Addiction Research. Online January 31, 2022.
Summary: This study proposed a new statistical method to analyze data from the measurement burst design (eg hourly, daily measurements are embedded in a larger longitudinal study). The proposed method is highly applicable as it can be easily implemented by substance use researchers and the results can be straightforwardly interpreted. The results suggest that e-cigarette use may play a role in promoting a long-term reduction in smoking among dual users.
- Christiansen B, Riemer D, Conner K, Fiore MC. The Bucket Approach: Developing and Implementing an Online Training Program in Tobacco Dependence Interventions Tailored for Behavioral Health Clinicians. Community Mental Health Journal.
- Cofresí RU, Kohen C, Motschman C, Wiers RW, Piasecki TM, Bartholow BD. Approach Bias to Alcohol Cues in Lower-Sensitivity Drinkers: Event-Related Potentials Implicate Response Conflict and Stimulus Significance.
To search a sortable database of all UW-CTRI papers since inception, click here.
Research Presentations and Posters
Note: Names in bold are current UW-CTRI employees.
- Chakraborti Y, Coffman D, Litson K, Piper ME. Using Mixture Models to Identify Smoking Cessation Profiles Based on Self-Efficacy, Positive Expectancy, Motivation, and Cessation Fatigue: An Exploratory Latent Profile and Latent Transition Analysis. Society for Research on Nicotine or Tobacco Conference. Poster. Baltimore, MD. March 2022.
- Conner, K. COVID-19 and Smoking EHR Data: 1 Million Patients and Counting. National Conference on Tobacco or Health. Presentation. New Orleans, LA. June 2022.
- Cook JW, Piper ME, McCarthy DE, Schlam TR, Zwaga D, Kaye JT, Johnson AL, Baker TB. Anhedonia: Relations with Withdrawal and Abstinence During a Smoking Cessation Attempt in a Randomized Controlled Trial. Society for Research on Nicotine or Tobacco Conference. Poster. Baltimore, MD. March 2022.
- Correa-Fernández V, Tavakoli N, Motsenbocker M, Llaneza D, Rabello L, Cartagenova D, Kim H, Wetter DW, Canino G, Li L, Piper ME. Telehealth Smoking Cessation Intervention for Latinx who Smoke and Had Depression and/or Anxiety: Findings from a Feasibility Study. Society for Research on Nicotine or Tobacco Conference. Poster. Baltimore, MD. March 2022.
- Creswell P, McCarthy DE, Trapskin P, Sheehy A, Skora A, Adsit RT, Zehner ME, Baker TB, Fiore MC. Can Inpatient Pharmacists Move the Needle on Smoking Cessation? Evaluation Reach and Representativeness of a Pharmacist-Led Opt-Out Smoking Cessation Intervention Protocol for Hospital Settings. Society for Research on Nicotine or Tobacco Conference. Baltimore, MD. March 2022.
- Fiore MC. Predicting Patient Outcomes in Wisconsin and Nationwide Using the University of Wisconsin’s COVID EHR Cohort Database. UW-Wisconsin Partnership Program (WPP) PERC Meeting. Virtual presentation. January 2022.
- Fiore MC. Breathe 2 Training. UW Health Union Corners. Virtual presentation. January 2022.
- Fiore MC. Tobacco Dependence and Treatments. UW-CTRI & Cessation Research Overview SMPH / UW-CTRI UW Spring 4th years’ Spring Elective. Virtual presentation. February 2022.
- Fiore MC. BREATHE2: Project 3: National Cancer Institute Research Program to Help UW-Health Patients Quit Smoking. UW Health Primary Care Leadership Council (PCLC) Meeting. Virtual presentation. March 2022.
- Fiore MC, Hohl SD, Salloum RG, Bernstein SL, Minion M, Lenhoff K, Dahl N, Juon HS, Tsosie U, Fleisher L, Rolland B, D’Angelo H, Ramsey AT, Ostroff JS, Ashing KT, Scholl R, Chen LS. Optimizing Reach and Effectiveness of Tobacco Treatment in Cancer Patients: Lessons from the Cancer Moonshot Cancer Center Cessation Initiative. Society for Research on Nicotine or Tobacco Conference. Presentation. Baltimore, MD. March 2022.
- Fiore MC. Tenure Track for Adrienne Johnson, PhD. Division of General Internal Medicine –UW-CTRI DOM Executive Meeting. Virtual presentation. March 2022.
- Fiore MC. Center Update / UW-CTRI 30th UW-CTRI All-Staff Meeting. Madison, WI. April 2022.
- Fiore MC. Helping Cancer Patients Who Smoke: Future Directions. American Association for Cancer Research Annual Meeting. New Orleans, LA. Presentation. April 2022.
- Fiore MC. Unfinished Business: The Achievable Goal of Eliminating All Tobacco Product Use in the United States by 2030. American Thoracic Society (ATS) Annual Conference. Keynote Presentation. San Francisco, CA. May 2022.
- Fiore MC. Integrating Tobacco Cessation Treatment on the Cancer Journey. National Conference on Tobacco or Health. Poster. New Orleans, LA. June 2022.
- Garner BR, Tueller SJ, Bradshaw M, Mungo J, McDaniel S, Ford II JH, Zehner ME, Roosa MR, Speck KJ, Satre DD, Martino S. Integrating Motivational Interviewing within HIV Service Organizations: Preliminary findings from a type 3 hybrid trial. Colorado Pragmatic Research in Health [Virtual] Conference. Poster. Aurora, CO. May 2022.
- Gorrilla A, Skora A, Thompson S, Lundsten S, Conner K. Improving Access to Tobacco Dependence Treatment for People Who Are Justice-Involved. National Conference on Tobacco or Health. Poster. New Orleans, LA. June 2022.
- Hollenback C, Jorenby DE, Fiore MC. Using Instagram to Refer Teens to Teen.Smokefree.gov. Society for Research on Nicotine or Tobacco Conference. Poster. Baltimore, MD. March 2022.
- Johnson A, Gleason CE, Cook JM, Mahoney JE, Piper ME. Motivating Change in Older Adults: Motivational Cessation Message Development Findings. Society for Research on Nicotine or Tobacco Conference. Poster. Baltimore, MD. March 2022.
- Jorenby DE. Smoking Cessation 2022: CVD Core (Prevention). UW Hospital and Clinics Cardiovascular Disease Fellowship. Madison, WI. June 2022.
- Kaye JT, Ives K, Christiansen B, Nolan MB, Fiore MC. Rethinking Tobacco Treatment for Incarcerated Adults to Achieve Health Equity. Society for Research on Nicotine or Tobacco Conference. Poster. Baltimore, MD. March 2022.
- Kaye JT, Ives K, Christiansen B, Nolan MB, Fiore MC. Presented by Conner K. Rethinking Tobacco Treatment for Incarcerated Adults to Achieve Health Equity. National Conference on Tobacco or Health. Poster. New Orleans, LA. June 2022.
- Kim N, McCarthy DE, Coffman D, Piper ME, Bolt D, Stein JH, Baker TB. Time-Varying Mediators of Pre- and Post-Quit Nicotine Patch Therapy in Adults Attempting to Quit Smoking with Varenicline. Society for Research on Nicotine or Tobacco Conference. Pre-recorded digital presentation only. Baltimore, MD. March 2022.
- Kirsch J, Zehner M, Adsit R, McCarthy D, Gorrilla A, Hayden K, Skora A, Rosenblum M, Fiore MC, Baker TB. Electronic Health Record Closed-loop Referral (eReferral) to a State Tobacco Quitline: Primary Care Implementation Challenges and Adaptations. Society for Research on Nicotine or Tobacco Conference. Poster. Baltimore, MD. March 2022.
- Piper ME. SRNT Presidential Symposium. Society for Research on Nicotine or Tobacco Conference. Baltimore, MD. March 2022.
- Piper ME (Chair), Cummings M, Munafo M, Castro Y, Benowitz N, Meyers M, Rigotti N, Hatsukami D, Carroll D, Leischow S, et al. It’s All About the Science: How Do We Do It Thoughtfully in a Changing Environment? Society for Research on Nicotine or Tobacco Conference. Symposium. Baltimore, MD. March 2022.
- Piper ME, Zeller M. Updates on the FDA Center for Tobacco Products with Mitch Zeller. Society for Research on Nicotine or Tobacco Conference. Symposium. Baltimore, MD. March 2022.
- McCarthy DE, Baker TB, Zehner M, Adsit R, Kim N, Zwaga D, Coates K, Wallenkamp H, Nolan M,Steiner M, Skora A, Kastman C, Fiore MC. Evaluation of an Opt-out Chronic Care Program to Treat Smoking in Adult Primary Care. Presentation. Baltimore, MD. March 2022.
- Macmaster D. Presented by Conner K. Tobacco Use Disorder Excluded from Substance Use Disorders for Nearly Half a Century. Society for Research on Nicotine or Tobacco Conference. Poster. Baltimore, MD. March 2022.
- Mundt MP, McCarthy DE, Baker TB, Zehner ME, Zwaga D, Fiore MC. Cost-Effectiveness of a Chronic Care Smoking Treatment Program in Primary Care. Society for Research on Nicotine or Tobacco Conference. Poster. Baltimore, MD. March 2022.
- Mundt MP, McCarthy DE, Baker TB, Zehner ME, Zwaga D, Fiore MC. The Cost-Effectiveness of a Tobacco Treatment Intervention with Certified Tobacco Treatment Specialists in Real-World Primary Care Clinics. Podium presentation at the Academy Health conference, Washington, DC, June 2022.
- Salloum RG, Hohl SD, Nolan MB, D’Angelo H, Asvat Y, Chen L-S, Day AT, Goldstein AO, Hitsman B, Hudson D, King AC, Lam CY, Lenhoff K, Levinson AH, Prochaska J, Shoenbill KA, Taylor K, Tindle H, Tong E, White JS, Warren GW, Fiore MC, Rolland B. Evaluating the Efficiency of Tobacco Treatment Programs in the Cancer Moonshot Cancer Center Cessation Initiative: Data Envelopment Analysis. Society for Research on Nicotine or Tobacco Conference. Poster. Baltimore, MD. March 2022.
- Schlam TR, Baker TB, Cook JW, Zwaga D, Smith SS, Fiore MC, Piper ME. Next Steps Following Unsuccessful Smoking Cessation Treatment: The Value of Chronic Care. Society for Research on Nicotine or Tobacco Conference. Pre-recorded paper online plus poster session. Baltimore, MD. March 2022.
- Schlam TR, Baker TB, Piper ME, Cook JW, Smith SS, Zwaga D, Jorenby DE, Bolt DM, Collins LM, Mermelstein R, Fiore MC. Relapse Recovery Treatment: An Experimental Evaluation of Multiple Approaches to Smoking Treatment. Annual Meeting of the Society of Behavioral Medicine (SBM). Poster. Baltimore, MD. April 2022.
- Zehner ME, Kirsch JA, Adsit RT, McCarthy DE, Gorrilla A, Hayden K, Skora A, Rosenblum M, Fiore MC, Baker TB. Electronic Health Record Closed-loop Referral (eReferral) to a State Tobacco Quitline: Primary Care Implementation Challenges and Adaptations. Annual Meeting of the Society for Research on Nicotine and Tobacco. Poster. Baltimore, MD. March 2022.
- Zwaga D, McCarthy DE, Baker TB, Zehner ME, Adist RT, Skora A, Kastman K, Steiner M, Wallenkamp H, Coates K, Fiore MC. Clinicians Who Provide More Chronic and Frequent Primary Care to Adult Patient Adopt and Implement Comprehensive Chronic Tobacco Treatment at Higher Rates. Society for Research on Nicotine or Tobacco Conference. Poster. Baltimore, MD. March 2022.
- 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, Jonah Stankovsky, 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. Data collection for the project concluded at the end of January 2022. EHR data on approximately 1.5 million patients who tested positive for, or were diagnosed with, COVID-19 was collected, including 149,989 hospitalized patients. May 2020-September 2022, $3 million. Funded by NCI. Dr. Michael Fiore, PI.
- Predicting Patient Outcomes in Wisconsin and Nationwide Using the University of Wisconsin’s COVID-19 EHR Cohort Database. The major goal of this study is to utilize the COVID EHR Cohort at the University of Wisconsin (CEC-UW) database to improve the health and well-being of the people of Wisconsin. This will be accomplished by examining predictors of patient outcomes at the UW Health site specifically and conducting focused contrasts of effects found at UW Health to those at other participating health systems. February 2022-January 2024, $300,000. Funded by Wisconsin Partnership Program. Michael Fiore and Tom Piasecki, PIs.
- Breaking Addiction to Tobacco for Health 2 (BREATHE 2). 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 people who smoke. 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 people who smoke 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 people who smoke in America make a primary care visit each year, but only about five percent of people who smoke 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.
- VA Merit Grant. 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. Jess Cook, PI.
- Motivating Change in Aging People Who Smoke. This K23 award funds a research study to increase smoking cessation in adults age 50 and older. While these adults smoke at lower rates (8.2%) than the general population (13%), their cessation rates are also lower because they are less likely to be advised to quit or offered help by providers. A common misperception is that mature adults can’t or won’t quit and, if they do, they won’t benefit from it. But the research reflects the contrary. When they do try to quit, they’re generally more successful than younger people, especially when they use evidenced-based treatments (which double their success). The study will run qualitative interviews to look at what might motivate older adults to quit. One potential incentive is pointing out that quitting smoking can reduce risk for cognitive decline—commonly cited as the greatest fear among mature adults, but one yet to be used for motivation with smoking cessation. UW-CTRI will recruit participants via signs, posters, calls from each person’s clinic, and a letter to motivate and offer treatment. Researchers will compare that to a clinic with no message and a clinic with a standard motivational method. The group plans to run the study at three clinics in the same health system. They’ll be tuned into any behavioral health symptoms and the socioeconomic status of the participants to better analyze and interpret results. Drs. Megan Piper, Carey Gleason, Jane Mahoney, and Jessica Cook are serving as co-mentors to Principal Investigator Dr. Adrienne Johnson. May 2021-Feb 2026, $782,000. Funded by the National Institute on Aging of the National Institutes of Health. Dr. Adrienne Johnson, PI.
- Alzheimer’s Disease Research Center (ADRC) Developmental Grant. This project aims to develop a tailored intervention for African Americans age 50 and older to motivate them to quit smoking. African Americans are disproportionately more likely than white adults to develop dementia and suffer health effects of smoking. For this project, UW-CTRI Researcher Dr. Adrienne Johnson is collaborating with Lorraine Lathen, Director of the Wisconsin African American Tobacco Prevention Network. April 2021-March 2023, $150,000. Funded by the Wisconsin Alzheimer’s Disease Research Center with funds from the National Institute on Aging of the National Institutes of Health. Adrienne Johnson, PI.
- Withdraw from Tobacco Study. This study has recruited more than 200 people to quit without medication for the first week. All participants then get eight weeks of combination nicotine-replacement medication (nicotine patch and mini lozenge). Study staff provide coaching to help participants quit smoking and confirm their smoking status 9 weeks after the quit date. One of the important products of our research at UW-CTRI is the Wisconsin Smoking Withdrawal Scale (WSWS). The Withdraw from Tobacco Study, led by Dr. Tim Baker and Dr. Jesse Kaye, will be critical to improving the scale, making it congruent with recent research on the nature of smoking withdrawal. June 2021-December 2022, $1.2 Million. Funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health. Drs. Timothy Baker and Jesse Kaye, PIs.
- First Breath Families: Helping Low-Income Moms Quit Smoking and Babies Grow Up Smoke-Free. 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). Karen Conner and Dr. Michael Fiore, Academic Partners. Lisette Kahlil, Wisconsin Women’s Health Foundation Community Lead.
- Improving Quitline Support Study (IQS). This project evaluated promising strategies to enhance quit-smoking success among low-income people who smoke. Researchers enrolled 1,408 Medicaid-eligible or uninsured people who smoke who continued smoking four months after engaging in standard services from the Wisconsin Tobacco Quit Line. These people who smoke were 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.
- 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: people who vape, smoke, vape and smoke, or never used. 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:
- Characterize carotid artery echogenicity (a novel measure of arterial injury).
- Perform treadmill exercise stress testing (to measure exercise capacity, heart rate recovery, heart rate reserve, and rate-pressure product).
- Electrocardiography (to measure heart rate variability).
- 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.
Recently Completed Studies
- Options Study. The Options Study has been conducted by UW-CTRI in the Madison and Milwaukee areas. Participants temporarily switch from just smoking to alternative products. These products include Juul e-cigarettes or cigarettes with very low nicotine content. Participants will get paid up to $380. All study participants were who didn’t want to quit smoking, but were willing to switch from their cigarettes to something new for a week. The four weeks of the study had different goals:
- Week 1: Try out the study product they were randomly assigned to use: Juul e-cigarettes, VLN cigarettes or no alternative product. They could smoke their own cigarettes as usual.
- Week 2 (Switch Week): Don’t smoke their own cigarettes but use a patch (active or placebo) and their assigned study product.
- Week 3: Smoke their own cigarettes and use their study product as much as they want.
- Week 4 (Switch Week): Don’t smoke their own cigarettes but use a patch (if they had an active patch with nicotine in Week 2 they now had a placebo patch with no nicotine or vice versa) and their assigned study product.
Researchers will examine how well Juul or low-nicotine cigarettes can substitute for regular smoking, and how nicotine patches factor into it and why. May 2019-April 2022, $1.4 million. Funded by NCI and FDA. Dr. Megan Piper, PI.
- Transforming the Treatment of Tobacco Use in Healthcare: Seizing the Potential of the Electronic Health Record (EHR) to Deliver Comprehensive Chronic Care Treatment for Smoking. This R35 grant to Dr. Michael Fiore was designed to offer flexibility to researchers in the quest to overcome barriers in helping primary-care patients quit smoking. In other words, it sparked innovation to translate efficacious treatments into clinical use. Projects have included:
- Tobacco Cessation Quitline eReferral. This study was 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 integrated 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 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 presented 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 people who smoke, 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—appeared to be safe and showed 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 people who smoke 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 ensured patients had the tools they needed to quit smoking for good. All six GHC primary-care sites were actively participating in this project.
- Tablet Technology Pilot Project with Low-Income People Who Smoke. 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 people who smoke 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 evaluated modest financial incentives to people who smoke who engaged in quit planning with the GHC Tobacco Cessation Outreach Specialists. More than 500 patients who smoked were 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.
- Quit Line eReferral with Feedback and Nicotine Patch Sampling. UW-CTRI partnered with Ascension Wisconsin to develop strategies to enhance system-wide implementation of electronic referral (eReferral) to the Wisconsin Tobacco Quit Line for adult primary care patients who smoke. UW-CTRI continues to work with 32 Ascension clinics to evaluate the effectiveness of monthly implementation feedback and provision of free nicotine patch samples in an ongoing experiment to identify strategies that increase the reach of Quit Line treatment. November 2019-February 2022, $150,000. Funded by the UW Institute for Clinical and Translational Research. Dr. Danielle McCarthy, PI.