Recent Papers

Published Papers

Below are the research papers published by UW-CTRI from January through June 2015. For a complete list of UW-CTRI publications, click here.

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

Adsit R, Wisinski K, Mattioson R, Bailey H, Fiore MC. A Survey of Baseline Tobacco Cessation Clinical

Practices and Receptivity to Academic Detailing. Wisconsin Medical Journal. 2016; 115(3):143-6.


Summary: Fifteen clinics responded to the survey and 11 agreed to onsite academic detailing. Most clinics reported that they identify tobacco users, but fewer advised smokers to quit or provided evidence-based tobacco cessation treatments. Less than half of Wisconsin cancer clinics consistently seize the oncology visit to address tobacco use, and the majority of cancer clinics are receptive to onsite academic detailing to increase the frequency and effectiveness of their tobacco cessation interventions.


Baker TBPiper ME, Stein JH, Smith SS, Bolt DM, Fraser DLFiore MC. The Effects of the Nicotine Patch vs. Varenicline vs. Combination Nicotine Replacement Therapy on Smoking Cessation at 26 Weeks: A Randomized Controlled Trial. JAMA. 2016;315 (4):371-379.


Summary: Research shows three medications combined with coaching to quit smoking—a pill called varenicline (Chantix), the nicotine patch alone, and a combination of nicotine-replacement medications—helped about the same percentage of participants to quit smoking. The research showed that about 1 out of 4 of the WSHS 2 patients had quit smoking 6 months after the quit date. Other studies have found that the average quit rate for those who try to quit without coaching or medication is only about 1 out of 20.

Berg KSmith SSCook JWFiore MCJorenby DE. Identifying Opportunities to Improve Smoking Cessation Among Women Veterans at a Veterans Hospital. Military Medicine. 2016 Oct;181(10):1340-1347.


Summary: Only 24 percent of women Veteran smokers were referred to the tobacco cessation clinic at the Veterans Hospital, and these smokers tended to be older, heavier smokers who were in need of more services. Of that subset, just 54 percent of referred women actually enrolled in treatment, and again these patients tended to have more medical needs. The women Veterans who were referred were a much different subset than those who were not. More research is needed on why there is a discrepancy.


Bold KW, McCarthy DE, Minami H, Yeh VM, Chapman GB, Waters AJ. Independent and Interactive Effects of

Real-Time Risk Factors on Later Temptations and Lapses Among Smokers Trying to Quit. Drug and Alcohol Dependence. 2016; 158:30-37.


Summary: Prior smoking, higher distress, and recent alcohol use predicted smoking versus resisting temptation, and momentary impulsiveness was related to smoking for individuals with higher baseline impulsiveness. The risk factors, and combinations of those factors, associated with temptations and smoking lapses differ, suggesting a need for separate models of temptation and lapse.


Bold KW, Witkiewitz K, McCarthy DE. Multilevel Factor Analysis of Smokers’ Real-Time Negative Affect Ratings While Quitting. Psychological Assessment. Vol 28(9), Sep 2016, 1033-1042.


Summary: In an examination of negative emotions related to quitting smoking, researchers found evidence supporting a 2-factor model with correlated but distinct agitation and distress factors. The agitation factor was indicated by these items: impatient, tense/anxious, restless. The distress factor was indicated by these items: sad/depressed, upset, distressed. The 2-factor model held true across 3 separate cessation phases: prequit, postquit with recent smoking, and postquit without recent smoking.


Bray BC, Smith RA, Piper ME, Roberts LJ, Baker TB. Transitions in Smokers’ Social Networks After Quit Attempts.Nicotine and Tobacco Research. 2016 Dec;18(12):2243-2251.


Summary: A common fear of many smokers who want to quit is that they will lose many people in their social network―family, friends or co-workers―when they quit smoking. In fact, the opposite is true. Smokers who quit were more likely to transition to larger social networks, especially amongst participants who had the highest levels of exposure to other smokers before quitting. In other words, quitting was associated with an increase in the number of people, especially non-smokers, in people’s social circles.


Chen LS, Baker TB, …Bierut L. Genetic Risk Can be Decreased: Quitting Smoking Decreases and Delays Lung Cancer for Smokers with High and Low CHRNA5 Risk Genotypes, a Meta-Analysis. EBioMedicine. 2016;S2352-3964(16)30361-9.


Summary: This paper demonstrates that quitting smoking is highly beneficial in reducing lung cancer risks for smokers regardless of their CHRNA5 rs16969968 genetic risk status. Smokers with high-risk CHRNA5 genotypes, on average, can largely eliminate their elevated genetic risk for lung cancer by quitting smoking—cutting their risk of lung cancer in half and delaying its onset by 7 years for those who develop it. These results suggest that the CHRNA5 rs16969968 genotype affects lung cancer diagnosis through its effects on smoking, and have potential value for framing preventive interventions for those who smoke.


Christiansen B, McMaster DR, Heiligenstein EL, Glysch RL, Reimer DM, Adsit R, Hayden KA, Hollenback C,Fiore MC. Measuring the Integration of Tobacco Policy and Treatment into the Behavioral Health Care Delivery System: How are we Doing? Journal of Health Care for the Poor and Underserved. 2016; 27(2):510-26.


Summary: A 65-item Internet survey measuring integration of tobacco treatment into behavioral health care garnered a response rate of 27.1%. Programs, on average, were 40% integrated. A significant proportion of programs (20%) were less than 20% integrated. A few programs (4.3%) exceeded 80% integration. Integration of tobacco policies and treatment into the behavioral-health-care delivery system remains limited and there is a need for ongoing education, technical assistance and training.


Fiore, MC. Tobacco Control in the Obama Era – Substantial Progress, Remaining Challenges. New England Journal of Medicine. 2016;375(15):1410-1412.


Summary: Since President Barack Obama took office in 2009, the U.S. age-adjusted prevalence of adult cigarette smoking has fallen markedly—from 20.6% in 2009 to 15.3% today. That’s a decrease of about 0.78 percentage points per year, more than double the annual rates of decline during the George W. Bush (.36 percentage points per year) and Bill Clinton (.28 percentage points per year) administrations. At the pace set during the Obama era, adult smoking in the US would end in about 20 years.


Fiore MC, Adsit R. Will Hospitals Finally “Do The Right Thing”? Providing Evidence-Based Tobacco Dependence Treatments to Hospitalized Patients Who Smoke. The Joint Commission Journal on Quality and Patient Safety. 2016 May; 42(5):207-8.


Summary: In this editorial, the authors discuss their optimism that more hospital staff will seize the opportunity to help inpatients quit tobacco use. Approximately 20% of 3,705 hospitals are now reporting their performance on the tobacco cessation measure set, according to The Joint Commission. A binding rule that incentivizes compliance would likely dramatically improve the percentage of inpatients who get help to quit smoking. A new measure set and the Affordable Care Act guidance to insurers to cover tobacco-use counseling and medications offer hope more hospitals will treat tobacco dependence.


Fiore MCJorenby DEBaker TB. Don’t Wait for COPD to Treat Tobacco Use and Dependence. Chest. 2016; 149(3):617-8.


Summary: Patients with COPD tend to be offered help to quit tobacco use at higher rates than other patients. This editorial calls on clinicians not to wait until COPD to treat tobacco use.


Hendricks PS, Hall SM, Tyus LR, Thorne CB, Lappan SN, McMurray MV, Bailey WC, Cropsey KL, Baker TB. Withdrawal Exposure and Withdrawal Regulation Training for Smoking Cessation: A Randomized Controlled Pilot Trial. Drug and Alcohol Dependence. 2016; 164:28-37.


Summary: Smokers were randomized to one of two conditions: 1) Withdrawal Exposure with Withdrawal Regulation Training (WT) over four separate sessions; or 2) Relaxation Control (RC) training, which controlled for the therapeutic contact of WT. All sessions occurred before the quit date. Twenty-two percent of participants in the WT condition were abstinent at both time points, whereas 0% and 4.2% of participants in the RC condition were abstinent at Months 2 and 3. This suggests WT promotes abstinence by enhancing withdrawal regulation.


Jorenby DSmith SSFiore MCBaker TB. Nicotine Levels, Withdrawal Symptoms, and Smoking Reduction Success in Real World Use: A Comparison of Cigarette Smokers and Dual Users of Both Cigarettes and E-Cigarettes. Drug and Alcohol Dependence. 2016 Nov 9;170:93-101.


Summary: Among a group of experienced dual users, e-cigarettes helped maintain smoking reduction and reduced some withdrawal symptoms, although both withdrawal symptoms and nicotine levels varied as a function of gender. Compared to those who only smoked cigarettes, dual users of cigarettes and e-cigarettes did not smoke significantly fewer cigarettes during either periods of ab lib use or during periods of smoking restriction, nor did they produce lower CO levels. Thus, this research yielded a mixed pattern of how effective e-cigarettes might be at displacing cigarette use.


King CC, Piper ME, Gepner AD, Fiore MCBaker TB, Stein JH. The Longitudinal Impact of Smoking and Smoking Cessation on Inflammatory Markers of Cardiovascular Disease Risk. Arteriosclerosis, Thrombosis, and Vascular Biology. 2016 Dec 8.


Summary: Researchers collected blood and urine samples and examined them for signs of inflammation, which is the body’s way of protecting itself. Inflammation affects not only how quickly injuries heal but also how healthy one’s heart and arteries are. The more inflammation a patient has, the harder it is on that patient’s heart. Researchers found that certain inflammation markers, such as the number of white blood cells, worsened the more people smoked. When people quit smoking, the number of white blood cells was much lower. This seemed to be one more way quitting can improve cardiovascular health.


Kruger J, O’Halloran A, Rosenthal AC, Babb SD and Fiore MC. Receipt of Evidence-Based Brief Cessation Interventions by Health Professionals and Use of Cessation Assisted Treatments Among Current Adult Cigarette-Only Smokers: National Adult Tobacco Survey, 2009–2010. BMC Public Health. February 2016; 11;16(1):141.


Summary: Among 10,000 smokers, 6% reported use of both counseling and medication for smoking cessation within the past year, medication-only (20%), a class or program (4%); one-on-one counseling (4%); and a telephone quitline (3%). Current cigarette-only smokers who reported receiving all 5 A’s during a recent clinic visit were more likely to use counseling, medication, or a combination of counseling and medication compared to smokers who received one or none of the 5 A’s components.


Land S, Toll BA, Moinpour CM, Mitchell SA, Ostroff JS, Hatsukami DK, Duffy SA, Gritz ER, Rigotti NA, Brandon TH, Prindiville SA, Sarna LP, Schnoll RA, Herbst RS, Cinciripini PM, Leischow SJ, Dresler CM, Fiore MC, Warren GW. Research Priorities, Measures, and Recommendations for Assessment of Tobacco Use in Clinical Cancer Research. Clinical Cancer Research. 2016 Apr 15; 22(8):1907-13.


Summary: A cognitive interview study was conducted with 30 cancer patients at the NIH Clinical Center to evaluate and improve tobacco measurement. The resulting Cancer Patient Tobacco Use Questionnaire (C-TUQ) includes cigarette and other tobacco use status, intensity, and past use; use relative to cancer diagnosis and treatment; cessation approaches and history; and secondhand smoke exposure. The Task Force recommends that assessment occur at study entry and, at a minimum, at the end of protocol therapy in clinical trials. Broad adoption is recommended.


McCarthy DE, Bold KW, Minami H, Yeh VM. A Randomized Clinical Trial of a Tailored Behavioral Smoking

Cessation Preparation Program. Behaviour Research and Therapy. 2016 March; 78:19-29.


Summary: Adult daily smokers were randomly assigned to standard treatment with nicotine patch and individual counseling or to standard treatment plus “practice quitting.” Treatment manipulation increased the interval between cigarettes across practice quitting sessions on average by 400%. The primary endpoint, seven-day point-prevalence abstinence at four weeks post-quit, was not significantly affected by practice quitting (31.9% in the standard treatment condition, 37.0% in the practice quitting condition). Practice quitting increased latency to a first lapse and prevented progression from a first lapse to relapse.

McCarthy DE, Bold KW, Minami H, Yeh VM, Rutten E, Nadkarni S, Chapman GB. Reliability and Validity of Measures of Impulsive Choice and Impulsive Action in Smokers Trying to Quit. Experimental and Clinical Psychopharmacology. 2016 Apr; 24(2):120-30.


Summary: Baseline behavioral measures of impulsive choice and impulsive action were used as predictors of smoking cessation success over 12 weeks. Facets of impulsiveness appear to function largely independently in adult smokers, as indicated by their lack of intercorrelation, differential stability, and differential relations with abstinence. Impulsive action may impede initial quitting, whereas impulsive choice may be an obstacle to maintaining lasting abstinence.


McCarthy DE, Ebssa L, Witkiewitz K, Shiffman S. Repeated Measures Latent Class Analysis of Daily Smoking in Three Smoking Cessation Studies. Drug and Alcohol Dependence. 2016;165:132-142.

Summary: In this analysis, 3-month point-prevalence abstinence rates varied among the latent classes, with 38-55% abstinent among early quitters, 3-20% abstinent among those who smoked intermittently throughout the first 27 days, and fewer than 5% abstinent in the classes marked by little or delayed change in smoking. High-dose nicotine patch and bupropion promoted abstinence.


Piper ME, Vasilenko SA, Cook JW, Lanza ST. What a Difference a Day Makes: Differences in Initial Abstinence Response During a Smoking Cessation Attempt. Addiction. 2016 Sep 15.


Summary: Combination nicotine-replacement therapy (NRT), which includes a pairing of patches with gum or lozenges, reduced the number of participants classified in the group who experienced especially low pleasure, illustrating the importance of NRT to mitigate relapse risks. This was especially important because the group with high cravings and low pleasure levels had the lowest abstinence rates at 8 weeks and 6 months, as well as the fewest days until they relapsed.


Rojewski AM, Baldassarri S, Cooperman NA, Gritz ER, Leone FT, Piper ME, Toll BA, & Warren GW, on behalf of the Comorbidities Workgroup of the Society for Research on Nicotine and Tobacco (SRNT) Treatment Network. Exploring Issues of Comorbid Conditions in People Who Smoke. Nicotine & Tobacco Research, 2016 Aug;18(8):1684-96.


Summary:  Across comorbid conditions, smoking adversely affects treatment efficacy and promotes other adverse health conditions. People with comorbid conditions who smoke are motivated to quit and respond to evidence-based smoking cessation treatments. However, tobacco cessation is not regularly incorporated into the clinical care of many individuals with comorbidities. Further work is needed to disseminate evidence-based care into clinical practice for smokers with comorbid disease and addiction. Research should consider comorbid conditions as an important construct to explore.

Schulte D, Duster M, Warrack S, Valentine S, Jorenby D, Shirley D, Sosman J, Catz S, Safdar N. Feasibility of Smoking Cessation Interventions for Prevention of Healthcare-Associated Infections in Inpatients. Substance Abuse Treatment, Prevention and Policy. 2016 Apr 26;11:15.


Summary:  This pilot examined the feasibility and acceptability of a tobacco-cessation intervention compared with usual care in inpatients. No subjects utilized free tobacco cessation services after discharge. After discharge, abstinence rates were 17% for the intervention group and 7% for the control group. Secondary outcomes with regard to infections showed that, at discharge, 12% of the intervention group (n=17) and 18% of the control group (n=22) tested positive for Staphylococcus aureus.


Smits JA, Kauffman BY, Lee-Furman E, Zvolensky MJ, Otto MW, Piper ME, Powers MB, Rosenfield D. Enhancing Panic and Smoking Reduction Treatment With D-Cycloserine: Study Protocol For a Randomized Control Trial.Contemporary Clinical Trials. 2016 May; 48:46-51.

Summary:  In this paper on research strategy, the authors discuss plans to study treatment strategies for smokers with panic attacks. Building upon emerging evidence supporting the efficacy of d-cycloserine (DCS) for augmenting exposure-based therapy, the authors are conducting an initial test of the efficacy of DCS for enhancing Panic and Smoking Reduction Treatment (PSRT) outcomes. Utilizing a randomized, double-blind trial comparing PSRT+DCS to PSRT+placebo, they’ll obtain short- and long-term smoking cessation outcomes and test mechanisms.


Zhang X, Martinez-Donate AP, Kuo D, Piper ME. Beyond Cigarette Smoking: Smoke-Free Home Rules and Use of Alternative Tobacco Products. Perspectives in Public Health. 2016;136(1)30-3.


Summary: Smoke-free home rules are associated with lower current use of alternative tobacco products (ATP) such as smokeless tobacco products, regular and water pipes, and cigars. Future research should examine whether promoting smoke-free home rules could help to reduce ATP use and related diseases.