Oncology Patient Smoking Cessation Treatment Preferences: Perceptions Across Former and Current Cigarette Smokers.

Although the benefits of smoking cessation following a cancer diagnosis have been well-established, up to 50% of cancer patients continue to smoke. Continued smoking through oncology treatment leads to increased risk of adverse events including reduced effectiveness of treatment, recurrence of additional malignancies, and reduced survival rates. Upon the cancer diagnosis, oncology healthcare providers become the primary trusted source of information and support, which represents a great opportunity to assist these patients to quit smoking. However, it remains unclear how oncology healthcare providers can best address smoking cessation from a patient-centered perspective. The present study surveyed oncology patients from Birmingham, AL, classified as either former (n = 174) or current smokers (n = 81) to identify their perceptions regarding the role of oncology healthcare providers in their smoking cessation efforts. Current smokers were more likely to be younger, received their cancer diagnosis within the past 3 years, and have a cancer diagnosis with high smoking-related public awareness (i.e., head, neck, or lung) compared to former smokers. Additionally, 81% of current smokers reported experiencing smoking cessation discussions with their oncology healthcare providers with the most prominent recommendations being use of nicotine replacement therapies (46.9%) and medication (35.8%). These smoking cessation experiences align with patient preferences. However, despite the frequency of smoking cessation discussions, current smokers demonstrated an ambivalence in understanding the risks of continued smoking during their medical treatment. Overall, this study highlights the important role of oncology healthcare providers on implementing smoking cessation intervention for their patients who continue to smoke.

Psychiatric Disorders and HIV Drug Risk Behaviors Among Individuals Under Community Correctional Supervision.

The prevalence of human immunodeficiency virus (HIV) is nearly three times higher in the incarcerated population than in the general population in the United States, and over half of the incarcerated population has a psychiatric diagnosis. Individuals under community corrections supervision continue to receive limited attention regarding HIV prevention and surveillance. Anxiety-related, depressive-related, and post-traumatic stress disorders are high in the community corrections population and may be potential correlates of HIV risk behaviors. Examining the link between psychiatric diagnosis and HIV risk behavior within the community correctional setting may shed light on who is at greatest risk for HIV. Individuals within community corrections who participated in a clinical trial completed questionnaires and semistructured interviews to screen for psychiatric disorders and HIV risk behaviors. Multivariate analyses revealed that individuals of younger age, of White race, and with anxiety disorders engaged in greater HIV drug risk behaviors, providing preliminary implications for whom testing and prevention efforts should be emphasized.

Body Mass Index Changes Associated with Smoking are Moderated by Race and Depression.

Smoking and obesity relate to several leading causes of death in the U.S. and are common within the criminal justice system. Previous studies demonstrate links between smoking, obesity, depression, and race but have not examined all four variables together. The current study evaluated these relationships after a smoking cessation intervention. Participants (N=500) were recruited from community corrections. The Center for Epidemiological Studies Depression Scale (CES-D) measured depression. Self-reported number of cigarettes and weight and height measurements assessed smoking status and body mass index (BMI) at baseline and 12-month follow-up. Depression was associated with increased BMI. Among Blacks without depression, there was a significant relationship between smoking and BMI, such that greater smoking reduction was associated with greater weight gain. This is the first study to assess the interaction between race, smoking, BMI and depression. These findings support tailoring smoking cessation and depression interventions for different races.

Naloxone Training From Nonmedical Personnel: Benefits Before, During, and After Overdose Events.

OBJECTIVES: Drug overdose death rates in the United States have increased exponentially over the past 2 decades, primarily driven by fatal opioid overdoses. To combat this epidemic, naloxone training programs have become prevalent, but still remain widely underutilized. The purpose of the current study was to assess the benefits of a brief training with differing educational approaches (individual training versus training in dyads) as well as the outcomes following overdose reversals. METHODS: Persons who use opioids (N = 448) were recruited from 4 sites including treatment facilities, inpatient hospitals, and criminal justice locations over a 3-year period. Training was delivered by nonmedical personnel and focused on safe naloxone usage and recognizing overdose signs. Overdose and naloxone knowledge were assessed before and following training with a 10-item questionnaire. Participants were trained individually, in a dyad with a partner who used opioids (PO), or in a dyad with a partner who did not use opioids (PNO). RESULTS: All training groups displayed an increased knowledge of naloxone and overdose situations following training. Approximately 11% of participants (n = 47) reported using their naloxone kit and 97.7% of those resulted in successful overdose reversals. Kits were primarily used by the trained participant on a third-party individual. CONCLUSIONS: The results of the current study substantiate the effectiveness of naloxone in reversing overdose symptoms. A brief, 15-minute naloxone training delivered by nonmedical personnel enhanced overdose knowledge and led to positive reversal outcomes. Training persons who use opioids in dyads may offer additional benefits and improve follow-up reporting.

Factors Associated With Marijuana Use Among Treatment-seeking Adult Cigarette Smokers in the Criminal Justice Population.

OBJECTIVES: Due to the elevated rates of cigarette use and marijuana use within the criminal justice system, it is critical to develop a stronger understanding of tobacco and marijuana co-use among this population to inform future interventions. METHODS: This study is a secondary analysis of baseline data from a smoking cessation randomized clinical trial of adults (n = 500) in a community correction program. Participants were classified as using cigarettes only or both cigarettes and marijuana through either self-report or positive urine drug screening. Demographics and measures regarding legal, drug use, smoking, mental health, and interpersonal histories were assessed. Logistic regression analyses were conducted to assess factors associated with co-use. RESULTS: Among adults who smoked cigarettes, 25% reported current marijuana use. Individuals who used both cigarettes and marijuana were more likely than those who only used cigarettes to be African American (80%), male (73.6%), and younger (M = 32.4 [SD = 11.0]). Increasing difficulties with last quit attempt was associated with a reduction in the likelihood of co-use (odds ratio [OR] 0.75, 95% confidence interval [CI] 0.60-0.94, P < 0.05), and benzodiazepine (OR 9.09, 95% CI 1.25-65.94, P < 0.05) and opioid (OR 8.17, 95% CI 2.03-32.93, P < 0.01) use was significantly associated with an increased likelihood of co-use. CONCLUSIONS: This study identified several factors that are associated with an increased risk of cigarette and marijuana co-use among a community correction population. These findings will be valuable for informing targeted prevention and treatment interventions.

Differences among cigarette-only smokers compared to dual users of cigarettes and little cigars/cigarillos in the criminal justice population.

INTRODUCTION: The FDA has restrictions on cigarettes; however, little cigars and cigarillos (LCCs) remain largely absent from these regulations. Due to their low prices and flavoring, many engage in dual use of both LCCs and cigarettes. Dual use is particularly prevalent among low income racial/ethnic minority groups. The purpose of this study was to (U.S. Department of Health and Human Services, 2014) conduct an exploratory examination among cigarette users compared to dual users on smoking characteristics; and (Centers for Disease Control and Prevention, 2016) to examine racial differences (White and Black) among cigarette users compared to dual users. METHODS: Participants (N = 500) were recruited from community corrections (i.e., parole/probation) and categorized as either cigarette-only (66.4%) or dual users (33.6%) if they used little cigars or cigarillos over a one-year period during a smoking cessation clinical trial. RESULTS: Dual users were more likely to be younger, Black, males with lower educational attainment compared to cigarette-only smokers. Smokers with increased nicotine dependence were 17% more likely to be cigarette-only smokers compared to dual users. Racial differences revealed that White/cigarette-only smokers were more likely to report non-menthol use and higher cigarette consumption at the end of treatment compared to Black/cigarette-only or Black/dual users. CONCLUSIONS: This study contributes to our understanding of dual use among a disenfranchised group of smokers. Overall, dual users were more likely to be younger, Black, and male with lower reported nicotine dependence compared to cigarette-only users. Racial differences revealed that non-menthol smokers as well as smokers with greater cigarettes smoked at the end of treatment were more likely White/cigarette-only smokers.

Medical, psychosocial, and treatment predictors of opioid overdose among high risk opioid users.

INTRODUCTION: Drug overdoses are the leading cause of accidental death in the United States. It is imperative to explore predictors of opioid overdose in order to facilitate targeted treatment and prevention efforts. The present study was conducted as an exploratory examination of the factors associated with having a past opioid overdose. METHODS: Participants (N = 244) from substance treatment facilities, inpatient services following ER admittance, or involved within the drug court system and who reported opioid use in the past 6 months were recruited in this study. Measures of opioid use and history were used to determine characteristics associated with previous experience of a non-fatal opioid overdose. RESULTS: Opioid users who were Caucasian and used a combination of prescription opioids and heroin were more likely to have experienced a prior overdose. Opioid user characteristics associated with greater odds of experiencing a prior overdose included: witnessing a friend overdose (OR 4.21), having chronic hepatitis C virus (HCV) infection (OR 2.44), reporting a higher frequency of buprenorphine treatment episodes (OR 1.55), and having a higher frequency of witnessing others overdose (OR 1.42). Greater frequency of methadone treatment episodes was related to decreased odds of experiencing an overdose (OR 0.67). CONCLUSION: Overall, this study demonstrated certain demographic and drug use factors associated with elevated risk for an overdose. Understanding the risk factors associated with drug overdose can lead to targeted naloxone training and distribution to prevent fatal overdoses.

Predictors of medication adherence and smoking cessation among smokers under community corrections supervision.

INTRODUCTION: Individuals in the U.S. criminal justice system now represent over 12% of all current U.S. smokers. With smoking banned in most U.S. jails and prisons, the cessation focus for this population has shifted to individuals who are under community correction supervision (e.g., probation, parole). The aim of this study was to examine predictors of successful smoking cessation among criminal justice individuals supervised in the community. METHODS: Five hundred participants under community corrections supervision were randomized to receive either four sessions of smoking cessation counseling or no counseling in conjunction with 12weeks of bupropion treatment plus brief physician advice to quit. Logistic regression analyses examined associations of smoking variables with medication adherence and successful abstinence. Mediation analysis evaluated the indirect effects of medication adherence on smoking abstinence. RESULTS: The strongest associate of medication adherence was previous use of bupropion, while the strongest associate of smoking abstinence was medication adherence. Mediation analysis indicated that previous use of bupropion indirectly increased cessation rates through the pathway of increased medication adherence. CONCLUSIONS: These results highlight the importance of medication adherence for smoking cessation among community corrections smokers. Providing exposure to medication may be a promising intervention to increase medication adherence and subsequent cessation rates in this population.

A pilot trial of In vivo NRT sampling to increase medication adherence in community corrections smokers.

BACKGROUND: Individuals in the criminal justice system demonstrate high rates of cigarette use (70-80%) and low adherence to smoking cessation medication. Educational approaches have not been shown to promote adherence or cessation, though medication sampling has boosted both use and cessation. The objective of the present study was to determine whether In vivo nicotine replacement therapy (NRT) sampling approach increases NRT adherence among criminal justice smokers during a subsequent quit attempt. METHODS: We conducted a pilot study with 43 community corrections smokers randomized to a 4-session (one 30-min session per week) precessation intervention of either In vivo NRT sampling (Session 1: patch; Session 2: gum; Session 3: combination NRT (cNRT); Session 4: review) vs. 4 time-matched sessions of standard smoking cessation with cNRT started after Session 1. Both groups received an additional 8weeks of cNRT following the four intervention sessions. RESULTS: During the in vivo administration of NRT, total withdrawal and craving severity significantly decreased from pre- to post-session compared to Control participants. In vivo participants evinced greater patch use at Session 4 and greater gum use through Week 8 relative to Controls. DISCUSSION: In vivo NRT sampling may increase NRT adherence relative to standard counseling sessions among criminal justice smokers. A larger trial of this novel intervention appears to be warranted.

Mixed-amphetamine salts expectancies among college students: Is stimulant induced cognitive enhancement a placebo effect?

INTRODUCTION: Non-medical use of prescription stimulants for cognitive enhancement in college students is increasing, despite evidence showing little benefit in non-clinical populations. The balanced placebo design (BPD) was used to independently evaluate the pharmacologic versus expectancy effects of mixed amphetamine salts on cognitive performance among a non-clinical sample of college-aged students. METHOD: Participants were screened and excluded for ADHD and other psychopathologies. A non-clinical sample (N=32) completed four two-hour laboratory sessions and were administered a neurocognitive battery in each session. Medication Assignment (10mg mixed-amphetamine salt (Adderall™) versus placebo) was crossed with Instructional Set (deception versus truth). A within-subjects design was used, such that all participants experienced each of the four conditions of the BPD during one of the four laboratory sessions. RESULTS: Participants performed no better than chance in identifying whether they received stimulant or placebo (Belief about Medication Assignment; 47% agreement; κ=-0.047, p=0.590). Participants showed improvement on only two of 31 subtests during active medication. Expecting and receiving stimulants was associated with improved cognitive performance. However, expecting placebo was associated with worse cognitive performance, regardless of the type of medication given. DISCUSSION: This study demonstrated that although non-medical use of stimulants does not enhance cognition, expectancies prominently influence cognitive performance. Participants who believed they received active medication both subjectively rated themselves as performing better and objectively performed better on a minority of subtests, independent of medication state.