The effect of varenicline on mood and cognition in smokers with HIV.

RATIONALE: Barriers to smoking cessation, including negative affect and cognitive dysfunction, may contribute to high smoking rates among people living with HIV/AIDS (PLWH). Varenicline may help PLWH quit smoking by improving mood and cognition, yet this has not been explored. OBJECTIVES: The goal of this study was to evaluate the effect of varenicline on mood and cognition among PLWH enrolled in a smoking cessation clinical trial. METHODS: In this secondary analysis of a varenicline trial (NCT01710137), we assessed mood (depression, anxiety) and cognition (attention, working memory) at weeks 0 (baseline), 1, 3, and 12 (end-of-treatment, EOT). Primary outcomes were changes in mood and cognition from baseline to EOT. Secondarily, mood and cognition were evaluated as predictors of biochemically confirmed 7-day point-prevalence abstinence at EOT. RESULTS: Overall, 173 subjects (87 varenicline, 86 placebo) were included. At EOT, varenicline reduced anxiety (P < 0.001), vs. placebo (P = 0.31; interaction P = 0.05). Across both treatment arms, reductions in anxiety from baseline to EOT were associated with a higher likelihood of abstinence (OR = 1.3, 95% CI 1.1 to 1.6, P = 0.01). There were no significant treatment by time interactions for cognition or depression. CONCLUSIONS: These data suggest that varenicline operates, at least in part, by reducing anxiety. Anxiety should be an intervention target for smokers with HIV interested in quitting.

Skin Cancer and UV Exposure-Related Behaviors Among Appalachian and Non-Appalachian Adults.

Introduction: Appalachian communities experience elevated rates of cancer incidence and mortality relative to other regions in the U.S. Specifically, melanoma mortality rates are higher in Appalachia compared to the national average, despite comparable incidence rates. Purpose: To examine differences in self-reported history of skin cancer and prevalence of two UV exposure behaviors between Appalachian and non-Appalachian adults in a nationally representative sample. Methods: Data are from four cross-sectional cycles of the Health Information National Trends Survey (2011-2014) (N=14,451). We examined sunscreen use and tanning bed use, and self-reported history of melanoma and non-melanoma skin cancer. Descriptive and weighted multivariable analyses were conducted to examine sunscreen and tanning bed use, controlling for sociodemographic characteristics. Results: Approximately 8% of the study sample resided in Appalachia (n=1,015). Self-reported melanoma (0.6%) and non-melanoma (3.2%) skin cancer histories were low among Appalachians and did not differ statistically from non-Appalachians (p>0.05). Only 21.2% of Appalachians reported using sunscreen often or always when going outside for more than one hour on a warm, sunny day compared to 27.4% of non-Appalachians (pp=0.04), but there were no regional differences in tanning bed use (OR=1.48, p=0.23) when controlling for sociodemographics and general health status. Implications: Appalachians had comparable histories of self-reported melanoma and non-melanoma skin cancer but were less likely to report sunscreen use than non-Appalachians. Enhanced communication efforts to promote sunscreen use and other UV protection behaviors in Appalachia may be valuable.

Placebo-controlled randomized clinical trial testing the efficacy and safety of varenicline for smokers with HIV.

BACKGROUND: People living with HIV/AIDS (PLWH) smoke tobacco at higher rates and have more difficulty quitting than the general population, which contributes to significant life-years lost. The effectiveness of varenicline, one of the most effective tobacco dependence treatments, is understudied in HIV. We evaluated the safety and efficacy of varenicline for smoking cessation among PLWH. METHODS: This was a single-site randomized, double-blind, placebo-controlled, phase 3 clinical trial (NCT01710137). PLWH on antiretroviral therapy (ART) who were treatment-seeking daily smokers were randomized (1:1) to 12 weeks of varenicline (n = 89) or placebo (n = 90). All participants were offered six smoking cessation behavioral counseling sessions. The primary outcome was 7-day point prevalence abstinence, confirmed with breath carbon monoxide, at Weeks 12 and 24. Continuous abstinence and time to relapse were secondary outcomes. Safety measures were treatment-related side effects, adverse events, blood pressure, viral load, and ART adherence. RESULTS: Of the 179 smokers, 81% were African American, and 68% were male. Varenicline increased cessation at Week 12 (28.1% vs. 12.1%; OR = 4.54, 95% CI:1.83-11.25, P = .001). Continuous abstinence from Week 9 to 12 was higher for varenicline vs. placebo (23.6% vs. 10%; OR = 4.65, 95% CI:1.71-12.67, P = .003); at Week 24, there was no effect of varenicline for point prevalence (14.6% vs. 10%), continuous abstinence (10.1% vs. 6.7%), or time to relapse (Ps > .05). There were no differences between varenicline and placebo on safety measures (Ps > .05). CONCLUSIONS: Varenicline is safe and efficacious for short-term smoking cessation among PLWH and should be used to reduce tobacco-related life-years lost in this population.

Brief Report: Rate of Nicotine Metabolism and Tobacco Use Among Persons With HIV: Implications for Treatment and Research.

BACKGROUND: The nicotine metabolite ratio (NMR) is a biomarker that represents individual variation in the speed that nicotine is metabolized. The rate of nicotine metabolism alters smoking behavior (eg, amount) and has been validated for personalizing tobacco dependence medication selection to increase treatment efficacy and reduce treatment side effects in the general population of smokers. Although smoking rates are extremely high among those with HIV, the NMR has not been evaluated in this underserved population. METHODS: We used baseline data from a smoking cessation clinical trial for smokers with HIV (N = 131) to examine associations between NMR and demographic, smoking, disease-related, and psychological characteristics. Pearson r and analysis of variance were used to identify univariate correlates of NMR, which were then entered into a multiple linear regression model. RESULTS: In univariate analyses, a higher NMR (faster nicotine metabolism) was associated with being white, and more cigarettes per day, nicotine dependence, exhaled carbon monoxide, and symptoms of depression and anxiety, and using efavirenz. In a multiple regression model, a higher NMR was associated with more cigarettes per day, higher anxiety symptoms, and efavirenz use. CONCLUSIONS: As in other populations, faster nicotine metabolism was associated with the use of more cigarettes and higher anxiety symptoms. Notably, efavirenz use was associated with faster metabolism, which might make it harder to quit smoking for people with HIV treated with that medication. These findings could help guide further study and the clinical use of the NMR to personalize nicotine dependence treatment in this underserved population.

Beliefs About Behavioral Determinants of Obesity in Appalachia, 2011-2014.

The populations of many Appalachian communities have high rates of unhealthy body weight. This study aimed to identify differences in beliefs about obesity between Appalachians and non-Appalachians. Our analyses explored health beliefs and behaviors among US adults aged ≥18 (n = 14 451) who responded to the Health Information National Trends Survey (2011-2014), of whom 1015 (8%) resided within the 420 counties recognized as Appalachian by the Appalachian Regional Commission. Using weighted regression analyses and controlling for sociodemographic characteristics and general health, we determined that self-reported body mass index was higher among Appalachians than among non-Appalachians ( B = 0.75, P = .03, 95% confidence interval, 0.08-1.47) and that Appalachians were less likely than non-Appalachians to believe that lifestyle factors were related to obesity ( B = -0.37, P = .03, 95% confidence interval, -0.04 to -0.71). Results suggest that Appalachians may regard behavioral prevention differently from non-Appalachians, perhaps with less confidence in the effectiveness of certain behaviors to reduce obesity risk. Future research may determine whether such beliefs could complicate efforts to encourage healthy lifestyles throughout the region.

Perceptions of Food Advertising and Association With Consumption of Energy-Dense Nutrient-Poor Foods Among Adolescents in the United States: Results From a National Survey.

The advertising and marketing of energy-dense, nutrient-poor (EDNP) food and drink has been cited as one contributor to unhealthy eating behaviors in adolescents. The present study examines perceptions about and trust in food advertising and their association with consumption of EDNP foods and drinks among adolescents in the United States. Data (n = 1,384) come from the U.S. National Cancer Institute's Family Life, Activity, Sun, Health, and Eating Survey. One way ANOVAs were conducted to assess differences between population subgroups in advertising perceptions. Bivariate and multivariable linear regression models were used to examine the associations between perceptions toward and trust in food advertising and consumption of EDNP foods and drinks, controlling for sociodemographic factors. Results show that there are significant differences between racial/ethnic groups on advertising perceptions (F = 16.32, p = < .0001). As positive perceptions toward food advertising increase among adolescents, there is an associated increase in daily frequency of consumption of EDNP foods and drinks (ß = 0.10, p < .01). Similarly, the more adolescents agreed that they trusted food advertising, the higher the reported daily frequency of EDNP food and drink consumption (ß = 0.08, p = .01). Targeting perceptions about food advertising may be a worthy intervention strategy to reduce the impact of food marketing and the consumption of heavily advertised EDNP foods and drinks among adolescents.

Advancing Cancer Prevention and Behavior Theory in the Era of Big Data.

The era of "Big Data" presents opportunities to substantively address cancer prevention and control issues by improving health behaviors and refining theoretical models designed to understand and intervene in those behaviors. Yet, the terms "model" and "Big Data" have been used rather loosely, and clarification of these terms is required to advance the science in this area. The objectives of this paper are to discuss conceptual definitions of the terms "model" and "Big Data", as well as examine the promises and challenges of Big Data to advance cancer prevention and control research using behavioral theories. Specific recommendations for harnessing Big Data for cancer prevention and control are offered.