Peer Texting to Promote Quitline Use and Smoking Cessation Among Rural Participants in Vietnam: Randomized Clinical Trial.

Objectives: We tested an adapted version of an effective U.S.-based peer-texting intervention to promote Quitline use and smoking cessation among rural participants in Vietnam. Methods: We conducted a two-arm randomized trial with participants recruited at four rural community centers. The intervention included peer messages sent for six months that promoted Quitline use and smoking cessation. Additionally, biweekly two-way text messages assessed participants' interest in Quitline referral and current smoking status. Comparison participants received only the bi-weekly text message assessment of their current smoking status. At six months, we assessed Quitline use and smoking cessation. Smoking cessation was assessed using the 7-day point prevalence question and verified with a carbon monoxide breath monitor (<=6 ppm). Results: Among 750 participants, the intervention had higher Quitline verified use (18%, 95% CI 0.14, 0.22) than comparison (1%, 95% CI .2, 2, p < 0.0001). Carbon-monoxide-verified smoking cessation did not differ between the two groups. However, intervention (28.3%, 95% CI) and comparison (28.1%, 95% CI) participants had substantial rates of carbon monoxide cessation at 6 months (both 28%). Conclusion: Our study highlighted the promise of texting interventions to extend tobacco control efforts in Vietnam.

mHealth Messaging to Motivate Quitline Use and Quitting: Protocol for a Community-Based Randomized Controlled Trial in Rural Vietnam.

BACKGROUND: Tobacco kills more than 8 million people each year, mostly in low- and middle-income countries. In Vietnam, 1 in every 2 male adults smokes tobacco. Vietnam has set up telephone Quitline counseling that is available to all smokers, but it is underused. We previously developed an automated and effective motivational text messaging system to support smoking cessation among US smokers. OBJECTIVE: The aim of this study is to adapt the aforementioned system for rural Vietnamese smokers to promote cessation of tobacco use, both directly and by increasing the use of telephone Quitline counseling services and nicotine replacement therapy. Moreover, we seek to enhance research and health service capacity in Vietnam. METHODS: We are testing the effectiveness of our culturally adapted motivational text messaging system by using a community-based randomized controlled trial design (N=600). Participants were randomly allocated to the intervention (regular motivational and assessment text messages) or control condition (assessment text messages only) for a period of 6 months. Trial recruitment took place in four communes in the Hung Yen province in the Red River Delta region of Vietnam. Recruitment events were advertised to the local community, facilitated by community health workers, and occurred in the commune health center. We are assessing the impact of the texting system on 6-month self-reported and biochemically verified smoking cessation, as well as smoking self-efficacy, uptake of the Quitline, and use of nicotine replacement therapy. In addition to conducting the trial, the research team also provided ongoing training and consultation with the Quitline during the study period. RESULTS: Site preparation, staff training, intervention adaptation, participant recruitment, and baseline data collection were completed. The study was funded in August 2017; it was reviewed and approved by the University of Massachusetts Medical School Institutional Review Board in 2017. Recruitment began in November 2018. A total of 750 participants were recruited from four communes, and 700 (93.3%) participants completed follow-up by March 2021. An analysis of the trial results is in progress; results are expected to be published in late 2022. CONCLUSIONS: This study examines the effectiveness of mobile health interventions for smoking in rural areas in low- and middle-income countries, which can be implemented nationwide if proven effective. In addition, it also facilitates significant collaboration and capacity building among a variety of international partners, including researchers, policy makers, Quitline counselors, and community health workers. TRIAL REGISTRATION: ClinicalTrials.gov NCT03567993; https://clinicaltrials.gov/ct2/show/NCT03567993. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/30947.

Applying Computer Adaptive Testing Methods to Suicide Risk Screening in the Emergency Department.

OBJECTIVE: Combine test theory with technology to develop brief, reliable suicide risk measures in the emergency department. METHODS: A computer adaptive test for suicide risk was built using the Beck Scale for Suicide Ideation and tested among the emergency department population. Data were analyzed from a sample of 1,350 patients in several Massachusetts emergency departments. The test was built as outlined by the National Institutes of Health Patient-Reported Outcomes Measurement Information System. RESULTS: Of 1,350 patients, 74 (5%) scored above the cutoff of BSS > 2. Item 2, "Wish to die", was the most informative item. When using only Item 2, 20% (n = 15/74) of at-risk patients and 3% (n = 40/1,276) of not-at-risk patients were misclassified. Patients were classified after four items with computer adaptive testing trait estimates highly comparable to those of the full scale. The precision rule model did not reduce the scale. CONCLUSIONS: This study models the creation of a computer adaptive test for suicide ideation and marks the start of the development of computer adaptive tests as a novel suicide risk screening tool in the emergency department. Computer adaptive tests hold promise for revolutionizing behavioral health screening by addressing barriers including time and knowledge deficits.

Physical and psychosomatic health outcomes in people bereaved by suicide compared to people bereaved by other modes of death: a systematic review.

BACKGROUND: Little research has been conducted into the physical health implications of suicide bereavement compared to other causes of death. There is some evidence that suicide bereaved parents have higher morbidity, particularly in terms of chronic illness. This systematic review aims to examine the physical and psychosomatic morbidities of people bereaved by a family member's suicide and compare them with family members bereaved by other modes of death. METHODS: MEDLINE, EMBASE, CINAHL, and PsycINFO were searched from 1985 to February 2016. The search was re-run in March 2017. Peer-reviewed English language articles comparing suicide-bereaved family members to non-suicide bereaved family members on measures of physical or psychosomatic health were eligible for inclusion. Cohort, cross-sectional, case-control and cohort-based register studies were eligible for inclusion. A modified version of the Newcastle Ottawa Scale was used for quality assessment. Results were synthesised using narrative synthesis. RESULTS: The literature search located 24 studies which met the inclusion criteria. Seven studies found statistically significant associations between physical health and suicide bereavement. Five of the studies found that suicide-bereaved family members were more likely to experience pain, more physical illnesses and poorer general health. They were also at increased risk of cardiovascular disease, hypertension, diabetes and chronic obstructive pulmonary disease. In contrast, another study in Denmark found that those bereaved by suicide had a lower risk of a number of physical health disorders, including cancers, diabetes, cardiovascular and chronic lower respiratory tract disorders compared to those bereaved by other causes of death. Additionally, a further study conducted in the United States found that suicide-bereaved children visited a GP less frequently than non-suicide bereaved children. CONCLUSIONS: Review findings are relevant for clinicians working with people bereaved by suicide as they highlight that such clients are at increased risk of several adverse physical health outcomes. Future research should examine health risk behaviours of suicide-bereaved and non-suicide bereaved family members as they may confound the association between exposure and outcome. TRIAL REGISTRATIONS: The review protocol has been registered on PROSPERO, registration number CRD42016030007 .

Tobacco use disorder and treatment: new challenges and opportunities.

Tobacco use remains a global problem, and options for consumers have increased with the development and marketing of e-cigarettes and other new nicotine and tobacco products, such as "heat-not-burn" tobacco and dissolvable tobacco. The increased access to these new products is juxtaposed with expanding public health and clinical intervention options, including mobile technologies and social media. The persistent high rate of tobacco-use disorders among those with psychiatric disorders has gathered increased global attention, including successful approaches to individual treatment and organizational-level interventions. Best outcomes occur when medications are integrated with behavioral therapies and community-based interventions. Addressing tobacco in mental health settings requires training and technical assistance to remove old cultural barriers that restricted interventions. There is still "low-hanging fruit" to be gained in educating on the proper use of nicotine replacement medications, how smoking cessation can change blood levels of specific medications and caffeine, and how to connect with quitlines and mobile technology options. Future innovations are likely to be related to pharmacogenomics and new technologies that are human-, home-, and community-facing.

El uso de tabaco sigue siendo un problema mundial, y las opciones para los consumidores han aumentado con el desarrollo y comercialización de cigarrillos electrónicos y otros nuevos productos de la nicotina y del tabaco, como el tabaco que "calienta pero no quema" y el tabaco soluble. El aumento del acceso a estos nuevos productos está yuxtapuesto con el desarrollo de la salud pública y de las opciones de intervenciones clínicas, incluyendo las tecnologías móviles y los medios de comunicación social. El persistente aumento en la frecuencia de los trastornos por uso de tabaco entre los pacientes con trastornos psiquiátricos ha atraído una mayor atención mundial, incluyendo intervenciones exitosas a nivel de los tratamientos individuales y en las organizaciones. Los mejores resultados se obtienen cuando se combinan medicamentos con terapias conductuales e intervenciones a nivel de la comunidad. El tratamiento del tabaquismo en los ambientes de salud mental requiere entrenamiento y asistencia técnica para remover las antiguas barreras culturales que restringen las intervenciones. Todavía hay posibilidades fáciles para enseñar la utilización correcta de medicamentos que reemplacen a la nicotina, para saber que el dejar de fumar puede modificar los niveles plasmáticos de determinados fármacos y de cafeína, y para conocer cómo conectarse con aplicaciones de tecnologías móviles y líneas telefónicas orientadas a dejar de fumar. Es probable que las futuras innovaciones estén relacionadas con la farmacogenómica y con nuevas tecnologías orientadas a los humanos, a la casa y a la comunidad.

L'usage du tabac reste un problème mondial, de nouvelles options se présentant aux consommateurs avec le développement et la commercialisation des cigarettes électroniques et d'autres nouveaux produits dérivés du tabac et de la nicotine, comme le tabac « qui chauffe mais ne brûle pas ¼ et le tabac soluble. L'accès accru à ces nouveaux produits se juxtapose au développement de la santé publique et aux options d'intervention clinique, telles que les technologies mobiles et les médias sociaux. L'attention générale s'est focalisée sur le taux élevé persistant des troubles liés au tabac parmi les patients qui ont des troubles psychiatriques, et notamment sur le succès des traitements individuels et des interventions organisationnelles. Les résultats sont meilleurs quand les traitements sont intégrés à des thérapies comportementales et à des interventions de proximité. Le traitement du tabagisme dans le cadre de la santé mentale nécessite une formation et une assistance technique pour supprimer les barrières culturelles qui restreignent les interventions. Il existe encore des solutions faciles à mettre en oeuvre pour éduquer les patients à l'utilisation correcte des substituts nicotiniques, leur expliquer comment l'arrêt du tabac change les taux sanguins de certains médicaments spécifiques et de la caféine et leur apprendre à se connecter aux applications mobiles et aux lignes téléphoniques dédiées à l'arrêt du tabac. De futures innovations seront probablement liées à la pharmacogénomique et à de nouvelles technologies qui seront tournées vers l'humain, la maison et la population.