RESUMO
BACKGROUND: Most adults who regularly use e-cigarettes or Electronic Nicotine Delivery Systems (ENDS) desire to discontinue use. ENDS use can result symptoms of nicotine withdrawal and dependence which can make it more difficult to discontinue use. Brief, valid assessment of nicotine dependence among adults who use ENDS is needed to guide treatment for nicotine dependence in this group. We sought to develop a brief, valid instrument to measure nicotine dependence among adults seeking to discontinue ENDS in a busy Quitline. METHODS: In this cross-sectional design, we examined content, construct, and concurrent validity of the Roswell ENDS Nicotine Dependence Scale (Roswell eND Scale) and the Penn State E-Cigarette Dependence Index (Penn State eCDI). Participants who called the New York Quitline from November 2019 to June 2020 seeking to discontinue ENDS use were invited to participate. Construct validity was examined with exploratory and confirmatory factor analyses. Instrument and factor scores were then correlated with cotinine, a biomarker of nicotine exposure. RESULTS: All participants (n = 209) were highly dependent and co-used combustible cigarettes to varying degrees. Both instruments demonstrated content validity and construct validity, however only the 5-item Roswell eND Scale demonstrated criterion-related validity by showing a significant positive correlation with salivary cotinine levels. CONCLUSIONS: The 5-item Roswell eND Scale can briefly and effectively assess nicotine dependence among treatment-seeking adults who co-use ENDS and cigarettes. These preliminary psychometric findings have the potential to be generalizable to other adults seeking to discontinue ENDS use, many of whom currently or formerly smoked cigarettes.
Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Produtos do Tabaco , Tabagismo , Vaping , Humanos , Adulto , Tabagismo/diagnóstico , Nicotina , Cotinina , Estudos TransversaisRESUMO
Many regulatory bodies now recommend that tobacco product manufacturers provide information regarding new tobacco products' abuse liability to inform regulatory authorization of currently marketed tobacco products or new product applications (including premarket tobacco product applications in the United States). In addition, the US Food and Drug Administration (FDA) recommends including this information as part of modified risk tobacco product applications. Regulators, including FDA, and many public health officials and researchers consider abuse liability assessment a model which predicts the likelihood that the use of the tobacco product would result in addiction and be used repeatedly or even sporadically resulting in undesirable effects. Abuse liability of a new, potentially reduced harm product can also inform its ability to substitute completely for more harmful tobacco products. While many methods exist, no standard tobacco product abuse liability assessment has been established. The purpose of this review is to provide background information and practical recommendations for human abuse liability testing methods to meet tobacco regulatory needs. A combination of nicotine test product pharmacokinetic, subjective effect and/or behavioral response, and physiological response data relative to comparator products with known abuse liability satisfies some regulatory requirements. Implications: This review provides a practical inspection of the current, international regulatory recommendations for abuse liability assessment of tobacco and regulatory review of such information within the United States and also recommends study designs and methods for abuse liability testing of tobacco products based on scientific and regulatory knowledge. Given that tobacco product abuse liability testing is of increasing interest to regulatory bodies globally, especially with the emergence of novel tobacco products, this timely work provides background and functional recommendations for tobacco product abuse liability testing.
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Produtos do Tabaco , Tabagismo , Humanos , Nicotina/efeitos adversos , Nicotiana/efeitos adversos , Produtos do Tabaco/efeitos adversos , Uso de Tabaco , Tabagismo/diagnóstico , Estados UnidosRESUMO
BACKGROUND: Clinical practice guidelines for promoting smoking cessation in cancer care exist; however, most oncology settings have not established tobacco use assessment and treatment as standard care. Inadequate staff training and other implementation challenges have been identified as barriers for delivery of evidence-based tobacco treatment. Providing training in tobacco treatment tailored to the unique needs of tobacco-dependent patients with cancer is one strategy to improve adoption of best practices to promote smoking cessation in cancer care. METHODS: A tobacco treatment training program for oncology care providers (tobacco treatment training-oncology [TTT-O]) consisting of a 2-day didactic and experiential workshop followed by 6 monthly, collaboratory videoconference calls supporting participants in their efforts to implement National Comprehensive Cancer Network guidelines in their oncology settings was developed and implemented. This article presents preliminary results on program evaluation, changes in participants' self-efficacy, and progress in implementing tobacco treatment. RESULTS: Data have been obtained from the first 5 cohorts of TTT-O participants (n = 110) who completed training, course evaluations, baseline and follow-up surveys. Participants rated the training as highly favorable and reported significant gains in self-efficacy in their ability to assess and treat tobacco dependence. Participants also demonstrated significant improvements in tobacco treatment skills and implementation of several indicators of improved adoption of best practices for tobacco treatment in their cancer care settings. CONCLUSIONS: Implementation of tobacco treatment training for cancer care providers is feasible, acceptable, and can have a significant positive impact on participants' tobacco treatment skills, self-efficacy, and greater adoption of tobacco treatment delivery in cancer care.
Assuntos
Abandono do Hábito de Fumar , Tabagismo , Humanos , Oncologia , Avaliação de Programas e Projetos de Saúde , Abandono do Hábito de Fumar/métodos , Uso de Tabaco , Tabagismo/diagnóstico , Tabagismo/terapiaRESUMO
BACKGROUND: Compared to white smokers, Black smokers are at disproportionately higher risk for smoking-related disease, despite consuming fewer cigarettes per day (CPD). To examine racial disparities in biobehavioral influences on smoking and disease risk, we analyzed the relationship between self-reported tobacco dependence and intensity of tobacco smoke exposure per cigarette, on the one hand, and intensity of nicotine intake per cigarette, on the other. METHODS: In 270 Black and 516 white smokers, smoke exposure was measured by expired carbon monoxide (CO), and nicotine intake was measured by plasma cotinine (COT) and cotinine+3'-hydroxycotinine ([COT + 3HC]). Using linear regression analyses, we analyzed how the Fagerström Test for Cigarette Dependence (FTCD) predicted intensity of smoke exposure per cigarette (CO/CPD) and intensity of nicotine intake per cigarette (COT/CPD; [COT + 3HC]/CPD), and how race moderated these relations. RESULTS: Overall, Black smokers consumed fewer CPD than white smokers and had higher levels of CO/CPD, COT/CPD, and [COT + 3HC]/CPD. These elevations were most pronounced at lower levels of dependence: amongst Black smokers, FTCD negatively predicted intensity of smoke exposure as measured by CO/CPD (B = -0.12, 95% CI = -0.18, -0.05, p = 0.0003) and intensity of nicotine intake as measured by [COT + 3HC]/CPD (B = -1.31, 95% CI = -2.15, -0.46, p = 0.002). CONCLUSIONS: Low-dependence Black smokers had higher intensities of both smoke exposure and nicotine intake per cigarette compared to similarly dependent white smokers, suggesting that measures of dependence, exposure, and intake underestimate incremental risk of each cigarette to Black smokers.
Assuntos
Negro ou Afro-Americano , Monóxido de Carbono/análise , Fumar Cigarros/sangue , Nicotina/análise , Poluição por Fumaça de Tabaco/análise , População Branca , Adulto , Negro ou Afro-Americano/etnologia , Fumar Cigarros/etnologia , Cotinina/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nicotina/administração & dosagem , Fatores Raciais/tendências , Tabagismo/sangue , Tabagismo/diagnóstico , Tabagismo/etnologia , População Branca/etnologiaRESUMO
BACKGROUND: The TAPS Tool is a substance use screening and brief assessment instrument that was developed for use in primary care medical settings. It is one of the first screening instruments to provide rapid assessment of all commonly used substance classes, including illicit and prescription opioids, and is one of the only available screeners designed and validated in an electronic self-administered format (myTAPS). This secondary analysis of data from the TAPS Tool validation study describes the feasibility and acceptability of the myTAPS among primary care patients. METHODS: Adult patients (N = 2000) from five primary care clinics completed the TAPS Tool on a tablet computer (myTAPS), and in an interviewer-administered format. Requests for assistance and time required were tracked, and participants completed a survey on ease of use, utilization of audio guidance, and format preference. Logistic regression was used to examine outcomes in defined subpopulations, including groups that may have greater difficulty completing an electronic screener, and those that may prefer an electronic self-administered approach. RESULTS: Almost all participants (98.3%) reported that the myTAPS was easy to use. The median time to complete myTAPS screening was 4.0 min (mean 4.48, standard deviation 2.57). More time was required by participants who were older, Hispanic, Black, or reported non-medical prescription drug use, while less time was required by women. Assistance was requested by 25% of participants, and was more frequently requested by those who with lower education (OR = 2.08, 95% CI 1.62-2.67) or age > 65 years (OR = 2.79, 95% CI 1.98-3.93). Audio guidance was utilized by 18.3%, and was more frequently utilized by participants with lower education (OR = 2.01, 95% CI 1.54-2.63), age > 65 years (OR = 1.79, 95% CI 1.22-2.61), or Black race (OR = 1.30, 95% 1.01-1.68). The myTAPS format was preferred by women (OR = 1.29, 95% CI 1.00-1.66) and individuals with drug use (OR = 1.43, 95% CI 1.09-1.88), while participants with lower education preferred the interviewer-administered format (OR = 2.75, 95% CI 2.00-3.78). CONCLUSIONS: Overall, myTAPS screening was feasible and well accepted by adult primary care patients. Clinics adopting electronic screening should be prepared to offer assistance to some patients, particularly those who are older or less educated, and should have the capacity to use an interviewer-administered approach when required.
Assuntos
Programas de Rastreamento/métodos , Atenção Primária à Saúde/métodos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Adolescente , Adulto , Fatores Etários , Idoso , Alcoolismo/diagnóstico , Analgésicos Opioides/administração & dosagem , Computadores de Mão , Estudos de Viabilidade , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Reprodutibilidade dos Testes , Fatores Sexuais , Fatores Socioeconômicos , Fatores de Tempo , Tabagismo/diagnóstico , Adulto JovemRESUMO
OBJECTIVE: The aim of this study is to estimate risky-drug use patterns of consumption of primary care patients. DESIGN: Multicentric descriptive cross-sectional study. SETTING: five primary health care centers of the South of Madrid. PARTICIPANTS: all patients between 16-100 year-old consulting with their family physician. MEASUREMENTS: Spanish-validated World Health Organization ASSIST test was use to screen risky drug use in primary care. Total points scored at the test were obtained. RESULTS: A sum of 441 screening test were collected. Mean age was 51,3 years and 51.6% of patients presented a moderate-severe risky drug use out of the nine drugs tested. The more frequent drug use screened were tobacco (41.7%) followed by alcohol (15.4%), hypnotics (13.7%) and cannabis (5.7%). Differences were found between genders in the patterns: men had higher risky drug uses compared to women regarding alcohol and cannabis. Women had higher sedatives/hypnotics consumption prevalence. A 16% of patients presented with polyconsumption drug use patterns. CONCLUSIONS: There is risk derived from drug misuse in primary care for tobacco, alcohol, hypnotics and cannabis as detected by the ASSIST test. There is a higher rate of hypnotics than expected.
Assuntos
Atenção Primária à Saúde/métodos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Alcoolismo/diagnóstico , Alcoolismo/epidemiologia , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Hipnóticos e Sedativos , Masculino , Abuso de Maconha/diagnóstico , Abuso de Maconha/epidemiologia , Pessoa de Meia-Idade , Prevalência , Risco , Medição de Risco , Fatores Sexuais , Fatores Socioeconômicos , Espanha/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Tabagismo/diagnóstico , Tabagismo/epidemiologia , Adulto JovemRESUMO
Basic and clinical addiction research use demand measures and analysis extensively to characterize drug use motivations. Hence, obtaining an accurate and brief measurement of demand that can be easily utilized in different settings is highly valued. In the current study, 2 versions of a breakpoint measure, designed to capture cigarette demand, were investigated in 119 smokers who were recruited from an online crowdsourcing platform. The first version determines the maximum price a smoker is willing to pay for one cigarette received right now when paid out of pocket, and the second determines the maximum price when paid using a hypothetical $100 gift card received for free. The breakpoint measures were administered along with the Cigarette Purchase Task (CPT), Fagerström Test for Cigarette Dependence (FTCD), and The Questionnaire of Smoking Urges (QSU-brief). Both single-item breakpoint versions were significantly correlated with CPT-derived demand measures loaded on the persistence factor (i.e., elasticity of demand, breakpoint, Pmax, and Omax), but not with those loaded on the amplitude factor (i.e., intensity of demand). In addition, both single-item measures were associated with metrics of tobacco dependence (e.g., FTCD, QSU) with effect sizes that are similar to the ones found between CPT-derived breakpoint and those same metrics. These findings suggest that the single-item breakpoint measure is a viable method for measuring demand that may provide a useful and efficient tool to capture crucial and distinct aspects of smoking. In addition, the breakpoint measures may help increase the utility of behavioral demand measures in novel research and clinical settings. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Assuntos
Comportamento Aditivo , Fumar Cigarros , Economia Comportamental , Fumantes/psicologia , Tabagismo , Adulto , Comportamento Aditivo/diagnóstico , Comportamento Aditivo/economia , Comportamento Aditivo/psicologia , Pesquisa Comportamental/métodos , Fumar Cigarros/economia , Fumar Cigarros/prevenção & controle , Fumar Cigarros/psicologia , Feminino , Humanos , Masculino , Motivação , Técnicas Psicológicas , Abandono do Hábito de Fumar/métodos , Abandono do Hábito de Fumar/psicologia , Tabagismo/diagnóstico , Tabagismo/economia , Tabagismo/psicologiaRESUMO
BACKGROUND: Tobacco smoking is a major health concern. Many women smoke during their reproductive years, some of them during their pregnancy. Adverse outcomes for the newborns physical health are well recognized, while the influence on their mental health is still under investigation. We aim at demonstrating the contribution of maternal personality disorders in maintaining addiction to tobacco during pregnancy, to underline their role and the need of their detection as a preventive effort. METHOD: 150 women, consecutively admitted to the Perinatal Psychiatric Outpatient Department were tested with the SCID II, CTQ, WHOQOL-BREF, EPDS, BDI and BAI. Tobacco use disorder was attested with the fulfillment of DSM 5 criteria. RESULTS: 46% (nâ¯=â¯69) of the sample was affected by at least one personality disorder ("PD+"). "PD+" showed a significant higher rate of pregnant women addicted to tobacco (pâ¯=â¯0.021). The average number of cigarettes per day was notably distinct, since patients affected by "NPD" smokes twice the amount compared to "PD-" and "other PDs", while those affected by Borderline PD has a halfway consumption (7.20⯱â¯5.54 vs 3.37⯱â¯4.62 vs 3⯱â¯3.39 vs 5.50⯱â¯4.10). ANOVA and POST HOC showed a significance between "NPD" and "other PDs" (pâ¯=â¯0.035), and "other PDs" has significantly the highest rate of active smokers. CONCLUSION: Personality disorders demonstrate to be a clear contributor in supporting addiction to tobacco during pregnancy. Short and long term health and mental consequences attested in the newborn, encourage awareness in detecting tobacco dependency during this sensitive period. The inclusion of personality evaluation and management in tobacco dependency treatment programs is strictly encouraged to boost their efficiency and increase tobacco abstinence.
Assuntos
Efeitos Psicossociais da Doença , Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtornos da Personalidade/psicologia , Complicações na Gravidez/psicologia , Tabagismo/psicologia , Adulto , Comportamento Aditivo/diagnóstico , Comportamento Aditivo/epidemiologia , Comportamento Aditivo/psicologia , Feminino , Humanos , Recém-Nascido , Masculino , Determinação da Personalidade , Transtornos da Personalidade/diagnóstico , Transtornos da Personalidade/epidemiologia , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/epidemiologia , Fumar/epidemiologia , Fumar/psicologia , Tabagismo/diagnóstico , Tabagismo/epidemiologiaRESUMO
BACKGROUND AND OBJECTIVES: About 22% of adult smokers in the U.S. are intermittent cigarette smokers (ITS). ITS can be further classified as native ITS who never smoked daily and converted ITS who formerly smoked daily but reduced to intermittent smoking. Ecological momentary assessment (EMA) was conducted to determine the behaviors and experiences that are associated with the decision to smoke. METHODS: The study included 24 native ITS and 36 converted ITS (N = 60) from the Pennsylvania Adult Smoking Study. A baseline questionnaire, daily log, and an EMA smoking log that assessed emotions, activities, and smoking urges was filled out with each cigarette for 1 week to capture 574 smoking sessions. RESULTS: Both groups had very low levels of cigarette dependence. Both groups were more tempted to smoke in positive or negative situations than situations associated with habituation. EMA showed that the most common emotional state during smoking sessions was positive (47%), followed by negative (32%), neutral (16%), and mixed (5%) emotions. Smokers were more likely to smoke during activities of leisure (48%) than during performative duties (29%), social (16%) or interactive occasions (7%). Converted ITS were more likely to smoke alone compared to native ITS (p < .001). DISCUSSION AND CONCLUSIONS: ITS report minimal levels of dependence when captured on traditional scales of nicotine dependence, yet experience loss of autonomy and difficulty quitting. The majority of the ITS reported positive emotions and leisure activities while smoking, and smoked during the evening. SCIENTIFIC SIGNIFICANCE: The current paper identifies environmental and behavioral factors that are associated with smoking among ITS in real time. (Am J Addict 2018;27:131-138).
Assuntos
Avaliação Momentânea Ecológica , Fumantes , Abandono do Hábito de Fumar/psicologia , Fumar , Tabagismo , Adulto , Emoções , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Pennsylvania/epidemiologia , Fumantes/classificação , Fumantes/psicologia , Fumar/epidemiologia , Fumar/psicologia , Inquéritos e Questionários , Tabagismo/diagnóstico , Tabagismo/psicologiaRESUMO
OBJECTIVE: Lung cancer screening programs have become increasingly prevalent within the United States after the National Lung Screening Trial results. We aimed to review the financial impact after programmatic implementation of Advanced Registered Nurse Practitioner-led programs of Lung Cancer Screening and Tobacco Related Diseases, Incidental Pulmonary Nodule Clinic, and Tobacco Cessation Services. METHODS: We reviewed revenue from 2013 to 2016 by our nurse practitioner-led program. Encounters were queried for charges related to outpatient evaluation and management, professional procedures, and facility charges related to both outpatient and inpatient procedures. Revenue was normalized using 2016 data tables and the national Medicare conversion factor (35.8043). RESULTS: Our program evaluated 694 individuals, of whom 75% (518/694) are enrolled within the lung cancer-screening program. Overall revenue associated with the programs was $733,336. Outpatient evaluation and management generated revenue of $168,372. In addition, professional procedure revenue accounted for an additional $60,015 with facility revenue adding an additional $504,949. CONCLUSIONS: A nurse practitioner-led program of lung cancer screening, incidental pulmonary nodules, and tobacco-cessation services can provide additional revenue opportunities for a Thoracic Surgery and Interventional Pulmonology Division, as well as a health care system. The current national, median annual wage of a nurse practitioner is $98,190, and the cost associated directly to their salary (and benefits) may remain neutral or negative within certain programs. However, the larger economic benefit may be realized within the division and institution. This potential additional revenue appears related to evaluation of newly identified diseases and subsequent evaluations, procedures, and operations.
Assuntos
Detecção Precoce de Câncer , Neoplasias Pulmonares , Padrões de Prática em Enfermagem/economia , Abandono do Uso de Tabaco , Tabagismo , Instituições de Assistência Ambulatorial/economia , Análise Custo-Benefício , Detecção Precoce de Câncer/economia , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/enfermagem , Humanos , Achados Incidentais , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/prevenção & controle , Profissionais de Enfermagem , Pesquisa em Avaliação de Enfermagem/métodos , Abandono do Uso de Tabaco/economia , Abandono do Uso de Tabaco/métodos , Tabagismo/diagnóstico , Tabagismo/economia , Tabagismo/prevenção & controle , Estados UnidosRESUMO
OBJECTIVES: Research shows transgender individuals experience pronounced health disparities compared with their nontransgender peers. Yet, there remains insufficient research about health differences within transgender populations. This study seeks to fill this gap by exploring how current urban/rural status is associated with lifetime diagnosis of mood disorder, alcohol dependence disorder, illicit drug abuse disorder, tobacco use, posttraumatic stress disorder, human immunodeficiency virus, and suicidal ideation or attempt among veterans with transgender-related diagnoses. METHODS: This study used a retrospective review of The Department of Veterans Affairs (VA) administrative data for transgender patients who received VA care from 1997 through 2014. Transgender patients were defined as individuals that had a lifetime diagnosis of any of 4 International Classification of Diseases-9 diagnosis codes associated with transgender status. Independent multivariable logistic regression models were used to explore associations of rural status with medical conditions. RESULTS: Veterans with transgender-related diagnoses residing in small/isolated rural towns had increased odds of tobacco use disorder (adjusted odds ratio=1.39; 95% confidence intervals, 1.09-1.78) and posttraumatic stress disorder (adjusted odds ratio=1.33; 95% confidence intervals, 1.03-1.71) compared with their urban transgender peers. Urban/rural status was not significantly associated with other medical conditions of interest. CONCLUSIONS: This study contributes the first empirical investigations of how place of residence is associated with medical diagnoses among veterans with transgender-related diagnoses. The importance of place as a determinant of health is increasingly clear, but for veterans with transgender-related diagnoses this line of research is currently limited. The addition of self-reported sex identity data within VA electronic health records is one way to advance this line of research.
Assuntos
Disparidades em Assistência à Saúde , População Rural , Pessoas Transgênero/psicologia , Veteranos/psicologia , Humanos , Estudos Retrospectivos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Tabagismo/diagnóstico , Estados Unidos , United States Department of Veterans AffairsRESUMO
Tobacco use is the leading cause of death and disability in the United States; cigarette smoking is the most common form of tobacco use. Smoking has become increasingly concentrated among individuals with behavioral health needs (e.g., persistent mental illness) and has led to increased morbidity and mortality in this group relative to the general population. Comprehensive tobacco-free workplace programs are effective in reducing tobacco use and cigarette smoke exposure among behavioral health consumers and the individuals who serve them. Taking Texas Tobacco-Free (TTTF) represents an academic-community partnership formed to address tobacco use among consumers and employees at behavioral health clinics across Texas via the dissemination of an evidence-based, multicomponent tobacco-free workplace program. Program components of TTTF include tobacco-free campus policy implementation and enforcement, staff education about tobacco use hazards, provider training to regularly screen for and address tobacco dependence via intervention, and community outreach. These components, the nature of the academic-community partnership, the process of behavioral health facility involvement and engagement, and the benefits and challenges of implementation from the perspectives of the project team and participating clinic leaders are described. This information can guide similar academic and community partnerships and inform the implementation of other statewide tobacco-free workplace programming.
Assuntos
Relações Comunidade-Instituição , Promoção da Saúde/organização & administração , Serviços de Saúde Mental/organização & administração , Poluição por Fumaça de Tabaco/prevenção & controle , Local de Trabalho/organização & administração , Humanos , Capacitação em Serviço/organização & administração , Programas de Rastreamento , Texas , Tabagismo/diagnóstico , Tabagismo/terapia , Estados Unidos , Universidades/organização & administraçãoRESUMO
BACKGROUND: Although non-cigarette tobacco product use is increasing among U.S. adults, their associations with substance use and mental health problems are unclear. This study examined co-occurrence of tobacco use, substance use, and mental health problems, and its moderation by gender, among 32,202U.S. adults from Wave 1 (2013-2014) of the nationally representative longitudinal Population Assessment of Tobacco and Health (PATH) Study. METHODS: Participants self-reported current cigarette, e-cigarette, traditional cigar, cigarillo, filtered cigar, hookah, smokeless tobacco and other tobacco product use; past year alcohol, marijuana, and other drug use; and past year substance use, internalizing and externalizing problems. RESULTS: Compared to non-current tobacco users, current users were more likely to report alcohol or drug use (adjusted odds ratio (AOR)=2.6; 95% confidence interval (CI): 2.3, 2.9), with the strongest associations observed for cigarillo and hookah users. Across all tobacco product groups, users were more likely to report internalizing (AOR=1.9; 95% CI: 1.7, 2.1), externalizing (AOR=1.6; 95% CI: 1.5, 1.8), and substance use (AOR=3.4; 95% CI: 2.9, 4.1) problems than non-users. Gender moderated many of these associations and, of these, all non-cigarette tobacco product associations were stronger among females. CONCLUSIONS: This nationally representative study of U.S. adults is the first to comprehensively document tobacco use, substance use, and mental health comorbidities across the range of currently available tobacco products, while also demonstrating that female tobacco users are at increased risk for substance use and mental health problems. These findings may point to gender differences in vulnerability and suggest that interventions incorporate gender-specific approaches.
Assuntos
Transtornos Mentais/epidemiologia , Saúde Mental/tendências , Vigilância da População , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Produtos do Tabaco/efeitos adversos , Tabagismo/epidemiologia , Adolescente , Adulto , Idoso , Comorbidade , Feminino , Humanos , Estudos Longitudinais , Masculino , Transtornos Mentais/diagnóstico , Pessoa de Meia-Idade , Autorrelato , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Tabagismo/diagnóstico , Tabaco sem Fumaça/efeitos adversos , Adulto JovemRESUMO
OBJECTIVE: This study aimed to examine secular trends of (i) maternal prescription opioid use in late pregnancy, (ii) neonatal abstinence syndrome (NAS) stratified by late maternal prescription opioid use, and (iii) maternal risk factors among NAS deliveries. METHODS: Women with a live birth who were enrolled 90 days before and 30 days after delivery in Florida Medicaid Analytic Extract billing records linked to birth certificates from 2000 to 2010 were identified for the study. Changes in the annual prevalence of prescription opioid use during pregnancy were tested with use of the Cochran-Armitage trend test. Temporal trends of NAS deliveries were estimated with the use of Poisson regression and stratified by prescription opioid exposure in the last 90 days of pregnancy in the study period. To identify contributors to the increase in NAS cases, variations in prevalence of opioid dispensing, tobacco use, antidepressant use, and substance use disorder among NAS and non-NAS deliveries were examined. RESULTS: There were 41,968 (9.4%) deliveries exposed to at least one opioid prescription in late pregnancy, and this rate remained stable from 2000 to 2010. Among prescription opioid-exposed deliveries, frequency of NAS increased from 1.6 to 25.2 per 1000 live births during the study period (p<0.05). Although the prevalence of maternal use of prescription opioid, tobacco, and antidepressants remained stable among NAS deliveries from 2000 to 2010, the prevalence of substance use disorder diagnoses increased substantially from 38.9% in 2000 to 67.9% in 2006 (p<0.05). CONCLUSIONS: The prevalence of NAS increased dramatically whereas the prevalence of major risk factors, including maternal prescription opioid use, remained stable in Florida between 2000 and 2010. The increase in substance use disorder may be responsible for the sharp increase in NAS deliveries.
Assuntos
Analgésicos Opioides/efeitos adversos , Medicaid/tendências , Síndrome de Abstinência Neonatal/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Complicações na Gravidez/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Adolescente , Adulto , Antidepressivos/efeitos adversos , Feminino , Florida/epidemiologia , Humanos , Recém-Nascido , Masculino , Síndrome de Abstinência Neonatal/diagnóstico , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Gravidez , Complicações na Gravidez/diagnóstico , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal/diagnóstico , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Tabagismo/diagnóstico , Tabagismo/epidemiologia , Estados Unidos/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Smoking is highly prevalent among people who have experience of severe mental ill health, contributing to their poor physical health. Despite the 'culture' of smoking in mental health services, people with severe mental ill health often express a desire to quit smoking; however, the services currently available to aid quitting are those which are widely available to the general population and may not be suitable or effective for people with severe mental ill health. The aim of this study is to explore the effectiveness and cost-effectiveness of a bespoke smoking-cessation intervention specifically targeted at people with severe mental ill health. METHODS/DESIGN: SCIMITAR+ is a multicentre, pragmatic, two-arm, parallel-group, individually randomised controlled trial. We aim to recruit 400 participants aged 18 years and above with a documented diagnosis of bipolar disorder, schizophrenia or schizoaffective disorder who smoke. Potentially eligible participants identified in primary or secondary care will be screened, and baseline data collected. Eligible, consenting participants will be randomly allocated to one of two groups. In the intervention arm, the participant will be assigned a mental health professional trained to deliver smoking-cessation interventions who will work with the participant and participant's GP or mental health specialist to provide an individually tailored smoking-cessation service. The comparator arm will be usual care - following current NICE guidelines for smoking cessation, in line with general guidance that is offered to all smokers, with no specific adaptation or enhancement in relation to severe mental ill health. The primary outcome will be self-reported smoking cessation at 12 months verified by expired carbon monoxide (CO) measurement. Secondary outcome measures include Body Mass Index at 12 months, the Fagerström Test for Nicotine Dependence, Motivation to Quit questionnaire, SF-12, PHQ-9, GAD-7, EQ-5D-5 L, and health service utilisation at 6 and 12 months. The economic evaluation at 12 months will be conducted in the form of an incremental cost-effectiveness analysis. DISCUSSION: SCIMITAR+ trial is the largest trial to our knowledge to investigate the effectiveness of a bespoke smoking-cessation service for people with severe mental ill health. TRIAL REGISTRATION: International Standard Randomised Controlled Trials Number, ISRCTN72955454 . Registered on 16 January 2015.
Assuntos
Transtorno Bipolar/psicologia , Transtornos Psicóticos/psicologia , Esquizofrenia , Psicologia do Esquizofrênico , Fumantes/psicologia , Abandono do Hábito de Fumar/métodos , Fumar/psicologia , Tabagismo/terapia , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/economia , Análise Custo-Benefício , Feminino , Custos de Cuidados de Saúde , Nível de Saúde , Humanos , Masculino , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/economia , Projetos de Pesquisa , Esquizofrenia/diagnóstico , Esquizofrenia/economia , Índice de Gravidade de Doença , Fumar/efeitos adversos , Fumar/economia , Abandono do Hábito de Fumar/economia , Inquéritos e Questionários , Fatores de Tempo , Tabagismo/diagnóstico , Tabagismo/economia , Tabagismo/psicologia , Resultado do Tratamento , Reino UnidoAssuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Atenção Primária à Saúde/métodos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Prescrições de Medicamentos , Tabagismo/diagnóstico , Programas de Rastreamento , Abuso de Maconha/diagnóstico , Inquéritos e Questionários , Ensaios Clínicos como Assunto , Estudos Multicêntricos como Assunto , Sensibilidade e Especificidade , Transtornos Relacionados ao Uso de Álcool/diagnósticoAssuntos
Codificação Clínica , Epidemiologia/estatística & dados numéricos , Revisão da Utilização de Seguros/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Centers for Medicare and Medicaid Services, U.S. , Depressão/diagnóstico , Depressão/epidemiologia , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Epidemiologia/legislação & jurisprudência , Regulamentação Governamental , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Hepatite C/diagnóstico , Hepatite C/epidemiologia , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Pacientes Internados/estatística & dados numéricos , Revisão da Utilização de Seguros/legislação & jurisprudência , Nefropatias/diagnóstico , Nefropatias/epidemiologia , Cirrose Hepática/diagnóstico , Cirrose Hepática/epidemiologia , Medicaid/legislação & jurisprudência , Pacientes Ambulatoriais/estatística & dados numéricos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/terapia , Fatores de Tempo , Tabagismo/diagnóstico , Tabagismo/epidemiologia , Estados Unidos/epidemiologiaRESUMO
Efforts to reduce the public health burden of tobacco use have not equally benefited all members of society, leading to disparities in tobacco use as a function of ethnicity/race, socioeconomic position, physical/behavioral comorbidity, and other factors. Although multilevel transdisciplinary models are needed to comprehensively understand sources of tobacco-related health disparities (TRHD), the incorporation of psychopharmacology into TRHD research is rare. Similarly, psychopharmacology researchers have often overlooked the societal context in which tobacco is consumed. In an effort to facilitate transdisciplinary research agendas for studying TRHD and the psychopharmacology of tobacco use, this article introduces a novel paradigm, called "sociopharmacology." Sociopharmacology is a platform for investigating how contextual factors amplify psychopharmacological determinants of smoking to disproportionately enhance vulnerability to smoking in populations subject to TRHD. The overall goal of sociopharmacology is to identify proximal person-level psychopharmacological mechanisms that channel distal societal-level influences on TRHD. In this article I describe: (1) sociopharmacology's overarching methodology and theoretical framework; (2) example models that apply sociopharmacology to understand mechanisms underlying TRHD; (3) how sociopharmacological approaches may enhance the public health impact of basic research on the psychopharmacology of tobacco use; and (4) how understanding sociopharmacological mechanisms of TRHD might ultimately translate into interventions that reduce TRHD.
Assuntos
Compreensão , Disparidades nos Níveis de Saúde , Tabagismo/epidemiologia , Tabagismo/psicologia , Comportamento Aditivo/diagnóstico , Comportamento Aditivo/epidemiologia , Comportamento Aditivo/psicologia , Humanos , Psicofarmacologia , Saúde Pública , Fumar/epidemiologia , Fumar/psicologia , Fatores Socioeconômicos , Tabagismo/diagnósticoRESUMO
BACKGROUND: Most telephone quitlines provide free nicotine replacement therapy (NRT). An 8-week course is recommended, but few users complete it. Information is needed to help quitlines distribute NRT cost-effectively. DESIGN: Randomised two-group trial. SETTING/PARTICIPANTS: Colorado QuitLine callers who smoked 16-20 cigarettes per day at enrolment and who were eligible for and agreed to receive free NRT. INTERVENTION: Provision of 4-week versus 8-week NRT supply; the 8-week supply was shipped in halves and required participants to request the second half (split-shipment protocol). Enrolment occurred during March 2010-February 2011, follow-up concluded in November 2011, and analysis was performed in 2012. MAIN OUTCOME MEASURES: Point abstinence (7 and 30 day) and prolonged abstinence (6 month) from tobacco use. RESULTS: Overall, 1495 study participants were enrolled and 57.7% completed follow-up. Abstinence rates did not differ significantly between study conditions: 13.8% versus 12.4% in 4-week versus 8-week arms, respectively, (30-day point abstinence, non-respondents treated as smokers). NRT duration was similar in both groups, due in part to purchase of additional patches in the 4-week group. About one-third of the 8-week group requested the full 8-week supply and had higher abstinence rates. Cost per quit was lower in the 4-week (compared to 8-week) group. CONCLUSIONS: A randomised trial did not find worse cessation outcomes among quitline users who received half the minimum recommended course of NRT, but offering the full recommended course using a split-shipment protocol may be reasonably cost-effective and supportive of NRT adherers. TRIAL REGISTRATION NUMBER: NCT01889771.
Assuntos
Nicotina/administração & dosagem , Agonistas Nicotínicos/administração & dosagem , Serviços Preventivos de Saúde/métodos , Abandono do Hábito de Fumar/métodos , Prevenção do Hábito de Fumar , Dispositivos para o Abandono do Uso de Tabaco , Tabagismo/prevenção & controle , Administração Cutânea , Adolescente , Adulto , Análise Custo-Benefício , Custos de Medicamentos , Feminino , Regulamentação Governamental , Humanos , Governo Local , Masculino , Pessoa de Meia-Idade , Nicotina/economia , Agonistas Nicotínicos/economia , Serviços Preventivos de Saúde/economia , Fumar/efeitos adversos , Fumar/economia , Fumar/psicologia , Abandono do Hábito de Fumar/economia , Abandono do Hábito de Fumar/psicologia , Fatores de Tempo , Dispositivos para o Abandono do Uso de Tabaco/economia , Tabagismo/diagnóstico , Tabagismo/economia , Tabagismo/psicologia , Adesivo Transdérmico , Resultado do Tratamento , Adulto JovemRESUMO
INTRODUCTION: The PROMIS Smoking Initiative has developed six item banks for assessment related to cigarette smoking among adult smokers (Nicotine Dependence, Coping Expectancies, Emotional and Sensory Expectancies, Health Expectancies, Psychosocial Expectancies, and Social Motivations). This article evaluates the psychometric performance of the banks when administered via short form (SF), computer adaptive test (CAT), and by mode of administration (computer vs. paper-and-pencil). METHODS: Data are from two sources: an internet sample (N = 491) of daily and nondaily smokers who completed both SFs and CATs via the web and a community sample (N = 369) that completed either paper-and-pencil or computer administration of the SFs at two time points. First a CAT version of the PROMIS Smoking Assessment Toolkit was evaluated by comparing item administration rates and scores to the SF administration. Next, we considered the effect of computer versus paper-and-pencil administration on scoring and test-retest reliability. RESULTS: Across the domains approximately 5.4 to 10.3 items were administered on average for the CAT. SF and CAT item response theory-scores were correlated from 0.82 to 0.92 across the domains. Cronbach's alpha for the four- to eight-item SFs among daily smokers ranged from .80 to .91 and .82 to .91 for paper-and-pencil and computer administrations, respectively. Test-retest reliability of the SFs ranged from 0.79 to 0.89 across mode of administration. CONCLUSIONS: Results indicate that the SF and CAT and computer and paper-and-pencil administrations provide highly comparable scores for daily and nondaily smokers, but preference for SF or CAT administration may vary by smoking domain.