Cigarette Smoking Behaviors and Beliefs in Persons Living With Hepatitis C.

BACKGROUND AND RATIONALE: Tobacco use is common among persons living with hepatitis C (PLHC), yet little is known about their smoking behaviors and beliefs. Modern hepatitis C treatment offers a unique opportunity to intensively engage this population about other health risks, including smoking. MAIN RESULTS: Seventy-seven tobacco users (40 hepatitis C virus [HCV] seropositive and 37 HCV seronegative) enrolled in an interview study in a New York City clinic. The mean age was 51.6, 57.1% were male, 40.3% Latino, and 49.4% black. 67.5% were single and 18.2% were employed. HCV+ smokers differed from HCV- smokers in having a higher prevalence of illicit substance use, depression, and hypertension. PLHC smokers were highly motivated to quit, with 52.5% stating an intention to quit within 30 days. Most of the PLHC smokers had used cessation-directed pharmacotherapy, but almost none had tried a quitline or a quit smoking website. PLHC smokers scored higher on the intrapersonal locus of control subscale. Almost a quarter (22.5%) believed that smoking "helped fight the HCV." CONCLUSIONS: PLHC smokers have a high burden of psychiatric and substance use comorbidity. They exhibit characteristics that distinguish them from uninfected smokers, and many harbor false beliefs about imagined benefits of smoking. They are highly motivated to quit but underutilize cessation aids. Without aggressive intervention, smoking-related morbidity will likely mute the health benefits and longevity gains associated with hepatitis C treatment. Research such as this may prove useful in guiding the development of future tobacco treatment strategies. IMPLICATIONS: This is the first paper to examine, in detail, sociobehavioral correlates of tobacco use in PLHC. PLHC are recognized by the Department of Health and Human Services as a high-priority health disparities population. We are not aware of any tobacco treatment services designed specifically for PLHC. The first step in designing an intervention is defining the characteristics of the target group. Our findings will begin to address this need, and may prove useful in optimizing tobacco treatment strategies for smokers living with hepatitis C.

Barriers to Telephone Quitline Use Among Methadone-Maintained Smokers.

INTRODUCTION: Drug users have high rates of tobacco use and tobacco-related disease. Telephone quitlines promote smoking cessation, but their reach among drug users is unknown. We thus aimed to assess utilization of and barriers to telephone quitlines among methadone-maintained smokers. METHODS: Subjects were opioid-dependent smokers in Bronx, New York, methadone treatment programs who were enrolled in a clinical trial of varenicline. All subjects were offered referral to a free, proactive quitline. We examined quitline records, surveyed barriers to quitline use, and queried reasons for declining referral. RESULTS: Of the 112 subjects enrolled, 47% were male, 54% were Hispanic, and 28% were Black. All subjects were offered referral, and 25 (22% of study participants) utilized the quitline. Quitline utilizers (vs. nonutilizers) were significantly more likely to have landline phone service (72 vs. 42%, p = .01), interest in quitline participation (92 vs. 62%, p < .01), and willingness to receive calls (96 vs. 76%, p = .02). Nonutilizers were significantly more likely to report cell phone service lapse (38 vs. 14%, p = .04), and difficulty charging cell phones (19 vs. 0%, p = .02). Reasons for quitline refusal included: (a) skepticism of quitline efficacy; (b) aversion to telephone communication; (c) competing life demands (e.g., drug treatment, shelter); and (d) problems with cell phone service or minutes. CONCLUSIONS: Despite several limitations to quitline access among methadone-maintained smokers, routine quitline referral was associated with 22% utilization. To expand provision of smoking cessation treatment to opioid-dependent smokers, interventions to promote routine quitline referral in substance abuse treatment programs warrant investigation.

A novel smoking-specific self-control task: An initial study of feasibility, acceptability, and changes in self-control and cigarette smoking behaviors among adults using cigarettes.

Objective: Self-control is a key factor in quitting cigarettes and practicing general self-control tasks may strengthen self-control. This study examined the feasibility and acceptability of a novel smoking-related self-control task. Method: Seventy-five adults with current cigarette smoking (Mage = 44.8, 74.7% male, 63.5% Black, 74.3% non-Latinx) were randomly assigned to practice a smoking-specific self-control task (Delay Smoking Task, n = 39) or a general self-control task (Posture Task, n = 36) for 1 week. Assessments included cigarettes per day (CPD), motivation to quit smoking, self-control, and task acceptability. Results: Most participants completed both appointments with no difference between task groups (p = .69). The Delay Smoking Task group rated the task as more difficult (p = .04) and more helpful for quitting smoking (p = .005) than did the Posture Task group. Self-control task groups did not differ in task effort (p = .66), task success (p = .14), or self-control used to practice the task (p = .13). Both task groups reported increased quit desire, expected quit success, quit confidence, and quit motivation (p < .05; partial η²s = 0.108-0.333). The time by task group interaction approached significance for expected quit success (p = .06; partial η² = .053), with the Delay Smoking Task group showing greater increases than the Posture Task group. Over the week, smoking decreased an average of 1.0 CPD with no difference between groups (p = .72; partial η² = 0.165). Conclusions: Practicing self-control was associated with increases in motivation to quit, confidence in quitting, and expected success at quitting smoking with similar changes for those practicing a smoking-specific versus a general self-control task. Self-control tasks may be useful for increasing motivation to quit cigarettes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Self-control and smoking in a sample of adults living with HIV/AIDS: A cross-sectional survey.

INTRODUCTION: Cigarette smoking prevalences are very high in persons living with HIV (PLWH). Identifying variables among PLWH that are linked to smoking in community samples (e.g., self-control) can inform smoking treatments for PLWH. The current study examined the association of self-reported self-control and smoking (e.g., smoking status, cigarette dependence) in a sample of PLWH. METHODS: Adult PLWH were recruited from the Center for Positive Living (Montefiore Medical Center, Bronx, New York, US). All participants completed measures of demographics, cigarette smoking, and self-control. Participants who reported current cigarette smoking completed measures of cigarette dependence; intolerance for smoking abstinence; and motivation, confidence, and desire to quit smoking. RESULTS: The overall sample included 285 PLWH (49.1% cigarette users, 55.4% male, 52.7% Black race, 54.8% Latino/a ethnicity). PLWH with current cigarette smoking reported lower self-control than PLWH with no current cigarette smoking (M = 116.88, SD = 17.07 versus M = 127.39, SD = 20.32; t = -4.15, df = 211, p < 0.001). Among PLWH with current cigarette smoking, lower self-control was associated with greater cigarette dependence (ρ = -0.272, p < 0.01), and lower confidence in quitting smoking cigarettes (ρ = 0.214, p < 0.05). Lower self-control was associated with greater overall smoking abstinence intolerance (ρ = -0.221, p < 0.05) and withdrawal intolerance (ρ = -0.264, p < 0.01). DISCUSSION: Among a sample of PLWH, lower self-control was related to cigarette smoking (versus no smoking), greater cigarette dependence, lower confidence in quitting smoking, and greater intolerance for smoking abstinence. It may be useful to target self-control among PLWH to increase confidence in quitting and abstinence intolerance with the goal of improving smoking cessation outcomes.

Rationale and design of a randomized controlled trial of varenicline directly observed therapy delivered in methadone clinics.

BACKGROUND: Tobacco cessation medication adherence is one of the few factors shown to improve smoking cessation rates among methadone-maintained smokers, but interventions to improve adherence to smoking cessation medications have not yet been tested among methadone treatment patients. Methadone clinic-based, directly observed therapy (DOT) programs for HIV and tuberculosis improve adherence and clinical outcomes, but have not been evaluated for smoking cessation. We describe a randomized controlled trial to evaluate whether a methadone clinic-based, directly observed varenicline therapy program increases adherence and tobacco abstinence among opioid-dependent drug users receiving methadone treatment. METHODS/DESIGN: We plan to enroll 100 methadone-maintained smokers and randomize them to directly observed varenicline dispensed with daily methadone doses or treatment as usual (self-administered varenicline) for 12 weeks. Our outcome measures are: 1) pill count adherence and 2) carbon monoxide-verified tobacco abstinence. We will assess differences in adherence and abstinence between the two treatment arms using repeated measures models. DISCUSSION: This trial will allow for rigorous evaluation of the efficacy of methadone clinic-based, directly observed varenicline for improving adherence and smoking cessation outcomes. This detailed description of trial methodology can serve as a template for the development of future DOT programs and can guide protocols for studies among opioid-dependent smokers receiving methadone treatment. TRIAL REGISTRATION: clinicaltrials.gov NCT01378858.

Varenicline efficacy and safety among methadone maintained smokers: a randomized placebo-controlled trial.

AIMS: To test the efficacy and safety of varenicline as an aid to smoking cessation in methadone-maintained smokers. DESIGN: Multicenter, randomized, double-blind, placebo-controlled trial with random assignment to 12 weeks of varenicline 1 mg twice daily (n = 57) or matched placebo (n = 55), with in-person and telephone counseling. SETTING: Urban methadone programs in the Bronx, New York City, New York, USA. PARTICIPANTS: Methadone maintenance patients, smoking ≥5 cigarettes/day, interested in quitting, stable in methadone treatment, without current Axis I psychiatric disorders, suicidal ideation or recent suicide attempts. MEASUREMENTS: Seven-day point prevalence abstinence verified by expired carbon monoxide (CO) < 8 parts per million at week 12 (primary outcome); carbon monoxide (CO)-verified abstinence, cigarettes/day, incident Axis I psychiatric illness, suicidal ideation or serious adverse events (SAEs) at weeks 2, 4, 8, 12 or 24 (secondary outcomes). FINDINGS: Baseline demographic, smoking and clinical factors were similar between groups. Retention at 24 weeks was 90%. Subjects receiving varenicline were more likely than those receiving placebo to achieve abstinence (10.5 versus 0%, P = 0.03; effect size 10.5%, 95% confidence interval (CI) = 4.4-19.3%) and to reduce smoking (median five versus two cigarettes/day, P < 0.001) at 12 weeks. These effects were not maintained after drug treatment ceased. Incident psychiatric illness (OR= 0.84, 95% CI = 0.16, 4.4) and suicidality [odds ratio (OR) = 0.88, 95% CI 0.2, 3.9] were not different between groups. There were no psychiatric or cardiac SAEs. CONCLUSIONS: Varenicline can aid short-term smoking abstinence in methadone-maintained smokers.