Hypnotherapy compared to cognitive-behavioral therapy for smoking cessation in a randomized controlled trial.

Worldwide, more than eight million people die each year as a result of tobacco use. A large proportion of smokers who want to quit are interested in alternative smoking cessation methods, of which hypnotherapy is the most popular. However, the efficacy of hypnotherapy as a tobacco cessation intervention cannot be considered sufficiently proven due to significant methodological limitations in the studies available to date. The aim of the present study was to compare the efficacy of a hypnotherapeutic group program for smoking cessation with that of an established cognitive-behavioral group program in a randomized controlled trial. A total of 360 smokers who were willing to quit were randomly assigned to either hypnotherapy (HT) or cognitive-behavioral therapy (CBT) at two study sites, without regard to treatment preference. They each underwent a 6 weeks smoking cessation course (one 90 min group session per week) and were followed up at regular intervals over a 12 months period. The primary outcome variable was defined as continuous abstinence from smoking according to the Russell standard, verified by a carbon monoxide measurement at three measurement time points. Secondary outcome variables were 7 days point prevalence abstinence during the 12 months follow up and the number of cigarettes the non-quitters smoked per smoking day (smoking intensity). Generalized estimating equations were used to test treatment condition, hypnotic suggestibility, and treatment expectancy as predictors of abstinence. The two interventions did not differ significantly in the proportion of participants who remained continuously abstinent throughout the follow-up period (CBT: 15.6%, HT: 15.0%) and also regarding the 7 days abstinence rates during the 12 months follow-up (CBT: 21.2%, HT: 16.7%). However, when controlling for hypnotic suggestibility, CBT showed significantly higher 7 days abstinence rates. In terms of the continuous abstinence rates, it can be concluded that the efficacy of hypnotherapeutic methods for smoking cessation seem to be comparable to established programs such as CBT. Clinical trial registration: ClinicalTrials.gov, identifier NCT01129999.

Silver Spike Point Therapy in smoking cessation: What is it and does it work?

Smoking is a global health challenge that causes a myriad of diseases. Smoking cessation services are part of the armamentarium to combat smoking epidemic. In addition to the approved treatments, alternative therapies, including electrical stimulation, have been proposed. The aim of this study is to review and summarize the evidence for the efficacy of electrical stimulation, including Silver Spike Point therapy, in smoking cessation. A historical background and descriptive summary of various acupuncture and related therapies is provided. Systematic reviews and original studies were reviewed, and their results were summarized. In conclusion, the current best available evidence does not support the use of electrical stimulation, including Silver Spike Point therapy, in smoking cessation. Policy makers and healthcare providers should aim to utilize the available resources to provide evidence-based treatment options for patients seeking to quit tobacco use.

Feasibility and Efficacy of a Brief Mindfulness-Based Smoking Intervention Delivered via the Internet: A Randomized Controlled Trial.

Background: A growing body of literature suggests that mindfulness-based interventions are effective in reducing smoking. However, existing mindfulness interventions are often lengthy and require extensive interaction with a therapist, making them inaccessible to a large percentage of the population. The current study addressed this issue by testing the feasibility and efficacy of a single session, web-based, mindfulness intervention for smoking cessation. Methods: Participants (N = 80) took part in a fully online cue exposure exercise interspersed with brief instructions on how to cope with cravings for cigarettes. All participants were randomly assigned to receive either mindfulness-based or coping as usual instructions. Outcomes included participant satisfaction with the intervention, self-reported craving following the cue exposure exercise, and cigarette use 30 days post-intervention. Results: Participants in both groups found the instructions moderately helpful and easy to understand. Participants in the mindfulness group reported a significantly smaller increase in craving than those in the control group following the cue exposure exercise. Averaging across conditions, participants reported smoking fewer cigarettes in the 30 days following the intervention than in the 30 days prior, however there were no between group differences in cigarette use. Conclusion: Mindfulness-based interventions for smoking reduction can be effectively implemented in a brief, single-session online format. These interventions are easy to disseminate and can reach a large number of smokers with minimal participant burden. Results from the current study suggest that mindfulness-based interventions can help participants control craving in the face of smoking-related cues, although perhaps not change smoking quantity. Future research is needed to explore factors which may increase the efficacy of online, mindfulness-based interventions for smoking cessation, while still maintaining their accessibility and reach.

Addressing nutrition and physical activity in substance use disorder treatment: Client reports from a wellness-oriented, tobacco-free policy intervention.

Introduction: Interest in wellness interventions in substance use disorder (SUD) treatment is growing although evidence remains limited. This study evaluated nutrition, physical activity, nutrition and physical activity counseling, and relationships of counseling with wellness behavior before and after a wellness-oriented, tobacco-free policy intervention in 17 residential SUD programs. Methods: Clients completed cross-sectional surveys reporting sugar-sweetened beverage consumption, physical activity, and receipt of nutrition and physical activity counseling before (n= 434) and after (n = 422) an 18-month intervention. Multivariable regression models assessed pre-post-intervention differences in these variables and examined associations of nutrition counseling with sugar-sweetened beverage consumption and physical activity counseling with physical activity. Results: Post-intervention clients were 83% more likely than pre-intervention clients to report nutrition counseling (p = 0.024). There were no pre-post- differences for other variables. Past week sugar-sweetened beverage consumption was 22% lower among clients reporting nutrition counseling than for those who did not (p = 0.008) and this association did not vary by time (pre/post). There was a significant interaction of physical activity counseling receipt by time on past week physical activity (p = 0.008). Pre-intervention clients reporting physical activity counseling had 22% higher physical activity than those who did not; post-intervention clients reporting physical activity counseling had 47% higher physical activity. Conclusion: A wellness policy intervention was associated with increased nutrition counseling. Nutrition counseling predicted lower sugar-sweetened beverage consumption. Physical activity counseling predicted higher physical activity, an association that was greater post-intervention. Adding wellness components to tobacco-related interventions may promote health among SUD clients.

Integrating Tobacco Use Assessment and Treatment in the Oncology Setting: Quality Improvement Results from the Georgetown Lombardi Smoking Treatment and Recovery Program.

As part of the NCI's Cancer Center Cessation (C3i) initiative, we initiated, expanded, and maintained an evidence-based tobacco treatment program at the Georgetown Lombardi Comprehensive Cancer Center. We present a quality improvement (QI) assessment of the implementation process and patient-level outcomes. At two hematology/oncology outpatient clinical sites, five oncology-based teams (clinical administrators, clinical staff, pharmacy, information technology, and tobacco treatment staff) developed implementation strategies for opt-out patient assessment and enrollment, centralized tobacco treatment, audit, feedback, and staff training. Among eligible patients (tobacco use in ≤30 days), we assessed demographic, clinical, and tobacco-related characteristics to examine predictors of enrollment (baseline completed), treatment engagement (≥one sessions completed), and self-reported 7-day abstinence (6 months post-enrollment). Across both sites, medical assistants screened 19,344 (82.4%) patients for tobacco use, which identified 1345 (7.0%) current tobacco users, in addition to 213 clinician referrals. Of the 687/1256 (54.7%) eligible patients reached, 301 (43.8%) enrolled, and 199 (29.0%) engaged in treatment, of whom 74.5% were African American and 68% were female. At the larger site, significant multivariate predictors of enrollment included African American race (vs. white/other) and clinician referral (vs. MA assessment). Treatment engagement was predicted by greater nicotine dependence, and abstinence (27.4%) was predicted by greater treatment engagement. In summary, the systematic utilization of multiple oncology-based teams and implementation strategies resulted in the development and maintenance of a high-quality, population-based approach to tobacco treatment. Importantly, these strategies addressed inequities in tobacco treatment, as the program reached and engaged a majority-African-American patient population. Finally, the opt-out patient assessment strategy has been implemented in multiple oncology settings at MedStar Health through the Commission on Cancer's Just Ask program.

Self-treatment attempt of tobacco use disorder with Melissa officinalis: a case report and brief review of literature.

In the treatment of tobacco use disorder, current approaches focus on pharmacotherapy, nicotine replacement, and psychotherapy. However, traditional treatments have been widely used in societies for the purpose of smoking cessation for years. Although cases using traditional herbs in the self-treatment of addiction have been reported in the literature, studies on this subject are very limited. Research on certain herbs shows that they may be effective in the treatment of tobacco use disorder by different mechanisms, however, there is no evidence that they are safe to consume as cigarettes. This article aims to question the place of traditional herbs in tobacco use disorder treatment through a case who started to smoke Melissa officinalis herb to help his nicotine withdrawal.

Rates of Tobacco Use Disorder, Pharmacologic Treatment, and Associated Mental Health Disorders in a Medicaid Claim Review Among Youth in Indiana, USA.

Purpose: This study delineates a number of Medicaid youth with tobacco use disorder (TUD), prescribing habits for treatment, and associated externalizing disorders. Methods: Youth Medicaid claims from 2007-2017 processed in a large Midwestern city were analyzed for a diagnosis of TUD, related pharmacotherapy, and externalizing mental health and substance use disorders. Results: Claims connected 6541 patients with 42 890 visits. Mean age was 16.4 with 40% female. 1232 of the 6541 charts contained a TUD diagnosis equating to 1848 visits. A comorbid diagnosis of ADHD, cannabis use, and conduct disorder were more common in males (3.9% vs 1.3% in females; 3.4% vs .8%; and 2.8% vs .8%; P < .05). 808 scripts were provided to 152 of the 1232 youths, with 4.7% of those scripts a nicotine replacement product. Conclusions: Pharmacotherapy is underutilized in this Medicaid claims data set. Certain externalizing factors were associated with males with TUD more than females.

Avaliação do potencial de melhoria de Baccharis trimeraem um modelo experimental de doença pulmonar / On the ameliorative potential of Baccharis trimera in an experimental model of pulmonary disease

Diabetes mellitus, tabagismo e dislipidemia são mais prevalentes em pacientes com doença pulmonar obstrutiva crônica (DPOC), a quarta causa de mortalidade no mundo. Este estudo empregou um modelo de doença pulmonar em ratos Wistar que incorporou esses três fatores de risco e investigou os efeitos da Baccharis trimera, uma planta medicinal amplamente utilizada, uma vez que nenhum estudo avaliou seus efeitos pulmonares. Os ratos diabéticos e dislipidêmicos foram expostos à fumaça de cigarro por 4 semanas e tratados com veículo (grupo C-), extrato de B. trimera (HEBT), ou sinvastatina+insulina, por 2 semanas. O lavado broncoalveolar foi realizado para avaliar a inflamação. Os pulmões foram coletados para análises histopatológicas e do estado redox. Foi observada diminuição do peso corporal, aumento do estresse oxidativo, inflamação e alterações histopatológicas no grupo C-. HEBT reverteu essas alterações e apresentou efeito antiinflamatório moderado. O tratamento com HEBT apresentou efeitos promissores para a DPOC.

Diabetes mellitus, smoking, and dyslipidemia are more prevalent in patients with chronic obstructive pulmonary disease (COPD), the fourth leading cause of mortality worldwide. This study employed a model of lung disease in Wistar rats that incorporated these three risk factors, and investigated the effects of Baccharis trimera, a widely used medicinal plant, since no previous studies have evaluated its pulmonary effects. The diabetic and dyslipidemic rats were exposed to smoke for 4 weeks and treated with vehicle (C- group), an extract of B. trimera (HEBT), or simvastatin+insulin, for 2 weeks. The bronchoalveolar lavage was performed to evaluate inflammation. The lungs were collected for histopathological and redox state analyses. A decrease in body weight, an increase in oxidative stress, inflammation, and histopathological changes were observed in C- group. HEBT reversed these alterations and had a moderate antiinflammatory effect. Treatment with HEBT present promising effects for COPD.

Classic Psychedelics in Addiction Treatment: The Case for Psilocybin in Tobacco Smoking Cessation.

This manuscript reviews research suggesting that classic psychedelics (5-HT2A receptor agonists) are effective in treating addictions including tobacco use disorder. I review historical research from the 1950s to 1970s suggesting that classic psychedelics are associated with addiction recovery across pharmacologically distinct drugs of addiction. I then review anthropological reports about ceremonial use of classic psychedelics and epidemiological studies that are consistent with anti-addiction efficacy. I review modern research using psilocybin in the treatment of alcohol use disorder and tobacco use disorder. Both lines of research show high success rates in preliminary studies. General anti-addiction efficacy across a variety of classes of addictive drugs is consistent with the notion that the persisting positive behavior change prompted by psychedelic therapy is due to amplification of psychotherapeutic processes. Future research should examine classic psychedelic treatment of additional substance use disorders including for opioids, cocaine, methamphetamine, and cannabis, and other disorders broadly characterized as addictions (e.g., obesity, problem gambling, hypersexual disorder). Future research should also explore addiction treatments with other classic psychedelics including LSD, mescaline, DMT, 5-MeO-DMT, and yet-to-be-discovered compounds. Experimental research is also needed to test different protocols for the delivery of classic psychedelic therapy for addictions. Given the staggering society costs of substance use disorders, including the mortality caused by tobacco smoking, it is critical that public funding be made available for scientists to follow up on promising early findings of classic psychedelics in addiction treatment. The costs and risks of not conducting such research are too great.

Quantitative evaluation of radon, tobacco use and lung cancer association in an occupational cohort with 27 follow-up years.

BACKGROUND: Occupational radon cohorts provide important information about exposure at residential level, which are difficult to observe prospectively. However, evidence about radon-related lung cancer risks from initial exposure in childhood or interaction between radon and smoking is still limited. METHODS: A total of 6017 tin miners with at least 10 years of underground radon exposure were enrolled beginning in 1992 and followed for up to 27 years. Lung cancer risks were estimated by modeling total and intensity of radon exposure. RESULTS: A total of 933 lung cancer cases occurred in this cohort over 89,092 person-years of follow up. Excess relative risk increased by 0.96% per cumulative working level month (WLM). A unique aspect of this population was the early age at first radon exposure for workers. Results showed that lung cancer risk from initial radon exposure in childhood (<13 years old) was greater than risk when first exposure occurred at later ages (13-17, 18-24, and ≥ 25 years old). Moreover, risk declined with years since last exposure and attained age, but increased with age at last exposure. Importantly, these patterns were stable after adjustment for tobacco use or arsenic exposure. For joint effects of radon and other agents, our results support sub-multiplicative as the most likely model for interaction between radon and tobacco use or arsenic exposure. CONCLUSION: This study highlights the possible importance of radon exposure in childhood in cancer etiology and suggests another potential strategy to mitigate the global lung cancer burden.

Frequency and Patterns of Brain Infarction in Patients With Embolic Stroke of Undetermined Source: NAVIGATE ESUS Trial.

BACKGROUND AND PURPOSE: The spectrum of brain infarction in patients with embolic stroke of undetermined source (ESUS) has not been well characterized. Our objective was to define the frequency and pattern of brain infarcts detected by magnetic resonance imaging (MRI) among patients with recent ESUS participating in a clinical trial. METHODS: In the NAVIGATE ESUS trial (New Approach Rivaroxaban Inhibition of Factor Xa in a Global Trial Versus ASA to Prevent Embolism in Embolic Stroke of Undetermined Source), an MRI substudy was carried out at 87 sites in 15 countries. Participants underwent an MRI using a specified protocol near randomization. Images were interpreted centrally by those unaware of clinical characteristics. RESULTS: Among the 918 substudy cohort participants, the mean age was 67 years and 60% were men with a median (interquartile range) of 64 (26-115) days between the qualifying ischemic stroke and MRI. On MRI, 855 (93%) had recent or chronic brain infarcts that were multiple in 646 (70%) and involved multiple arterial territories in 62% (401/646). Multiple brain infarcts were present in 68% (510/755) of those without a history of stroke or transient ischemic attack before the qualifying ESUS. Prior stroke/transient ischemic attack (P<0.001), modified Rankin Scale score >0 (P<0.001), and current tobacco use (P=0.01) were associated with multiple infarcts. Topographically, large and/or cortical infarcts were present in 89% (757/855) of patients with infarcts, while in 11% (98/855) infarcts were exclusively small and subcortical. Among those with multiple large and/or cortical infarcts, 57% (251/437) had one or more involving a different vascular territory from the qualifying ESUS. CONCLUSIONS: Most patients with ESUS, including those without prior clinical stroke or transient ischemic attack, had multiple large and/or cortical brain infarcts detected by MRI, reflecting a substantial burden of clinical stroke and covert brain infarction. Infarcts most frequently involved multiple vascular territories. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02313909.

Youth susceptibility to tobacco use: is it general or specific?

BACKGROUND: Susceptibility to tobacco use predicts tobacco use onset among youth. The current study aimed to estimate the extent of overlap in susceptibilities across various tobacco products, investigate sociopsychological correlates with susceptibilities, and examine whether the relationship linking susceptibility with the onset of use is product-specific or is accounted for by a general susceptibility-onset relationship. METHODS: The study population consisted of US youth 12-17 years old who had never used a tobacco product, sampled in the longitudinal Population Assessment of Tobacco and Health study wave 4 (Dec. 2016-Jan. 2018; n = 10,977). Tobacco product-specific susceptibility at wave 4 was assessed via questions about curiosity, likelihood to try, and likelihood of use if a best friend offered. The onset of use of various tobacco products was defined as first use occurring between the wave 4 and wave 4.5 (Dec. 2017-Dec. 2018) assessments (n = 8841). Generalized linear regression and structural equation models were used for data analysis. RESULTS: There is a large degree of overlap in susceptibilities across tobacco products (65% of tobacco-susceptible youth were susceptible to more than one tobacco product). Tobacco-susceptible youths were more likely to have recently used cannabis, consumed alcohol, or to have been associated with tobacco-using peers. Structural equation models suggest that the susceptibility-onset relationship largely operates in a non-product-specific manner after accounting for the general susceptibility-to-tobacco-onset relationship. CONCLUSIONS: Youth susceptibility to tobacco use overlaps widely across different tobacco products and other risky behaviors. Findings from this study support a holistic approach towards the prevention of risk behaviors, supplemented by product-specific strategies when needed.

Evidence for the Confluence of Cigarette Smoking, Other Substance Use, and Psychosocial and Mental Health in a Sample of Urban Sexual Minority Young Adults: The P18 Cohort Study.

BACKGROUND: Sexual minority men (SMM) and transgender women (TW) are more likely to smoke cigarettes than heterosexual and cisgender peers, which may exacerbate existing disparities in mental and psychosocial health and substance use. PURPOSE: As few existing studies have examined the confluence of these factors, we sought to examine tobacco use in a diverse sample of SMM and TW and describe its relationship with other substance use and health. METHODS: Data were drawn from a study of syndemic conditions among SMM and TW, which included measures assessing tobacco use, substance use, and mental, psychosocial, and general health. RESULTS: A majority of the racially/ethnically and socioeconomically diverse sample (n = 665) reported ever smoking a cigarette, and more than half of them were current smokers. Current smoking was associated with more frequent recent substance use and poorer mental, psychosocial, and general health. In multivariable analyses, current smoking was predicted by more frequent substance use and more severe anxiety, when adjusting for demographic, substance use, and health factors. CONCLUSIONS: A syndemic approach to health conditions such as substance use, mental health, and psychosocial burden dictates a framework of interrelation and mutual exacerbation. In doing so, we found that current cigarette use was associated with more frequent alcohol and marijuana use and more severe anxiety, suggesting a confluence of cigarette smoking, other substance use, and mental health burden. We recommend a holistic approach to treating tobacco use in sexual and gender minority populations that addresses both substance use and the myriad psychosocial burdens that sexual and gender minority communities experience.

Mindfulness-based treatment for smoking cessation: a randomized controlled trial / Tratamento baseado em atenção plena (mindfulness) para cessação do tabagismo: ensaio clínico controlado randomizado

ABSTRACT Objective: To evaluate the efficacy of a mindfulness-based treatment (MBT) for smoking cessation or reduction and compare it with that of cognitive behavioral therapy (CBT). Methods: This was a single-center randomized controlled clinical trial including 113 patients divided into two groups: MBT (n = 54) and CBT (n = 59). The interventions comprised eight 90-min sessions. The primary outcome was smoking cessation at 16 weeks after program initiation. Secondary outcomes included reduction in the mean number of cigarettes smoked/day at 16 weeks after treatment initiation, as well as smoking cessation and reduction in the number of cigarettes smoked/day at the last program session. Participants had to attend ≥ 50% of the sessions to be included in the primary outcome analysis. An intention-to-treat analysis was also performed. Results: There was no difference between the groups regarding the primary outcome (30.4% in the MBT group vs. 31.6% in the CBT group, p = 0.68) or immediate abstinence rates (47.8% in the MBT group vs. 36.8% in the CBT group, p = 0.47). Both treatments were equally effective in reducing the number of cigarettes smoked/day at the last program session (a reduction of 93.33% [0-100%] in the MBT group and of 70% [33.3-100%] in the CBT group, p = 0.92) and at 16 weeks after program initiation (a reduction of 57.1% [0-100%] in the MBT group and of 70% [25-100%] in the CBT group, p = 0.49). Conclusions: MBT appears to be as effective as CBT for smoking cessation or reduction and can be an option for the treatment of tobacco use disorders in Brazil (Brazilian Registry of Clinical Trials identifier: RBR-3w2scz [http://www.ensaiosclinicos.gov.br])

RESUMO Objetivo: Avaliar a eficácia de um mindfulness treatment (MT, tratamento baseado em atenção plena) para a cessação ou redução do tabagismo e compará-la à da terapia cognitivo-comportamental (TCC). Métodos: Ensaio clínico controlado randomizado realizado em um único centro, com 113 pacientes divididos em dois grupos: MT (n = 54) e TCC (n = 59). As intervenções consistiram em oito sessões de 90 min cada. O desfecho primário foi a cessação do tabagismo 16 semanas após o início do programa. Os desfechos secundários foram a redução da média de cigarros fumados/dia em 16 semanas após o início do programa, bem como a cessação do tabagismo e redução do número de cigarros fumados/dia na última sessão do programa. Os participantes deveriam comparecer a ≥ 50% das sessões para que fossem incluídos na análise do desfecho primário. Foi também realizada uma análise por intenção de tratamento. Resultados: Não houve diferença entre os grupos quanto ao desfecho primário (30,4% no grupo MT vs. 31,6% no grupo TCC, p = 0,68) ou às taxas de abstinência imediata (47,8% no grupo MT vs. 36,8% no grupo TCC, p = 0,47). Ambos os tratamentos foram igualmente eficazes na redução do número de cigarros fumados/dia na última sessão do programa [redução de 93,33% (0-100%) no grupo MT e de 70% (33,3-100%) no grupo TCC, p = 0,92] e em 16 semanas após o início do programa [redução de 57,1% (0-100%) no grupo MT e de 70% (25-100%) no grupo TCC, p = 0,49]. Conclusões: A MT parece ser tão eficaz quanto a TCC para a cessação ou redução do tabagismo e pode ser uma opção para o tratamento do tabagismo no Brasil. [Registro Brasileiro de Ensaios Clínicos - ReBEC; número de identificação: RBR-3w2scz (http://www.ensaiosclinicos.gov.br)]

Food Addiction and Tobacco Use Disorder: Common Liability and Shared Mechanisms.

As food addiction is being more commonly recognized within the scientific community, parallels can be drawn between it and other addictive substance use disorders, including tobacco use disorder. Given that both unhealthy diets and smoking are leading risk factors for disability and death, a greater understanding of how food addiction and tobacco use disorder overlap with one another is necessary. This narrative review aimed to highlight literature that investigated prevalence, biology, psychology, and treatment options of food addiction and tobacco use disorder. Published studies up to August 2020 and written in English were included. Using a biopsychosocial lens, each disorder was assessed together and separately, as there is emerging evidence that the two disorders can develop concurrently or sequentially within individuals. Commonalities include but are not limited to the dopaminergic neurocircuitry, gut microbiota, childhood adversity, and attachment insecurity. In addition, the authors conducted a feasibility study with the purpose of examining the association between food addiction symptoms and tobacco use disorder among individuals seeking tobacco use disorder treatment. To inform future treatment approaches, more research is necessary to identify and understand the overlap between the two disorders.

Implementation of the Smoking Treatment and Recovery (STAR) program: healthy cancer survivorship through integrated tobacco control.

PURPOSE: It is well-established that persistent tobacco use among patients with cancer results in numerous adverse outcomes. However, the assessment and treatment of tobacco use with evidence-based methods have been lacking in cancer care. Our cancer center has established its first tobacco treatment program, a multidisciplinary, evidence-based, clinical program for hematology/oncology patients. METHODS: We describe the development and implementation of the program, emphasizing lessons learned in treating nicotine addiction among patients who are at very high risk for continuing to use tobacco throughout the survivorship phase. RESULTS: We developed a system to assess tobacco use at each outpatient visit, from those recently diagnosed to long-term survivors. For patients who have smoked in the past month, the protocol offers standard behavioral and pharmacological treatments, delivered by tobacco treatment specialists and nurse practitioners over four in-person and/or telephone-based sessions. Partnerships with the Psychosocial Oncology and Cancer Survivorship Programs have provided integrated and comprehensive care for patients during and after their cancer treatment. CONCLUSIONS: The systematic efforts to reach and engage current smokers have laid the groundwork for maximizing the program's future effectiveness and impact. Our initial results demonstrate not only the complexities but also the feasibility of developing a new tobacco treatment program in the oncology setting. IMPLICATIONS FOR CANCER SURVIVORS: The implications for cancer survivors are the significant improvements in treatment outcomes that occur with tobacco abstinence.

Dispositional mindfulness, affect and tobacco dependence among treatment naive cigarette smokers in Brazil.

INTRODUCTION: The current study examined associations between affective and smoking-related factors, and dispositional mindfulness among smokers seeking enrollment in a cessation program in Brazil. METHODS: Participants were first-time treatment seeking adult smokers (N=90) on a waiting list for a government-sponsored cessation program. Pearson's bivariate correlations assessed relationships between the primary outcome variable (dispositional mindfulness) and each explanatory variable (nicotine dependence, depression, anxiety, and state positive/negative affect). Linear regression analyses evaluated the unique contribution of each explanatory variable when controlling for the others. RESULTS: The sample (N=90) was predominantly female (n=71) and most (79%) had 11 or fewer years of education. In the final regression model, a total of 36.2% of the variance in dispositional mindfulness was accounted for by positive affect (B=0.81, p<0.001), negative affect (B= -0.44, p=0.02), and level of nicotine dependence (B=1.48, p=0.007). CONCLUSIONS: Positive and negative affect, as well as nicotine dependence, account for a significant and sizable amount of the variance in dispositional mindfulness. Future mindfulness interventions for smoking cessation should be designed to address individual differences in affect, as well as nicotine dependence, in order to better tailor treatment to address baseline differences in mindfulness.

Chronic kidney disease patients who smoke have higher serum phosphorus / Pacientes tabagistas com doença renal crônica apresentam fósforo sérico mais elevado

ABSTRACT Introduction: Mineral and bone metabolism disorders in chronic kidney disease (CKD-MBD) constitute a syndrome defined by changes in calcium, phosphorus (P), vitamin D and parathormone, fibroblast growth factor 23 (FGF-23) and its specific cofactor, Klotho. CKD-MBD, as well as smoking, are associated with an increased risk of cardiovascular disease. However, it is not known whether or not smoking impacts the cardiovascular risk in CKD- MBD. Objective: To analyze the relationship between smoking and CKD-MBD markers. Methods: We evaluated 92 patients divided into: 1) Control Group: non-smokers without CKD; 2) CKD group in stages III and IV under conservative treatment (20 non-smokers and 17 smokers); 3) CKD group on dialysis (21 non-smokers and 19 smokers). Clinical, demographic, and biochemical markers were compared between the groups. Results: FGF-23 and Klotho levels were not different between smokers and non-smokers. Patients in the CKD group on conservative treatment had higher serum P than non-smokers (p = 0.026) even after adjusted for renal function (p = 0.079), gender (p = 0.145) and age (p = 0.986). Conclusion: Smoking confers a higher cardiovascular risk to CKD patients under conservative treatment as it is associated with higher levels of P. Further studies are needed to confirm and better elucidate this finding.

RESUMO Introdução: Os distúrbios do metabolismo mineral e ósseo da doença renal crônica (DMO-DRC) constituem uma síndrome definida por alterações do cálcio, do fósforo (P), da vitamina D e do paratormônio, do fator de crescimento de fibroblastos 23 (FGF-23) e de seu cofator específico, Klotho. Os DMO-DRC, assim como o tabagismo, estão associados a maior risco de doença cardiovascular. Porém, não se sabe se há influência do tabagismo no risco cardiovascular dos DMO-DRC. Objetivo: Analisar a relação entre o tabagismo e marcadores dos DMO-DRC. Métodos: Avaliamos 92 pacientes divididos em: 1) Grupo controle sem DRC não tabagistas; 2) Grupo DRC em tratamento conservador estágios III e IV (20 não tabagistas e 17 tabagistas); 3) Grupo DRC em diálise (21 não tabagistas e 19 tabagistas). Marcadores clínicos, demográficos e bioquímicos foram comparados entre os grupos. Resultados: Níveis de FGF-23 e Klotho não foram diferentes entre tabagistas e não tabagistas. Pacientes tabagistas do grupo com DRC em tratamento conservador exibiram maior P sérico do que não tabagistas (p = 0,026) mesmo após ajuste para função renal (p = 0,079), sexo (p = 0,145) e idade (p = 0,986). Conclusão: O tabagismo confere um maior risco cardiovascular adicional aos pacientes com DRC em tratamento conservador à medida que se associa com maiores níveis de P. Novos estudos são necessários para confirmar e melhor elucidar esse achado.

Cost-effectiveness of electronic- and clinician-delivered screening, brief intervention and referral to treatment for women in reproductive health centers.

AIMS: To determine the cost-effectiveness of electronic- and clinician-delivered SBIRT (Screening, Brief Intervention and Referral to Treatment) for reducing primary substance use among women treated in reproductive health centers. DESIGN: Cost-effectiveness analysis based on a randomized controlled trial. SETTING: New Haven, CT, USA. PARTICIPANTS: A convenience sample of 439 women seeking routine care in reproductive health centers who used cigarettes, risky amounts of alcohol, illicit drugs or misused prescription medication. INTERVENTIONS: Participants were randomized to enhanced usual care (EUC, n = 151), electronic-delivered SBIRT (e-SBIRT, n = 143) or clinician-delivered SBIRT (SBIRT, n = 145). MEASUREMENTS: The primary outcome was days of primary substance abstinence during the 6-month follow-up period. To account for the possibility that patients might substitute a different drug for their primary substance during the 6-month follow-up period, we also considered the number of days of abstinence from all substances. Incremental cost-effectiveness ratios and cost-effectiveness acceptability curves determined the relative cost-effectiveness of the three conditions from both the clinic and patient perspectives. FINDINGS: From a health-care provider perspective, e-SBIRT is likely (with probability greater than 0.5) to be cost-effective for any willingness-to-pay value for an additional day of primary-substance abstinence and an additional day of all-substance abstinence. From a patient perspective, EUC is most likely to be the cost-effective intervention when the willingness to pay for an additional day of abstinence (both primary-substance and all-substance) is less than $0.18 and e-SBIRT is most likely to be the cost-effective intervention when the willingness to pay for an additional day of abstinence (both primary-substance and all-substance) is greater than $0.18. CONCLUSIONS: e-SBIRT could be a cost-effective approach, from both health-care provider and patient perspectives, for use in reproductive health centers to help women reduce substance misuse.

Assessment of Self-Management Treatment Needs Among COPD Helpline Callers.

Telephone quitlines are an effective population-based strategy for smoking cessation, particularly among individuals with tobacco-related diseases such as chronic obstructive pulmonary disease (COPD). Expanding quitline services to provide COPD-focused self-management interventions is potentially beneficial; however, data are needed to identify specific treatment needs in this population. We conducted a telephone-based survey (N = 5,772) to examine educational needs, behavioral health characteristics, and disease-related interference among individuals with COPD who received services from the American Lung Association (ALA) Lung Helpline. Most participants (73.7%) were interested in COPD-focused information, and few had received prior instruction in breathing exercises (33.9%), energy conservation (26.5%), or airway clearing (32.1%). About one-third of participants engaged in regular exercise, 16.3% followed a special diet, and 81.4% were current smokers. Most participants (78.2%) reported COPD-related interference in daily activities and 30.8% had been hospitalized within the past six months for their breathing. Nearly half of participants (45.4%) reported current symptoms of anxiety or depression. Those with vs. without anxiety/depression had higher rates of COPD-related interference (83.9% vs. 73.5%, p < .001) and past six-month hospitalization (33.4% vs. 28.3%, p < .001). In conclusion, this survey identified strong interest in disease-focused education; a lack of prior instruction in specific self-management strategies for COPD; and behavioral health needs in the areas of exercise, diet, and smoking cessation. Anxiety and depression symptoms were common and associated with greater disease burden, underscoring the importance of addressing coping with negative emotions. Implications for self-management treatments that target multiple behavioral needs of COPD patients are discussed.