Monday-Enhanced CEASE Program for Underserved Ethnic Minorities: a Mixed-Methods Study.

BACKGROUND: Due to the persistence of tobacco-related health disparities in the U.S., there is a need for innovative strategies to reach the underserved ethnic minority populations who are most at risk. As contemplations for health behavior modification tend to surge on Mondays, we explored the feasibility and effect of a Monday-enhanced smoking cessation program on quitting outcomes in a low-income ethnic minority community. AIMS: To compare a Monday-enhanced with a standard Communities Engaged and Advocating for a Smoke-free Environment (CEASE) program and understand the overall experiences of participants in the program. METHODS: In this mixed-methods study, affordable housing complexes (n = 4) and a church were randomly assigned either a Monday-enhanced (n = 3) or standard (n = 2) CEASE smoking cessation program. CEASE comprised twelve weekly group counseling sessions facilitated by trained peer motivators plus nicotine replacement products. Participants in the Monday-enhanced arm were encouraged to pick Mondays as a quitting day. Quantitative and qualitative data were collected during the program and at 3-month post-graduation. RESULTS: Seventy-seven participants were enrolled in the study arms. In both groups combined, tobacco consumption reduced from 7.7 to 5.6 cig/day (mean reduction, 2.1; 95% CI: 0.9 to 5.1, p = 0.08). Although no significant difference in quit rate was observed between the two arms, more participants completed the follow-up survey in the Monday-enhanced than standard CEASE program [82.4% vs. 36.0%, p < 0.05]. While qualitative data suggested an overall satisfaction of participants with the program, motivation for quitting was higher in the Monday-enhanced CEASE program compared to the standard CEASE program. CONCLUSION: The Monday-enhanced program is promising and may enhance participants' engagement and willingness to quit smoking, particularly in low-income ethnic minority communities. Further research should include larger sample sizes to better assess the efficacy of a Monday-enhanced program across diverse populations.

Suicide poisoning mortality: a comparison of the national poison data system and centers for disease control national dataset.

The America's Poison Centres National Poison Data System (NPDS) is set up for the active surveillance of voluntarily reported poisoning cases in near real-time. The Centres for Disease Control and Prevention (CDC)'s Wide-ranging Online Data for Epidemiologic Research (WONDER) database is final national mortality data from state registries. We compared suicide poisoning deaths in both datasets from 2000 to 2020 and tested their relationship using a simple linear regression model. Mean annual suicide poisoning deaths during the review period were 699 (SD 145) in NPDS, and 6150 (SD 577) in WONDER. NPDS annual cases averaged 11% of cases recorded in WONDER (SD 2%; Range 8%-16%). The regression coefficient for the linear relationship between annual deaths recorded in both datasets was 0.18 (p-value<0.001, R2=0.51). The rapidly available NPDS data on fatal self-poisoning may provide sentinel surveillance regarding self-poisonings, but do not reliably predict final national data on suicide poisoning.

Assessing the risk of intentional self-harm in montelukast users: an updated Sentinel System analysis using ICD-10 coding.

BACKGROUND: Montelukast prescribing information includes a Boxed Warning issued in March 2020 regarding neuropsychiatric adverse events. A previous Sentinel System study of asthma patients from 2000 to 2015 did not demonstrate an increased risk of intentional self-harm measured using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, with montelukast compared to inhaled corticosteroids (ICS). METHODS: Using a new user cohort study design, we examined intentional self-harm events in patients aged 10 years and older who were incident users of either montelukast or ICS as monotherapy, with a diagnosis of asthma, between October 1, 2015, to June 30, 2022, in the Sentinel System. We measured intentional self-harm using ICD-10-CM codes, which may have better accuracy for capturing suicide attempts than ICD-9-CM codes. We used inverse probability of treatment weighting to balance baseline covariates. We performed subgroup analyses by age group, sex, psychiatric history, and pre/post Boxed Warning era and conducted sensitivity analyses varying type of care setting of the outcome and exposure episode gaps. RESULTS: Among 752,230 and 724,855 patients in the montelukast and ICS exposure groups respectively, we found no association between montelukast use and self-harm compared to ICS use [Hazard Ratio (95% Confidence Interval): 0.96 (0.85, 1.08)]. This finding was consistent across all subgroups, and sensitivity analyses. CONCLUSION: Our results cannot exclude other neuropsychiatric idiosyncratic reactions to montelukast. Compared to the previous Sentinel study, this study identified about double the rate of self-harm events, suggesting a greater sensitivity of ICD-10 codes for measuring self-harm than ICD-9.

Black Americans' Diminished Return of Educational Attainment on Tobacco Use in Baltimore City.

BACKGROUND: Socioeconomic status (SES) indicators such as educational attainment are fundamental factors affecting health. One mechanism through which education affects health is by reducing the likelihood of engaging in high-risk behaviors such as smoking. However, according to the marginalization-related diminished returns (MDRs) theory, the association between education and health may be weaker for marginalized populations such as Black than White, primarily due to racism and discrimination. However, little is known about the racial variations in the differential associations between educational attainment and tobacco use in a local setting. AIM: This study aimed to investigate the differential association between educational attainment and tobacco use among racial groups in a community sample in Baltimore City. METHODS: This cross-sectional study used data from a community survey conducted in 2012-2013 in Baltimore City among adults aged 18 years or older. The participants were 3501 adults. Univariate, bivariate, and logistic regression analyses were performed using Stata to investigate the racial difference in the association between education and two outcomes: current smoking status and menthol tobacco product use. RESULTS: The study found that adults with a graduate degree were less likely to be current smokers (adjusted odds ratio [AOR]: 0.10, 95% confidence interval [CI]: 0.08-0.13) and menthol tobacco users (AOR: 0.10, 95% CI: 0.07-0.14) compared to those with less than high school diploma. The inverse associations between educational attainment and current smoking (AOR: 1.83, 95% CI: 1.05-3.21) and menthol tobacco product use (AOR: 4.73, 95% CI: 2.07-10.80) were weaker for Back individuals than those who were White. CONCLUSION: Due to MDRs of educational attainment, while highly educated White adults show a low risk of tobacco use, educated Black adults remain at a disproportionately increased risk. The study emphasizes the need for better policies and programs that address minorities' diminished return of education for tobacco use.

Efficacy of a Smoking Cessation Program for Underserved Ethnic Minority Communities: Results of a Smoking Cessation Trial.

Objectives: Using a participatory research approach, this study reports the efficacy of the Communities Engaged and Advocating for a Smoke-free Environment (CEASE)-4 intervention offered by the local peers. Methods: CEASE-4 is a theory-based tobacco-cessation intervention, tailored to the needs of underserved populations. 842 tobacco users self-selected into: a) self-help (n = 472), b) single-session class (n = 163), and c) four-session class (n = 207). While self-help group only received educational materials, curriculum for other arms was built on the social cognitive, motivational interviewing, and trans-theoretical- frameworks. Participants could also receive nicotine replacement therapy (NRT). Outcome was self-reported smoking cessation measured 12 weeks after completion of the intervention, validated by exhaled carbon monoxide (CO) test. Results: Quit rate was statistically different across groups, with highest quit rate in four-session and lowest quit rate in self-help arm. Cessation rates at follow up (12 weeks after completion of the intervention) were 2.3% in the self-help arm, 6.1% in the single-session arm and 13.0% in the four-session arm. Conclusion: While theory-based smoking cessation services are effective for underserved populations, four-session curriculum might be superior to a single session program.

The use of analgesics for intentional self-poisoning: Trends in U.S. poison center data.

In the U.S., intentional self-poisonings with analgesics that are available without a prescription increased from 2000 to 2018. Given concerns regarding mental health outcomes during the COVID-19 pandemic, we examined and compared trends in pediatric and adult intentional self-poisoning with acetaminophen, aspirin, ibuprofen, and naproxen from 2016 to 2021 using the National Poison Data System (NPDS) to see if these trends have continued. We extracted annual case counts of all suspected suicide attempts from intentional poisoning, and of suspected suicide attempts resulting in major effects or death, from the NPDS for non-prescription single ingredient adult formulation acetaminophen, non-prescription single ingredient adult formulation aspirin, single ingredient formulation ibuprofen, and single ingredient formulation naproxen. We enumerated the cases by year, age, and gender. Most cases of intentional self-poisoning within the review period involved acetaminophen and ibuprofen and the 13-19-year-olds constituted the highest proportion of intentional self-poisoning cases across age groups for all four analgesics. Cases involving females predominated cases involving males by 3:1 or greater. The 13-19-year-old age group also represented the largest proportion of cases that resulted in major clinical effects or deaths. An increasing trend in suicide poisoning cases with acetaminophen and ibuprofen was observed in the 6-19-years age group and this trend appeared to exacerbate from 2020 to 2021 corresponding with the start of the COVID-19 pandemic period.

Hypertension, smoking, and preexistence of multiple cardiac risk factors correlate with carfilzomib-induced cardiovascular adverse events in a racially diverse population.

Background: Use of the proteasome inhibitor carfilzomib has become a standard of care in patients with relapsed/refractory multiple myeloma. An association between carfilzomib and cardiovascular adverse events has been well documented, but this had not been investigated in a racially diverse population. Black patients in particular are underrepresented in the reported outcomes of treatment with carfilzomib. Objective: The purpose of this study was to identify risk factors for carfilzomib-associated cardiovascular events in a diverse, single-center population. Methods: We conducted a retrospective review of 161 patients with multiple myeloma treated with carfilzomib between 2011 and 2020 at the University of Maryland Medical Center. Over half (86) were Black patients, with the remainder (75) being White patients. We did a multivariate analysis to determine risk factors for developing cardiovascular events during treatment with carfilzomib. Results: There was no statistically significant association with cardiotoxicity and race, gender, or age at first dose of carfilzomib. In multivariable analysis, patients with history of hypertension had a higher risk of cardiotoxicity [adjusted odds ratio (OR): 2.5; 95% CI: 1.1-5.9; P = 0.03] as did those with a history of smoking [OR: 2.8; 95% CI: 1.3-6.4; P = 0.01]. Conclusions: Here we report the largest cohort of Black patients treated with carfilzomib as yet reported. The results of this single center retrospective study show history of hypertension and smoking are associated with carfilzomib associated cardiotoxicity in a diverse patient population. There is a need for well-designed prospective studies enrolling a diverse population to investigate potential interventions to prevent carfilzomib-associated cardiotoxicity.

Race by Education Intersectional Differences in Exposure to Tobacco Advertisement in Baltimore City.

Objective: This study aimed to examine the intersectional effects of race and educational attainment on tobacco advertising exposure among adults in Baltimore, given the growing evidence on differential influence of education for Black and White populations. Methods: A survey was conducted in Baltimore, collecting data on educational attainment, demographics, and tobacco advertising exposure among adults (n = 3028, 22.7% 18 - 29, 17.9% 30 - 39, 23.4% 40 - 49, 20.9% 50-59, and 11.1% 60+ years old). The sample included both Black and White adult individuals. Logistic regression analyses were employed to assess the association between educational attainment and tobacco advertising exposure, without and with interaction with race, adjusting for relevant covariates such as age, gender, and employment. Sensitivity analysis also controlled for smoking status. Results: The study results indicated that while high educational attainment is associated with less exposure to tobacco ads, highly educated Black adults report significantly higher tobacco advertising exposure compared to highly educated White adults. Same results were observed after controlling for smoking status. Conclusion: Educational attainment may not exhibit a large protective effect against environmental risks such as tobacco ad exposure for Black populations, possibly because of segregation and racism that hinder highly educated Black people ability to move to low-risk neighborhoods.

Small CBPR Grants Program: An Innovative Model to Build Sustainable Academic-Community Partnerships.

Community-based participatory research (CBPR) is an effective approach for addressing health disparities by integrating diverse knowledge and expertise from both academic and community partners throughout the research process. However, more is needed to invest in the foundational infrastructure and resources that are necessary for building and maintaining lasting trusting research partnerships and supporting them to generate impactful CBPR-based research knowledge and solutions. Small CBPR Grants Program is a CBPR-seed-funding program that may be particularly helpful to minority-serving institutions' and universities' goal to invest in genuine community-engaged participatory research. Between 2016 and 2019, the Morgan State University Prevention Sciences Research Center, in collaboration with other community and academic organizations, provided 14 small CBPR awards to new partnerships, and evaluated the success and challenges of the program over a period of three years. To achieve our goal, technical support and training were provided to these partnerships to help with their growth and success. The expected outcomes included trusting relationships and equitable partnerships, as well as publications, presentations, and new proposals and awards to work on mutually identified issues. The program's resulted in continued partnerships beyond the program (in most cases), a founded CBPR Center namely ASCEND, and several secured additional fundings. Keys to the program's success were supporting the formation of research partnerships through networking opportunities and information sessions, as well as providing small grants to incentivize the development of innovative concepts and projects. A learning network and local support group were also created to enhance productivity and the overall impact of each project.

An Innovative Biomedical Research Training Model: Rationale, Design, and Evaluation.

Much is told regarding the need for greater diversity in the biomedical research workforce in terms of race, ethnicity, and socioeconomic status. However, there are few evidence-based models that are tested and can have significant effects in this regard. Thus, there is a need for development and evaluation of innovative models that may help train a more diverse biomedical research workforce. In this study, we provided the rationale, conceptual model, and preliminary evaluation of a program called "A Student-Centered Entrepreneurship Development (ASCEND)". This training program was designed, implemented, and evaluated between 2017 and 2020 at Morgan State University, Baltimore, Maryland, United States. The program's conceptual model is based on four stages: Attraction and Inspiration, Ideation and Innovation, Research Implementation, and Career Growth. Results of the comparative survey between 50 students who participated in ASCEND and 86 non-member controls showed an increase in science identity, academic self-concept, science self-efficacy, and peer support. The only domain that did not show a larger increase in participants in our program compared to controls was social self-concept. In addition, a total of 59 students submitted 48 research concepts, and 16 undergraduate student projects were funded. Of participants in the Health Research Concepts Competition, 39 students graduated, and 13 were pursuing graduate programs in STEM fields at the time of evaluation. The number of research projects and trainees who started a graduate degree were also reported. The ASCEND training model fosters an entrepreneurial mindset among undergraduate students. Such a program might be effective in diversifying the biomedical research workforce. While this preliminary evaluation indicates the efficacy of the ASCEND model, there is a need for further long-term and multi-center evaluations with the trainees' research productivity and receipt of independent funding as outcomes.

Peer mentoring for smoking cessation in public housing: A mixed-methods study.

Introduction: Tobacco use disproportionately affects low-income African American communities. The recent public housing smoke-free policy has increased the demand for effective smoking cessation services and programs in such settings. Methods: This mixed-method pilot study explored feasibility and potential impact of a peer-mentoring program for smoking cessation in a public housing unit. The quantitative study used a quasi-experimental design while qualitative data were collected via focus group discussions with peer mentors and participants. Three residents of the public housing complex were trained as peer mentors. Each peer mentor recruited up to 10 smokers in the residence and provided them individual support for 12 weeks. All participants were offered Nicotine Replacement Therapy (NRT). A follow-up investigation was conducted 3 months after completion of the 12-week intervention. At baseline and follow-up, the participants' smoking status was measured using self-report and was verified using exhaled carbon monoxide (eCO) monitoring. Results: The intervention group was composed of 30 current smokers who received the peer-mentoring intervention. The control group was composed of 14 individuals. Overall mean eCO levels dropped from 26 ppm (SD 19.0) at baseline to 12 (SD 6.0) at follow-up (P < 0.01). Participants who were enrolled in our program were more likely to have non-smoking eCO levels (<7 ppm) at follow-up (23.3%) compared to those who did not enroll (14.3%). Conclusion: Our program is feasible for low-income predominantly African American communities. Using peers as mentors may be helpful in providing services for hard-to-reach populations. Given the non-randomized design of our study, randomized trials are needed to test the efficacy of our program in the future.

Venous thromboembolism incidence and risk factors in adults with acute lymphoblastic leukemia treated with and without pegylated E. coli asparaginase-containing regimens.

PURPOSE: Asparaginases, key agents in treatment of acute lymphoblastic leukemia (ALL), are associated with venous thromboembolism (VTE). While risks of short-acting asparaginase-related VTE is well-known, we studied VTE incidence and risk factors in adult ALL patients treated with and without long-acting pegylated asparaginase (PegA). METHODS: Single-center, retrospective analysis of 89 ALL patients treated with (n = 61) or without (n = 28) PegA at Greenebaum Comprehensive Cancer Center. Reviewed patient and disease characteristics, treatment, and VTE incidence. RESULTS: VTE during treatment occurred in 31 patients (35%), and was associated with PegA (p = 0.001) and Philadelphia chromosome negativity (p = 0.002). Among PegA recipients, VTE was associated with a significantly higher mean body mass index (BMI) of 31.3 kg/m2 (p = 0.037), and was more common with pre-T/T cell compared to pre-B/B cell ALL (68.2% vs. 33.3%, p = 0.009). Antithrombin-III (ATIII) levels were measured for 26 patients; 16 (61.5%) were < 50%. Of those, 8 (50%) experienced VTE, while 3 of 10 (30%) patients with ATIII levels ≥ 50% experienced VTE. VTE occurred in 7 of 13 (54%) of patients who received ATIII repletion. There was a trend toward a higher incidence of VTE in the PegA group among patients with non-O compared to O blood type (55.9% vs. 33.3%, p = 0.079) as well as those with a higher hemoglobin at diagnosis (9.3 vs 8.1 g/dL, p = 0.056). CONCLUSION: This study confirms PegA as a risk factor for VTE in patients with ALL. Risk factors among those receiving PegA include higher BMI and pre-T/T cell ALL. ATIII repletion was not shown to be protective against VTE. There was a higher incidence of VTE in patients who received PegA with non-O compared to O blood type, but the precise correlation is uncertain.

Addressing Tobacco Use in Underserved Communities Through a Peer-Facilitated Smoking Cessation Program.

Communities Engaged and Advocating for a Smoke-Free Environment (CEASE) is a long-standing research partnership between a university and the neighboring community that was established to reduce tobacco use among poor and underserved residents. The CEASE tobacco cessation program was implemented in four phases, with each new phase applying lessons learned from the previous phases to improve outcomes. This study describes CEASE's community-based approach and reports results from implementing the second phase of the intervention which, among other things, varied in the type of incentives, setting, and providers used. CEASE implemented a mixed-methods study following the Community-Based Participatory Research (CBPR) approach. During Phase II, a total of 398 smokers were recruited into two 12-session group counseling interventions facilitated by trained peers in community venues, which differed in the type of incentives used to increase participation and reward the achievement of milestones. At 12-week follow-up, 21% of all participants reported not smoking, with a retention rate (i.e., attendance at six or more of the 12 cessation classes offered) of 51.9%. No significant differences in cessation outcomes were found between the two study arms. Using a CBPR approach resulted in a peer-led model of care with improved outcomes compared to Phase I, which was provided by clinicians. The combined use of monetary and non-monetary incentives was helpful in increasing participation in the program but did not significantly impact smoking cessation. A CBPR approach can increase the acceptability and effectiveness of cessation services for underserved populations.

What Differentiates Underserved Smokers Who Successfully Quit From Those Who Do Not.

Poor persons continue to smoke at high rates and suffer grave health effects. We have been working with our community partners since 2008 to help poor people in the surrounding neighborhoods stop smoking through a multi-phase CBPR intervention known as CEASE. Our study used qualitative methods to identify factors that characterized those who successfully quit smoking (doers) and those who did not (non-doers). Both doers and non-doers identified social pressure as the main reason for starting to smoke, and health as the main motivator for quitting. Although they were similar in many ways, the doers seemed to have more social support for cessation-i.e., more people in their lives who wanted them to quit and whom they wanted to protect from secondhand smoke. The non-doers offered more feedback on how to improve the cessation classes, including making them longer, reducing the class size, adding extra counseling, and using quitting partners. Both doers and non-doers reported increased self-confidence, appreciation for the cessation support they received from CEASE, and a desire that the group classes continue. Cessation is a social event and smokers with more social support appear to be more successful at quitting. Showing interest in and offering social support to poor underserved smokers in their own communities is a powerful way to help them.

Improving Participants' Retention in a Smoking Cessation Intervention Using a Community-based Participatory Research Approach.

BACKGROUND: This study compares participant' sretention in three phases of smoking cessation interventions, one provided in a health clinic and the subsequent two in community-based settings. METHODS: Smoking cessation interventions were conducted in three phases from 2008 to 2015 in two underserved urban communities with low socioeconomic profiles and high rates of smoking (n = 951). Phase I was conducted in a clinic; Phases II and III were conducted in community venues. In Phases II and III, incremental changes were made based on lessons learned from the previous phases. Retention (attending six or more sessions) was the primary predictor of cessation and was analyzed while controlling for associated factors including age, gender, race, employment, education, and nicotine dependence. RESULTS: Retention increased substantially over the three phases, with rates for attending six or more sessions of 13.8%, 51.9%, and 67.9% in Phases I, II, and III, respectively. Retention was significantly higher in community settings than in the clinic setting (adjusted odds ratio [OR] = 6.7; 95% confidence intervals [CI] = 4.6, 9.8). In addition to the intervention in community venues, predictors of retention included age and unemployment. Higher retention was significantly associated with higher quit rates (adjusted OR = 2.4; 95% CI = 1.5, 3.8). CONCLUSIONS: Conducting the intervention in community settings using trained peer motivators rather than health-care providers resulted in significantly higher retention and smoking cessation rates. This was due in part to the ability to tailor cessation classes in the community for specific populations and improving the quality of the intervention based on feedback from participants and community partners.

Examining Smoking Cessation in a Community-Based Versus Clinic-Based Intervention Using Community-Based Participatory Research.

Tobacco use remains a major public health problem in the U.S. disproportionately affecting underserved communities. The Communities Engaged and Advocating for a Smoke-free Environment (CEASE) initiative is an intervention to address the problem using a community-based participatory research (CBPR) approach. This study compares quit rates in a peer-led community-based intervention with those achieved in a clinical setting. The intervention consisted of three Phases. Phase I (n = 404) was a clinic-based trial comparing two types of counseling. Phase II (n = 398) and Phase III (n = 163) interventions were conducted in community venues by trained Peer Motivators. Quit rates at 12-week follow-up increased from 9.4 % in Phase I (clinic-based) to an average of 23.7 % in Phases II and III combined (community-based). The main predictor of smoking cessation was delivery of services in community settings (OR 2.6, 95 % CI 1.7-4.2) while controlling for possible confounders. A community-based approach can significantly guide and improve effectiveness and acceptability of smoking cessation services designed for low-income urban populations. In addition, CBPR can result in better recruitment and retention of the participants.