An Algorithm Approach to Determining Smoking Cessation Treatment for Persons Living With HIV/AIDS: Results of a Pilot Trial.

BACKGROUND: Smoking now represents one of the biggest modifiable risk factors for disease and mortality in people living with HIV (PLHIV). To produce significant changes in smoking rates among this population, treatments will need to be both acceptable to the larger segment of PLHIV smokers and feasible to implement in busy HIV clinics. The purpose of this study was to evaluate the feasibility and effects of a novel proactive algorithm-based intervention in an HIV/AIDS clinic. METHODS: PLHIV smokers (N = 100) were proactively identified through their electronic medical records and were subsequently randomized at baseline to receive a 12-week pharmacotherapy-based algorithm treatment or treatment as usual. Participants were tracked in-person for 12 weeks. Participants provided information on smoking behaviors and associated constructs of cessation at each follow-up session. RESULTS: The findings revealed that many smokers reported using prescribed medications when provided with a supply of cessation medication as determined by an algorithm. Compared with smokers receiving treatment as usual, PLHIV smokers prescribed these medications reported more quit attempts and greater reduction in smoking. Proxy measures of cessation readiness (eg, motivation, self-efficacy) also favored participants receiving algorithm treatment. CONCLUSIONS: This algorithm-derived treatment produced positive changes across a number of important clinical markers associated with smoking cessation. Given these promising findings coupled with the brief nature of this treatment, the overall pattern of results suggests strong potential for dissemination into clinical settings and significant promise for further advancing clinical health outcomes in this population.

Race and Medication Adherence Moderate Cessation Outcomes in Criminal Justice Smokers.

INTRODUCTION: Smokers in the criminal justice system represent some of the most disadvantaged smokers in the U.S., as they have high rates of smoking (70%-80%) and are primarily uninsured, with low access to medical interventions. Few studies have examined smoking-cessation interventions in racially diverse smokers, and none have examined these characteristics among individuals supervised in the community. The purpose of this study is to determine if four sessions of standard behavioral counseling for smoking cessation would differentially aid smoking cessation for African American versus non-Hispanic white smokers under community corrections supervision. DESIGN: An RCT. SETTING/PARTICIPANTS: Five hundred smokers under community corrections supervision were recruited between 2009 and 2013 via flyers posted at the community corrections offices. INTERVENTION: All participants received 12 weeks of bupropion plus brief physician advice to quit smoking. Half of the participants received four sessions of 20-30 minutes of smoking-cessation counseling following tobacco treatment guidelines, whereas half received no additional counseling. MAIN OUTCOME MEASURES: Generalized estimating equations were used to determine factors associated with smoking abstinence across time. Analyses were conducted in 2014. RESULTS: The end-of-treatment abstinence rate across groups was 9.4%, with no significant main effects indicating group differences. However, behavioral counseling had a differential effect on cessation: whites who received counseling had higher quit rates than whites who did not receive counseling. Conversely, African Americans who did not receive counseling had higher average cessation rates than African Americans who received counseling. Overall, medication-adherent African American smokers had higher abstinence rates relative to other smokers. CONCLUSIONS: Racial disparities in smoking cessation are not evident among those who are adherent to medication. More research is needed to better understand the differential effect that behavioral counseling might have on treatment outcomes between white and African American smokers under community corrections supervision.

Evaluating the effect of access to free medication to quit smoking: a clinical trial testing the role of motivation.

INTRODUCTION: Although the majority of smokers are ambivalent about quitting, few treatments specifically target smokers lacking motivation to quit in the near future. Most existing interventions are instead predicated on the belief that active treatments should only be distributed to smokers interested in quitting, a largely untested assumption. METHODS: In the current clinical trial (N = 157), motivated smokers wanting to quit in the next 30 days were given a 2-week nicotine replacement therapy (NRT) sample and a referral to a quitline (Group MNQ), while unmotivated smokers were randomized to receive the same treatment (Group UNQ) or a quitline referral only (Group UQ). Participants were tracked via telephone for 3 months to assess quitting behaviors and smoking reduction. RESULTS: Groups significantly differed across all comparisons with regard to incidence of any quit attempt (MNQ: 77%, UNQ: 40%, UQ: 18%, p < .05) and any 24-hr quit attempts (62%, 32%, 16%, p < .05). Clinically meaningful differences emerged in the rates of floating (19%, 17%, 6%) and point prevalence abstinence (17%, 15%, 5%). Compared to participants in Group UQ (11%), a greater proportion of participants in Group MNQ (48%, p = .01) and Group UNQ (31%, p = .01) reduced their daily cigarette consumption by at least half. Proxy measures of cessation readiness (e.g., motivation) favored participants receiving active forms of treatment. CONCLUSIONS: Providing NRT samples engaged both motivated and unmotivated smokers into the quitting process and produced positive changes in smoking outcomes. This suggests that motivation should not be considered a necessary precondition to receiving treatment.

Clinical strategies to enhance the efficacy of nicotine replacement therapy for smoking cessation: a review of the literature.

A number of smoking cessation pharmacotherapies have led to increases in quitting and thus to significant benefits to public health. Among existing medications, nicotine replacement therapy (NRT) has been available the longest, has the largest literature base in support, and is the only option for over-the-counter access. While the short-term efficacy of NRT is well documented in clinical trials, long-term abstinence rates associated with using NRT are modest, as most smokers will relapse. This literature review examines emerging clinical strategies to improve NRT efficacy. After an initial overview of NRT and its FDA-approved indications for use, we review randomized trials in which clinical delivery of NRT was manipulated and tested, in an attempt to enhance efficacy, through (1) duration of use (pre-quit and extended use), (2) amount of use (high-dose and combination NRT), (3) tailoring to specific smoker groups (genotype and phenotype), or (4) use of NRT for novel purposes (relapse prevention, temporary abstinence, cessation induction). Outcomes vary within and across topic area, and we highlight areas that offer stronger promise. Combination NRT likely represents the most promising strategy moving forward; other clinical strategies offer conflicting evidence but deserve further testing (pre-quit NRT or tailored treatment) or offer potential utility but are in need of further, direct tests. Some areas, though based on a limited set of studies, do not offer great promise (high-dose and extended treatment NRT). We conclude with a brief discussion of emergent NRT products (e.g., oral nicotine spray, among others), which may ultimately offer greater efficacy than current formulations. In order to further lower the prevalence of smoking, novel strategies designed to optimize NRT efficacy are needed.

Predictors of quit attempts and abstinence among smokers not currently interested in quitting.

INTRODUCTION: Rates of quitting smoking remain stagnant, and thus it is becoming increasingly important to identify determinants of successful quitting behavior. The primary purpose of the current study was to examine predictors of quit attempts and 7-day point prevalence abstinence in a large nationally based sample. The study population consisted exclusively of smokers with minimal interest in quitting in the immediate future, for whom the need to identify facilitating factors of cessation is highly significant. METHODS: Participants consisted of 849 smokers participating in a nationwide population-based randomized controlled trial (RCT) to promote quit attempts and cessation; all participants were not currently interested in cessation. RESULTS: After adjusting for treatment group, and using a multivariate logistic approach, a combination of motivational and self-efficacy variables consistently predicted quit attempts, regardless of how quit attempts were defined (i.e., any self-defined vs. 24 hr). Additionally, a greater number of previous quit attempts significantly predicted making future quit attempts. In terms of achieving short-term abstinence, regardless of whether analyses were restricted to individuals who made prior quit attempts or not, self-efficacy emerged as the only significant consistent predictor. CONCLUSIONS: Unlike previous studies, we did not find strong evidence suggesting unique predictors for making a quit attempt compared with achieving abstinence. Our findings demonstrate that even among smokers not currently interested in quitting, self-efficacy and motivation are key factors in the cessation process. Overall, the findings have important implications, as they highlight factors to target for future treatment.

The use of messages in altering risky gambling behavior in experienced gamblers.

The present study was an experimental analogue that examined the relationship between gambling-related irrational beliefs and risky gambling behavior. Eighty high-frequency gamblers were randomly assigned to four conditions and played a chance-based computer game in a laboratory setting. Depending on the condition, during the game a pop-up screen repeatedly displayed either accurate or inaccurate messages concerning the game, neutral messages, or no messages. Consistent with a cognitive-behavioral model of gambling, accurate messages that correctly described the random contingencies governing the game decreased risky gambling behavior. Contrary to predictions, inaccurate messages designed to mimic gamblers' irrational beliefs about their abilities to influence chance events did not lead to more risky gambling behavior than exposure to neutral or no messages. Participants in the latter three conditions did not differ significantly from one another and all showed riskier gambling behavior than participants in the accurate message condition. The results suggest that harm minimization strategies that help individuals maintain a rational perspective while gambling may protect them from unreasonable risk-taking.

The Obsessive Compulsive Cocaine Scale: assessment of factor structure, reliability, and validity.

The present study assessed the factor structure, reliability, test retest, convergent validity, and predictive validity of the Obsessive Compulsive Cocaine Scale (OCCS), a newly developed questionnaire adapted from the Obsessive Compulsive Drinking Scale (OCDS). The questionnaire was administered to 189 cocaine-dependent individuals participating in two medication treatment trials for cocaine dependence. Confirmatory factor analysis of this measure revealed that it primarily assesses two factors, obsessions and compulsions. In addition, the data provided strong support for the internal consistency, test-retest reliability, predictive validity, and convergent validity of this two-factor measure. Overall, the data provide support for the psychometric strength of a modified version of the OCDS specifically designed to assess obsessive and compulsive cocaine use among those with cocaine dependence.

Bulimic symptoms in undergraduate men and women: Contributions of mindfulness and thought suppression.

Experiential avoidance, the refusal to accept contact with unpleasant private experiences, is believed to play a role in the onset and maintenance of eating disorders. Preliminary evidence suggests that mindfulness- and acceptance-based interventions that reduce avoidance may be effective in treating disordered eating behaviors. The purpose of the current investigation was to examine whether one form of experiential avoidance (thought suppression) and the theoretically opposing construct of dispositional mindfulness are associated with bulimic symptoms. Undergraduate men (n=219) and women (n=187) completed questionnaires assessing mindful attention and awareness, chronic thought suppression, and bulimic symptoms. A series of hierarchical regression analyses revealed that thought suppression and mindfulness accounted for unique variance in bulimic symptoms among men and women after accounting for BMI. Results are discussed in terms of the role of dispositional mindfulness and thought suppression in disordered eating.