Publications by authors named "David W Wetter"

209 Publications

Workflow analysis for design of an electronic health record-based tobacco cessation intervention in community health centers.

JAMIA Open 2021 Jul 11;4(3):ooaa070. Epub 2021 Feb 11.

Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, Salt Lake City, Utah, USA.

Objective: Tobacco use is the leading cause of preventable morbidity and mortality in the United States. Quitlines are effective telephone-based tobacco cessation services but are underutilized. The goal of this project was to describe current clinical workflows for Quitline referral and design an optimal electronic health record (EHR)-based workflow for Ask-Advice-Connect (AAC), an evidence-based intervention to increase Quitline referrals.

Materials And Methods: Ten Community Health Center systems (CHC), which use three different EHRs, participated in this study. Methods included: 9 group discussions with CHC leaders; 33 observations/interviews of clinical teams' workflow; surveys with 57 clinical staff; and assessment of the EHR ecosystem in each CHC. Data across these methods were integrated and coded according to the Fit between Individual, Task, Technology and Environment (FITTE) framework. The current and optimal workflow were notated using Business Process Modelling Notation. We compared the requirements of the optimal workflow with EHR capabilities.

Results: Current workflows are inefficient in data collection, variable in who, how, and when tobacco cessation advice and referral are enacted, and lack communication between referring clinics and the Quitline. In the optimal workflow, medical assistants deliver a standardized AAC intervention during the visit intake. Referrals are submitted electronically, and there is bidirectional communication between the clinic and Quitline. We implemented AAC within all three EHRs; however, deviations from the optimal workflow were necessary.

Conclusion: Current workflows for Quitline referral are inefficient and ineffective. We propose an optimal workflow and discuss improvements in EHR capabilities that would improve the implementation of AAC.
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http://dx.doi.org/10.1093/jamiaopen/ooaa070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8423419PMC
July 2021

Trajectories of motivation and self-efficacy during a smoking quit attempt: An ecological momentary assessment study.

Psychol Addict Behav 2021 Aug 26. Epub 2021 Aug 26.

Department of Population Health Sciences.

Objective: Conceptual models of addiction highlight self-efficacy and motivation as key variables important during a smoking quit attempt; however, recent research has primarily focused on self-efficacy. Given the importance of motivation in these models, a clearer understanding of the effects of motivation during a smoking quit attempt is needed.

Method: This study utilized ecological momentary assessment (EMA) to investigate the dynamic effects of motivation and self-efficacy early in a quit attempt. Participants were 356 smokers (45% male; 34% African American, 33% non-Hispanic White, 33% Latino). Participants completed EMAs of motivation, self-efficacy, and smoking for 4 days prequit through 1 week postquit, and returned for a follow-up assessment at 4 weeks postquit. Trajectory parameters of motivation and self-efficacy (mean, slope, and volatility) were analyzed in separate and combined regression models to predict smoking outcomes.

Results: Prequit results showed that parameters of motivation and self-efficacy were not associated with smoking on quit day. Postquit analyses revealed that participants with lower mean levels of motivation and self-efficacy were more likely to smoke at the end of Week 1. Moreover, individuals with decreasing levels of motivation over the first week of their quit attempt were more likely to be smoking at the end of Week 4.

Conclusions: These findings highlight the need to incorporate dynamic measures of motivation in smoking research. Furthermore, the results underscore the value of utilizing EMA methods and trajectory parameters to gain a more nuanced understanding of the dynamic effects that key mechanisms have on smoking during a quit attempt. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/adb0000734DOI Listing
August 2021

Increasing treatment enrollment among smokers who are not motivated to quit: a randomized clinical trial.

Transl Behav Med 2021 Aug 23. Epub 2021 Aug 23.

University of Utah and the Huntsman Cancer Institute, Salt Lake City, UT, USA.

There is a significant research-to-practice gap with respect to reaching underserved populations with evidence-based tobacco cessation treatments. Increasing enrollment in evidence-based treatments is necessary to reduce tobacco use and tobacco-related health inequities. The purpose of the current study was to evaluate whether Motivation And Problem Solving (MAPS), a flexible, holistic counseling/navigation approach delivered via phone, and proactive provision of Nicotine Replacement Therapy (NRT) would improve Quitline enrollment among a sample of low SES smokers who were not motivated to quit. In a 3×2 factorial design, cigarette smokers (N = 603) were randomized to one of six treatment conditions (Standard Treatment, MAPS-6, or MAPS-12 by NRT or no NRT). Results indicated that both MAPS-6 and MAPS-12 increased Quitline enrollment compared to Standard Treatment (ps < .03). There were no differences between MAPS conditions. NRT did not increase Quitline enrollment. MAPS is an effective intervention with the potential to be disseminated and implemented in healthcare and community settings to increase the reach of evidence-based interventions for tobacco cessation.
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http://dx.doi.org/10.1093/tbm/ibab114DOI Listing
August 2021

Establishing a multidisciplinary initiative for interoperable electronic health record innovations at an academic medical center.

JAMIA Open 2021 Jul 31;4(3):ooab041. Epub 2021 Jul 31.

Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.

Objective: To establish an enterprise initiative for improving health and health care through interoperable electronic health record (EHR) innovations.

Materials And Methods: We developed a unifying mission and vision, established multidisciplinary governance, and formulated a strategic plan. Key elements of our strategy include establishing a world-class team; creating shared infrastructure to support individual innovations; developing and implementing innovations with high anticipated impact and a clear path to adoption; incorporating best practices such as the use of Fast Healthcare Interoperability Resources (FHIR) and related interoperability standards; and maximizing synergies across research and operations and with partner organizations.

Results: University of Utah Health launched the ReImagine EHR initiative in 2016. Supportive infrastructure developed by the initiative include various FHIR-related tooling and a systematic evaluation framework. More than 10 EHR-integrated digital innovations have been implemented to support preventive care, shared decision-making, chronic disease management, and acute clinical care. Initial evaluations of these innovations have demonstrated positive impact on user satisfaction, provider efficiency, and compliance with evidence-based guidelines. Return on investment has included improvements in care; over $35 million in external grant funding; commercial opportunities; and increased ability to adapt to a changing healthcare landscape.

Discussion: Key lessons learned include the value of investing in digital innovation initiatives leveraging FHIR; the importance of supportive infrastructure for accelerating innovation; and the critical role of user-centered design, implementation science, and evaluation.

Conclusion: EHR-integrated digital innovation initiatives can be key assets for enhancing the EHR user experience, improving patient care, and reducing provider burnout.
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http://dx.doi.org/10.1093/jamiaopen/ooab041DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8325485PMC
July 2021

Perceived discrimination and smoking lapse among Mexican Americans: An ecological momentary assessment study.

Health Psychol 2021 Jun;40(6):388-397

Department of Population Health Sciences, University of Utah.

Objective: Racial/ethnic minorities face unique stressors, including perceived discrimination (PD), that may increase the difficulty of quitting smoking relative to the general population of smokers. The current study examines the impact of acute PD on smoking lapse during a quit attempt, as well as potential mechanisms linking PD to lapse among Spanish-speaking Mexican Americans.

Method: Participants (N = 169) were Spanish-speaking Mexican Americans living in the United States who completed ecological momentary assessments (EMAs) multiple times per day for 21 days postquit. A multilevel structural equation model decomposed the effect of PD on smoking lapse into indirect effects through negative affect, positive affect, smoking urge, motivation to quit, and self-efficacy.

Results: Results indicated that PD operated indirectly through negative affect, positive affect, and urge to smoke, above and beyond other mechanisms, to increase risk for smoking lapse.

Conclusions: Findings have direct implications for intervention development among this population, including the potential for developing strategies to buffer the impact of PD, as well as skills to directly manage increased negative affect and urge to smoke. Just-in-time adaptive interventions (JITAIs) might be particularly useful, given they are designed to deliver treatment in real-time (e.g., delivery of strategies to build resilience and implement coping strategies) that could counter the impact of PD on smoking lapse. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/hea0001093DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8344071PMC
June 2021

The mobile assistance for regulating smoking (MARS) micro-randomized trial design protocol.

Contemp Clin Trials 2021 Jul 24:106513. Epub 2021 Jul 24.

Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States of America.

Smoking is the leading preventable cause of death and disability in the U.S. Empirical evidence suggests that engaging in evidence-based self-regulatory strategies (e.g., behavioral substitution, mindful attention) can improve smokers' ability to resist craving and build self-regulatory skills. However, poor engagement represents a major barrier to maximizing the impact of self-regulatory strategies. This paper describes the protocol for Mobile Assistance for Regulating Smoking (MARS) - a research study designed to inform the development of a mobile health (mHealth) intervention for promoting real-time, real-world engagement in evidence-based self-regulatory strategies. The study will employ a 10-day Micro-Randomized Trial (MRT) enrolling 112 smokers attempting to quit. Utilizing a mobile smoking cessation app, the MRT will randomize each individual multiple times per day to either: (a) no intervention prompt; (b) a prompt recommending brief (low effort) cognitive and/or behavioral self-regulatory strategies; or (c) a prompt recommending more effortful cognitive or mindfulness-based strategies. Prompts will be delivered via push notifications from the MARS mobile app. The goal is to investigate whether, what type of, and under what conditions prompting the individual to engage in self-regulatory strategies increases engagement. The results will build the empirical foundation necessary to develop a mHealth intervention that effectively utilizes intensive longitudinal self-report and sensor-based assessments of emotions, context and other factors to engage an individual in the type of self-regulatory activity that would be most beneficial given their real-time, real-world circumstances. This type of mHealth intervention holds enormous potential to expand the reach and impact of smoking cessation treatments.
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http://dx.doi.org/10.1016/j.cct.2021.106513DOI Listing
July 2021

A pilot randomized controlled trial of smartphone-assisted mindfulness-based intervention with contingency management for smokers with mood disorders.

Exp Clin Psychopharmacol 2021 Jul 22. Epub 2021 Jul 22.

School of Nursing.

Cigarette smoking disproportionately affects individuals with mood disorders, but smoking cessation interventions have modest effects in this population. Home mindfulness practice during abstinence incentivized via contingency management (CM) may help those in affective distress quit smoking.

Method: Adult smokers receiving outpatient psychiatric treatment for mood disorders were randomized to receive a smartphone-assisted mindfulness-based smoking cessation intervention with contingency management (SMI-CM, = 25) or enhanced standard treatment (EST, = 24) with noncontingent rewards. Participants in SMI-CM were prompted to practice audio-guided mindfulness five times per day for 38 days (vs. no comparison intervention in EST), and received monetary incentives for carbon monoxide (CO) ≤ 6 ppm. The primary outcome was biochemically verified 7-day point prevalence abstinence rates 2, 4, and 13 weeks after a target quit day.

Results: Of the 49 participants, 63.3% were Latinx and 30.6% Black; 75.5% reported household incomes < $25,000. Abstinence rates for SMI-CM were 40.0%, 36.0%, and 16.0% versus 4.2%, 8.3%, and 4.2% in EST at weeks 2, 4, and 13. A generalized estimating equations (GEE) model showed significant overall differences in abstinence rates in SMI-CM versus EST (adjusted odds ratio [A] = 8.12, 95% CI = 1.42-46.6, = .019). Those who received SMI-CM reported significantly greater reduction in smoking-specific experiential avoidance from baseline to 3 days prior to quit date (β = -7.21, 95% CI = -12.1-2.33, = .006).

Conclusions: SMI-CM may increase cessation rates among smokers with mood disorders, potentially through reduced smoking-specific experiential avoidance. SMI-CM is a promising intervention, and warrants investigation in a fully powered randomized controlled trial (RCT). (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/pha0000506DOI Listing
July 2021

Understanding the Prevalence of Prediabetes and Diabetes in Patients With Cancer in Clinical Practice: A Real-World Cohort Study.

J Natl Compr Canc Netw 2021 Mar 10;19(6):709-718. Epub 2021 Mar 10.

2Huntsman Cancer Institute, and.

Background: This study aimed to understand the prevalence of prediabetes (preDM) and diabetes mellitus (DM) in patients with cancer overall and by tumor site, cancer treatment, and time point in the cancer continuum.

Methods: This cohort study was conducted at Huntsman Cancer Institute at the University of Utah. Patients with a first primary invasive cancer enrolled in the Total Cancer Care protocol between July 2016 and July 2018 were eligible. Prevalence of preDM and DM was based on ICD code, laboratory tests for hemoglobin A1c, fasting plasma glucose, nonfasting blood glucose, or insulin prescription.

Results: The final cohort comprised 3,512 patients with cancer, with a mean age of 57.8 years at cancer diagnosis. Of all patients, 49.1% (n=1,724) were female. At cancer diagnosis, the prevalence of preDM and DM was 6.0% (95% CI, 5.3%-6.8%) and 12.2% (95% CI, 11.2%-13.3%), respectively. One year after diagnosis the prevalence was 16.6% (95% CI, 15.4%-17.9%) and 25.0% (95% CI, 23.6%-26.4%), respectively. At the end of the observation period, the prevalence of preDM and DM was 21.2% (95% CI, 19.9%-22.6%) and 32.6% (95% CI, 31.1%-34.2%), respectively. Patients with myeloma (39.2%; 95% CI, 32.6%-46.2%) had the highest prevalence of preDM, and those with pancreatic cancer had the highest prevalence of DM (65.1%; 95% CI, 57.0%-72.3%). Patients who underwent chemotherapy, radiotherapy, or immunotherapy had a higher prevalence of preDM and DM compared with those who did not undergo these therapies.

Conclusions: Every second patient with cancer experiences preDM or DM. It is essential to foster interprofessional collaboration and to develop evidence-based practice guidelines. A better understanding of the impact of cancer treatment on the development of preDM and DM remains critical.
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http://dx.doi.org/10.6004/jnccn.2020.7653DOI Listing
March 2021

Motivation and Problem Solving Versus Mobile 360° Videos to Promote Enrollment in the National Diabetes Prevention Program's Lifestyle Change Program Among People With Prediabetes: Protocol for a Randomized Trial.

JMIR Res Protoc 2021 Jun 14;10(6):e28884. Epub 2021 Jun 14.

Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, Salt Lake City, UT, United States.

Background: More than 88 million Americans are at risk of developing type 2 diabetes mellitus (T2DM). The National Diabetes Prevention Program's Lifestyle Change Program (DPP LCP) has been shown to be effective in reducing the risk of progressing from prediabetes to T2DM. However, most individuals who could benefit from the program do not enroll.

Objective: The aim of this trial is to test the real-world efficacy of 3 mobile phone-based approaches to increasing enrollment in the DPP LCP including a best-practice condition and 2 novel approaches.

Methods: We will conduct a 3-armed randomized clinical trial comparing enrollment and 1-month engagement in the DPP LCP among adults with prediabetes from 2 health care settings. Participants in the best-practice condition will receive SMS-based notifications that they have prediabetes and a link to a website that explains prediabetes, T2DM, and the DPP LCP. This will be followed by a single question survey, "Would you like the DPP LCP to call you to enroll?" Participants in the 2 intervention arms will receive the same best-practice intervention plus either 2 mobile 360° videos or up to 5 brief phone calls from a health coach trained in a motivational coaching approach known as Motivation and Problem Solving (MAPS). We will collect measures of diabetes-related knowledge, beliefs in the controllability of risk for T2DM, risk perceptions for T2DM, and self-efficacy for lifestyle change pre-intervention and 4 weeks later. The primary outcomes of the study are enrollment in the DPP LCP and 4-week engagement in the DPP LCP. In addition, data on the person-hours needed to deliver the interventions as well as participant feedback about the interventions and their acceptability will be collected. Our primary hypotheses are that the 2 novel interventions will lead to higher enrollment and engagement in the DPP LCP than the best-practice intervention. Secondary hypotheses concern the mechanisms of action of the 2 intervention arms: (1) whether changes in risk perception are associated with program enrollment among participants in the mobile 360° video group and (2) whether changes in self-efficacy for lifestyle change are associated with program enrollment among participants in the MAPS coaching group. Finally, exploratory analyses will examine the cost effectiveness and acceptability of the interventions.

Results: The project was funded in September 2020; enrollment began in February 2021 and is expected to continue through July 2022.

Conclusions: We are conducting a test of 2 novel, scalable, mobile phone-based interventions to increase enrollment in the DPP LCP. If effective, they have tremendous potential to be scaled up to help prevent T2DM nationwide.

Trial Registration: ClinicalTrials.gov NCT04746781; https://clinicaltrials.gov/ct2/show/NCT04746781.

International Registered Report Identifier (irrid): DERR1-10.2196/28884.
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http://dx.doi.org/10.2196/28884DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8240802PMC
June 2021

A Robust Functional EM Algorithm for Incomplete Panel Count Data.

Adv Neural Inf Process Syst 2020 Dec;33:19828-19838

Georgia Institute of Technology.

Panel count data describes aggregated counts of recurrent events observed at discrete time points. To understand dynamics of health behaviors and predict future negative events, the field of quantitative behavioral research has evolved to increasingly rely upon panel count data collected via multiple self reports, for example, about frequencies of smoking using in-the-moment surveys on mobile devices. However, missing reports are common and present a major barrier to downstream statistical learning. As a first step, under a missing completely at random assumption (MCAR), we propose a simple yet widely applicable functional EM algorithm to estimate the counting process mean function, which is of central interest to behavioral scientists. The proposed approach wraps several popular panel count inference methods, seamlessly deals with incomplete counts and is robust to misspecification of the Poisson process assumption. Theoretical analysis of the proposed algorithm provides finite-sample guarantees by expanding parametric EM theory [3, 34] to the general non-parametric setting. We illustrate the utility of the proposed algorithm through numerical experiments and an analysis of smoking cessation data. We also discuss useful extensions to address deviations from the MCAR assumption and covariate effects.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8182728PMC
December 2020

Comparing models of delivery for cancer genetics services among patients receiving primary care who meet criteria for genetic evaluation in two healthcare systems: BRIDGE randomized controlled trial.

BMC Health Serv Res 2021 Jun 2;21(1):542. Epub 2021 Jun 2.

Perlmutter Cancer Center, NYU Langone Health, 160 E. 34th Street, New York, NY, 10016, USA.

Background: Advances in genetics and sequencing technologies are enabling the identification of more individuals with inherited cancer susceptibility who could benefit from tailored screening and prevention recommendations. While cancer family history information is used in primary care settings to identify unaffected patients who could benefit from a cancer genetics evaluation, this information is underutilized. System-level population health management strategies are needed to assist health care systems in identifying patients who may benefit from genetic services. In addition, because of the limited number of trained genetics specialists and increasing patient volume, the development of innovative and sustainable approaches to delivering cancer genetic services is essential.

Methods: We are conducting a randomized controlled trial, entitled Broadening the Reach, Impact, and Delivery of Genetic Services (BRIDGE), to address these needs. The trial is comparing uptake of genetic counseling, uptake of genetic testing, and patient adherence to management recommendations for automated, patient-directed versus enhanced standard of care cancer genetics services delivery models. An algorithm-based system that utilizes structured cancer family history data available in the electronic health record (EHR) is used to identify unaffected patients who receive primary care at the study sites and meet current guidelines for cancer genetic testing. We are enrolling eligible patients at two healthcare systems (University of Utah Health and New York University Langone Health) through outreach to a randomly selected sample of 2780 eligible patients in the two sites, with 1:1 randomization to the genetic services delivery arms within sites. Study outcomes are assessed through genetics clinic records, EHR, and two follow-up questionnaires at 4 weeks and 12 months after last genetic counseling contactpre-test genetic counseling.

Discussion: BRIDGE is being conducted in two healthcare systems with different clinical structures and patient populations. Innovative aspects of the trial include a randomized comparison of a chatbot-based genetic services delivery model to standard of care, as well as identification of at-risk individuals through a sustainable EHR-based system. The findings from the BRIDGE trial will advance the state of the science in identification of unaffected patients with inherited cancer susceptibility and delivery of genetic services to those patients.

Trial Registration: BRIDGE is registered as NCT03985852 . The trial was registered on June 6, 2019 at clinicaltrials.gov .
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http://dx.doi.org/10.1186/s12913-021-06489-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8170651PMC
June 2021

Program uptake of a parent-tailored telephone smoking cessation counselling: An examination of recruitment approaches.

Tob Prev Cessat 2021 26;7:30. Epub 2021 Apr 26.

Department of Interdisciplinary Social Sciences, Utrecht University, Utrecht, the Netherlands.

Introduction: Recently, a Dutch proactive parent-tailored telephone smoking cessation counselling program, Smoke-free Parents (SFP), was demonstrated to be effective in helping parents to quit smoking. This study aimed to examine the program's uptake and the costs of two recruitment approaches (i.e. healthcare vs mass media) for SFP. In addition, parent's barriers to participating in SFP and the characteristics of participating parents were assessed.

Methods: As part of an effectiveness-implementation hybrid trial, 402 smoking parents were recruited via healthcare settings and mass media for an informal, proactive, and free phone call with a smoking cessation counsellor about SFP (the Netherlands, September 2016 - September 2018). Parents were asked whether they wanted to participate in SFP. If parents refused, reasons for decline and additional information (e.g. educational level) were collected.

Results: Results revealed that 26.4% of the recruited parents participated in SFP. Although the program uptake of parents recruited via mass media was slightly, but not significantly, higher than via healthcare (27.3% vs 26.8%, p=0.92), the healthcare approach resulted in lower costs per participant (€99.62 vs €205.72). Smoking cessation counsellors were unable to reach almost one-third (32.7%) of the parents after they had agreed to be called about SFP.

Conclusions: The present study showed that more than a quarter of all recruited parents participated in SFP and that the mass media approach and healthcare approach can be used to recruit parents for SFP. To increase the number of parents participating in SFP, it is important to overcome the identified barriers that prevent parents from participating.
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http://dx.doi.org/10.18332/tpc/133019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8066574PMC
April 2021

Developments in Mobile Health Just-in-Time Adaptive Interventions for Addiction Science.

Curr Addict Rep 2020 Sep 27;7(3):280-290. Epub 2020 Jun 27.

Harvard University, Cambridge, MA.

Purpose Of Review: Addiction is a serious and prevalent problem across the globe. An important challenge facing intervention science is how to support addiction treatment and recovery while mitigating the associated cost and stigma. A promising solution is the use of mobile health (mHealth) just-in-time adaptive interventions (JITAIs), in which intervention options are delivered in situ via a mobile device when individuals are most in need.

Recent Findings: The present review describes the use of mHealth JITAIs to support addiction treatment and recovery, and provides guidance on when and how the micro-randomized trial (MRT) can be used to optimize a JITAI. We describe the design of five mHealth JITAIs in addiction and three MRT studies, and discuss challenges and future directions.

Summary: This review aims to provide guidance for constructing effective JITAIs to support addiction treatment and recovery.
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http://dx.doi.org/10.1007/s40429-020-00322-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7968352PMC
September 2020

The Validity of MotionSense HRV in Estimating Sedentary Behavior and Physical Activity under Free-Living and Simulated Activity Settings.

Sensors (Basel) 2021 Feb 18;21(4). Epub 2021 Feb 18.

Department of Health and Kinesiology, University of Utah, Salt Lake City, UT 84112, USA.

MotionSense HRV is a wrist-worn accelerometery-based sensor that is paired with a smartphone and is thus capable of measuring the intensity, duration, and frequency of physical activity (PA). However, little information is available on the validity of the MotionSense HRV. Therefore, the purpose of this study was to assess the concurrent validity of the MotionSense HRV in estimating sedentary behavior (SED) and PA. A total of 20 healthy adults (age: 32.5 ± 15.1 years) wore the MotionSense HRV and ActiGraph GT9X accelerometer (GT9X) on their non-dominant wrist for seven consecutive days during free-living conditions. Raw acceleration data from the devices were summarized into average time (min/day) spent in SED and moderate-to-vigorous PA (MVPA). Additionally, using the Cosemed K5 indirect calorimetry system (K5) as a criterion measure, the validity of the MotionSense HRV was examined in simulated free-living conditions. Pearson correlations, mean absolute percent errors (MAPE), Bland-Altman (BA) plots, and equivalence tests were used to examine the validity of the MotionSense HRV against criterion measures. The correlations between the MotionSense HRV and GT9X were high and the MAPE were low for both the SED (r = 0.99, MAPE = 2.4%) and MVPA (r = 0.97, MAPE = 9.1%) estimates under free-living conditions. BA plots illustrated that there was no systematic bias between the MotionSense HRV and criterion measures. The estimates of SED and MVPA from the MotionSense HRV were significantly equivalent to those from the GT9X; the equivalence zones were set at 16.5% for SED and 29% for MVPA. The estimates of SED and PA from the MotionSense HRV were less comparable when compared with those from the K5. The MotionSense HRV yielded comparable estimates for SED and PA when compared with the GT9X accelerometer under free-living conditions. We confirmed the promising application of the MotionSense HRV for monitoring PA patterns for practical and research purposes.
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http://dx.doi.org/10.3390/s21041411DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7922785PMC
February 2021

Smoking Cessation Using Wearable Sensors: Protocol for a Microrandomized Trial.

JMIR Res Protoc 2021 Feb 24;10(2):e22877. Epub 2021 Feb 24.

Moffitt Cancer Center, Tampa, FL, United States.

Background: Cigarette smoking has numerous health consequences and is the leading cause of morbidity and mortality in the United States. Mindfulness has the ability to enhance resilience to stressors and can strengthen an individual's ability to deal with discomfort, which may be particularly useful when managing withdrawal and craving to smoke.

Objective: This study aims to evaluate feasibility results from an intervention that provides real-time, real-world mindfulness strategies to a sample of racially and ethnically diverse smokers making a quit attempt.

Methods: This study uses a microrandomized trial design to deliver mindfulness-based strategies in real time to individuals attempting to quit smoking. Data will be collected via wearable sensors, a study smartphone, and questionnaires filled out during the in-person study visits.

Results: Recruitment is complete, and data management is ongoing.

Conclusions: The data collected during this feasibility trial will provide preliminary findings about whether mindfulness strategies delivered in real time are a useful quit smoking aid that warrants additional investigation.

Trial Registration: Clinicaltrials.gov NCT03404596; https://clinicaltrials.gov/ct2/show/NCT03404596.

International Registered Report Identifier (irrid): DERR1-10.2196/22877.
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http://dx.doi.org/10.2196/22877DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7946584PMC
February 2021

Evaluation of Revised US Preventive Services Task Force Lung Cancer Screening Guideline Among Women and Racial/Ethnic Minority Populations.

JAMA Netw Open 2021 01 4;4(1):e2033769. Epub 2021 Jan 4.

Department of Population Health Sciences, University of Utah, Salt Lake City.

Importance: Lung cancer incidence and mortality disproportionately affect women and racial/ethnic minority populations, yet screening guidelines for the past several years were derived from clinical trials of predominantly White men. To reflect current evidence, the US Preventive Services Task Force (USPSTF) has revised the eligibility criteria, which may help to ameliorate sex- and race/ethnicity-related disparities in lung cancer screening.

Objective: To determine the changes associated with the revised USPSTF guideline for lung cancer screening eligibility among female, Black, and Hispanic populations using a large nationwide survey.

Design, Setting, And Participants: This cross-sectional study included respondents to the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System who were 50 to 80 years of age with a smoking history in 19 states that used the optional lung cancer screening module. The change in eligibility among female, male, Black, Hispanic, and White participants was examined. Eligibility by sex and race/ethnicity was compared with a reference population. Data were collected from January 1, 2017, to December 31, 2018, and analyzed from May 8 to June 11, 2020.

Exposures: Self-reported sex, race/ethnicity, age, and smoking history.

Main Outcomes And Measures: Lung cancer screening eligibility using the revised USPSTF criteria. The previous criteria included current or past smokers (within 15 years) who were 55 to 80 years of age and had a smoking history of more than 30 pack-years. In the revised criteria, age was modified to 50 to 80 years; smoking history, to 20 pack-years.

Results: Among 40 869 respondents aged 50 to 80 years with a smoking history, 21 265 (52.0%) were women, 3430 (8.4%) were Black, and 1226 (30.0%) were Hispanic (mean [SD] age, 65.6 [7.9] years). The revised criteria increased eligibility for the following populations: men (29.4% to 38.3% [8.9% difference]; P < .001), women (25.9% to 36.4% [10.5% difference]; P < .001), White individuals (31.1% to 40.9% [9.8% difference]; P < .001), Black individuals (16.3% to 28.8% [12.5% difference]; P < .001), and Hispanic individuals (10.5% to 18.7% [8.2% difference]; P < .001). The odds of eligibility were lower for women compared with men (adjusted odds ratio [AOR], 0.88; 95% CI, 0.79-0.99; P = .04) and for Black (AOR, 0.43; 95% CI, 0.33-0.56; P < .001) and Hispanic populations (AOR, 0.70; 95% CI, 0.62-0.80; P < .001) compared with the White population.

Conclusions And Relevance: The revised USPSTF guideline may likely increase lung cancer screening rates for female, Black, and Hispanic populations. However, despite these potential improvements, lung cancer screening inequities may persist without tailored eligibility criteria.
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http://dx.doi.org/10.1001/jamanetworkopen.2020.33769DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7804914PMC
January 2021

Strategies for Success: Landing Your First Academic Position and Navigating the Early Years-A Report from the American Society of Preventive Oncology's Early Career Investigator Special Interest Group.

Cancer Epidemiol Biomarkers Prev 2021 01;30(1):233-236

Department of Population Health Sciences, Albany College of Pharmacy and Health Sciences, Albany, New York.

As part of the 2019 American Society of Preventative Oncology (ASPO) annual meeting, the Early Career Investigator Special Interest Group organized a session entitled "Strategies for Success: Landing Your First Academic Position and Navigating the Early Years."* This session was designed to provide senior doctoral students and postdoctoral fellows with strategies for preparing successful faculty job applications. Furthermore, strategies and best practices to help guide early career faculty through the initial years of their academic positions were also discussed. This report summarizes the main themes of the session, including advice and recommendations from the panelists.
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http://dx.doi.org/10.1158/1055-9965.EPI-20-0750DOI Listing
January 2021

A time-varying model of the dynamics of smoking lapse.

Health Psychol 2021 Jan;40(1):40-50

Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, University of Utah.

Objective: The majority of smokers who make a quit attempt experience their first lapse within the first week of quitting, yet limited research to date has examined how the strength and direction of the relationship between smoking risk factors and lapse may change over longer periods of time. Time-varying effect modeling (TVEM) was used to address this gap.

Method: A diverse sample (N = 325) of adult smokers completed ecological momentary assessments of risk factors for lapse for 28 days after quitting. TVEM was used to examine the relationship between risk factors (abstinence self-efficacy, positive affect, positive coping expectancies, smoking expectancies, motivation, negative affect, stress, and urge) and lapse for 28 days postquit.

Results: Some associations were stable (e.g., negative affect, motivation), whereas others varied over time. Abstinence self-efficacy, positive affect, and positive coping expectancies were most strongly associated with lapse between Days 3 and 8 postquit. The association of urge with lapse was strongest between Days 4 and 10, as well as near the end of the quit attempt. Stress was also most strongly associated with lapse near the beginning and end of the postquit period and was the only predictor associated with lapse on quit date. The strength of the association between smoking expectancies and lapse increased over time.

Conclusion: There may be periods during a quit attempt when certain risk factors are more strongly related to lapse. This work has relevance for tailoring interventions designed to deliver intervention components in particular contexts or times of need. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/hea0001036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8265776PMC
January 2021

Development of a mindfulness-based treatment for smoking cessation and the modification of alcohol use: A protocol for a randomized controlled trial and pilot study findings.

Contemp Clin Trials 2021 01 14;100:106218. Epub 2020 Nov 14.

Moffitt Cancer Center, USA; University of South Florida, USA. Electronic address:

The combined use of cigarettes and alcohol is associated with an increased risk of morbidity and mortality. Yet, efficacious interventions that address both behaviors concurrently are lacking. Smoking cessation and alcohol modification not only garner health benefits, but there is also value in addressing alcohol use in the context of smoking cessation to reduce the risk for smoking relapse. In this paper we describe the development of mindfulness-based relapse prevention for smoking cessation and alcohol modification (MBRP-SA) and pilot study findings (Phase 1). Next, details regarding the methods and design of an ongoing, randomized controlled trial, Project RISE (Phase 2), are described. MBRP-SA is a group-based intervention that consists of eight weekly treatment sessions. Results from the Phase 1 pilot study (N = 21 enrolled) indicated that participants planned to use the skills learned in their everyday activities and to address their smoking and alcohol goals. Based on the progression of Phase 1 cohorts, modifications were made to the inclusion/exclusion criteria and recruitment methods that will be implemented in Phase 2. Phase 2 will assess the feasibility and acceptability of MBRP-SA, delivered via live online groups, as a primary treatment option for smoking cessation and alcohol use modification.
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http://dx.doi.org/10.1016/j.cct.2020.106218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7887009PMC
January 2021

Intersectionality and Smoking Cessation: Exploring Various Approaches for Understanding Health Inequities.

Nicotine Tob Res 2021 01;23(1):115-123

Center for Health Outcomes and Population Equity (HOPE), Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, Salt Lake City, UT.

Objective: Many marginalized groups smoke at higher rates and have greater difficulty quitting than less marginalized groups. Most research on smoking cessation inequities has focused on a single sociodemographic attribute (eg, race or socioeconomic status), yet individuals possess multiple attributes that may increase risk. The current study used an intersectionality framework to examine how the interplay between multiple marginalized attributes may impact smoking cessation outcomes.

Methods: A diverse sample of 344 adults enrolled in a smoking cessation program and reported on sociodemographic attributes (eg, race/ethnicity, gender, income) and continuous smoking abstinence on their quit date and at 1, 2, and 4 weeks postquit date. A Cox proportional hazard regression model was used to estimate whether intersectional links among race/ethnicity, gender, and income were related to smoking cessation outcomes.

Results: Lower household income may be related to higher risk of smoking cessation failure. There were no significant interactions among race/ethnicity, gender, and income in predicting relapse. Pairwise intersectional group differences suggested some groups may be at higher risk of relapse. Number of marginalized sociodemographic attributes did not predict relapse.

Conclusions: Intersectionality may be a promising framework for addressing health inequities, and may help elucidate how to best design and target intervention efforts for individuals characterized by sociodemographic intersections that concur particularly high risk for poor tobacco cessation outcomes.

Implications: Despite an overall decline in smoking rates, socioeconomic inequities in smoking prevalence and cancer mortality are widening. Efforts targeting tobacco cessation should incorporate new theory to capture the complex set of factors that may account for tobacco cessation inequities (eg, multiple aspects of identity that may influence access to tobacco cessation treatment and exposure to certain stressors that impede cessation efforts). Intersectionality may be a promising framework for addressing health inequities in tobacco use and cessation and may help elucidate how to best design and target intervention efforts for individuals that concur particularly high risk for poor tobacco cessation outcomes.
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http://dx.doi.org/10.1093/ntr/ntaa052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7789945PMC
January 2021

Intersectionality and Smoking Cessation: Exploring Various Approaches for Understanding Health Inequities.

Nicotine Tob Res 2021 01;23(1):115-123

Center for Health Outcomes and Population Equity (HOPE), Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, Salt Lake City, UT.

Objective: Many marginalized groups smoke at higher rates and have greater difficulty quitting than less marginalized groups. Most research on smoking cessation inequities has focused on a single sociodemographic attribute (eg, race or socioeconomic status), yet individuals possess multiple attributes that may increase risk. The current study used an intersectionality framework to examine how the interplay between multiple marginalized attributes may impact smoking cessation outcomes.

Methods: A diverse sample of 344 adults enrolled in a smoking cessation program and reported on sociodemographic attributes (eg, race/ethnicity, gender, income) and continuous smoking abstinence on their quit date and at 1, 2, and 4 weeks postquit date. A Cox proportional hazard regression model was used to estimate whether intersectional links among race/ethnicity, gender, and income were related to smoking cessation outcomes.

Results: Lower household income may be related to higher risk of smoking cessation failure. There were no significant interactions among race/ethnicity, gender, and income in predicting relapse. Pairwise intersectional group differences suggested some groups may be at higher risk of relapse. Number of marginalized sociodemographic attributes did not predict relapse.

Conclusions: Intersectionality may be a promising framework for addressing health inequities, and may help elucidate how to best design and target intervention efforts for individuals characterized by sociodemographic intersections that concur particularly high risk for poor tobacco cessation outcomes.

Implications: Despite an overall decline in smoking rates, socioeconomic inequities in smoking prevalence and cancer mortality are widening. Efforts targeting tobacco cessation should incorporate new theory to capture the complex set of factors that may account for tobacco cessation inequities (eg, multiple aspects of identity that may influence access to tobacco cessation treatment and exposure to certain stressors that impede cessation efforts). Intersectionality may be a promising framework for addressing health inequities in tobacco use and cessation and may help elucidate how to best design and target intervention efforts for individuals that concur particularly high risk for poor tobacco cessation outcomes.
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http://dx.doi.org/10.1093/ntr/ntaa052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7789945PMC
January 2021

Socioeconomic status, mindfulness, and momentary associations between stress and smoking lapse during a quit attempt.

Drug Alcohol Depend 2020 04 30;209:107840. Epub 2020 Jan 30.

Huntsman Cancer Institute and the Department of Population Health Sciences, University of Utah, United States.

Background: Models of health disparities highlight stress among low socioeconomic status (SES) smokers as a barrier to cessation. Recent studies suggest that mindfulness may improve cessation outcomes by reducing stress during a quit attempt. The current study examined associations of SES and mindfulness with ecological momentary assessments (EMAs) of stress and smoking lapse during a quit attempt.

Methods: EMAs (N = 32,329) were gathered from 364 smokers engaged in a quit attempt. A multilevel structural equation model estimated within person paths from momentary stress to subsequent smoking lapse. Between person paths estimated paths from a latent variable for SES and mindfulness to stress and smoking lapse, the indirect effect of SES and mindfulness on lapse through stress, and moderation of within person stress-lapse associations by SES and mindfulness.

Results: Within person estimates found that momentary increases in stress predicted increased risk of subsequent smoking lapse. Between person estimates found that lower SES was indirectly associated with greater risk for smoking lapse through increased stress; and, higher mindfulness was indirectly associated with lower risk for smoking lapse through reduced stress. Additionally, higher SES participants, who reported lower stress during the quit attempt, showed a stronger relationship between momentary increases in stress and risk for subsequent smoking lapse.

Conclusions: Among low SES smokers engaged in a quit attempt, both SES and mindfulness uniquely influenced smoking lapse through their influence on stress. Findings support reports that mindfulness presents a promising intervention target to reduce stress and improve cessation outcomes among low SES smokers.
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http://dx.doi.org/10.1016/j.drugalcdep.2020.107840DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7534963PMC
April 2020

QuitSMART Utah: an implementation study protocol for a cluster-randomized, multi-level Sequential Multiple Assignment Randomized Trial to increase Reach and Impact of tobacco cessation treatment in Community Health Centers.

Implement Sci 2020 01 30;15(1). Epub 2020 Jan 30.

Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr, Salt Lake City, UT, 84112, USA.

Background: Tobacco use remains the leading cause of death and disability in the USA and is disproportionately concentrated among low socioeconomic status (SES) populations. Community Health Centers (CHCs) are a key venue for reaching low SES populations with evidence-based tobacco cessation treatment such as Quitlines. Electronic health record (EHR)-based interventions at the point-of-care, text messaging (TM), and phone counseling have the potential to increase Quitline reach and are feasible to implement within CHCs. However, there is a lack of data to inform how, when, and in what combination these strategies should be implemented. The aims of this cluster-randomized trial are to evaluate multi-level implementation strategies to increase the Reach (i.e., proportion of tobacco-using patients who enroll in the Quitline) and Impact (i.e., Reach × Efficacy [efficacy is defined as the proportion of tobacco-using patients who enroll in Quitline treatment that successfully quit]) and to evaluate characteristics of healthcare system, providers, and patients that may influence tobacco-use outcomes.

Methods: This study is a multilevel, three-phase, Sequential Multiple Assignment Randomized Trial (SMART), conducted in CHCs (N = 33 clinics; N = 6000 patients). In the first phase, clinics will be randomized to two different EHR conditions. The second and third phases are patient-level randomizations based on prior treatment response. Patients who enroll in the Quitline receive no further interventions. In phase two, patients who are non-responders (i.e., patients who do not enroll in Quitline) will be randomized to receive either TM or continued-EHR. In phase three, patients in the TM condition who are non-responders will be randomized to receive either continued-TM or TM + phone coaching.

Discussion: This project will evaluate scalable, multi-level interventions to directly address strategic national priorities for reducing tobacco use and related disparities by increasing the Reach and Impact of evidence-based tobacco cessation interventions in low SES populations.

Trial Registration: This trial was registered at ClinicalTrials.gov (NCT03900767) on April 4th, 2019.
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http://dx.doi.org/10.1186/s13012-020-0967-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6993416PMC
January 2020

Quitline Treatment Enrollment and Cessation Outcomes Among Smokers Linked With Treatment via Ask-Advise-Connect: Comparisons Among Smokers With and Without HIV.

Nicotine Tob Res 2020 08;22(9):1640-1643

Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL.

Introduction: Given that people living with HIV (PLWH) are disproportionately burdened by tobacco-related morbidity and mortality, it is critically important to understand the degree to which evidence-based cessation interventions are utilized by and are effective among PLWH.

Aims And Methods: This secondary data analysis aimed to examine differences in Quitline treatment enrollment and 6-month cessation outcomes among smokers seeking care at 1 HIV clinic and 12 non-HIV clinics that were part of a large healthcare system in the greater Houston, Texas metropolitan area, United States. Data were from a 34-month (April 2013-February 2016) one-group implementation trial that evaluated the Ask-Advise-Connect (AAC) approach to linking smokers with Quitline treatment. Primary outcomes included (1) treatment enrollment and (2) 6-month self-reported and biochemically confirmed abstinence.

Results: The smoking status of 218 915 unique patients was recorded in the electronic health record; 5285 (2.7%) of these patients were seen at the HIV clinic where the smoking prevalence was 45.9%; smoking prevalence at the non-HIV clinics was 17.9%. The proportion of identified smokers who enrolled in treatment was 10.8% at the HIV clinic and 11.8% at the non-HIV clinics. The self-reported abstinence rate was 18.7% among HIV clinic patients and 16.5% among non-HIV clinic patients. Biochemically confirmed abstinence was lower at 4.2% and 4.5%, respectively (all ps > .05).

Conclusions: AAC resulted in rates of Quitline treatment enrollment and abstinence rates that were comparable among patients seen at an HIV clinic and non-HIV clinics. Findings suggest that AAC should be considered for widespread implementation in HIV clinics.

Implications: PLWH were as likely as other patients to enroll in evidence-based tobacco cessation treatment when it was offered in the context of a primary care visit. Cessation outcomes were also comparable. Therefore, standard care for PLWH should include routine screening for smoking status and referrals to cessation treatment.
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http://dx.doi.org/10.1093/ntr/ntz227DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7749194PMC
August 2020

Socioeconomic Status, Social Context, and Smoking Lapse During a Quit Attempt: An Ecological Momentary Assessment Study.

Ann Behav Med 2020 02;54(3):141-150

Huntsman Cancer Institute and the Department of Population Health Sciences, University of Utah, Salt Lake City, UT.

Background: Low socioeconomic status (SES) is linked to failure to quit smoking. Health inequity models suggest that low SES smokers experience barriers to quitting in part due to greater exposure to pro-smoking social contexts.

Purpose: The current study examined longitudinal associations among socioeconomic status, pro-smoking social context factors (i.e., exposure to other smokers, places where smoking was allowed), cigarette availability, and smoking lapse during a quit attempt.

Methods: Ecological momentary assessments (EMA) were gathered from a multiethnic sample of 365 smokers engaged in a quit attempt. A multilevel structural equation model estimated a latent variable for SES indicated by income, education, health insurance, and employment, associations among EMAs for pro-smoking social contexts and cigarette availability, and indirect effects of SES through, pro-smoking social contexts and cigarette availability to subsequent smoking lapse.

Results: Lower SES scores were associated with a higher likelihood of smoking lapse. Decomposition of the path from SES to smoking lapse into indirect effects showed significant paths through exposure to places where smoking is allowed and cigarette availability. Additionally, significant serial indirect paths from SES through both exposure to other smokers and places where smoking was allowed, in turn, through cigarette availability, and, ultimately, to smoking lapse were noted.

Conclusions: Consistent with models positing that SES influences health behaviors via contextual factors, the current study demonstrated that low SES smokers attempting to quit experienced greater pro-smoking social contexts that affected subsequent risk for lapse.
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http://dx.doi.org/10.1093/abm/kaz034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7455803PMC
February 2020

Promoting Smoke-Free Homes Through Biomarker Feedback Documenting Child Exposure to Tobacco Toxins: Protocol for a Randomized Clinical Trial.

JMIR Res Protoc 2019 Oct 4;8(10):e12654. Epub 2019 Oct 4.

Brown University School of Public Health and Alpert School of Medicine, Providence, RI, United States.

Background: Exposure to secondhand smoke (SHS) early in life increases the risk of sudden infant death syndrome (SIDS), asthma, and respiratory illnesses. Since children's primary exposure to SHS occurs in the home, these most vulnerable members of our society are not fully protected by recent increases in the adoption of smoking bans in public spaces. Although exposure to SHS is a quickly reversible cause of excess morbidity, few low-income homes strictly enforce smoking restrictions.

Objective: This study aims to test a novel approach to motivate the adoption of home smoking restrictions and to eliminate child SHS exposure by providing parents with objective data documenting home SHS exposure and "biomarker feedback" of child ingestion of tobacco toxins, that is, objective, laboratory-based results of assays performed on child urine, documenting levels of nicotine; cotinine; and NNAL (4-[methylnitrosamino]-1-[3-pyridyl]-1-butanol), which is a metabolite of the known tobacco carcinogen NNK (4-[methylnitro-samino]-1-[3-pyridyl]-1-butanone).

Methods: From 2011 to 2013, 195 low-income, female smokers with children aged ≤10 years residing in their homes were recruited into a two-arm randomized clinical trial. Participants were assigned to one of two groups: biomarker feedback (n=98) and health education (n=97). In-home assessments were administered at baseline, week 16, and week 26. Children's home SHS exposure and nicotine, cotinine, and NNAL levels from urine samples, measured through a passive nicotine dosimeter and a surface sample of residual tobacco smoke (ie, thirdhand smoke), were collected at all three time points. Primary outcome was dosimeter-verified, self-reported complete home smoking restrictions at 6 months after randomization. Secondary outcomes included parental self-report of smoking behavior change and child urine tobacco toxin (biomarker) change.

Results: Data collection and analyses are complete, and the results are being interpreted.

Conclusions: The study protocol describes the development of a novel community-based controlled trial designed to examine the efficacy of biomarker feedback documenting home and child exposure to SHS on parental smoking behavior change.

International Registered Report Identifier (irrid): RR1-10.2196/12654.
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http://dx.doi.org/10.2196/12654DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6913685PMC
October 2019

Momentary precipitants connecting stress and smoking lapse during a quit attempt.

Health Psychol 2019 Dec 26;38(12):1049-1058. Epub 2019 Sep 26.

Huntsman Cancer Institute, University of Utah.

Objective: Most attempts at smoking cessation are unsuccessful, and stress is frequently characterized both as a momentary precipitant of smoking lapse and a predictor of subsequent changes in other key precipitants of lapse. The current study examined longitudinal associations among stress, multiple precipitants of lapse, and lapse among smokers attempting to quit.

Method: Ecological momentary assessments (EMAs) were gathered from a multiethnic, gender-balanced sample of 370 adults enrolled in a smoking cessation program. EMAs (N = 32,563) assessed smoking lapse and precipitants of lapse, including stress, negative affect, smoking urge, abstinence self-efficacy, motivation to quit, difficulty concentrating, coping outcome expectancies, and smoking outcome expectancies. A multilevel structural equation model simultaneously estimated within-subject paths from stress to multiple precipitants and subsequent smoking lapse. Indirect effects of stress to smoking lapse through precipitants were computed.

Results: Results indicated that increased stress was significantly associated with all precipitants of lapse, consistent with a greater risk for lapse (i.e., increased negative affect, smoking urge, difficulty concentrating, and smoking outcome expectancies and reduced abstinence self-efficacy, motivation to quit, and coping outcome expectancies). All precipitants were significantly associated with subsequent lapse. Indirect effects indicated that stress was uniquely connected to lapse through negative affect, smoking urge, abstinence self-efficacy, coping outcome expectancies, and smoking outcome expectancies.

Conclusions: Results of this study highlight the broad importance of stress for smoking lapse during a quit attempt. Smoking cessation programs should pay close attention to the role of stress in exacerbating key precipitants of lapse to improve cessation success rates. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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http://dx.doi.org/10.1037/hea0000797DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6861642PMC
December 2019

Differences in reported sun protection practices, skin cancer knowledge, and perceived risk for skin cancer between rural and urban high school students.

Cancer Causes Control 2019 Nov 14;30(11):1251-1258. Epub 2019 Sep 14.

Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA.

Purpose: The purpose of the current study was to evaluate differences in reported use of sun protection, tanning behaviors, skin cancer-related knowledge, and perceived risk between rural and urban high school students in a geographic area with high rates of melanoma.

Methods: A total of 1,570 high school students (56.8% female) from urban (6 schools) and rural (7 schools) geographic areas in Utah completed questionnaires assessing sun protection and tanning behaviors, skin cancer-related knowledge, and perceived risk for skin cancer. Analyses examined potential differences in these outcomes between rural and urban students and by gender.

Results: Compared to students in urban areas, those in rural areas had lower odds of wearing sunscreen (OR 0.71; 95% CI 0.53, 0.95; p = 0.022), re-applying sunscreen (OR 0.61; 95% CI 0.74, 1.02; p = 0.002), wearing long-sleeved shirts (OR 0.63 95% CI 0.46, 0.86; p = 0.004), and seeking shade (OR 0.67; 95% CI 0.50, 0.88; p = 0.005).

Conclusions: Rural students reported less adequate use of sun protection than urban students. Rural male students reported lower knowledge scores compared to urban males. Future skin cancer prevention efforts targeting rural high schoolers are warranted.
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http://dx.doi.org/10.1007/s10552-019-01228-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6802938PMC
November 2019

Enhancing Smoking Risk Communications: The Influence of Need for Cognition.

Am J Health Behav 2019 09;43(5):950-962

Professor and Associate Director for Cancer Prevention and Control and Director of the Oklahoma Tobacco Research Center, Stephenson Cancer Center, Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK.

One way to enhance the impact of smoking health risk messages may be to tailor their content to individual difference factors such as need for cognition (NFC). In this study, we examined how NFC influenced responses to different smoking risk messages. Outcomes included knowledge, risk perceptions, and behavioral expectations related to quitting smoking. We randomized 402 participants to one of 4 different risk message sets that were manipulated in terms of emotionality and framing in a 2x2 design: (1) factual gain-framed, (2) factual loss-framed, (3) emotional gain-framed, and (4) emotional loss-framed. Statistically significant main effects emerged for NFC and emotionality. For certain risk perceptions, those with lower NFC reported greater perceived risk in response to emotional messages and lower risk in response to factual messages; those with higher NFC showed an opposite pattern. Similarly, those with lower NFC reported greater risk in response to gain-framed messages and lower risk in response to loss-framed messages; the opposite pattern emerged for those lower in NFC. Findings highlight the importance of an individual difference variable in influencing the impact of different types of smoking risk messages.
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http://dx.doi.org/10.5993/AJHB.43.5.7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7045173PMC
September 2019

Comparing Multiple Measures of Physical Activity in African-American Adults.

Am J Health Behav 2019 09;43(5):877-886

Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX.

We assessed the agreement between self-reported and accelerometer-assessed physical activity (PA) in African-American adults by sex, education, income, and weight status. Participants (N = 274) completed the International PA Questionnaire short form (IPAQS), Behavioral Risk Factor Surveillance System (BRFSS) PA questions, and PA Questionnaire (PAQ) and a 7-day accelerometer protocol using a waist-worn ActiGraph GT3X accelerometer. Interrelationships among PA measures were assessed by sociodemographics. Participants consistently reported doing ≥150 minutes of moderate-to-vigorous-intensity PA (MVPA) per week via self-report measures and did 113.5±179.4 minutes of accelerometer-assessed MVPA/week. Men self-reported and did more MVPA than women (p < .01). Regardless of sex, there were low correlations between self-report and accelerometer-assessed MVPA (r = .092-.190). Poor agreement existed between self-report and accelerometry for classifying participants as meeting PA recommendations (Cohen κ = .054-.136); only half of the participants were classified the same by both self-report and accelerometry. There was generally poor relative agreement between self-report and accelerometer-based assessments of MVPA in this sample of African-American adults. Findings suggest that self-report measures may perform better among African-American women than men, regardless of socioeconomic or weight status.
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http://dx.doi.org/10.5993/AJHB.43.5.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7249482PMC
September 2019
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