Publications by authors named "Rashelle B Hayes"

31 Publications

Vape shop owners'/managers' attitudes about CBD, THC, and marijuana legal markets.

Prev Med Rep 2020 Dec 12;20:101208. Epub 2020 Sep 12.

Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, 3300 Hillview Ave, Suite 120, Palo Alto, CA 94304, USA.

Over the past decade in the US there have been marked pivotal changes in the policy and retail environment regarding cannabinoids, particularly cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC). Many vape shops may carry products relevant to these two markets. This study interviewed vape shop owners/managers to assess their perceptions of consumer interests/behaviors regarding CBD and THC and of the impact of legalized marijuana retail on vape shops. The current study involved phone-based semi-structured interviews of 45 vape shop owners/managers in six metropolitan statistical areas (MSAs; Atlanta, Boston, Minneapolis, Oklahoma City, San Diego, and Seattle) during Summer 2018. Overall, 82.2% of participants were male, 77.8% were non-Hispanic White, 64.4% were managers, 8.9% reported past 30-day smoking, and 95.6% reported past 30-day vaping. Overall, 44.4% sold e-liquids containing CBD. Vape shop owners/managers indicated minimal perceived risk and some beliefs in therapeutic benefits of CBD products; however, there was a broader range of perspectives regarding marijuana retail and selling marijuana for recreational use. Some chose to distance themselves from marijuana products, their use, and the possibility of entering marijuana retail if it were to evolve in their state, while some indicated high levels of enthusiasm for the growing retail marijuana market. Future research should examine how vape shops and other retailers of CBD and marijuana communicate with consumers about products and modes of using such products, as well as how various industry sectors (e.g., vape shops) adapt or evolve with increasing regulation of nicotine and increasing legalization of marijuana retail.
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http://dx.doi.org/10.1016/j.pmedr.2020.101208DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7516178PMC
December 2020

Vape Shop Owners/Managers' Opinions About FDA Regulation of E-Cigarettes.

Nicotine Tob Res 2021 Feb;23(3):535-542

Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA.

Introduction: In the United States, prominent sources of vaping products are specialty vape shops, which are subject to Food and Drug Administration (FDA) regulation. This study interviewed vape shop owners/managers to assess: (1) reasons for entering into or engaging in vape shop retail; (2) personnel training, particularly with regard to FDA and state regulations; and (3) how existing regulations are perceived and the anticipated impact of future regulation.

Aims And Methods: The current study involved phone-based semi-structured interviews of 45 vape shop owners/managers in six metropolitan statistical areas (Atlanta, Boston, Minneapolis, Oklahoma City, San Diego, and Seattle) during Summer 2018 as FDA regulations regarding minimum age verification, bans on product sampling, and health warnings (among others) were first being implemented.

Results: Vape shop owners/managers reported: (1) entering the industry with positive intentions for their customers, (2) training their personnel to adhere to regulations and provide good customer service, and (3) significant concerns about the impact of FDA regulations. With regard to the latter, participants reported mistrust of the intentions of the FDA regulations, financial implications of the regulations (particularly for small businesses), difficulty understanding and interpreting the regulations, insufficient evidence to support the regulations, negative impact on customer service, negative impact on product offerings and product innovation/advancement, and negative implications of flavor bans and/or restrictions on sale of flavors.

Conclusions: These findings indicate the complexities in implementing tobacco regulations, particularly from the perspective of the vape shop industry. Current findings should inform future regulatory actions and efforts to assess compliance with regulations.

Implications: Current and impending FDA regulation of vaping products present a critical period for examining regulatory impact on the vape shop industry. Current results indicated that many vape shop owners/managers reporting positive intentions for engaging in the vaping product industry and in training vape shop personnel to adhere to regulations. However, the majority reported concerns about FDA regulation and other state/local regulations that could have negative implications for their industry. Particular concerns include difficulty understanding the regulations due to complexity, vagueness, and changes in language and/or interpretation over time. These issues have implications for compliance that must be addressed.
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http://dx.doi.org/10.1093/ntr/ntaa138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7885784PMC
February 2021

Neighborhood Disadvantage and Tobacco Retail Outlet and Vape Shop Outlet Rates.

Int J Environ Res Public Health 2020 04 21;17(8). Epub 2020 Apr 21.

Massey Cancer Center, Virginia Commonwealth University, Richmond, VA 23298, USA.

Neighborhood-level socioeconomic variables, such as the proportion of minority and low-income residents, have been associated with a greater density of tobacco retail outlets (TROs), though less is known about the degree to which these neighborhood indicators are related to vape shop outlet (VSO) density. Many studies of TROs and neighborhood characteristics include only a small set of variables and also fail to take into account the correlation among these variables. Using a carefully curated database of all TROs and VSOs in Virginia (2016-2018), we developed a Bayesian model to estimate a neighborhood disadvantage index and examine its association with rates of outlets across census tracts while also accounting for correlations among variables. Models included 12 census tract variables from the American Community Survey. Results showed that increasing neighborhood disadvantage was associated with a 63% and 64% increase in TRO and VSO risk, respectively. Important variables associated with TRO rates included % renter occupied housing, inverse median gross rent, inverse median monthly housing costs, inverse median monthly housing costs, and % vacant housing units. Important variables associated with VSO rates were % renter occupied housing and % Hispanic population. There were several spatial clusters of significantly elevated risk for TROs and VSOs in western and eastern Virginia.
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http://dx.doi.org/10.3390/ijerph17082864DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7215286PMC
April 2020

Determinants of Youth-Reported Past 30-Day Tobacco Use.

J Community Health 2020 10;45(5):954-964

Department of Health Behavior & Policy, Virginia Commonwealth University, Box 980430, Richmond, VA, 23298, USA.

The objective of this study was to utilize cross-sectional surveys to identify factors associated with past 30-day tobacco use among a sample youth and to determine whether regional differences exist. Data were obtained from the Virginia Youth Survey (2015 and 2017). Multinomial logistic regression models were used to examine associations between measures of past 30-day tobacco use and region, sex, grade, race/ethnicity, tobacco advertisement exposure, and presence of tobacco-free policies in the home and personal vehicles. These correlates were selected based upon existing literature on youth tobacco use. Past 30-day cigarette use, combustible tobacco use, non-combustible tobacco use, and dual product use were associated with region, sex, grade, and race/ethnicity. Specifically, youth residing in the Southwestern region of the state, males, and non-Hispanic White students and youth of other race/ethnicity were more likely to report past 30-day tobacco use. Additionally, higher levels of exposure to tobacco advertisements was also associated with past 30-day tobacco use. Future research needs to investigate the mechanisms by which youth tobacco use may differ by region, to help guide and target future policy and programming related to tobacco prevention and control at the local level.
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http://dx.doi.org/10.1007/s10900-020-00813-zDOI Listing
October 2020

Exploring the Point-of-Sale Among Vape Shops Across the United States: Audits Integrating a Mystery Shopper Approach.

Nicotine Tob Res 2021 Feb;23(3):495-504

Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA.

Introduction: Vape shops represent prominent, unique retailers, subject to Food and Drug Administration (FDA) regulation in the United States.

Aims And Methods: This study assessed compliance of US vape shop retail marketing strategies with new regulations (eg, required age verification, prohibited free samples) and pre-implementation conditions for other regulations (eg, health warning labels on all nicotine products, required disclosures of e-liquid contents).

Results: 95.0% of shops displayed minimum-age signage; however, mystery shoppers were asked for age verification at 35.6% upon entry and at 23.4% upon purchase. Although 85.5% of shops had some evidence of implementing FDA health warnings, 29.1% had signage indicating prohibited health claims, 16.3% offered free e-liquid samples, 27.4% had signage with cartoon imagery, and 33.3% were within two blocks of schools. All shops sold open-system devices, 64.8% sold closed-system devices, 68.2% sold their own brand of e-liquids, 42.5% sold e-liquids containing cannabidiol, 83.2% offered price promotions of some kind, and 89.9% had signage for product and price promotions.

Conclusions: Results indicated that most shops complied with some implementation of FDA health warnings and with free sampling bans and minimum-age signage. Other findings indicated concerns related to underage access, health claims, promotional strategies, and cannabidiol product offerings, which call for further FDA and state regulatory/enforcement efforts.
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http://dx.doi.org/10.1093/ntr/ntaa041DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7885776PMC
February 2021

Associations between Religiosity, Spirituality, and Happiness among Adults Living with Neurological Illness.

Geriatrics (Basel) 2018 Jun 23;3(3). Epub 2018 Jun 23.

Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA.

The study examined the associations between religiosity, spirituality, and happiness in 354 outpatients suffering from neurological disorders. After accounting for severity of cognitive decline, physical activity level, depression severity, and demographic variables (i.e., subject age, sex, ethnicity, and marital status) multivariate linear regression revealed a unique association between the Spiritual Well-Being Existential Spirituality scale (SWBS ES), and not the SWBS Religious Scale (SWBS RS), with both the Pemberton Remembered Happiness Index (PHI R) ( < 0.001), and the Pemberton Experienced Happiness Index (PHI E) ( < 0.001). Interventions focused on existential spirituality may improve health related quality of life among adult medical patients with neurological illness.
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http://dx.doi.org/10.3390/geriatrics3030035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6319216PMC
June 2018

Longitudinal Analysis of Associations Between Reasons for Electronic Cigarette Use and Change in Smoking Status Among Adults in the Population Assessment of Tobacco and Health Study.

Nicotine Tob Res 2020 04;22(5):663-671

Westat, Behavioral Health Group, Rockville, MD.

Introduction: Electronic cigarette (ECIG) use and changes in cigarette smoking status may be influenced by self-reported reasons for using ECIGs.

Methods: We analyzed adult current and former cigarette smokers who were also current or former ECIG users at wave 1 (n = 3044) using wave 1 and wave 2 Population Assessment of Tobacco and Health Study data (2013-2015). Prevalence of reporting 13 reasons for ECIG use at wave 1 was examined and weighted logistic regressions were conducted predicting smoking status changes from wave 1 to wave 2.

Results: Reasons for ECIG use ranged from 18.1% (people in the media or public figures use them) to 82.5% (they might be less harmful to people around me than cigarettes). From wave 1 to wave 2, 27.2% of former smokers (n = 249) became current smokers and 11.6% of current smokers (n = 246) became former smokers. Among wave 1 former smokers, using ECIGs because of the availability of flavors (AOR = 0.57, 95% CI = 0.39-0.85) or because they don't smell (AOR = 0.64, 95% CI = 0.42-0.97) was associated with lower odds of relapse to smoking, but using ECIGs because using them helps people quit smoking (AOR = 1.55, 95% CI = 1.01-2.38) was associated with greater odds of relapse. Among wave 1 current smokers, using ECIGs because they can be used where smoking is not allowed (AOR = 0.56, 95% CI = 0.38-0.85) was associated with reduced odds of quitting cigarettes.

Conclusions: Some reasons for ECIG use are associated with changes in self-reported smoking status. Researchers should examine ECIG user characteristics when assessing associations between ECIG use and smoking status transitions.

Implications: Given that certain reasons for ECIG use, such as using ECIGs in locations are where smoking is not allowed, may inhibit smoking reduction, policies may be developed to prevent ECIG use in locations where smoking is banned. In addition, because certain reasons for ECIG use may aid in relapse prevention, such as availability of desired flavors, efforts should be made to identify ECIG device characteristics that are appealing to smokers but not youth or nontobacco users. These results provide support for future research on reasons for ECIG use to inform regulatory policies.
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http://dx.doi.org/10.1093/ntr/ntz005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7171285PMC
April 2020

Comparison of Dietary Quality Assessment Using Food Frequency Questionnaire and 24-hour-recalls in Older Men and Women.

AIMS Public Health 2017 3;4(4):326-346. Epub 2017 Jul 3.

Health Statistics and Geography Lab, Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA.

Objectives: To examine the agreement in nutrient intake and alternative healthy eating indices (AHEI) between a self-administered Food Frequency Questionnaire (FFQ) and 24-hour recall (24HR) measurements of diet by gender, among older adults.

Material And Methods: This is a cross-sectional observational study of 105 men and 99 women aged 65 and older living in urban and rural neighborhoods in Worcester County, Massachusetts, USA. Participants were queried on diet using both FFQ and 24HR. The healthy eating classification was compared between the two instruments by gender.

Results: For men, the mean ± SD of AHEI total score was 48.2 ± 12.3 based on FFQ versus 34.7 ± 10.2 based on 24HR. For women, the mean ± SD was 47.9 ± 10.1 based on FFQ versus 36.1 ± 10.0 based on 24HR. Using 32 as the cutoff (40% of maximum AHEI score), 9% of men and 7% of women were classified as eating unhealthy based on the FFQ, versus 47% of men and 38% of women based on 24HR. Compared to women, men had larger 24HR to FFQ discrepancies in the nuts and vegetable protein subscore and white/red meat ratio, and smaller discrepancy in alcohol beverages subscore.

Conclusion: Agreements between FFQ and 24HR-based measures of diet quality were roughly comparable between men and women, though slightly better for women than men. Compared to 24HR, the FFQ tended to underestimate the proportions of older men and women classified as eating unhealthy and misclassified more men than women. Such limitations should be considered when the FFQ is used to study healthy eating in older age.
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http://dx.doi.org/10.3934/publichealth.2017.4.326DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5690458PMC
July 2017

Methods for Evaluating the Content, Usability, and Efficacy of Commercial Mobile Health Apps.

JMIR Mhealth Uhealth 2017 Dec 18;5(12):e190. Epub 2017 Dec 18.

Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States.

Commercial mobile apps for health behavior change are flourishing in the marketplace, but little evidence exists to support their use. This paper summarizes methods for evaluating the content, usability, and efficacy of commercially available health apps. Content analyses can be used to compare app features with clinical guidelines, evidence-based protocols, and behavior change techniques. Usability testing can establish how well an app functions and serves its intended purpose for a target population. Observational studies can explore the association between use and clinical and behavioral outcomes. Finally, efficacy testing can establish whether a commercial app impacts an outcome of interest via a variety of study designs, including randomized trials, multiphase optimization studies, and N-of-1 studies. Evidence in all these forms would increase adoption of commercial apps in clinical practice, inform the development of the next generation of apps, and ultimately increase the impact of commercial apps.
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http://dx.doi.org/10.2196/mhealth.8758DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5748471PMC
December 2017

Design and rationale of the medical students learning weight management counseling skills (MSWeight) group randomized controlled trial.

Contemp Clin Trials 2018 01 9;64:58-66. Epub 2017 Nov 9.

Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States. Electronic address:

Physicians have an important role addressing the obesity epidemic. Lack of adequate teaching to provide weight management counseling (WMC) is cited as a reason for limited treatment. National guidelines have not been translated into an evidence-supported, competency-based curriculum in medical schools. Weight Management Counseling in Medical Schools: A Randomized Controlled Trial (MSWeight) is designed to determine if a multi-modal theoretically-guided WMC educational intervention improves observed counseling skills and secondarily improve perceived skills and self-efficacy among medical students compared to traditional education (TE). Eight U.S. medical schools were pair-matched and randomized in a group randomized controlled trial to evaluate whether a multi-modal education (MME) intervention compared to traditional education (TE) improves observed WMC skills. The MME intervention includes innovative components in years 1-3: a structured web-course; a role play exercise, WebPatientEncounter, and an enhanced outpatient internal medicine or family medicine clerkship. This evidence-supported curriculum uses the 5As framework to guide treatment and incorporates patient-centered counseling to engage the patient. The primary outcome is a comparison of scores on an Objective Structured Clinical Examination (OSCE) WMC case among third year medical students. The secondary outcome compares changes in scores of medical students from their first to third year on an assessment of perceived WMC skills and self-efficacy. MSWeight is the first RCT in medical schools to evaluate whether interventions integrated into the curriculum improve medical students' WMC skills. If this educational approach for teaching WMC is effective, feasible and acceptable it can affect how medical schools integrate WMC teaching into their curriculum.
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http://dx.doi.org/10.1016/j.cct.2017.11.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5745008PMC
January 2018

Twitter-Delivered Behavioral Weight-Loss Interventions: A Pilot Series.

JMIR Res Protoc 2015 Oct 23;4(4):e123. Epub 2015 Oct 23.

Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States.

Background: Lifestyle interventions are efficacious at reducing risk for diabetes and cardiovascular disease but have not had a significant public health impact given high cost and patient and provider burden.

Objective: Online social networks may reduce the burden of lifestyle interventions to the extent that they displace in-person visits and may enhance opportunities for social support for weight loss.

Methods: We conducted an iterative series of pilot studies to evaluate the feasibility and acceptability of using online social networks to deliver a lifestyle intervention.

Results: In Study 1 (n=10), obese participants with depression received lifestyle counseling via 12 weekly group visits and a private group formed using the online social network, Twitter. Mean weight loss was 2.3 pounds (SD 7.7; range -19.2 to 8.2) or 1.2% (SD 3.6) of baseline weight. A total of 67% (6/9) of participants completing exit interviews found the support of the Twitter group at least somewhat useful. In Study 2 (n=11), participants were not depressed and were required to be regular users of social media. Participants lost, on average, 5.6 pounds (SD 6.3; range -15 to 0) or 3.0% (SD 3.4) of baseline weight, and 100% (9/9) completing exit interviews found the support of the Twitter group at least somewhat useful. To explore the feasibility of eliminating in-person visits, in Study 3 (n=12), we delivered a 12-week lifestyle intervention almost entirely via Twitter by limiting the number of group visits to one, while using the same inclusion criteria as that used in Study 2. Participants lost, on average, 5.4 pounds (SD 6.4; range -14.2 to 3.9) or 3.0% (SD 3.1) of baseline weight, and 90% (9/10) completing exit interviews found the support of the Twitter group at least somewhat useful. Findings revealed that a private Twitter weight-loss group was both feasible and acceptable for many patients, particularly among regular users of social media.

Conclusions: Future research should evaluate the efficacy and cost-effectiveness of online social network-delivered lifestyle interventions relative to traditional modalities.
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http://dx.doi.org/10.2196/resprot.4864DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4704936PMC
October 2015

Teaching Medical Students to Help Patients Quit Smoking: Outcomes of a 10-School Randomized Controlled Trial.

J Gen Intern Med 2016 Feb;31(2):172-181

Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA.

Background: Early in medical education, physicians must develop competencies needed for tobacco dependence treatment.

Objective: To assess the effect of a multi-modal tobacco dependence treatment curriculum on medical students' counseling skills.

Design: A group-randomized controlled trial (2010-2014) included ten U.S. medical schools that were randomized to receive either multi-modal tobacco treatment education (MME) or traditional tobacco treatment education (TE).

Setting/participants: Students from the classes of 2012 and 2014 at ten medical schools participated. Students from the class of 2012 (N = 1345) completed objective structured clinical examinations (OSCEs), and 50 % (N = 660) were randomly selected for pre-intervention evaluation. A total of 72.9 % of eligible students (N = 1096) from the class of 2014 completed an OSCE and 69.7 % (N = 1047) completed pre and post surveys.

Interventions: The MME included a Web-based course, a role-play classroom demonstration, and a clerkship booster session. Clerkship preceptors in MME schools participated in an academic detailing module and were encouraged to be role models for third-year students.

Measurements: The primary outcome was student tobacco treatment skills using the 5As measured by an objective structured clinical examination (OSCE) scored on a 33-item behavior checklist. Secondary outcomes were student self-reported skills for performing 5As and pharmacotherapy counseling.

Results: Although the difference was not statistically significant, MME students completed more tobacco counseling behaviors on the OSCE checklist (mean 8.7 [SE 0.6] vs. mean 8.0 [SE 0.6], p = 0.52) than TE students. Several of the individual Assist and Arrange items were significantly more likely to have been completed by MME students, including suggesting behavioral strategies (11.8 % vs. 4.5 %, p < 0.001) and providing information regarding quitline (21.0 % vs. 3.8 %, p < 0.001). MME students reported higher self-efficacy for Assist, Arrange, and Pharmacotherapy counseling items (ps ≤0.05).

Limitations: Inclusion of only ten schools limits generalizability.

Conclusions: Subsequent interventions should incorporate lessons learned from this first randomized controlled trial of a multi-modal longitudinal tobacco treatment curriculum in multiple U.S. medical schools. NIH Trial Registry Number: NCT01905618.
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http://dx.doi.org/10.1007/s11606-015-3508-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4720645PMC
February 2016

Assessing Medical Students' Tobacco Dependence Treatment Skills Using a Detailed Behavioral Checklist.

Teach Learn Med 2015 ;27(3):292-8

a Meyers Primary Care Institute , Worcester , Massachusetts , USA , and Department of Medicine , University of Massachusetts Medical School , Worcester , Massachusetts , USA.

Unlabelled: CONSTRUCT: This article describes the development and implementation of an assessment intended to provide objective scores that would be valid indications of medical students' abilities to counsel patients about tobacco dependence.

Background: Assessing medical students' advanced communication skills, particularly in the context of providing tobacco-dependence treatment, consistently and accurately is challenging; doing so across multiple medical schools is even more difficult.

Approach: Ten medical schools implemented a tobacco-dependence treatment case as part of an Objective Structured Clinical Examination for 3rd-year medical students. A 33-item checklist with detailed criteria and examples was developed for scoring students' performances. Trained coders viewed and coded 660 videotaped encounters; approximately 10% also were coded by the coding supervisor to check accuracy.

Results: Average time required to code an encounter was approximately 31 minutes; accuracy (i.e., agreement with the gold standard coder) was excellent. Overall, students performed an average of 1 in 4 of the 33 behaviors included on the checklist, and only 1 in 10 discussed setting a quit date. Most students (almost 9 in 10) asked how much the patient smoked in a day, and just over 7 in 10 informed the patient that the cough was due to smoking.

Conclusions: The authors developed and implemented a rigorous assessment that will be used to evaluate medical students' tobacco-dependence treatment skills. Operationalizing the specific counseling behaviors, training coders to accurately capture students' performances using a structured checklist, and conducting the coding all required substantial time commitments but will provide confidence in the objectivity of the assessment results. In addition, this assessment can be used to provide formative information on medical students' tobacco-dependence treatment skills and to tailor ongoing training for medical students in this area.
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http://dx.doi.org/10.1080/10401334.2015.1044660DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4685671PMC
May 2016

Tobacco counseling experience prior to starting medical school, tobacco treatment self-efficacy and knowledge among first-year medical students in the United States.

Prev Med 2015 Apr 7;73:119-24. Epub 2015 Feb 7.

Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue, Worcester, MA 01655, USA.

Objective: To explore students' tobacco dependence counseling experiences prior to medical school and their associations with tobacco counseling self-efficacy, and familiarity with and perceived effectiveness of tobacco dependence treatment among first-year medical students in the United States.

Method: In 2010, 1266 first-year medical students from 10 US medical schools completed a survey reporting their clinical experiences with specific tobacco counseling skills (e.g., 5As) prior to medical school. The survey also included questions on tobacco counseling self-efficacy, perceived physician impact on smokers, and familiarity and effectiveness of tobacco-related treatments.

Results: Half (50.4%) reported some tobacco counseling experiences prior to medical school (i.e. at least one 5A). Students with prior counseling experiences were more likely to have higher tobacco counseling self-efficacy, and greater familiarity with medication treatment, nicotine replacement treatment, and behavioral counseling for smoking cessation, compared to those with no prior experiences. Perceived physician impact on patient smoking outcomes did not differ by prior tobacco counseling experiences.

Conclusions: Many first-year medical students may already be primed to learn tobacco dependence counseling skills. Enhancing early exposure to learning these skills in medical school is likely to be beneficial to the skillset of our future physicians.
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http://dx.doi.org/10.1016/j.ypmed.2015.02.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378235PMC
April 2015

Evaluating and selecting mobile health apps: strategies for healthcare providers and healthcare organizations.

Transl Behav Med 2014 Dec;4(4):363-71

Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA USA.

Mobile applications (apps) to improve health are proliferating, but before healthcare providers or organizations can recommend an app to the patients they serve, they need to be confident the app will be user-friendly and helpful for the target disease or behavior. This paper summarizes seven strategies for evaluating and selecting health-related apps: (1) Review the scientific literature, (2) Search app clearinghouse websites, (3) Search app stores, (4) Review app descriptions, user ratings, and reviews, (5) Conduct a social media query within professional and, if available, patient networks, (6) Pilot the apps, and (7) Elicit feedback from patients. The paper concludes with an illustrative case example. Because of the enormous range of quality among apps, strategies for evaluating them will be necessary for adoption to occur in a way that aligns with core values in healthcare, such as the Hippocratic principles of nonmaleficence and beneficence.
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http://dx.doi.org/10.1007/s13142-014-0293-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4286553PMC
December 2014

Medical school curriculum characteristics associated with intentions and frequency of tobacco dependence treatment among 3rd year U.S. medical students.

Prev Med 2015 Mar 5;72:56-63. Epub 2015 Jan 5.

Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States.

Objective: Physicians play a critical role in addressing tobacco dependence, yet report limited training. Tobacco dependence treatment curricula for medical students could improve performance in this area. This study identified student and medical school tobacco treatment curricula characteristics associated with intentions and use of the 5As for tobacco treatment among 3rd year U.S. medical students.

Methods: Third year medical students (N=1065, 49.3% male) from 10 U.S. medical schools completed a survey in 2009-2010 assessing student characteristics, including demographics, tobacco treatment knowledge, and self-efficacy. Tobacco curricula characteristics assessed included amount and type of classroom instruction, frequency of tobacco treatment observation, instruction, and perception of preceptors as role models.

Results: Greater tobacco treatment knowledge, self-efficacy, and curriculum-specific variables were associated with 5A intentions, while younger age, tobacco treatment self-efficacy, intentions, and each curriculum-specific variable were associated with greater 5A behaviors. When controlling for important student variables, greater frequency of receiving 5A instruction (OR=1.07; 95%CI 1.01-1.12) and perception of preceptors as excellent role models in tobacco treatment (OR=1.35; 95%CI 1.04-1.75) were significant curriculum predictors of 5A intentions. Greater 5A instruction (B=.06 (.03); p<.05) and observation of tobacco treatment (B=.35 (.02); p<.001) were significant curriculum predictors of greater 5A behaviors.

Conclusions: Greater exposure to tobacco treatment teaching during medical school is associated with both greater intentions to use and practice tobacco 5As. Clerkship preceptors, or those physicians who provide training to medical students, may be particularly influential when they personally model and instruct students in tobacco dependence treatment.
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http://dx.doi.org/10.1016/j.ypmed.2014.12.035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4562320PMC
March 2015

A research agenda for gender and substance use disorders in the emergency department.

Acad Emerg Med 2014 Dec 1;21(12):1438-46. Epub 2014 Dec 1.

Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI.

For many years, gender differences have been recognized as important factors in the etiology, pathophysiology, comorbidities, and treatment needs and outcomes associated with the use of alcohol, drugs, and tobacco. However, little is known about how these gender-specific differences affect ED utilization; responses to ED-based interventions; needs for substance use treatment and barriers to accessing care among patients in the ED; or outcomes after an alcohol-, drug-, or tobacco-related visit. As part of the 2014 Academic Emergency Medicine consensus conference on "Gender-Specific Research in Emergency Care: Investigate, Understand and Translate How Gender Affects Patient Outcomes," a breakout group convened to generate a research agenda on priority questions related to substance use disorders.
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http://dx.doi.org/10.1111/acem.12534DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4318812PMC
December 2014

Tobacco Use, Quitting Behavior, and Health Characteristics Among Current Electronic Cigarette Users in a National Tri-Ethnic Adult Stable Smoker Sample.

Nicotine Tob Res 2015 Sep 10;17(9):1085-95. Epub 2014 Nov 10.

Center for Health Equity, University of Minnesota Medical School, Minneapolis, MN.

Introduction: The present study characterizes the tobacco use, quitting behaviors, and health characteristics of cigarette smokers who did not change their smoking pattern over the past 6 months and have used electronic cigarettes (ECs) in the past 30 days. This is an important subpopulation to characterize if EC dual use with cigarettes continues to grow.

Methods: Participants (N = 2,376) from a research survey panel completed an online cross-sectional survey between June and August 2012. Sampling was stratified to recruit equal numbers of cigarette smoking participants by race/ethnicity (Black, Hispanic, and Caucasian) and smoking frequency (nondaily and daily). All displayed a stable rate of smoking for the past 6 months and were not currently in treatment. Bivariate and multivariate analyses were used to examine correlates of current EC use (any use within the past 30 days).

Results: Current EC use was reported by 9.2% (n = 219) of the total sample. Of current EC users, 44% reported having used ECs as a quit method. Bivariate and multivariate analyses showed that current EC use was significantly associated with greater nicotine dependence, concurrent poly-tobacco use, more past-year quit attempts, past use of multiple cessation methods, and more depressive symptoms. No demographic variables were significantly associated with current EC use.

Conclusions: This study suggests that stable smokers who currently use ECs possess characteristics that are associated with difficulty in achieving smoking cessation. These characteristics should be considered when examining the effectiveness of ECs on cessation and in designing future cessation trials using ECs.
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http://dx.doi.org/10.1093/ntr/ntu241DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4627485PMC
September 2015

Teaching tobacco dependence treatment and counseling skills during medical school: rationale and design of the Medical Students helping patients Quit tobacco (MSQuit) group randomized controlled trial.

Contemp Clin Trials 2014 Mar 31;37(2):284-93. Epub 2014 Jan 31.

Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA, United States. Electronic address:

Introduction: Physician-delivered tobacco treatment using the 5As is clinically recommended, yet its use has been limited. Lack of adequate training and confidence to provide tobacco treatment is cited as leading reasons for limited 5A use. Tobacco dependence treatment training while in medical school is recommended, but is minimally provided. The MSQuit trial (Medical Students helping patients Quit tobacco) aims to determine if a multi-modal and theoretically-guided tobacco educational intervention will improve tobacco dependence treatment skills (i.e. 5As) among medical students.

Methods/design: 10 U.S. medical schools were pair-matched and randomized in a group-randomized controlled trial to evaluate whether a multi-modal educational (MME) intervention compared to traditional education (TE) will improve observed tobacco treatment skills. MME is primarily composed of TE approaches (i.e. didactics) plus a 1st year web-based course and preceptor-facilitated training during a 3rd year clerkship rotation. The primary outcome measure is an objective score on an Objective Structured Clinical Examination (OSCE) tobacco-counseling smoking case among 3rd year medical students from schools who implemented the MME or TE.

Discussion: MSQuit is the first randomized to evaluate whether a tobacco treatment educational intervention implemented during medical school will improve medical students' tobacco treatment skills. We hypothesize that the MME intervention will better prepare students in tobacco dependence treatment as measured by the OSCE. If a comprehensive tobacco treatment educational learning approach is effective, while also feasible and acceptable to implement, then medical schools may substantially influence skill development and use of the 5As among future physicians.
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http://dx.doi.org/10.1016/j.cct.2014.01.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4048818PMC
March 2014

Recent increases in efficiency in cigarette nicotine delivery: implications for tobacco control.

Nicotine Tob Res 2014 Jun 13;16(6):753-8. Epub 2014 Jan 13.

Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA;

Introduction: Recent increases in nicotine yield of cigarettes sold in the United States have been attributed by tobacco manufacturers to natural variation in agricultural products. We tested this assertion using data reported by the manufacturers.

Methods: Data were collected from the annual reports filed with the Massachusetts Department of Public Health by 4 major manufacturers of cigarettes from 1997 to 2012. Reportable measures included nicotine yield (mg/cig) in smoke generated by a smoking machine based on the Massachusetts smoking regimen and nicotine content in the unburned tobacco per cigarette (mg/cig). We used multilevel linear mixed-effect models to examine temporal trends in and predictors of these measures, overall and by brand style and by brand family.

Results: While nicotine content remained relatively stable in the range of 12-14 mg/cig between 1998 and 2012, average nicotine yield increased significantly (p < .01) over time and ranged from the lowest level of 1.65 mg/cigarette in 1999 to the highest level of 1.89 mg/cigarette in 2011. Nicotine yield and yield-to-content ratio varied significantly among manufacturers and brand families. When controlling for market category and all available design features, the yield-to-content ratio of all manufacturers except Lorillard increased significantly over time.

Conclusions: The data provided by tobacco manufacturers suggest that the increasing trend in yield is not related to variations in nicotine content but to the yield-to-content ratio, which contradicts their assertions of agricultural variations. Nicotine yield and yield-to-content ratio are controllable features of cigarettes, and they should be monitored and regulated by government agencies.
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http://dx.doi.org/10.1093/ntr/ntt219DOI Listing
June 2014

Cotinine and tobacco-specific carcinogen exposure among nondaily smokers in a multiethnic sample.

Nicotine Tob Res 2014 May 1;16(5):600-5. Epub 2013 Dec 1.

Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, MN.

Background: Nondaily smoking has increased among current U.S. smokers during the past decade and is practiced by a significant percentage of smokers. Although research in nondaily smoking has grown, little is known about levels of exposure to tobacco toxicants among nondaily smokers and their variation across ethnic groups.

Methods: We examined urinary levels of cotinine and a tobacco-specific nitrosamine (NNAL) in community participants. Associations between the biomarker data and smoking characteristics were evaluated with Spearman's correlation analysis.

Results: Participants included 28 Blacks, 4 Latinos, and 25 Whites who smoked at least 1 cigarette on 4-24 days in the past 30 days. Participants averaged 3.3 (SD = 2.1) cigarettes per day (cpd) on days smoked, they smoked an average of 13.0 (SD = 5.4) days in the past month, and they smoked nondaily for 10.5 (SD = 10.5) years. Median levels of creatinine-normalized cotinine and NNAL were 490.9 ng/mg and 140.7 pg/mg, respectively. NNAL and cotinine were highly correlated (r = .84); NNAL and cotinine were modestly correlated with cpd (r = .39 and r = .34; all p values <.05). The number of days smoked per month was not associated with any biomarker levels.

Conclusions: Our findings demonstrate that nondaily smokers are, on average, exposed to significant levels of nicotine and carcinogenic nitrosamines, with exposures of 40%-50% of those seen in daily smokers. This level of exposure suggests a significant health risk. Nicotine and carcinogen exposure is most closely related to number of cigarettes smoked per day but not to number of days per month of smoking.
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http://dx.doi.org/10.1093/ntr/ntt194DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3988430PMC
May 2014

Tobacco dependence treatment teaching by medical school clerkship preceptors: survey responses from more than 1,000 US medical students.

Prev Med 2013 Aug 25;57(2):81-6. Epub 2013 Apr 25.

Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA 02115, USA.

Objective: To determine factors associated with tobacco cessation counseling in medical school clerkships.

Methods: Third-year medical students at 10 medical schools across the United States completed a 100-item survey, measuring the frequency with which they experienced their preceptors providing clinical teaching components: clear instruction, feedback, modeling behavior, setting clear objectives, and responding to questions about tobacco dependence counseling as well as frequency of use of tobacco prompts and office systems. Our primary dependent measure was student self-reported skill level for items of tobacco dependence treatment (e.g. "5As").

Results: Surveys were completed by 1213 students. For both family medicine and internal medicine clerkships, modeling and providing clear instruction on ways to provide tobacco counseling were reported most commonly. In contrast, providing feedback and clear objectives for tobacco dependence treatment lagged behind. Overall, students who reported preceptors' provision of optimal clinical teaching components and office system prompts in both family medicine and internal medicine clerkships had higher self-reported skill (P<0.001) than students with no exposure or exposure during only one of the clerkships.

Conclusions: Future educational interventions intended to help students adopt effective tobacco dependence treatment techniques should be engineered to facilitate these critical precepting components.
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http://dx.doi.org/10.1016/j.ypmed.2013.04.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3767283PMC
August 2013

Smoking status, physical health-related quality of life, and mortality in middle-aged and older women.

Nicotine Tob Res 2013 Mar 10;15(3):662-9. Epub 2012 Sep 10.

Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX 78712, USA.

Introduction: Women who smoke, particularly older women, have been relatively neglected in smoking research. There is a lack of knowledge concerning the relation of level of smoking to quality of life and mortality among middle-aged and older women smokers.

Methods: This study examined the relation of smoking status to physical health-related quality of life (PHRQL) and total mortality in women in the Women's Health Initiative (WHI) Observational Study. Participants were 90,849 postmenopausal women, who were an average age of 63.6 years at baseline. Analyses used multiple linear and Cox proportional hazards regression and controlled for age, educational level, and ethnicity. Never-smokers were the reference group.

Results: We found that smoking status was significantly related to PHRQL cross-sectionally at baseline and prospectively at a 3-year follow-up, with those who smoked having lower PHRQL. Heavier smokers showed large, clinically meaningful associations with PHRQL and light smokers showed small associations. In addition, we found that the smoking status at baseline was significantly related to 10-year total mortality. Both light and heavier smoking at baseline significantly correlated with higher mortality risk; however, the relationship of smoking to mortality was dose dependent. Among former smokers, those who had smoked longer showed significantly lower PHRQL and significantly increased mortality risk.

Conclusions: Findings suggest that the risks of smoking may not be evident to light smokers and that educational interventions targeted to middle-aged and older women stressing the consequences of light smoking may be particularly beneficial.
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http://dx.doi.org/10.1093/ntr/nts182DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3611990PMC
March 2013

Differences between Latino daily light and heavier smokers in smoking attitudes, risk perceptions, and smoking cessation outcome.

Nicotine Tob Res 2013 Jan 15;15(1):103-11. Epub 2012 May 15.

Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA.

Introduction: Daily light smoking is increasing and disproportionately represented among Latinos. The current study examines differences in smoking attitudes, psychosocial characteristics, risk perceptions, and cessation rates between Latino daily light (3-9 cigarettes/day) and heavier smokers (≥ 10 cigarettes/day).

Methods: Participants (N = 131; M(age) = 36.8, 73.3% female, 53.1% light smokers) were enrolled in a study focused on motivating smokers to quit. Cessation was biochemically verified at 2 and 3 months after end of treatment.

Results: Heavier smoking was more prevalent among males (65.7%) and those from Puerto Rico (69.0%). Compared with heavier smokers, light smokers were less nicotine dependent (p < .001), reported fewer pros of smoking (p ≤ .001), less perceived stress (p ≤ .001), had fewer friends who smoked (p ≤ .005), were more likely to live in a household with an indoor smoking ban (p ≤ .001), and self-reported better health (p < .05). Regarding risk perceptions, Latino light smokers reported less perceived vulnerability for the health effects from smoking on their child's health (p < .05). There were no significant differences in smoking cessation rates between daily light and heavier smokers at either 2- or 3-month follow-up. Belief that quitting would improve "their own health," however, significantly predicted smoking cessation at both 2- and 3-month follow-up, but only among heavier smokers.

Conclusions: Latino light smokers do not seem to be more likely to quit smoking than Latinos who smoke at heavier rates. Differences between Latino light and heavier smokers in demographics, smoking attitudes, and psychosocial factors may need to be considered when developing cessation programs and mass media campaigns. Future research should continue to explore whether Latino light smokers need different or more targeted treatments.
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http://dx.doi.org/10.1093/ntr/nts095DOI Listing
January 2013

Smoking frequency among current college student smokers: distinguishing characteristics and factors related to readiness to quit smoking.

Health Educ Res 2012 Feb 7;27(1):141-50. Epub 2011 Dec 7.

Department of Behavioral Sciences and Health Education, Emory University, 1518 Clifton Road NE, Fifth Floor, Atlanta, GA 30322, USA.

Given the increased prevalence of non-daily smoking and changes in smoking patterns, particularly among young adults, we examined correlates of smoking level, specifically motives for smoking, and readiness to quit smoking among 2682 college undergraduates who completed an online survey. Overall, 64.7% (n = 1736) were non-smokers, 11.6% (n = 312) smoked 1-5 days, 10.5% (n = 281) smoked 6-29 days and 13.2% (n = 353) were daily smokers. Ordinal regression analyses modeling smoking level indicated that correlates of higher smoking level included having more friends who smoke (β = 0.63, 95% CI 0.57-0.69) and more frequent other tobacco use (β = 0.04, 95% CI 0.02-0.05), drinking (β = 0.04, 95% CI 0.02-0.07) and binge drinking (β = 0.09, 95% CI 0.06-0.13). Bivariate analyses indicated that daily smokers (versus the subgroups of non-daily smokers) were less likely to smoke for social reasons but more likely to smoke for self-confidence, boredom, and affect regulation. Controlling for sociodemographics, correlates of readiness to quit among current smokers included fewer friends who smoke (P = 0.002), less frequent binge drinking (P = 0.03), being a social smoker (P < 0.001), smoking less for self-confidence (P = 0.04), smoking more for boredom (P = 0.03) and less frequent smoking (P = 0.001). Specific motives for smoking and potential barriers to cessation particularly may be relevant to different groups of college student smokers.
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http://dx.doi.org/10.1093/her/cyr106DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3605919PMC
February 2012

Social influences on smoking in middle-aged and older women.

Psychol Addict Behav 2012 Sep 17;26(3):519-26. Epub 2011 Oct 17.

Department of Psychology, University of Texas at Austin, Austin, TX 78712, USA.

The purpose of this study was to examine the role of 2 types of social influence--general social support and living with a smoker--on smoking behavior among middle-aged and older women in the Women's Health Initiative (WHI) Observational Study. Participants were postmenopausal women who reported smoking at some time in their lives (N=37,027), who were an average age of 63.3 years at baseline. Analyses used multiple logistic regression and controlled for age, educational level, and ethnicity. In cross-sectional analyses, social support was associated with a lower likelihood and living with a smoker was associated with a higher likelihood of being a current smoker and, among smokers, of being a heavier smoker. Moreover, in prospective analyses among baseline smokers, social support predicted a higher likelihood and living with a smoker predicted a lower likelihood of smoking cessation 1-year later. Further, in prospective analyses among former smokers who were not smoking at baseline, social support predicted a lower likelihood and living with a smoker predicted a higher likelihood of smoking relapse 1-year later. Overall, the present results indicate that social influences are important correlates of smoking status, smoking level, smoking cessation, and smoking relapse among middle-aged and older women.
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http://dx.doi.org/10.1037/a0025843DOI Listing
September 2012

Differences in smoking behavior and attitudes among Puerto Rican, Dominican, and non-Latino white caregivers of children with asthma.

Am J Health Promot 2011 May-Jun;25(5 Suppl):S91-5

Centers for Behavioral and Preventive Medicine, Miriam Hospital, Brown Medical School, Providence, Rhode Island 02903, USA.

Purpose: No studies have examined the differences in smoking attitudes and behavior between Dominicans (DRs) and Puerto Ricans (PRs). Identification of pretreatment differences is important for cultural adaptation of evidenced-based smoking cessation treatments.

Design: Secondary analysis. SETTING/INTERVENTION: Three home visits for asthma education and smoking cessation.

Subjects: Caregivers who smoke and have a child with asthma: DRs (n = 30), PRs (n = 67), and non-Latino whites (n = 128; NLWs).

Measures: Baseline assessment of psychosocial variables.

Analyses: Controlled for age, education, and acculturation.

Results: Compared with DRs, PRs were more acculturated, more nicotine dependent, less motivated and confident to quit, and identified more pros of smoking (all p < .05). Compared with NLWs, PRs were less likely to be employed, smoked fewer cigarettes per day, and had lower education, greater depressed mood, greater pros and cons of smoking, less social support, and higher child asthma morbidity (all p < .05). Compared with NLWs, DRs were less nicotine dependent, more confident to quit, and less likely to live with a smoker; reported greater cons of smoking and greater stress; and were more likely to have a household smoking ban (DRs 60% vs. NLWs 33.6%). Only 3.3% of DRs were precontemplators vs. 16.4% (PRs) and 10.9% (NLWs).

Conclusions: PRs appear to have more factors associated with risk of smoking treatment failure; DRs appear to have more protective factors. Examination of the role of these smoking attitudes as potential moderators and mediators of smoking behavior are needed to guide the cultural adaptation of evidenced-based treatments.
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http://dx.doi.org/10.4278/ajhp.100624-ARB-214DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4993097PMC
July 2011

Depressive symptoms and smoking in middle-aged and older women.

Nicotine Tob Res 2011 Aug 19;13(8):722-31. Epub 2011 Apr 19.

Department of Kinesiology and Health Education, University of Texas at Austin, 1 University Station, Austin, TX 78712, USA.

Introduction: Smoking research and intervention efforts have neglected older women. Depressive symptoms, which are common in middle-aged and older women, are related to the maintenance of adult smoking.

Methods: This study investigated the relation of a composite measure of current depressive symptoms, derived from a short form of the Center for Epidemiological Studies Depression Scale, and history of depressive symptoms, derived from two items from the Diagnostic Interview Schedule, to smoking outcomes in the Women's Health Initiative Observational Study (N = 90,627). Participants were postmenopausal with an average age of 63.6 years at baseline. Participants were recruited from urban, suburban, and rural areas surrounding 40 clinical centers in the United States. Analyses controlled for age, educational level, and ethnicity.

Results: In multinomial logistic regression analyses, depressive symptoms were related cross-sectionally to current light (odds ratio [OR] = 1.19, 95% CI = 1.14-1.23) and heavier (OR = 1.28, 95% CI = 1.23-1.32) smoking at baseline compared with nonsmokers. In prospective multiple logistic regression analyses, baseline depressive symptoms were negatively predictive of smoking cessation at a 1-year follow-up (OR = .85, 95% CI = 0.77-0.93) and at participants' final assessments in the study (OR = .92, 95% CI = 0.85-0.98). Light smokers had more than 2 times higher odds of smoking cessation than did heavier smokers.

Conclusions: The present findings demonstrate a consistent link between depressive symptoms and negative smoking-related behaviors among middle-aged and older women at both light and heavier smoking levels.
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http://dx.doi.org/10.1093/ntr/ntr066DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150691PMC
August 2011

Risk perception and smoking behavior in medically ill smokers: a prospective study.

Addiction 2010 Jun 22;105(6):1100-8. Epub 2010 Mar 22.

Centers for Behavioral and Preventive Medicine, Warren Alpert Medical School of Brown University and The Miriam Hospital, Providence, RI 02903, USA.

Aims: To examine the influence of risk perception on intentions to quit smoking and post-treatment abstinence.

Design: Prospective and longitudinal.

Setting: United States.

Participants: A total of 237 adult smokers (mean age 56 years) receiving medical care from home health-care nurses. Participants did not have to want to quit smoking to participate, but received cessation counseling within the context of their medical care.

Measurements: Three measures of risk perception were given pre- and post-treatment: perceived vulnerability, optimistic bias and precaution effectiveness. Smoking status was verified biochemically at end of treatment and at 2, 6 and 12 months later.

Findings: Principal components analysis supported the theoretical discriminability of the risk perception measures, and intercorrelations provided evidence for concurrent and predictive validity. Elevated risk perception was associated with a variety of socio-demographic and psychosocial characteristics. Optimistic bias was associated significantly with older age and ethnic minority status. Smokers in pre-contemplation had lower perceived vulnerability and precaution effectiveness and greater optimistic bias than those in contemplation and preparation. Smokers in preparation had higher perceived vulnerability and lower optimistic bias than those in earlier stages. Change in perceived vulnerability predicted smoking cessation at follow-up. Optimistic bias predicted a lower likelihood of cessation and precaution effectiveness predicted a greater likelihood of smoking cessation, but only among those with a smoking-related illness.

Conclusions: In patients receiving medical care from home health-care nurses, change in perceived vulnerability to smoking-related disease is predictive of smoking cessation. In those with smoking-related illnesses, optimistic bias predicts continued smoking while precaution effectiveness predicts cessation.
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http://dx.doi.org/10.1111/j.1360-0443.2010.02900.xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2908209PMC
June 2010

Predictors of retention in smoking cessation treatment among Latino smokers in the Northeast United States.

Health Educ Res 2010 Aug 17;25(4):687-97. Epub 2010 Mar 17.

Center for Alcohol.ddiction Studies, Brown Medical School, 121 South Main Street, Providence, RI 02912, USA.

Introduction: Only one previous study on minority retention in smoking cessation treatment has been conducted (Nevid JS, Javier RA, Moulton JL III. Factors predicting participant attrition in a community-based, culturally specific smoking cessation program for Hispanic smokers. Health Psychol 1996; 15: 226-29). We investigated predictors of intervention completion and assessment completion among Latino smokers (n = 131) with asthmatic children participating in a home-based asthma education study that included smoking cessation counseling.

Methods: We examined a variety of pretreatment demographic and psychosocial predictors of intervention completion (completing all three home visits versus <3), assessment completion (attendance/not) and total study participation (completing all six contacts versus <6).

Results: Lower levels of depressed mood (OR = 0.912, 95% CI: 0.857-0.971, P < 0.01) and fewer 'pros' of smoking (OR = 0.882, 95% CI: 0.809-0.961, P < 0.01) predicted intervention completion. Predictors of assessment completion included having more friends who smoke (OR = 2.09, 95% CI: 1.23-3.56, P < 0.01), fewer pros of smoking (OR = 0.87, 95% CI: 0.81-0.95, P < 0.01) and a strong belief that quitting smoking would benefit the child's asthma (OR = 1.69, 95% CI: 1.04-2.74, P < 0.05). Unemployed participants were more likely to complete all six study contacts than those who were working (OR = 0.37, 95% CI: 0.14-0.99, P < 0.05).

Discussion: Findings suggest the need to tailor retention strategies during active treatment and follow-up assessments to target those who at risk of dropping out.
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http://dx.doi.org/10.1093/her/cyq010DOI Listing
August 2010