Faculty Bibliography

BACKGROUND:Financial capability is an understudied social determinant of health (SDoH). Bank account ownership, an indicator of financial capability, has been linked to better health. No research has explored how bank account ownership relates to health behaviors, such as tobacco use. OBJECTIVES/OBJECTIVE:To examine participant characteristics, intervention use, and intervention outcomes among subgroups of unbanked and banked participants enrolled in a randomized controlled trial (RCT) that integrated financial coaching and SDoH referrals into smoking cessation treatment for low-income individuals (N = 257). DESIGN/METHODS:Secondary analysis of an RCT. INTERVENTIONS/METHODS:The parent RCT provided a multi-component intervention (N = 136) that included smoking cessation coaching, nicotine replacement therapy, money management coaching, and referral to financial empowerment services and other SDoH resources. A waitlisted control group (N = 121) received usual care. MEASURES/METHODS:Bivariate analyses compared baseline characteristics and multivariable logistic regression compared intervention use by banking status. Within unbanked and banked subgroups, logistic regression examined treatment group differences (intervention vs. control) in self-reported 7-day abstinence and financial stress at 6 months. RESULTS:At baseline, 36% (n = 92) of participants were unbanked. Unbanked participants had lower income and education, higher unemployment, and greater financial distress (all p < 0.05). Intervention use did not differ by banking status (p > 0.05). At 6 months, unbanked participants had high abstinence rates in the intervention and control groups (ITT 21% vs. 13%, p > 0.05) and no significant treatment group differences in financial stress (p > 0.05). Among banked participants, the intervention group reported higher abstinence than the control group (ITT 19% vs. 6%, p = 0.01) and reduced financial stress across multiple domains (all p = 0.01). CONCLUSIONS:A significant portion of participants in the RCT were unbanked, but being unbanked was not a barrier to smoking cessation. The intervention reduced financial stress among banked participants only. Further research is needed to develop interventions that can support unbanked individuals' health and financial well-being. TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov Identifier: NCT03187730.

OBJECTIVE/UNASSIGNED:Social support interventions may enhance access and use of evidence-based tobacco cessation treatments (EBCTs). We assessed the feasibility of a proactive social support intervention for Veterans who smoke. METHODS/UNASSIGNED:We used national Veterans Health Administration (VHA) data to identify Veterans who smoke cigarettes in the United States. We mailed invitation letters to a random national sample, followed by telephone outreach. Veteran-support person dyads were randomly assigned to intervention or control conditions. Support persons in the intervention group additionally received a 1-call coaching session. Assessments were conducted at baseline, 1-month, and 4-months post-randomization. Data collection occurred from March 2021 - August 2022. RESULTS/UNASSIGNED:A total of 27 dyads were randomized. Two-thirds of Veteran participants were women. Veteran follow-up survey response rates were 81.5 %. Intervention participants reported a higher rate of cessation medication use (57.1 % vs. 30.8 %), use of any EBCT (64.3 % vs. 38.5 %), and biochemically confirmed seven-day point-prevalence abstinence (14.3 % vs 7.7 %) than control participants. The proactive recruitment rate was 6 % for Veterans, 74 % for support persons, and a 93 % support person completion rate for the coaching call intervention. CONCLUSIONS/UNASSIGNED:Recruitment methods were feasible, especially for women Veterans. A proactive social support intervention shows promise for increasing Veteran utilization of EBCTs.

BACKGROUND:The National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) has supported clinical trials of substance use disorder (SUD) interventions for 25 years. This review describes the use of implementation outcomes across CTN trials, characterizes outcomes included, and identifies gaps and potential opportunities to strengthen implementation research within the CTN and the field of SUD treatment. METHODS:This systematic review included active or completed studies listed on the CTN Dissemination Library webpage as of August 18, 2021, and approved by the CTN for development by January 1, 2022. Study summaries and protocols were reviewed if they: 1) measured at least one implementation outcome and 2) examined a practice change, intervention, or process. Extracted data elements included trial design characteristics, implementation frameworks, and outcome assessment domains informed by the RE-AIM and Proctor Implementation Outcomes Frameworks. RESULTS:114 protocols were considered, 42 full-text protocols were screened, and 25 were included for data extraction. Start dates of trials spanned a 20-year period (2004-2024) with latter studies including more implementation outcomes. Fidelity (n = 29) and reach/penetration (n = 26) were the most included implementation outcomes. Equity was not identified in any protocols. Methods of defining, capturing, and evaluating outcomes data varied across trials and outcomes. CONCLUSION/CONCLUSIONS:The inclusion of implementation outcomes increased over time, perhaps reflecting a growing emphasis on implementation research. Incorporating measures of equity could advance knowledge about differential receipt or effectiveness of SUD interventions. Future research should seek to improve the consistency and comprehensiveness in descriptions of implementation science elements.

INTRODUCTION/BACKGROUND:Spending on tobacco products may exacerbate health-related financial hardship experienced by low-income older adults. This study examined tobacco spending and the relationship between tobacco use and non-tobacco spending among low-income older adults in the U.S. METHODS:Using pooled 2021-2023 Consumer Expenditure Survey data, 1,983 single-person households (aged ≥65, with income <200% of the federal poverty level) were analyzed. Descriptive statistics summarized quarterly expenditures and budget shares for tobacco and non-tobacco goods. Generalized linear and fractional logit models compared non-tobacco expenditures and budget shares between people who use (versus do not use) tobacco, controlling for sociodemographic covariates. RESULTS:Overall, 10.6% of respondents reported tobacco spending. Respondents who used tobacco spent an average of $305.0 (SD = 303.4) per quarter on tobacco (7.8% of their total budget). Compared to respondents that did not use tobacco, respondents that used tobacco spent significantly more per quarter on alcohol ($54.8 vs. $22.0, P<0.001) and significantly less per quarter on food ($783.9 vs. $837.0, P<0.01), housing ($1,754.5 vs. $2,189.7, P<0.05), health care ($564.0 vs. $720.2, P<0.05), and clothing ($47.8 vs. $64.7, P<0.05). Similarly, respondents that used tobacco spent a significantly greater portion of their budget on alcohol (1.3% vs. 0.4%, P<0.001) and a significantly lower portion on food (19.6% vs. 19.7%, P<0.05), housing (38.8% vs. 43.4%, P<0.01), health care (14.7% vs. 16.8%, P<0.01), and other expenses (2.0% vs. 3.9%, P<0.01). CONCLUSIONS:Tobacco spending and its complementary alcohol spending may reduce low-income older adults' expenditures on food, housing and health care.

BACKGROUND:Chinese immigrants experience significant disparities in tobacco use. Culturally adapted tobacco treatments targeting this population are sparse and the use is low. The low use of these treatment programs is attributed to their exclusive focus on individuals who are ready to quit and the wide range of barriers that Chinese immigrants face to access these programs. To support Chinese immigrant smokers at all levels of readiness to quit and address their access barriers, we developed the WeChat Quit Coach, a culturally and linguistically appropriate WeChat (Tencent Holdings Limited)-based peer group mobile messaging smoking cessation intervention. OBJECTIVE:This study aims to assess the feasibility, acceptability, and preliminary effects of WeChat Quit Coach. METHODS:We enrolled a total of 60 Chinese immigrant smokers in 2022 in New York City for a pilot randomized controlled trial (RCT) and a single-arm pilot test. The first 40 participants were randomized to either the intervention arm (WeChat Quit Coach) or the control arm (self-help print material) using 1:1 block randomization stratified by sex. WeChat Quit Coach lasted 6 weeks, featuring small peer groups moderated by a coach, daily text messages with text questions, and chat-based instant messaging support from the coach in response to peer questions. The next 20 participants were enrolled in the single-arm pilot test to further assess intervention feasibility and acceptability. All 60 participants were offered a 4-week supply of complimentary nicotine replacement therapy. Surveys were administered at baseline and 6 weeks, with participants in the pilot RCT completing an additional survey at 6 months and biochemical verification of abstinence at both follow-ups. RESULTS:Of 74 individuals screened, 68 (92%) were eligible and 60 (88%) were enrolled. The majority of participants, with a mean age of 42.5 (SD 13.8) years, were male (49/60, 82%) and not ready to quit, with 70% (42/60) in the precontemplation or contemplation stage at the time of enrollment. The pilot RCT had follow-up rates of 98% (39/40) at 6 weeks and 93% (37/40) at 6 months, while the single-arm test achieved 100% follow-up at 6 weeks. On average, participants responded to daily text questions for 25.1 days over the 42-day intervention period and 23% (9/40) used the chat-based instant messaging support. Most participants were satisfied with WeChat Quit Coach (36/39, 92%) and would recommend it to others (32/39, 82%). At 6 months, self-reported 7-day point prevalence abstinence rates were 25% (5/20) in the intervention arm and 15% (3/20) in the control arm, with biochemically verified abstinence rates of 25% (5/20) and 5% (1/20), respectively. CONCLUSIONS:WeChat Quit Coach was feasible and well-received by Chinese immigrants who smoke and produced promising effects on abstinence. Large trials are warranted to assess its efficacy in promoting abstinence in this underserved population. TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov NCT05130788; https://clinicaltrials.gov/study/NCT05130788.

BACKGROUND:Quitting smoking may lead to improvement in substance use, psychiatric symptoms, and pain, especially among high-risk populations who are more likely to experience comorbid conditions. However, causal inferences regarding smoking cessation and its subsequent benefits have been limited. METHODS:We emulated a hypothetical open-label randomized control trial of smoking cessation using longitudinal observational data of HIV-positive and HIV-negative US veterans from 2003-2015 in the Veterans Aging Cohort Study. We followed individuals from the first time they self-reported current cigarette smoking (baseline). We categorized participants as quitters or non-quitters at the first follow-up visit (approximately 1 year after baseline). Using inverse probability weighting to adjust for confounding and selection bias, we estimated odds ratios for improvement of co-occurring conditions (unhealthy alcohol use, cannabis use, illicit opioid use, cocaine use, depressive symptoms, anxiety symptoms, and pain symptoms) at second follow-up (approximately 2 years after baseline) for those who quit smoking compared to those who did not, among individuals who had the condition at baseline. RESULTS:Of 4,165 eligible individuals (i.e., current smokers at baseline), 419 reported no current smoking and 2,330 reported current smoking at the first follow-up. Adjusted odds ratios (95% confidence intervals) for associations between quitting smoking and improvement of each condition at second follow-up were: 2.10 (1.01, 4.35) for unhealthy alcohol use, 1.75 (1.00, 3.06) for cannabis use, 1.10 (0.58, 2.08) for illicit opioid use, and 2.25 (1.20, 4.24) for cocaine use, 0.78 (0.44, 1.38) for depressive symptoms, 0.93 (0.58, 1.49) for anxiety symptoms, and 1.31 (0.84, 2.06) for pain symptoms. CONCLUSIONS:While a causal interpretation of our findings may not be warranted, we found evidence for decreased substance use among veterans who quit cigarette smoking but none for the resolution of psychiatric conditions or pain symptoms. Findings suggest the need for additional resources combined with smoking cessation to reduce psychiatric and pain symptoms for high-risk populations.

BACKGROUND:Few studies have examined the effectiveness of telephone smoking cessation interventions by severity of behavioral health symptoms. Using data from a telephone counseling study, we examined whether abstinence rates varied by level of behavioral health symptoms. METHODS:The parent study recruited adults who smoke cigarettes (N = 577) referred by mental health providers at six Veterans Health Administration facilities. Participants were randomized to specialized telephone counseling (intervention) or state Quitline referral (control). Participants completed assessments at baseline and 6 months, including the BASIS-24, a self-report measure of behavioral health symptoms and functioning. We used the BASIS-24 median to dichotomize participants as having high or low scores. The primary outcome was 30-day self-reported abstinence at 6 months. We compared groups on outcomes by logistic regression and performed an interaction effect analysis between treatment assignment and groups. RESULTS:At baseline, those with high behavioral health symptoms scores reported heavier nicotine dependence and more sedative and/or antidepressant use, compared to participants with low behavioral health symptoms. At 6 months, participants with low behavioral health symptoms scores in the intervention reported higher rates of 30-day abstinence compared to those in the control arm (26% vs 13%, OR = 2.3, 95% CI = 1.8, 2.9). People with high behavioral health symptoms scores reported no difference in 30-day abstinence between the treatment assignments at 6 months (12% vs. 13%, OR = 1.1, 95% CI = 0.6, 2.0). CONCLUSIONS:Only participants with low behavioral health symptoms scores reported higher abstinence rates in the intervention compared to the state Quitline. Future research can examine alternative approaches for people with worse mental well-being and functioning. TRIAL REGISTRATION:The parent study is registered at www. CLINICALTRIALS:gov NCT00724308.

BACKGROUND:Prediabetes affects 26.4 million people aged 65 years or older (48.8%) in the United States. Although older adults respond well to the evidence-based Diabetes Prevention Program, they are a heterogeneous group with differing physiological, biomedical, and psychosocial needs who can benefit from additional support to accommodate age-related changes in sensory and motor function. OBJECTIVE:The purpose of this paper is to describe adaptations of the Centers for Disease Control and Prevention's Diabetes Prevention Program aimed at preventing diabetes among older adults (ages ≥65 years) and findings from a pilot of 2 virtual sessions of the adapted program that evaluated the acceptability of the content. METHODS:The research team adapted the program by incorporating additional resources necessary for older adults. A certified lifestyle coach delivered 2 sessions of the adapted content via videoconference to 189 older adults. RESULTS:The first session had a 34.9% (38/109) response rate to the survey, and the second had a 34% (30/88) response rate. Over three-quarters (50/59, 85%) of respondents agreed that they liked the virtual program, with 82% (45/55) agreeing that they would recommend it to a family member or a friend. CONCLUSIONS:This data will be used to inform intervention delivery in a randomized controlled trial comparing in-person versus virtual delivery of the adapted program.

INTRODUCTION/UNASSIGNED:) model offers a long-term approach to treating tobacco use by encouraging people to quit, requit, or recommit to quit smoking every Monday. AIM/UNASSIGNED:model into multicomponent smoking cessation services among people with an MHC. METHODS/UNASSIGNED:= 36) received information about contacting their state Quitline for usual services. Primary outcomes were self-reported quit attempts, 7-day abstinence, and intervention satisfaction at 3 months. RESULTS/UNASSIGNED:email, and text messaging, respectively, were very or somewhat helpful. CONCLUSIONS/UNASSIGNED:delivery approaches to improve patient engagement and potential efficacy of the model. This trial is registered with clinicaltrials.gov (NCT04512248).

In the Diabetes Prevention Program (DPP) randomized, controlled clinical trial, participants who were  ≥ 60 years of age in the intensive lifestyle (diet and physical activity) intervention had a 71% reduction in incident diabetes over the 3-year trial. However, few of the 26.4 million American adults age ≥65 years with prediabetes are participating in the National DPP. The BRInging the Diabetes prevention program to GEriatric Populations (BRIDGE) randomized trial compares an in-person DPP program Tailored for Older AdulTs (DPP-TOAT) to a DPP-TOAT delivered via group virtual sessions (V-DPP-TOAT) in a randomized, controlled trial design (N = 230). Eligible patients are recruited through electronic health records (EHRs) and randomized to the DPP-TOAT or V-DPP-TOAT arm. The primary effectiveness outcome is 6-month weight loss and the primary implementation outcome is intervention session attendance with a non-inferiority design. Findings will inform best practices in the delivery of an evidence-based intervention.