Faculty Bibliography

Background: Modifiable risk factors contribute to not only the development, but also the progression of dementia. Smoking is a relevant risk factor, and although relatively few people with dementia are smokers, smoking cessation can positively impact both patient quality of life and healthcare system costs. Notably, these patients also have an increased risk of smoking-related accidents and fire hazards. Despite this, smoking cessation is not routinely addressed in dementia care, and there are no reported smoking cessation interventions specifically for dementia patients. Therefore, we are developing and pilot testing an approach to help smokers with cognitive impairment quit smoking.
Method(s): We are conducting a study of financial incentives to increase smoking cessation among patients hospitalized at 2 public safety net hospitals. We received an NIA supplement to include cognitively impaired patients, who were originally excluded from the study. We will begin by investigating how to adapt smoking cessation interventions for patients with cognitive impairment by conducting structured interviews with 15 current smokers, who have a diagnosis of cognitive impairment or dementia, and their caregivers. Based on analysis of interview transcripts, we will adapt both the intervention arms and our smoking cessation counseling manuals. We will then test these modifications on 6 patients with cognitive impairment and adapt them further. For the FIESTA II pilot study, we will recruit 50 participants, who will be randomized to standard therapy or one of the two financial incentive arms. Standard therapy includes the use of NRT, medication, and individual counseling targeting smoking cessation. The two financial incentive arms will be either outcome-based or goalbased, where patients are compensated for successful smoking abstinence or utilization of counseling and quitting aids, respectively. Our outcomes for the pilot study are use of smoking cessation treatments, quit attempts and abstinence.
Result(s): We are currently conducting the initial qualitative interviews.
Conclusion(s): We will discuss the results of the pilot study and their implications for geriatric practice

BACKGROUND:Tobacco-use among cancer survivors leads to preventable morbidity, mortality, and increased healthcare costs. We sought to explore the prevalence of smoking and e-cigarette use among survivors of tobacco and non-tobacco related cancers. METHODS:A cross-sectional analysis was conducted using the 2015-2018 National Health Interview Survey. Our primary outcome was the prevalence of current cigarette smoking or e-cigarette use among adults with self-reported history of tobacco related or non-tobacco related cancer. Logistic regression analysis was to assess the association of reported cancer type with cigarette smoking or e-cigarette use. Secondary outcomes included yearly trends and dual use. RESULTS:A total of 12,984 respondents reported a history of cancer, representing a weighted estimate of 5,060,059 individuals with a history of tobacco-related malignancy and 17,583,788 with a history of a tobacco and non-tobacco related cancer, respectively. Survivors of tobacco-related cancers had a significantly higher prevalence of current cigarette use (18.2 % vs 9.7 %, P < 0.0001), e-cigarette use (2.7 % vs 1.6 %, P < 0.0001) and similar rates of dual use. The prevalence of cigarette smoking among all survivors increased as time increased from the year of diagnosis up to 2 years post-diagnosis (P = 0.047). Odds of reporting current cigarette smoking use was higher for survivors of tobacco-related cancers, adjusted for sociodemographic factors (OR1.69, 95 % CI 1.44-1.99). CONCLUSIONS:Survivors of tobacco-related cancers have a higher prevalence of current cigarette smoking and e-cigarette use compared to survivors of non-tobacco related cancers. There was a sequential increase in the prevalence of cigarette use during each subsequent year from the time of a new cancer diagnosis, underscoring the need for long term tobacco cessation support among newly diagnosed adults with cancer.

Aim: Our primary study objective was to identify risk factors for serious psychological distress (SPD) within the lesbian, gay, and bisexual (LGB) population, while accounting for the differences across these groups compared to heterosexual adults. We hypothesized that LGB adults had a higher risk for SPD compared to heterosexual adults, and that variation existed in SPD risk factors between LGB groups. Methods: National Health Interview Survey data collected from 2013 to 2018 were pooled to examine risk factors for SPD among gay men (n = 1752), bisexual men (n = 509), lesbian women (n = 1421), bisexual women (n = 1235), heterosexual men (n = 80,191) and heterosexual women (n = 97,909). A multivariate logistic regression model estimated SPD risk factors. Results: Bisexual women were at higher risk for SPD [adjusted odds ratio (AOR)= 2.5; 95% CI 1.8, 3.5]compared to heterosexual women. Bisexual (AOR = 3.8; 95% CI 1.9, 7.4) and gay men (AOR = 2.0; 95% CI 1.4, 3.0) were at increased risk for SPD compared to heterosexual men. Younger vs older adults were more likely to identify as bisexual or gay (18"�25�years vs 65�years and older identifying as gay men 17.0% vs 9.5%; bisexual men 33.4% vs 8.0%; lesbian 18.0% vs 8.6% and bisexual women 37.7% vs 3.5%). Gay men were more likely to live alone compared to other groups (34.5% vs 16.9% heterosexual men, 31.8% bisexual men, 17.6% heterosexual women, 20.7% lesbian, 19.7% bisexual women). Living alone increased risk for SPD among men (AOR = 2.2; 95%�CI 1.6, 3.0). Conclusion: Sexual minorities have increased mental health risks compared to heterosexual adults. Word Count: 248.

OBJECTIVE:Individuals with posttraumatic stress disorder (PTSD) smoke at higher rates compared to the general population and experience significant barriers to initiating cessation treatment. Proactive outreach addresses these barriers by directly engaging with smokers and facilitating access to treatment. The objective of the present study was to evaluate a proactive outreach intervention for increasing rates of treatment utilization and abstinence among veteran smokers with and without PTSD. METHOD/METHODS:= 1,583) a diagnosis of PTSD. Logistic regressions modeled cessation treatment utilization (counseling, nicotine replacement therapy [NRT], and combination treatment) and abstinence (7-day point prevalence and 6-month prolonged at 6- and 12-month follow-ups) among participants randomized to proactive outreach versus usual care in the PTSD and non-PTSD subgroups, respectively. RESULTS:= 1.61, [1.11, 2.34]). CONCLUSIONS:Proactive outreach increased treatment utilization and abstinence among smokers with and without PTSD. Smokers with PTSD may need additional facilitation to initiate cessation treatment but are receptive when it is offered proactively. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Introduction/UNASSIGNED:Smoking cessation after a cancer diagnosis can significantly improve treatment outcomes and reduce the risk of cancer recurrence and all-cause mortality. Aim/UNASSIGNED:We sought to measure the association between cancer diagnosis and subsequent smoking cessation. Methods/UNASSIGNED:. Our sample was composed of 7,286 adult smokers at the baseline representing an estimated 40.9 million persons. Smoking cessation rates after a diagnosis differed after a tobacco-related cancer (25.9%), a nontobacco-related cancer (8.9%), and no cancer diagnosis (17.9%). After adjustment, diagnosis with a tobacco-related cancer was associated with a higher odds of smoking cessation (OR 1.83, 95% CI 1.00-3.33) compared to no cancer diagnosis. Diagnosis with a nontobacco-related cancer was not significantly linked to smoking cessation (OR 0.52, 95% CI 0.48-1.45). Conclusion/UNASSIGNED:Diagnosis with a tobacco-related cancer is associated with greater odds of subsequent smoking cessation compared to no cancer diagnosis, suggesting that significant behavioral change may occur in this setting.

PURPOSE/UNASSIGNED:This study describes the frequency of JUUL e-cigarette (referred to as JUUL) quit attempts and identifies characteristics associated with confidence in quitting and perceived difficulty quitting JUUL. DESIGN/UNASSIGNED:Cross-sectional study from a self-administered online survey. SETTING/UNASSIGNED:Two public southern California universities. PARTICIPANTS/UNASSIGNED:A total of 1,001 undergraduate students completed the survey from February to May 2019. MEASURES/UNASSIGNED:Self-report measures about JUUL included use, history of quit attempts, time to first use, perceived difficulty with cessation/reduction, and confidence in quitting. ANALYSIS/UNASSIGNED:Binary logistic regressions were used to identify demographic and tobacco-related behavioral correlates of JUUL cessation-related perceptions and behaviors. RESULTS/UNASSIGNED:Nearly half of ever-JUUL users (47.8%) reported a JUUL quit attempt. Adjusting for demographic factors and other tobacco product use, shorter time to first JUUL use after waking was associated with lower confidence in quitting JUUL (aOR = 0.02, 0.00-0.13) and greater perceived difficulty in quitting JUUL (aOR = 8.08, 2.15-30.35). Previous JUUL quit attempt history was also associated with greater odds of perceived difficulty quitting JUUL (aOR = 5.97, 1.74-20.53). CONCLUSIONS/UNASSIGNED:History of JUUL quit attempts among college students was common. Those who had previously tried quitting were more likely to perceive difficulty with cessation. Time to first JUUL use, a marker of dependence, was linked with greater perceived cessation difficulty and lower confidence in quitting. These findings suggest that there is a need for cessation and relapse prevention support for college student JUUL users.

INTRODUCTION AND OBJECTIVE/OBJECTIVE:Cigarette smoking is the leading modifiable risk factor for several genitourinary (GU) malignancies. Although smoking cessation after GU cancer diagnosis is a critical component of survivorship, factors related to continued smoking are understudied. METHODS:A cross-sectional analysis was conducted using data from the NHIS (2014-2018). Our primary study outcome was the prevalence and correlates of cigarette smoking among adults with history of smoking-related (kidney or bladder) urologic cancer compared with a nonsmoking-related control (prostate cancer). We used regression analyses to assess the association of having a smoking-related GU cancer history with continued cigarette smoking after diagnosis. Secondary outcomes were yearly smoking trends, quit attempts and reported receipt of smoking cessation counseling. RESULTS:A total of 2,664 respondents reported a history of a GU cancer, representing weighted estimates of 990,820 (smoking-related GU cancer) and 2,616,596 (prostate cancer) adults. Survivors of smoking-related GU cancers had a significantly higher overall prevalence of current cigarette use (14.8% vs 8.6%, p <0.001) and also reported more frequent receipt of counseling (79.8% vs 66.2%, p=0.02) but did not attempt to quit any more often than those with prostate cancer (52.4% vs 47.2%, p=0.44). Time trends demonstrated stable and persistent cigarette use among survivors of all GU cancers. After adjustment for sociodemographic confounders, cancer type was not associated with current cigarette smoking (OR 1.23, 95% CI 0.86-1.77). However, older age and more advanced educational attainment were associated with lower odds of current cigarette smoking while single marital status was associated with higher odds. CONCLUSIONS:In this population-based cross-sectional study of survivors of GU cancers, those with a reported smoking-related GU cancer had a higher prevalence of current cigarette smoking compared to prostate cancer, our nonsmoking related control. Those with smoking-related GU cancers reported more frequent receipt of smoking cessation counseling.

BACKGROUND:Most hookah use studies have not included racial and ethnic minorities which limits our understanding of its use among these growing populations. This study aimed to investigate the individual characteristics of hookah use patterns and associated risk behaviors among an ethnically diverse sample of college students. METHODS:A cross-sectional survey of 2460 students (aged 18-25) was conducted in 2015, and data was analyzed in 2017. Descriptive statistics were used to present the sociodemographic characteristics, hookah use-related behavior, and binge drinking and marijuana use according to the current hookah use group, including never, exclusive, dual/poly hookah use. Multivariate logistic regression was conducted to examine how hookah related behavior and other risk behaviors varied by sociodemographics and hookah use patterns. RESULTS:Among current hookah users (n = 312), 70% were exclusive hookah users and 30% were dual/poly hookah users. There were no statistically significant differences in sociodemographic characteristics except for race/ethnicity (p < 0.05). Almost half (44%) of the exclusive hookah users reported having at least five friends who also used hookah, compared to 30% in the dual/poly use group. Exclusive users were less likely to report past year binge drinking (17%) and past year marijuana use (25%) compared to those in the dual/poly use group (44 and 48% respectively); p < 0.001. CONCLUSIONS:The socialization aspects of hookah smoking seem to be associated with its use patterns. Our study calls for multicomponent interventions designed to target poly tobacco use as well as other substance use that appears to be relatively common among hookah users.

INTRODUCTION/BACKGROUND:People with serious mental illness (SMI) have a high smoking prevalence and low quit rates. Few cessation treatments are tested in smokers with SMI. Mental health (MH) providers are reluctant to address smoking. Proactive tobacco cessation treatment strategies reach out directly to smokers to offer counseling and medication and improve treatment utilization and quit rates. The current study is a secondary analysis of a randomized controlled trial of proactive outreach for tobacco cessation treatment in VA MH patients. METHODS:Participants (N=1938, 83% male, mean age 55.7) across 4 recruitment sites, who were current smokers and had a MH visit in the past 12 months, were identified using the electronic medical record. Participants were randomized to Intervention (telephone outreach call plus invitation to engage in MH tailored telephone counseling and assistance obtaining nicotine replacement therapy [NRT]) or Control (usual care). The current study assessed outcomes in participants with SMI (N=982). RESULTS:Compared to the Control group, participants assigned to the Intervention group were more likely to engage in telephone counseling (22% vs. 3%) and use NRT (51% vs. 41%). Participants in the Intervention group were more likely to be abstinent (7-day point prevalence; 18%) at 12 months than participants in the Control group; 11%) but equally likely to make quit attempts. CONCLUSIONS:Proactive tobacco cessation treatment is an effective strategy for tobacco users with SMI. Proactive outreach had a particularly strong effect on counseling utilization. Future randomized clinical trials examining proactive tobacco treatment approaches in SMI treatment settings are needed. IMPLICATIONS/CONCLUSIONS:Few effective treatment models exist for smokers with serious mental illness. Proactive tobacco cessation outreach with connections to mental health tailored telephone counseling and medication promotes tobacco abstinence among smokers with serious mental illness and is an effective treatment strategy for this underserved population.