Faculty Bibliography

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.

Tobacco use is the cause of several urologic cancers. Persistent use after diagnosis is associated with worse cancer-specific, quality of life, and overall mortality outcomes. Cigarette smoking remains the most common form of tobacco use despite significant population-level decline over the past few decades. The burden of smoking-related urologic disease is under appreciated by urologists and patients which has resulted in gaps in clinical care and limitations to research progress. We sought to summarize evidence-based practices and guideline recommendations for assessing and reporting tobacco use in the clinical and research settings. With a focus on smoking, our two primary goals are: 1) to promote the adoption of standardized and validated measures of tobacco use and 2) to highlight evidence-based strategies for urologists to use in clinical practice.

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.

Background/UNASSIGNED:We explored characteristics and beliefs associated with e-cigarette use patterns among cigarette smokers requiring inpatient detoxification for opioid and/or alcohol use disorder(s). Methods/UNASSIGNED:-test statistics, and logistic regression models were used. Results/UNASSIGNED: Conclusions/UNASSIGNED:E-cigarette use seems to be appealing to a small proportion of cigarette smokers with SUD. Although, dual smokers seem to use e-cigarettes for its cessation premise, they don't appear to be actively seeking to quit. E-cigarettes may offer a more effective method for harm reduction, further evaluation of incorporating it within smoking cessation protocols among patients in addiction treatment is needed.

BACKGROUND:Evidence suggests that individuals with history of substance use disorder (SUD) are at increased risk of COVID-19, but little is known about relationships between SUDs, overdose and COVID-19 severity and mortality. This study investigated risks of severe COVID-19 among patients with SUDs. METHODS:We conducted a retrospective review of data from a hospital system in New York City. Patient records from 1 January to 26 October 2020 were included. We assessed positive COVID-19 tests, hospitalizations, intensive care unit (ICU) admissions and death. Descriptive statistics and bivariable analyses compared the prevalence of COVID-19 by baseline characteristics. Logistic regression estimated unadjusted and sex-, age-, race- and comorbidity-adjusted odds ratios (AORs) for associations between SUD history, overdose history and outcomes. RESULTS:Of patients tested for COVID-19 (n = 188 653), 2.7% (n = 5107) had any history of SUD. Associations with hospitalization [AORs (95% confidence interval)] ranged from 1.78 (0.85-3.74) for cocaine use disorder (COUD) to 6.68 (4.33-10.33) for alcohol use disorder. Associations with ICU admission ranged from 0.57 (0.17-1.93) for COUD to 5.00 (3.02-8.30) for overdose. Associations with death ranged from 0.64 (0.14-2.84) for COUD to 3.03 (1.70-5.43) for overdose. DISCUSSION/CONCLUSIONS:Patients with histories of SUD and drug overdose may be at elevated risk of adverse COVID-19 outcomes.

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).

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.