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Integrating Financial Coaching and Referrals into a Smoking Cessation Program for Low-income Smokers: a Randomized Waitlist Control Trial

Rogers, Erin S; Rosen, Marc I; Elbel, Brian; Wang, Binhuan; Kyanko, Kelly; Vargas, Elizabeth; Wysota, Christina N; Sherman, Scott E
BACKGROUND:Financial distress is a barrier to cessation among low-income smokers. OBJECTIVE:To evaluate an intervention that integrated financial coaching and benefits referrals into a smoking cessation program for low-income smokers. DESIGN/METHODS:Randomized waitlist control trial conducted from 2017 to 2019. PARTICIPANTS/METHODS:Adult New York City residents were eligible if they reported past 30-day cigarette smoking, had income below 200% of the federal poverty level, spoke English or Spanish, and managed their own funds. Pregnant or breastfeeding people were excluded. Participants were recruited from two medical centers and from the community. INTERVENTION/METHODS:The intervention (n = 208) offered smoking cessation coaching, nicotine replacement therapy, money management coaching, and referral to financial benefits and empowerment services. The waitlist control (n=202) was usual care during a 6-month waiting period. MAIN MEASURES/METHODS:Treatment engagement, self-reported 7-day abstinence, and financial stress at 6 months. KEY RESULTS/RESULTS:At 6 months, intervention participants reported higher abstinence (17% vs. 9%, P=0.03), lower stress about finances (β, -0.8 [SE, 0.4], P=0.02), and reduced frequency of being unable to afford activities (β, -0.8 [SE, 0.4], P=0.04). Outcomes were stronger among participants recruited from the medical centers (versus from the community). Among medical center participants, the intervention was associated with higher abstinence (20% vs. 8%, P=0.01), higher satisfaction with present financial situation (β, 1.0 [SE, 0.4], P=0.01), reduced frequency of being unable to afford activities (β, -1.0 [SE, 0.5], P=0.04), reduced frequency in getting by paycheck-to-paycheck (β, -1.0 [SE, 0.4], P=0.03), and lower stress about finances in general (β, -1.0 [SE, 0.4], P = 0.02). There were no group differences in outcomes among people recruited from the community (P>0.05). CONCLUSIONS:Among low-income smokers recruited from medical centers, the intervention produced higher abstinence rates and reductions in some markers of financial distress than usual care. The intervention was not efficacious with people recruited from the community. TRIAL REGISTRATION/ Identifier: NCT03187730.
PMID: 35018561
ISSN: 1525-1497
CID: 5118702

Minimally Invasive versus Full Sternotomy for Isolated Aortic Valve Replacement in Low-risk Patients

Russo, Mark J; Thourani, Vinod H; Cohen, David J; Malaisrie, S Chris; Szeto, Wilson Y; George, Isaac; Kodali, Susheel K; Makkar, Raj; Lu, Michael; Williams, Mathew; Nguyen, Tom; Aldea, Gabriel; Genereux, Philippe; Fang, H Kenith; Alu, Maria C; Rogers, Erin; Okoh, Alexis; Herrmann, Howard C; Kapadia, Samir; Webb, John G; Smith, Craig R; Leon, Martin B; Mack, Michael J
BACKGROUND:Surgical aortic valve replacement can be performed either through a minimally invasive (MI) or full sternotomy (FS) approach. The present study compared outcomes of MI versus FS for isolated surgery among patients enrolled in the PARTNER 3 low-risk trial. METHODS:Patients with severe, symptomatic aortic stenosis at low surgical risk with anatomy suitable for transfemoral access were eligible for PARTNER 3 enrollment. The primary outcome was the composite endpoint of death, stroke, or rehospitalization (valve-, procedure-, or heart-failure-related) at 1 year. Secondary outcomes included the individual components of the primary endpoint as well as patient-reported health status at 30 days and 1 year. RESULTS:In the PARTNER 3 study, 358 patients underwent isolated surgery at 68 centers through an MI (n=107) or FS (n=251) approach (8 patients were converted from MI to FS). Mean age and Society of Thoracic Surgeons score were similar between groups. The Kaplan-Meier estimate of the primary outcome was similar in the MI versus FS groups (16.9% versus 14.9%; hazard ratio [95% CI]: 1.15 [0.66 - 2.03]; P=0.618). There were no significant differences in the 1-year rates of all-cause death (2.8% versus 2.8%), all stroke (1.9% versus 3.6%), or rehospitalization (13.3% versus 10.6%, P > 0.05 for all). Quality of life as assessed by the Kansas City Cardiomyopathy Questionnaire score at 30 days or 1 year was comparable in both groups. CONCLUSIONS:For patients at low risk for isolated surgery, MI and FS approaches were associated with similar in-hospital and 1-year outcomes.
PMID: 34958771
ISSN: 1552-6259
CID: 5108042

Implementing the Federal Smoke-Free Public Housing Policy in New York City: Understanding Challenges and Opportunities for Improving Policy Impact

Jiang, Nan; Gill, Emily; Thorpe, Lorna E; Rogers, Erin S; de Leon, Cora; Anastasiou, Elle; Kaplan, Sue A; Shelley, Donna
In 2018, the U.S. Department of Housing and Urban Development required public housing authorities to implement a smoke-free housing (SFH) policy that included individual apartments. We analyzed the policy implementation process in the New York City Public Housing Authority (NYCHA). From June-November 2019, we conducted 9 focus groups with 64 NYCHA residents (smokers and nonsmokers), 8 key informant interviews with NYCHA staff and resident association leaders, and repeated surveys with a cohort of 130 nonsmoking households pre- and 12-month post policy. One year post policy implementation, participants reported widespread smoking violations and multi-level factors impeding policy implementation. These included the shared belief among residents and staff that the policy overreached by "telling people what to do in their own apartments". This hindered compliance and enforcement efforts. Inconsistent enforcement of illegal marijuana use, staff smoking violations, and a lack of accountability for other pressing housing issues created the perception that smokers were being unfairly targeted, as did the lack of smoking cessation resources. Resident support for the policy remained unchanged but satisfaction with enforcement declined (60.1% vs. 48.8%, p = 0.047). We identified multilevel contextual factors that are influencing SFH policy implementation. Findings can inform the design of strategies to optimize policy implementation.
PMID: 34886292
ISSN: 1660-4601
CID: 5109502

Association of substance use disorders and drug overdose with adverse COVID-19 outcomes in New York City: January-October 2020

Allen, Bennett; El Shahawy, Omar; Rogers, Erin S; Hochman, Sarah; Khan, Maria R; Krawczyk, Noa
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.
PMID: 33367823
ISSN: 1741-3850
CID: 4731512

The Association Between Smoking Abstinence and Pain Trajectory Among Veterans Engaged in U.S. Department of Veterans Affairs Mental Health Care

Hammett, Patrick J; Businelle, Michael S; Taylor, Brent C; Erbes, Christopher R; Bastian, Lori; Doran, Neal; Sherman, Scott E; Rogers, Erin S; Burgess, Diana J; Fu, Steven S
OBJECTIVE:To prospectively examine associations between smoking and nicotine abstinence and pain trajectory over 12 months among smokers with low, moderate, and severe pain and to assess whether these associations differ over time. DESIGN/METHODS:A secondary analysis of the "Proactive Outreach for Smokers in VA Mental Health" study, a randomized controlled trial of proactive outreach for veteran smokers engaged in U.S. Department of Veterans Affairs (VA) mental health care. METHODS:Participants were categorized into "low" (n = 616), "moderate" (n = 479), and "severe" pain (n = 656) groups according to baseline pain score. Associations between self-reported abstinence from smoking and nicotine at 6 and 12 months and pain trajectory, measured via the PEG scale (Pain intensity, Enjoyment of life, General activity) composite score, were assessed through the use of general linear mixed models. Interaction tests assessed whether these associations differed at 6 and 12 months. Analyses were conducted within the overall sample and within the separate pain groups. RESULTS:There were significant interactions in the overall sample and the low and moderate pain groups, such that 7-day point prevalence smoking abstinence was associated with lower pain scores at 6 but not 12 months. In the severe pain group, 7-day abstinence from both smoking and nicotine was associated with lower pain scores across both time points. Six-month prolonged abstinence was not associated with pain scores. CONCLUSIONS:In this prospective analysis conducted among veteran smokers engaged in mental health services, 7-day abstinence from smoking and nicotine was associated with significantly lower levels of pain. Education efforts could help better inform smokers on the relationship between smoking and pain.
PMID: 33502511
ISSN: 1526-4637
CID: 4987832

A pilot study on the use of cfinancial incentives for smoking cessation in cognitively impaired patients [Meeting Abstract]

Burley, C; Stevens, E; Rogers, E; El-Shahawy, O; Sherman, S
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
ISSN: 1532-5415
CID: 4870552

Tobacco Screening and Treatment during Outpatient Urologic Office Visits in the United States

Bernstein, Ari P; Bjurlin, Marc A; Sherman, Scott E; Makarov, Danil V; Rogers, Erin; Matulewicz, Richard S
PURPOSE/OBJECTIVE:Tobacco-use is a causative or exacerbating risk factor for benign and malignant urologic disease. However, it is not well known how often urologists screen for tobacco use and provide tobacco cessation treatment at the population level. Therefore, we sought to evaluate how often urologists see patients for tobacco-related diagnoses in the outpatient setting and how often these visits include tobacco-use screening and treatment. MATERIALS AND METHODS/METHODS:We used the National Ambulatory Medical Care Survey (NAMCS) public use files for the years 2014-2016 to identify all outpatient urology visits with adults 18 years and older. Clinic visit reasons were categorized according to diagnoses associated with the encounter: all urologic diagnoses, a tobacco-related urologic condition, or a urologic cancer. Our primary outcome was the percentage of visits during which tobacco screening was reported. Secondary outcomes included reported delivery of cessation counseling and provision of cessation pharmacotherapy. RESULTS:We identified 4,625 unique urologic outpatient encounters, representing a population-weighted estimate of 63.9 million visits over three years. Approximately a third of all urology visits were for a tobacco-related urologic diagnoses and 15% were for urologic cancers. An estimated 1.1 million visits over three years were with patients who identified as current tobacco users. Of all visits, 70% included tobacco screening. However, only 7% of visits with current smokers included counseling and only 3% were prescribed medications. No differences in screening and treatment were observed between visit types. CONCLUSIONS:Urologists regularly see patients for tobacco-related conditions and frequently, though not universally, screen patients for tobacco. However, urologists rarely offer counseling or cessation treatment. These findings may represent missed opportunities to decrease the morbidity associated with tobacco use.
PMID: 33525926
ISSN: 1527-3792
CID: 4799222

Proactive tobacco treatment for veterans with posttraumatic stress disorder

Hammett, Patrick J; Japuntich, Sandra J; Sherman, Scott E; Rogers, Erin S; Danan, Elisheva R; Noorbaloochi, Siamak; El-Shahawy, Omar; Burgess, Diana J; Fu, Steven S
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).
PMID: 32614201
ISSN: 1942-969x
CID: 4504512

Hookah use patterns, social influence and associated other substance use among a sample of New York City public university students

El Shahawy, Omar; Park, Su Hyun; Rogers, Erin S; Shearston, Jenni A; Thompson, Azure B; Cooper, Spring C; Freudenberg, Nicholas; Ball, Samuel A; Abrams, David; Shelley, Donna; Sherman, Scott E
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.
PMID: 32859230
ISSN: 1747-597x
CID: 4582572

Effectiveness of proactive tobacco cessation outreach in smokers with serious mental illness

Japuntich, Sandra J; Hammett, Patrick J; Rogers, Erin S; Fu, Steven; Burgess, Diana J; El Shahawy, Omar; Melzer, Anne C; Noorbaloochi, Siamak; Krebs, Paul; Sherman, Scott E
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.
PMID: 31957794
ISSN: 1469-994x
CID: 4272672