Editor’s Note: In light of the U.S. Food and Drug Administration’s recent attention to nicotine levels in cigarettes as an anti-smoking measure, today’s post features a selection of relevant dissertations on smoking cessation. These entries are part of an ongoing drug-related dissertation bibliography being compiled by Jonathon Erlen, which was formerly published in the Social History of Alcohol and Drugs journal but is now periodically featured on the Points blog. Contact Dr. Erlen through the link above.
A Unique Tobacco Cessation Service for Cancer Patients at Roswell Park Cancer Institute: Acceptance, Participation and Impact
Author: Amato, Katharine Ann
Abstract: Problem under Investigation: Smoking cessation amongst cancer patients is often thought of as less important because the patient has already developed cancer. However, increasing evidence suggests that continued tobacco use during cancer treatment reduces the effectiveness of treatment, increases negative side effects of the treatment, decreases the quality of life, and increases the risk for tumor recurrence, second primary tumors or death. To date, limited research has been conducted to improve cessation efforts among cancer patients or measure the impact of smoking cessation on survival. Most studies rely on an opt-in randomized control design impacting a limited number of patients or on retrospective chart review with smoking status collected in an inconsistent manner. More data are needed to better understand the impact of smoking cessation among cancer patients. Roswell Park Cancer Institute Tobacco Assessment and Cessation Service: Patients seen in all clinics at Roswell Park Cancer Institute (RPCI), including the thoracic clinic, have tobacco use assessed every thirty days; an automatic electronic referral is generated to a free opt-out telephone based cessation support service for all patients who indicate current or recent (last 30 days) tobacco use, which offers up to eight cessation support telephone calls. Specific Aims: The goal of Specific Aim 1 is to describe the reach and potential impact of the RPCI Tobacco Assessment and Cessation Service (TACS) by describing the patients who participate in the service and by examining the initial quit rates of participants in the current program. The goal of Specific Aim 2 is to conduct a 3-month follow-up of all participants to determine their self-reported quit rates for the previous seven days, as well as patient satisfaction with the RPCI TACS. The goal of Specific Aim 3 is to examine survival rates with relation to smoking status for lung cancer patients referred to the RPCI TACS. Research Methodology: The majority of patient information was extracted from the electronic medical records, finance records, and tumor registry at RPCI for all three specific aims. Mailed surveys, along with follow-up telephone interviews for non-responders or to obtain any missing information, were conducted to obtain self-reported quit status 3-months after the first contact by the RPCI TACS for Specific Aim 2. Univariate and multivariate statistics were used to examine the factors associated with and predictors of quit rates at 1-month and 3-months for Specific Aims 1 and 2. Stratification by patient gender, tobacco use status at referral, disease characteristics, and other health behaviors were explored. Specific Aim 3 was evaluated using univariate and survival analysis statistical methods to determine predictors of other health outcomes associated with thoracic cancer. Results: For Specific Aim 1, 78.3% of 942 thoracic clinic patients referred to RPCI TACS were successfully contacted and participated in the first call; among those who participated in the first call and were called for a follow-up, 88.7% (401/452) participated. Among current users at referral, 26.0% (89/342) reported cessation at follow-up. Among those contacted twice, lung cancer patients were statistically more likely to quit at follow-up compared to other thoracic clinic patients (OR=1.78; 95% CI: 1.02-3.11) and thoracic clinic patients in poorer health (as indicated by a higher ECOG performance score (≥1)) were less likely to quit at follow-up compared to healthier patients (ECOG PS=0; OR=0.43; 95% CI: 0.34-0.77), while controlling for other demographic, health and disease characteristics. For Specific Aim 2, 55.5% (142/256) reported being smoke-free for at least the previous 24 hours at the 3-month follow-up; 86.4% reported being very or mostly satisfied with the service they received from RPCI TACS. For Specific Aim 3, after controlling for age, pack-year history, sex, performance status, time between diagnosis and last contact, tumor histology and clinical stage; a statistically significant increase in survival was associated with quitting compared to continued tobacco use at last contact (HR=1.79; 95% CI: 1.14-2.82), with a median 9 month improvement in overall survival. Conclusions: Thoracic cancer clinic patients are receptive to a free opt-out telephone-based cessation service following a cancer diagnosis, negative biopsy, or participation in a high risk screening program, as indicated by the high participation rates. Patients are interested in participating, are making efforts to quit, and are satisfied with the service they have received. Lung cancer patients who quit show improved survival compared to those who continued using tobacco. Potential Significance: This unique RPCI Tobacco Assessment and Cessation Program will benefit from evaluation and improvement. Results from this dissertation can be applied to making future improvements within RPCI TACS (i.e. by determining optimal timing, frequency, duration, and framing of cessation support messages), can guide the development of a framework to evaluate and improve the cessation service for all other cancer sites, and can offer an example for other comprehensive cancer centers intending to implement a similar program with mandatory tobacco use assessments and automatic referrals to an opt-out cessation support service.
Publication year: 2015
Advisor: Hyland, Andrew
Committee members: Baansal-Travers, Maansi; Giovino, Gary; Ochs-Balcom, Heather
University/institution: State University of New York at Buffalo
Housing and the Environment: Smoking Triggers and Tobacco Smoke Exposure
Author: Farley, Shannon M.
Abstract: Background: Despite decades of smoking prevalence declines and more recent smoke-free indoor and outdoor air laws, smoking causes 400,000 preventable deaths and secondhand smoke (SHS) exposure leads to 40,000 deaths from respiratory and cardiovascular disease among non-smokers annually. Built and social environment factors linked to smoking include tobacco retailer density and neighborhood poverty. Housing environments including multiunit housing are linked to SHS exposure and adverse health outcomes. Objectives: To investigate possible associations of different environmental factors with smoking, SHS exposure, and SHS-related health outcomes. Methods : Many data sources were used: New York City Community Health Survey, Department of Consumer Affairs, American Community Survey, Primary Land Use Tax Lot Output, and Health and Nutrition Examination Survey data. Ecological and multilevel models examined tobacco retailer density and neighborhood poverty associations with smoking prevalence and behavior, assessing for moderation by neighborhood poverty and housing environments. Logistic regression assessed associations between housing type and elevated SHS exposure as well as possible mediation of the housing-health outcome associations by SHS exposure. Results: Ecological analyses demonstrated a potential differential effect of economic strata on tobacco retailer density and neighborhood smoking and multilevel analyses found positive associations between neighborhood poverty and smoking behavior. Logistic regression found no adjusted associations between multiunit housing and SHS exposure, nor did SHS exposure mediate the housing and health outcome associations. Conclusions: Environmental factors contributed to smoking prevalence and behavior in NYC, while associations between housing, SHS and SHS-related health outcomes in non-smoking adults require more investigation.
Publication year: 2015
Advisor: Thorpe, Lorna E.
Committee members: Maroko, Andrew; Morabia, Alfredo; Suglia, Shakira F.
University/institution: City University of New York
Department: Public Health
A Culturally Tailored Tobacco Cessation Program for American Indians: Program Development
Author: Rollins, Kathryn L.
Abstract: American Indian communities face an ongoing challenge of effectively addressing tobacco related health disparities in an environment that often lacks culturally tailored interventions. This dissertation identified the knowledge, attitudes, and beliefs about SLT and SLT use within the AI community and addressed the program development phases of a culturally tailored SLT cessation program. A CBPR approach served as the foundational approach to this study. A three phase research plan was created to guide the research team through program development, implementation, and assessment of program materials. The first two phases of the research plan were undertaken as part of this study. Phases 1 and 2 were specifically designed to gather formative data and guide the research team through program development. Results showed that community members were willing to provide comments and suggestions that influenced the design of an SLT cessation program. Community feedback speci?cally addressed SLT cessation, which may improve individual and community health and well-being within the AI community. The results from this study support a culturally appropriate cessation program for AI that addresses traditional tobacco use. Studies such as this can potentially contribute to a better understanding of strategies to involve community members in all phases of the research process, as well as how to improve the threat of commercial tobacco use in the AI population.
Publication year: 2016
Advisor: Greene, Leon
Committee members: Daley, Christine; Gallagher, Phillip; Hansen, David; Harvey, Susan; Kish, Bernie
University/institution: University of Kansas
Department: Health, Sport and Exercise Sciences