•Mechanisms of e-cigarettes for smoking cessation are poorly understood.•An experimental design with dual users crossed nicotine and sensorimotor stimuli.•Receiving nicotine led to reduced cravings ...to smoke and vape.•Deprivation of usual sensorimotor stimuli led to reduced cravings to smoke and vape.•The role of sensorimotor cues in reducing cravings among dual users is complex.
When considering the clinical efficacy of e-cigarettes for smoking cessation, non-pharmacologic influences, such as conditioned reinforcers (e.g. sensorimotor stimuli), must be considered in addition to nicotine. The present study parsed the influences of nicotine delivery and sensorimotor stimuli (i.e, similarity to smoking) on cravings and other immediate outcomes of e-cigarette use.
Participants (N = 127 dual users) completed an experimental ad-lib vaping session in one of 4 conditions: Drug (open label nicotine vs non-nicotine e-cigarettes) crossed with delivery apparatus (normal e-cigarette vs altered sensorimotor apparatus). It was hypothesized that participants who were deprived of the usual vaping stimuli would report less craving reduction via vaping. Nicotine was hypothesized to enhance physiological outcomes.
Moderate effects emerged for nicotine, whereas smaller effects were observed for the sensorimotor manipulation upon both cravings to smoke and cravings to vape. Contrary to the hypothesis, participants who vaped using the altered sensorimotor apparatus reported greater craving reduction compared to those who used normal e-cigarettes. Nicotine delivery also had moderate effects on psychological reward. Main effects were not moderated by gender, withdrawal, or dependence.
Findings support the role of nicotine in reducing cravings via vaping. They also suggest that sensorimotor similarities to smoking may be less important among experienced vapers or dual users. Indeed, in this sample, the altered sensorimotor apparatus may have reduced craving via distraction or other mechanisms.
Electronic (e-)cigarette use has increased in popularity, especially among those attempting to quit smoking. Previous studies evaluating the therapeutic efficacy of e-cigarettes have suggested that ...non-pharmacologic factors, such as expectancies about nicotine effects, may influence the experienced effects of e-cigarettes.
The independent and synergistic influences of drug and expectancies were parsed using a balanced-placebo design, whereby 128 participants (52 dual users) were provided an e-cigarette that either contained nicotine or non-nicotine solution, while told that it did or did not contain nicotine. We hypothesized main effects of nicotine content on physiological, objective outcomes (attention, appetite, aversion, respiratory tract sensations), and main effects of the instructions on more subjective, psychosocial outcomes (affect, reward, satisfaction). Sex was included as a moderator.
Results showed that nicotine increased sustained attention, and more so among females. Nicotine delivery was associated with aversion among females, but not males. Among those who were both told and did not receive nicotine, higher enjoyment of respiratory tract sensations was reported. Nicotine with complementary instructions produced the highest reward ratings; additionally, nicotine was rewarding to males but not females.
Findings demonstrated that both nicotine content and non-pharmacologic factors impact acute outcome effects of e-cigarettes, with moderation by sex in some cases. Results are relevant to the interpretation of clinical trials of e-cigarettes and suggest a more nuanced view of reinforcement pathways.
•Outcomes of e-cigarette use (cravings) are driven by expectancies as well as nicotine.•To parse these effects on additional outcomes, we conducted a balanced-placebo design.•Nicotine, expectancies, and sex interacted on a variety of outcome variables.•Results provide insight into the addictive and clinical potential of e-cigarettes.
Approximately 62,000 Zambian children are living with HIV. HIV care and treatment is generally more limited in rural areas, where a heavy reliance on rain-fed subsistence agriculture also places ...households at risk of food and water insecurity. We nested a mixed methods study with an explanatory sequential design in a clinical cohort of children and adolescents living with HIV (CHIV) in rural Zambia. We used validated questionnaires to assess household food and water insecurity and examined associations between indicators derived from those scales, household characteristics, and HIV treatment adherence and outcomes using log-binomial regression. We identified caregivers and older CHIV from food insecure households for in-depth interviews. Of 186 participants completing assessments, 72% lived in moderately or severely food insecure households and 2% in water insecure households. Food insecurity was more prevalent in households of lower socioeconomic status (80% vs. 59% for higher scores; p = 0.02) and where caregivers had completed primary (79%) vs. secondary school or higher (62%; p = 0.01). No other characteristics or outcomes were associated with food insecurity. Parents limited both the quality and quantity of foods they consumed to ensure food availability for their CHIV. Coping strategies included taking on piecework or gathering wild foods; livestock ownership was a potential buffer. Accessing sufficient clean water was less of a concern. During periods of drought or service interruption, participants travelled further for drinking water and accessed water for other purposes from alternative sources or reduced water use. Community contributions afforded some protection against service interruptions. Overall, while food insecurity was prevalent, strategies used by parents may have protected children from a measurable impact on HIV care or treatment outcomes. Reinforcing social protection programs by integrating livestock ownership and strengthening water infrastructure may further protect CHIV in the case of more extreme food or water system shocks.
Highlights • Participation in lung cancer screening may represent a teachable moment for quitting smoking. • Evidence has not yet supported tailored self-help cessation interventions for this ...population. • There have been few studies testing smoking cessation interventions for lung screening patients. • Research is needed to test and implement cessation interventions in the LDCT screening setting.
Nicotine vaping among youth has increased, warranting concern from tobacco control proponents. Many youth who vape indicate interest in quitting; however, few empirically supported vaping cessation ...interventions exist. This pilot feasibility study adapted an established behavioral intervention, contingency management (CM), delivered via telehealth to promote vaping cessation among young adults.
Participants (N = 27; ages 17–21) vaping nicotine regularly were recruited via social media and digital advertisements from across the US (June 2020–January 2021). Participants were randomized at approximately 4:1 to CM or Monitoring control (22:5). CM was delivered through DynamiCare Health’s smartphone app for 4 weeks, in which financial incentives were delivered contingent on abstinent cotinine samples after the quit day until the end of treatment (EOT; Days 7–28; 10 expected submissions). Control participants earned incentives for submitting cotinine, regardless of abstinence. Feasibility, acceptability, and abstinence was collected throughout treatment, at EOT, and at 1-month follow-up.
The majority of enrolled participants completed treatment (Monitoring: 5/5; CM: 20/22), and intervention components were rated favorably overall (> 80%). CM participants submitted 112/220 (55%) abstinent cotinine samples throughout the quit attempt, while the Monitoring group submitted 4/50 (8%) negative samples. There were no differences in abstinence between groups at EOT or follow-up.
This pilot study of a telehealth-based youth vaping cessation intervention demonstrated preliminary feasibility and acceptability. These results suggest that CM for young adult vaping cessation, delivered remotely, is a promising direction for future work and fully powered trials are warranted to assess intervention efficacy.
•We evaluated a short-term remote vaping cessation intervention for young adults.•24/27 (89%) participants completed the 2-month study.•Intervention components were rated favorably overall (> 80%).•The CM group submitted 112/220 negative cotinine samples during treatment.•Telehealth-delivered CM for young adult vaping cessation is a promising future area.
At the 2017 NCTE Annual Convention, I was gifted the opportunity to write the November 2018 High School Matters feature for publication. SET ASIDE TIME TO TALK If "reading and writing float on a sea ...of talk," then students must be provided structured time to talk about their writing ideas (Britton 164). Model using those stems in your own writing to remind students of their availability. MODEL AND PROVIDE MENTORS Like reading, students need to see how a successful writer navigates writing.
Replacement of conventional staples with biofortified or industrially fortified staples in household diets may increase maternal breast milk retinol content and vitamin A intakes from complementary ...foods, improving infant total body stores (TBS) of vitamin A.
To determine whether biofortified or industrially fortified maize consumption by Zambian women and their breastfeeding infants could improve milk retinol concentration and infant TBS.
We randomly assigned 255 lactating women and their 9-mo-old infants to a 90-d intervention providing 0 µg retinol equivalents (RE)/d as conventional maize or ∼315 µg RE/d to mothers and ∼55 µg RE/d to infants as provitamin A carotenoid-biofortified maize or retinyl palmitate–fortified maize. Outcomes were TBS, measured by retinol isotope dilution in infants (primary), and breast milk retinol, measured by HPLC in women (secondary).
The intervention groups were comparable at baseline. Loss to follow-up was 10% (n = 230 mother-infant pairs). Women consumed 92% of the intended 287 g/d and infants consumed 82% of the intended 50 g/d maize. The baseline geometric mean (GM) milk retinol concentration was 1.57 μmol/L (95% CI: 1.45, 1.69 μmol/L), and 24% of women had milk retinol <1.05 μmol/L. While mean milk retinol did not change in the biofortified arm (β: 0.11; 95% CI: −0.02, 0.24), the intervention reduced low milk retinol (RR: 0.42; 95% CI: 0.21, 0.85). Fortified maize increased mean milk retinol (β: 0.17; 95% CI: 0.04, 0.30) and reduced the prevalence of low milk retinol (RR: 0.46; 95% CI: 0.25, 0.82). The baseline GM TBS was 178 μmol (95% CI: 166, 191 μmol). This increased by 24 µmol (± 136) over the 90-d intervention period, irrespective of treatment group.
Both biofortified and fortified maize consumption improved milk retinol concentration. This did not translate into greater infant TBS, most likely due to adequate TBS at baseline. This trial was registered at clinicaltrials.gov as NCT02804490.
Objective
To describe the workflow, reach, cost, and self‐reported quit rates for an opt‐out tobacco treatment program (TTP) for patients seen in 43 oncology outpatient clinics.
Methods
Between May ...25, 2021, and December 31, 2022, adult patients (≥18 years) visiting clinics affiliated with the Medical University of South Carolina Hollings Cancer Center were screened for smoking status. Those currently smoking were referred to a telehealth pharmacy‐assisted TTP. An attempt was made to contact referred patients by phone. Patients reached were offered free smoking cessation counseling and a 2‐week starter kit of nicotine replacement medication. A random sample of 420 patients enrolled in the TTP were selected to participate in a telephone survey to assess smoking status 4 to 12 months after enrollment.
Results
During the reference period 35,756 patients were screened and 9.3% were identified as currently smoking. Among the 3319 patients referred to the TTP at least once, 2393 (72.1%) were reached by phone, of whom 426 (12.8%) were ineligible for treatment, 458 (13.8%) opted out of treatment, and 1509 (45.5%) received treatment. More than 90% of TTP enrollees smoked daily, with an average of 13.1 cigarettes per day. Follow‐up surveys were completed on 167 of 420 patients, of whom 23.4% to 33.5% reported not smoking; if all nonresponders to the survey are counted as smoking, the range of quit rates is 9.3% to 13.3%.
Conclusion
The findings demonstrate the feasibility of reaching and delivering smoking cessation treatments to patients from a diverse set of geographically dispersed oncology clinics.
This study describes the workflow, reach, cost, and self‐reported abstinence rates for an opt‐out tobacco treatment program (TTP) for patients seen in 43 Hollings Cancer Center outpatient clinics over a 19‐month period. Using electronic health records 9.3% of patients were classified as currently smoking, and among the 3319 patients referred to the TTP at least once, 2393 (72.1%) were reached by phone and 1509 (45.5%) received treatment. Among a random sample of 420 patients surveyed 4 to 12 months after enrollment in the TTP, 23.4% to 33.5% reported not smoking; if all nonresponders to the survey are counted as smoking, the range of quit rates is 9.3% to 13.3%.
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