Judith Prochaska

All Publications

The 2016 Tips From Former Smokers Campaign: Associations With Quit Intentions and Quit Attempts Among Smokers With and Without Mental Health Conditions. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco Prochaska, J. J., Gates, E. F., Davis, K. C., Gutierrez, K., Prutzman, Y., Rodes, R. 2018
Abstract

Introduction: People living with mental health conditions (MH+) are more likely to smoke cigarettes than people without mental health conditions (MH-) and to experience tobacco-related disparities. The Tips From Former Smokers (Tips) campaign is a proven population-level strategy for motivating smokers to quit. In 2016, Tips included ads featuring Rebecca, a former smoker with depression. We evaluated self-reported frequency of exposure to the Rebecca and other Tips ads in association with quit intentions and quit attempts among MH+ and MH- smokers.Methods: Intentions to quit and past 6-month quit attempts lasting at least 24 hours were reported from a two-wave longitudinal online survey conducted before and after the 2016 Tips campaign with a nationally representative sample of US adult cigarette smokers with (MH+, N = 777) and without (MH-, N = 1806) lifetime mental health conditions.Results: In 2016, among MH+ respondents, greater exposure to the Rebecca ads was significantly associated with increased odds of intending to quit in the next 30 days (adjusted odds ratio [AOR] = 1.40, p < .05) and with reporting a quit attempt in the past 6 months (AOR = 1.25, p < .05). Among MH- respondents, greater exposure to the other Tips ads was associated with increased odds of making a quit attempt (AOR = 1.19, p < .05).Conclusions: Exposure to the Rebecca ads was associated with a greater likelihood of intentions to quit and quit attempts among MH+ smokers; whereas, exposure to the other (non-mental-health-related) Tips ads was associated with a greater likelihood of quit attempts among MH- smokers.Implications: National media campaigns are an important population-level strategy for reaching specific population groups who are experiencing tobacco-related disparities. The findings support the inclusion of ads featuring people living with mental health conditions in national tobacco education media campaigns, such as Tips.

View details for DOI 10.1093/ntr/nty241

View details for PubMedID 30496491
The Public Health Consequences of E-cigarettes: A Review by the National Academies of Sciences A Call for More Research, a Need for Regulatory Action. Addiction (Abingdon, England) Prochaska, J. J. 2018
View details for DOI 10.1111/add.14478

View details for PubMedID 30347473
A randomized controlled evaluation of the tobacco status project, a Facebook intervention for young adults ADDICTION Ramo, D. E., Thrul, J., Delucchi, K. L., Hall, S., Ling, P. M., Belohlavek, A., Prochaska, J. J. 2018; 113 (9): 1683–95
Abstract

To test the efficacy of the Tobacco Status Project (TSP) Facebook smoking cessation intervention for young adults relative to referral to an on-line program on biochemically verified 7-day abstinence from smoking.Two-group parallel randomized controlled trial, comparing TSP (n = 251) to on-line control (n = 249) with follow-up to 12 months.On-line, throughout the United States.Young adult cigarette smokers (mean age 21 years; 73% white, 55% female, 87% daily smokers).TSP provided private Facebook groups tailored to stage of change to quit smoking, daily contacts, weekly live counseling sessions, and for those ready to quit, six cognitive behavioral therapy counseling sessions. Some TSP groups were assigned randomly to receive a monetary incentive for engagement. Control provided referral to the National Cancer Institute Smokefree.gov website.PRIMARY OUTCOME: Biochemically verified 7-day abstinence over 12 months.Post-treatment (3-month) abstinence; reported abstinence, quit attempt, reduction in smoking, readiness to quit smoking over 12 months.Verified 7-day abstinence was not significantly different for intervention compared with control over 1 year: month 3 (8.3 versus 3.2%), 6 (6.2 versus 6.0%), and 12 (5.9 versus 10.0%); odds ratio (OR) = 1.07; 95% confidence interval (CI) = 0.23, 4.97; retention = 71%. There was an effect at 3 months (OR = 2.52; CI = 1.56, 4.04; P < 0.0001). There were no 12-month treatment effects for reported abstinence (P = 0.746), reduction in smoking by 50% or more (P = 0.533), likelihood of having made a quit attempt (P = 0.387) or stage of change over time (0.968). Participants in TSP engaged more and rated the intervention more favorably than those in the control condition.Compared with referral to a smoking cessation website, a novel USA-focused Facebook smoking cessation intervention did not improve abstinence from smoking over 1 year, but increased abstinence at the end of treatment and was engaging to participants.

View details for DOI 10.1111/add.14245

View details for Web of Science ID 000440644200012

View details for PubMedID 29797621
Secular Trends in Blood Pressure and Overweight and Obesity in Chinese Boys and Girls Aged 7 to 17 Years From 1995 to 2014 HYPERTENSION Dong, Y., Ma, J., Song, Y., Ma, Y., Dong, B., Zou, Z., Prochaska, J. J. 2018; 72 (2): 298–305
Abstract

The current study aimed to assess the secular trends in overweight and obesity status and high blood pressure (HBP) in Chinese children and adolescents for 2 decades. Data on 943 128 participants aged 7 to 17 years were obtained from the Chinese National Survey on Students' Constitution and Health from 1995 to 2014. The population attributable risk of overweight status for HBP was calculated. The prevalence of overweight increased from 4.3% in 1995 to 18.4% in 2014, whereas HBP prevalence fluctuated in the range of 4.4% to 6.4% during the same time period, the lowest in 2005. Within each survey year, blood pressure levels and HBP prevalence increased with higher body mass index. Notably, the population attributable risk of HBP because of being overweight steadily increased from 6.3% in 1995 to 19.2% in 2014. The same trends of linear growth for obesity, fluctuating blood pressure, and its sustained increasing population attributable risk for overweight also occurred among the domestic 29 provinces. Despite dramatic increases in overweight prevalence among Chinese children from 1995 to 2014, the HBP prevalence remained relatively stable, suggesting that other independent factors are affecting HBP trends to a greater extent. Yet, over time, the magnitude of the impact of being overweight or obese on HBP increased sharply, predicting looming heavy burden of HBP. Reductions in overweight status may aid in preventing HBP so as to prevent coronary risk in adulthood.

View details for DOI 10.1161/HYPERTENSIONAHA.118.11291

View details for Web of Science ID 000438231100015

View details for PubMedID 29866739

View details for PubMedCentralID PMC6043402
The Healing and Empowering Alaskan Lives Toward Healthy-Hearts (HEALTHH) Project: Study protocol for a randomized controlled trial of an intervention for tobacco use and other cardiovascular risk behaviors for Alaska Native People. Contemporary clinical trials Prochaska, J. J., Epperson, A., Skan, J., Oppezzo, M., Barnett, P., Delucchi, K., Schnellbaecher, M., Benowitz, N. L. 2018
Abstract

BACKGROUND: Tobacco use and tobacco-related diseases disproportionately affect Alaska Native (AN) people. Using telemedicine, this study aims to identify culturally-tailored, theoretically-driven, efficacious interventions for tobacco use and other cardiovascular disease (CVD) risk behaviors among AN people in remote areas.DESIGN: Randomized clinical trial with two intervention arms: 1) tobacco and physical activity; 2) medication adherence and a heart-healthy AN diet.PARTICIPANTS: Participants are N = 300 AN men and women current smokers with high blood pressure or high cholesterol.INTERVENTIONS: All participants receive motivational, stage-tailored, telemedicine-delivered counseling sessions at baseline and 3, 6, and 12 months follow-up; an individualized behavior change plan that is updated at each contact; and a behavior change manual. In Group 1, the focus is on tobacco and physical activity; a pedometer is provided and nicotine replacement therapy is offered. In Group 2, the focus is on medication adherence for treating hypertension and/or hypercholesterolemia; a medication bag and traditional food guide are provided.MEASUREMENTS: With assessments at baseline, 3, 6, 12, and 18 months, the primary outcome is smoking status, assessed as 7-day point prevalence abstinence, biochemically verified with urine anabasine. Secondary outcomes include physical activity, blood pressure and cholesterol, medication compliance, diet, multiple risk behavior change indices, and cost-effectiveness.COMMENTS: The current study has the potential to identify novel, feasible, acceptable, and efficacious interventions for treating the co-occurrence of CVD risk factors in AN people. Findings may inform personalized treatment and the development of effective and cost-effective intervention strategies for use in remote indigenous communities more broadly. Clinical Trial Registration # NCT02137902.

View details for DOI 10.1016/j.cct.2018.06.003

View details for PubMedID 29864548
Documentation of e-cigarette use and associations with smoking from 2012 to 2015 in an integrated healthcare delivery system PREVENTIVE MEDICINE Young-Wolff, K. C., Klebaner, D., Folck, B., Tan, A. L., Fogelberg, R., Sarovar, V., Prochaska, J. J. 2018; 109: 113–18
Abstract

It is unclear whether use of electronic nicotine delivery systems (ENDS) precedes cigarette smoking initiation, relapse, and/or quitting. Healthcare systems with electronic health records (EHRs) provide unique data to examine ENDS use and changes in smoking. We examined the incidence of ENDS use (2012-2015) based on clinician documentation and tested whether EHR documented ENDS use is associated with twelve-month changes in patient smoking status using a matched retrospective cohort design. The sample was Kaiser Permanente Northern California (KPNC) patients aged ≥12 with documented ENDS use (N = 7926); 57% were current smokers, 35% former smokers, and 8% never-smokers. ENDS documentation incidence peaked in 2014 for current and former smokers and in 2015 for never-smokers. We matched patients with documented ENDS use to KPNC patients without documented ENDS use (N = 7926) on age, sex, race/ethnicity, and smoking status. Documented ENDS use predicted the likelihood of smoking in the following year. Among current smokers, ENDS use was associated with greater odds of quitting smoking (OR = 1.17, 95%CI = 1.05-1.31). Among former smokers, ENDS use was associated with greater odds of smoking relapse (OR = 1.53, 95%CI = 1.22-1.92). Among never-smokers, ENDS use was associated with greater odds of initiating smoking (OR = 7.41, 95%CI = 3.14-17.5). The overall number of current smokers at 12 months was slightly higher among patients with (N = 3931) versus without (N = 3850) documented ENDS use. Results support both potential harm reduction of ENDS use (quitting combustibles among current smokers) and potential for harm (relapse to combustibles among former smokers, initiation for never-smokers).

View details for DOI 10.1016/j.ypmed.2018.01.012

View details for Web of Science ID 000426921600017

View details for PubMedID 29360481
National Blood Pressure Reference for Chinese Han Children and Adolescents Aged 7 to 17 Years HYPERTENSION Dong, Y., Ma, J., Song, Y., Dong, B., Wang, Z., Yang, Z., Wang, X., Prochaska, J. J. 2017; 70 (5): 897-+
Abstract

We sought to develop and validate a national blood pressure (BP) reference based on age, sex, and height for Chinese children. Data were obtained on 197 430 children aged 7 to 17 who participated in the Chinese National Survey on Students' Constitution and Health in 2010. BP percentiles were estimated and fitted using the lambda, mu, and sigma method and then compared with a US reference and China existing reference. In an external independent validation sample of 59 653 children aged 7 to 18 from 7 Chinese provinces in 2013, the prevalence of elevated BP was compared applying the 3 references. BP values were similar for boys and girls at the younger ages (7-13 years) and lower height percentiles, whereas higher at the older ages (14-17 years) for boys than girls. At medial height in boys and girls aged 7 to 13, the 50th, 90th, 95th, and 99th percentiles of BP for the new national reference were consistent with US reference and lower than current Chinese reference. In the independent sample, elevated BP prevalence, based on the new national reference, ranged from 7.8% to 18.5% among children aged 7 to 17, which was higher than the US reference values (4.3%-14.5%) and lower than the current Chinese reference (12.9%-25.5%) in each age group. The new national BP reference for Chinese children based on age, sex, and height from large-scale and nationally representative data seems to improve the ability for identifying Chinese hypertensive children and for stratifying them with regard to cardiovascular risk.

View details for DOI 10.1161/HYPERTENSIONAHA.117.09983

View details for Web of Science ID 000413010300011

View details for PubMedID 28923902

View details for PubMedCentralID PMC5722224
Natural American Spirit Brand Marketing Casts Health Halo Around Smoking. American journal of public health Epperson, A. E., Henriksen, L., Prochaska, J. J. 2017; 107 (5): 668-670
View details for DOI 10.2105/AJPH.2017.303719

View details for PubMedID 28398789
Randomised controlled trial evaluation of Tweet2Quit: a social network quit-smoking intervention. Tobacco control Pechmann, C., Delucchi, K., Lakon, C. M., Prochaska, J. J. 2017; 26 (2): 188-194
Abstract

We evaluated a novel Twitter-delivered intervention for smoking cessation, Tweet2Quit, which sends daily, automated communications to small, private, self-help groups to encourage high-quality, online, peer-to-peer discussions.A 2-group randomised controlled trial assessed the net benefit of adding a Tweet2Quit support group to a usual care control condition of nicotine patches and a cessation website.Participants were 160 smokers (4 cohorts of 40/cohort), aged 18-59 years, who intended to quit smoking, used Facebook daily, texted weekly, and had mobile phones with unlimited texting.All participants received 56 days of nicotine patches, emails with links to the smokefree.gov cessation website, and instructions to set a quit date within 7 days. Additionally, Tweet2Quit participants were enrolled in 20-person, 100-day Twitter groups, and received daily discussion topics via Twitter, and daily engagement feedback via text.The primary outcome was sustained abstinence at 7, 30 and 60 days post-quit date.Participants (mean age 35.7 years, 26.3% male, 31.2% college degree, 88.7% Caucasian) averaged 18.0 (SD=8.2) cigarettes per day and 16.8 (SD=9.8) years of smoking. Participants randomised to Tweet2Quit averaged 58.8 tweets/participant and the average tweeting duration was 47.4 days/participant. Tweet2Quit doubled sustained abstinence out to 60 days follow-up (40.0%, 26/65) versus control (20.0%, 14/70), OR=2.67, CI 1.19 to 5.99, p=0.017. Tweeting via phone predicted tweet volume, and tweet volume predicted sustained abstinence (p<0.001). The daily autocommunications caused tweeting spikes accounting for 24.0% of tweets.Tweet2Quit was engaging and doubled sustained abstinence. Its low cost and scalability makes it viable as a global cessation treatment.NCT01602536.

View details for DOI 10.1136/tobaccocontrol-2015-052768

View details for PubMedID 26928205

View details for PubMedCentralID PMC5112138
Social Media and Mobile Technology for Cancer Prevention and Treatment. American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Meeting Prochaska, J. J., Coughlin, S. S., Lyons, E. J. 2017; 37: 128-137
Abstract

Given the number of lives affected by cancer and the great potential for optimizing well-being via lifestyle changes, patients, providers, health care systems, advocacy groups, and entrepreneurs are looking to digital solutions to enhance patient care and broaden prevention efforts. Thousands of health-oriented mobile websites and apps have been developed, with a majority focused upon lifestyle behaviors (e.g., exercise, diet, smoking). In this review, we consider the use and potential of social media and mHealth technologies for cancer prevention, cancer treatment, and survivorship. We identify key principles in research and practice, summarize prior reviews, and highlight notable case studies and patient resources. Further, with the potential for scaled delivery and broad reach, we consider application of social media and mHealth technologies in low-resource settings. With clear advantages for reach, social media and mHealth technologies offer the ability to scale and engage entire populations at low cost, develop supportive social networks, connect patients and providers, encourage adherence with cancer care, and collect vast quantities of data for advancing cancer research. Development efforts have been rapid and numerous, yet evaluation of intervention effects on behavior change and health outcomes are sorely needed, and regulation around data security issues is notably lacking. Attention to broader audiences is also needed, with targeted development for culturally diverse groups and non-English speakers. Further investment in research to build the evidence base and identify best practices will help delineate and actualize the potential of social media and mHealth technologies for cancer prevention and treatment.

View details for DOI 10.14694/EDBK_173841

View details for PubMedID 28561647
Smoking, Mental Illness, and Public Health. Annual review of public health Prochaska, J. J., Das, S., Young-Wolff, K. C. 2016
Abstract

Tobacco remains the leading preventable cause of death worldwide. In particular, people with mental illness are disproportionately affected with high smoking prevalence; they account for more than 200,000 of the 520,000 tobacco-attributable deaths in the United States annually and die on average 25 years prematurely. Our review aims to provide an update on smoking in the mentally ill. We review the determinants of tobacco use among smokers with mental illness, presented with regard to the public health HAVE framework of "the host" (e.g., tobacco user characteristics), the "agent" (e.g., nicotine product characteristics), the "vector" (e.g., tobacco industry), and the "environment" (e.g., smoking policies). Furthermore, we identify the significant health harms incurred and opportunities for prevention and intervention within a health care systems and larger health policy perspective. A comprehensive effort is warranted to achieve equity toward the 2025 Healthy People goal of reducing US adult tobacco use to 12%, with attention to all subgroups, including smokers with mental illness. Expected final online publication date for the Annual Review of Public Health Volume 38 is March 20, 2017. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

View details for DOI 10.1146/annurev-publhealth-031816-044618

View details for PubMedID 27992725
Online Patient-Provider E-cigarette Consultations: Perceptions of Safety and Harm. American journal of preventive medicine Brown-Johnson, C. G., Burbank, A., Daza, E. J., Wassmann, A., Chieng, A., Rutledge, G. W., Prochaska, J. J. 2016
Abstract

E-cigarettes are popular and unregulated. Patient-provider communications concerning e-cigarettes were characterized to identify patient concerns, provider advice and attitudes, and research needs.An observational study of online patient-provider communications was conducted January 2011-June 2015 from a network providing free medical advice, and analyzed July 2014-May 2016. Patient and provider themes, and provider attitudes toward e-cigarettes (positive, negative, or neutral) were coded qualitatively. Provider attitudes were analyzed with cumulative logit modeling to account for clustering. Patient satisfaction with provider responses was expressed via a Thank function.An increase in e-cigarette-related questions was observed over time. Patient questions (N=512) primarily concerned specific side effects and harms (34%); general safety (27%); e-cigarettes as quit aids (19%); comparison of e-cigarette harms relative to combusted tobacco (18%); use with pre-existing medical conditions (18%); and nicotine-free e-cigarettes (14%). Half of provider responses discussed e-cigarettes as a harm reduction option (48%); 26% discussed them as quit aids. Overall, 47% of providers' responses represented a negative attitude toward e-cigarettes; 33% were neutral (contradictory or non-committal); and 20% were positive. Attitudes did not differ statistically by medical specialty; provider responses positive toward e-cigarettes received significantly more Thanks.Examination of online patient-provider communications provides insight into consumer health experience with emerging alternative tobacco products. Patient concerns largely related to harms and safety, and patients preferred provider responses positively inclined toward e-cigarettes. Lacking conclusive evidence of e-cigarette safety or efficacy, healthcare providers encouraged smoking cessation and recommended first-line cessation treatment approaches.

View details for DOI 10.1016/j.amepre.2016.06.018

View details for PubMedID 27576005

View details for PubMedCentralID PMC5118131
Likelihood of Unemployed Smokers vs Nonsmokers Attaining Reemployment in a One-Year Observational Study JAMA INTERNAL MEDICINE Prochaska, J. J., Michalek, A. K., Brown-Johnson, C., Daza, E. J., Baiocchi, M., Anzai, N., Rogers, A., Grigg, M., Chieng, A. 2016; 176 (5): 662-670
Abstract

Studies in the United States and Europe have found higher smoking prevalence among unemployed job seekers relative to employed workers. While consistent, the extant epidemiologic investigations of smoking and work status have been cross-sectional, leaving it underdetermined whether tobacco use is a cause or effect of unemployment.To examine differences in reemployment by smoking status in a 12-month period.An observational 2-group study was conducted from September 10, 2013, to August 15, 2015, in employment service settings in the San Francisco Bay Area (California). Participants were 131 daily smokers and 120 nonsmokers, all of whom were unemployed job seekers. Owing to the study's observational design, a propensity score analysis was conducted using inverse probability weighting with trimmed observations. Including covariates of time out of work, age, education, race/ethnicity, and perceived health status as predictors of smoking status.Reemployment at 12-month follow-up.Of the 251 study participants, 165 (65.7) were men, with a mean (SD) age of 48 (11) years; 96 participants were white (38.2%), 90 were black (35.9%), 24 were Hispanic (9.6%), 18 were Asian (7.2%), and 23 were multiracial or other race (9.2%); 78 had a college degree (31.1%), 99 were unstably housed (39.4%), 70 lacked reliable transportation (27.9%), 52 had a criminal history (20.7%), and 72 had received prior treatment for alcohol or drug use (28.7%). Smokers consumed a mean (SD) of 13.5 (8.2) cigarettes per day at baseline. At 12-month follow-up (217 participants retained [86.5%]), 60 of 108 nonsmokers (55.6%) were reemployed compared with 29 of 109 smokers (26.6%) (unadjusted risk difference, 0.29; 95% CI, 0.15-0.42). With 6% of analysis sample observations trimmed, the estimated risk difference indicated that nonsmokers were 30% (95% CI, 12%-48%) more likely on average to be reemployed at 1 year relative to smokers. Results of a sensitivity analysis with additional covariates of sex, stable housing, reliable transportation, criminal history, and prior treatment for alcohol or drug use (25.3% of observations trimmed) reduced the difference in employment attributed to smoking status to 24% (95% CI, 7%-39%), which was still a significant difference. Among those reemployed at 1 year, the average hourly wage for smokers was significantly lower (mean [SD], $15.10 [$4.68]) than for nonsmokers (mean [SD], $20.27 [$10.54]; F(1,86) = 6.50, P = .01).To our knowledge, this is the first study to prospectively track reemployment success by smoking status. Smokers had a lower likelihood of reemployment at 1 year and were paid significantly less than nonsmokers when reemployed. Treatment of tobacco use in unemployment service settings is worth testing for increasing reemployment success and financial well-being.

View details for DOI 10.1001/jamainternmed.2016.0772

View details for Web of Science ID 000375292500023

View details for PubMedID 27065044
The Past, Present, and Future of Nicotine Addiction Therapy ANNUAL REVIEW OF MEDICINE, VOL 67 Prochaska, J. J., Benowitz, N. L. 2016; 67: 467-486
View details for DOI 10.1146/annurev-med-111314-033712

View details for Web of Science ID 000368346100031
Cost-Effectiveness of Smoking Cessation Treatment Initiated During Psychiatric Hospitalization: Analysis From a Randomized, Controlled Trial JOURNAL OF CLINICAL PSYCHIATRY Barnett, P. G., Wong, W., Jeffers, A., Hall, S. M., Prochaska, J. J. 2015; 76 (10): E1285-?
View details for DOI 10.4088/JCP.14m09016

View details for Web of Science ID 000368347900005
Development of a Twitter-based intervention for smoking cessation that encourages high-quality social media interactions via automessages. Journal of medical Internet research Pechmann, C., Pan, L., Delucchi, K., Lakon, C. M., Prochaska, J. J. 2015; 17 (2)
Abstract

The medical field seeks to use social media to deliver health interventions, for example, to provide low-cost, self-directed, online self-help groups. However, engagement in online groups is often low and the informational content may be poor.The specific study aims were to explore if sending automessages to online self-help groups encouraged engagement and to see if overall or specific types of engagement related to abstinence.We conducted a Stage I Early Therapy Development Trial of a novel social media intervention for smoking cessation called Tweet2Quit that was delivered online over closed, 20-person quit-smoking groups on Twitter in 100 days. Social media such as Twitter traditionally involves non-directed peer-to-peer exchanges, but our hybrid social media intervention sought to increase and direct such exchanges by sending out two types of autocommunications daily: (1) an "automessage" that encouraged group discussion on an evidence-based cessation-related or community-building topic, and (2) individualized "autofeedback" to each participant on their past 24-hour tweeting. The intervention was purposefully designed without an expert group facilitator and with full automation to ensure low cost, easy implementation, and broad scalability. This purely Web-based trial examined two online quit-smoking groups with 20 members each. Participants were adult smokers who were interested in quitting and were recruited using Google AdWords. Participants' tweets were counted and content coded, distinguishing between responses to the intervention's automessages and spontaneous tweets. In addition, smoking abstinence was assessed at 7 days, 30 days, and 60 days post quit date. Statistical models assessed how tweeting related to abstinence.Combining the two groups, 78% (31/40) of the members sent at least one tweet; and on average, each member sent 72 tweets during the 100-day period. The automessage-suggested discussion topics and participants' responses to those daily automessages were related in terms of their content (r=.75, P=.012). Responses to automessages contributed 22.78% (653/2867) of the total tweets; 77.22% (2214/2867) were spontaneous. Overall tweeting related only marginally to abstinence (OR 1.03, P=.086). However, specific tweet content related to abstinence including tweets about setting of a quit date or use of nicotine patches (OR 1.52, P=.024), countering of roadblocks to quitting (OR 1.76, P=.008) and expressions of confidence about quitting (OR 1.71, SE 0.42, P=.032). Questionable, that is, non-evidence-based, information about quitting did not relate to abstinence (OR 1.12, P=.278).A hybrid social media intervention that combines traditional online social support with daily automessages appears to hold promise for smoking cessation. This hybrid approach capitalizes on social media's spontaneous real-time peer-to-peer exchanges but supplements this with daily automessages that group members respond to, bolstering and sustaining the social network and directing the information content. Highly engaging, this approach should be studied further.Clinicaltrials.gov NCT01602536; https://clinicaltrials.gov/ct2/show/NCT01602536 (Archived by WebCite at http://www.webcitation.org/6WGbt0o1K).

View details for DOI 10.2196/jmir.3772

View details for PubMedID 25707037
Multiple Risk-Behavior Profiles of Smokers With Serious Mental Illness and Motivation for Change HEALTH PSYCHOLOGY Prochaska, J. J., Fromont, S. C., Delucchi, K., Young-Wolff, K. C., Benowitz, N. L., Hall, S., Bonas, T., Hall, S. M. 2014; 33 (12): 1518-1529
Abstract

Objective: Individuals with serious mental illness (SMI) are dying on average 25 years prematurely. The leading causes are chronic preventable diseases. In the context of a tobacco-treatment trial, this exploratory study examined the behavioral risk profiles of adults with SMI to identify broader interventional needs. Method: Recruited from five acute inpatient psychiatry units, participants were 693 adult smokers (recruitment rate = 76%, 50% male, 45% Caucasian, age M = 39, 49% had income < $10,000) diagnosed with mood disorders (71%), substance-use disorders (63%), posttraumatic stress disorder (39%), psychotic disorders (25%), and attention deficit-hyperactivity disorder (25%). The Staging Health Risk Assessment, the primary measure used in this study, screened for risk status and readiness to change 11 health behaviors, referencing the period prior to acute hospitalization. Results: Participants averaged 5.2 (SD = 2.1) risk behaviors, including smoking (100%), high-fat diet (68%), inadequate fruits/vegetables (67%), poor sleep (53%), physical inactivity (52%), and marijuana use (46%). The percent prepared to change ranged from 23% for tobacco and marijuana to 76% for depression management. Latent class analysis differentiated three risk groups: the global higher risk group included patients elevated on all risk behaviors; the global lower risk group was low on all risks; and a mood and metabolic risk group, characterized by inactivity, unhealthy diet, sleep problems, and poor stress and depression management. The global higher risk group (11% of sample) was younger, largely male, and had the greatest number of risk behaviors and mental health diagnoses; had the most severe psychopathologies, addiction-treatment histories, and nicotine dependence; and the lowest confidence for quitting smoking and commitment to abstinence. Conclusion: Most smokers with SMI engaged in multiple risks. Expanding targets to treat co-occurring risks and personalizing treatment to individuals' multibehavioral profiles may increase intervention relevance, interest, and impact on health. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

View details for DOI 10.1037/a0035164

View details for Web of Science ID 000345741900008

View details for PubMedID 24467257
E-Cigarette Use among Smokers with Serious Mental Illness PLOS ONE Prochaska, J. J., Grana, R. A. 2014; 9 (11)
Abstract

We examined electronic cigarette (EC) use, correlates of use, and associated changes in smoking behavior among smokers with serious mental illness in a clinical trial.Adult smokers were recruited during acute psychiatric hospitalization (N = 956, 73% enrollment among approached smokers) in the San Francisco Bay Area between 2009-2013. At baseline, participants averaged 17 (SD = 10) cigarettes per day for 19 (SD = 14) years; 24% intended to quit smoking in the next month. Analyses examined frequency and correlates of EC use reported over the 18-month trial and changes in smoking behavior by EC use status.EC use was 11% overall, and by year of enrollment, increased from 0% in 2009 to 25% in 2013. In multiple logistic regression, the likelihood of EC use was significantly greater with each additional year of recruitment, for those aged 18-26, and for those in the preparation versus precontemplation stage of change, and unlikely among Hispanic participants. EC use was unrelated to gender, psychiatric diagnosis, and measures of tobacco dependence at baseline. Further, over the 18-month trial, EC use was not associated with changes in smoking status or, among continued smokers, with reductions in cigarettes per day.Within a clinical trial with smokers with serious mental illness, EC use increased over time, particularly among younger adults and those intending to quit tobacco. EC use was unrelated to changes in smoking. The findings are of clinical interest and warrant further study.

View details for DOI 10.1371/journal.pone.0113013

View details for Web of Science ID 000346766900016

View details for PubMedID 25419703
Engaging Patients and Clinicians in Treating Tobacco Addiction JAMA INTERNAL MEDICINE Prochaska, J. J. 2014; 174 (8): 1299-1300
View details for DOI 10.1001/jamainternmed.2014.729

View details for Web of Science ID 000340447000021

View details for PubMedID 24910949
Efficacy of Initiating Tobacco Dependence Treatment in Inpatient Psychiatry: A Randomized Controlled Trial AMERICAN JOURNAL OF PUBLIC HEALTH Prochaska, J. J., Hall, S. E., Delucchi, K., Hall, S. M. 2014; 104 (8): 1557-1565
Abstract

We evaluated the efficacy of a motivational tobacco cessation treatment combined with nicotine replacement relative to usual care initiated in inpatient psychiatry.We randomized participants (n = 224; 79% recruitment rate) recruited from a locked acute psychiatry unit with a 100% smoking ban to intervention or usual care. Prior to hospitalization, participants averaged 19 (SD = 12) cigarettes per day; only 16% intended to quit smoking in the next 30 days. Results. Verified smoking 7-day point prevalence abstinence was significantly higher for intervention than usual care at month 3 (13.9% vs 3.2%), 6 (14.4% vs 6.5%), 12 (19.4% vs 10.9%), and 18 (20.0% vs 7.7%; odds ratio [OR] = 3.15; 95% confidence interval [CI] = 1.22, 8.14; P = .018; retention > 80%). Psychiatric measures did not predict abstinence; measures of motivation and tobacco dependence did. The usual care group had a significantly greater likelihood than the intervention group of psychiatric rehospitalization (adjusted OR = 1.92; 95% CI = 1.06, 3.49).The findings support initiation of motivationally tailored tobacco cessation treatment during acute psychiatric hospitalization. Psychiatric severity did not moderate treatment efficacy, and cessation treatment appeared to decrease rehospitalization risk, perhaps by providing broader therapeutic benefit.

View details for DOI 10.2105/AJPH.2013.301403

View details for Web of Science ID 000341811000055

View details for PubMedID 23948001
Encouraging and supporting smoking cessation in the workforce. Occupational and environmental medicine Prochaska, J. J., Brown-Johnson, C. G. 2014; 71 (6): 385-387
View details for DOI 10.1136/oemed-2014-102145

View details for PubMedID 24759972
Quitting smoking is associated with long term improvements in mood BMJ-BRITISH MEDICAL JOURNAL Prochaska, J. J. 2014; 348
View details for DOI 10.1136/bmj.g1562

View details for Web of Science ID 000332153700006

View details for PubMedID 24534077
Tobacco use among the job-seeking unemployed in California. Preventive medicine Prochaska, J. J., Shi, Y., Rogers, A. 2013; 56 (5): 329-332
Abstract

Given the current economic climate, with 8.1% unemployment nationally and 10.6% among the Californian labor force in August 2012, employers can be more selective in their hiring decisions, and individuals who smoke may be at a serious economic disadvantage. The current study examined the association between cigarette smoking and employment status among adults in California, a state with strong antitobacco sentiment.Cross-sectional data were analyzed from the 2007 and 2009 California Health Interview Survey on 68,501 noninstitutionalized adults age 20-65.The job-seeking unemployed had the highest smoking prevalence (20.9%) relative to the non-job-seeking unemployed (15.9%) and employed (14.8%). In a multivariate multinomial logistic regression that controlled for demographic factors and other risk characteristics (obesity, binge drinking), current (adjusted odds ratio [AOR]=1.23, 95% CI=1.01-1.49) but not former smoking status (AOR=0.95, 95% CI=0.76-1.19) was significantly associated with being unemployed and job-seeking.Smokers in California were more likely than never and former smokers to be unemployed. Employment service agencies may be well placed for reaching smokers and treating tobacco dependence.

View details for DOI 10.1016/j.ypmed.2013.01.021

View details for PubMedID 23415765
Cytisine, the world's oldest smoking cessation aid. BMJ (Clinical research ed.) Prochaska, J. J., Das, S., Benowitz, N. L. 2013; 347: f5198-?
View details for DOI 10.1136/bmj.f5198

View details for PubMedID 23974638
Twitter=quitter? An analysis of Twitter quit smoking social networks TOBACCO CONTROL Prochaska, J. J., Pechmann, C., Kim, R., Leonhardt, J. M. 2012; 21 (4): 447-449
Abstract

Widely popular, Twitter, a free social networking and micro-blogging service, offers potential for health promotion. This study examined the activity of Twitter quit smoking social network accounts.A cross-sectional analysis identified 153 activated Twitter quit smoking accounts dating back to 2007 and examined recent account activity for the month of August 2010.The accounts had a median of 155 followers and 82 total tweets per account; 49% of accounts had >100 tweets. Posted content was largely inconsistent with clinical guidelines; 48% linked to commercial sites for quitting smoking and 43% had tweets on e-cigarettes. In August 2010, 81 of the accounts (53%) were still active.Though popular for building quit smoking social networks, many of the Twitter accounts were no longer active, and tweet content was largely inconsistent with clinical guidelines. Future research is needed to examine the effectiveness of Twitter for supporting smoking cessation.

View details for DOI 10.1136/tc.2010.042507

View details for Web of Science ID 000305799600026

View details for PubMedID 21730101
Medical Students' Attention to Multiple Risk Behaviors: A Standardized Patient Examination JOURNAL OF GENERAL INTERNAL MEDICINE Prochaska, J. J., Gali, K., Miller, B., Hauer, K. E. 2012; 27 (6): 700-707
Abstract

Risk behaviors tend to cluster, particularly among smokers, with negative health effects. To optimize patients' health and wellbeing, health care providers ideally would assess and intervene upon the multiple risks with which patients may present.This study examined medical students' skills in assessing and treating multiple risk behaviors.Using a randomized experimental design, medical students' counseling interactions were evaluated with a standardized patient presenting with sexual health concerns and current tobacco use with varied problematic drinking status (alcohol-positive or alcohol-negative).One hundred and fifty-six third-year medical students.Student and standardized patient completed measures evaluated student knowledge, attitudes, and clinical performance.Overall, most students assessed tobacco use (85%); fewer assessed alcohol use (54%). Relative to the alcohol-negative case, students seeing the alcohol-positive case were less likely to assess sexually transmitted disease history (80% vs. 91%, p = 0.042), or patients' readiness to quit smoking (41% vs. 60%, p = 0.025), and endorsed greater attitudinal barriers to tobacco treatment (p = 0.030). Patient satisfaction was significantly lower for the alcohol-positive than the alcohol-negative case; clinical performance ratings moderated this relationship.When presented with a case of multiple risks, medical students performed less effectively and received lower patient satisfaction ratings. Findings were moderated by students' overall clinical performance. Paradigm shifts are needed in medical education that emphasize assessment of multiple risks, new models of conceptualizing behavior change as a generalized process, and treatment of the whole patient for optimizing health outcomes.

View details for DOI 10.1007/s11606-011-1953-9

View details for Web of Science ID 000304402900015

View details for PubMedID 22215267
Risk of cardiovascular serious adverse events associated with varenicline use for tobacco cessation: systematic review and meta-analysis BRITISH MEDICAL JOURNAL Prochaska, J. J., Hilton, J. F. 2012; 344
Abstract

To examine the risk of treatment emergent, cardiovascular serious adverse events associated with varenicline use for tobacco cessation.Meta-analysis comparing study effects using four summary estimates.Medline, Cochrane Library, online clinical trials registries, and reference lists of identified articles.We included randomised controlled trials of current tobacco users of adult age comparing use of varenicline with an inactive control and reporting adverse events. We defined treatment emergent, cardiovascular serious adverse events as occurring during drug treatment or within 30 days of discontinuation, and included any ischaemic or arrhythmic adverse cardiovascular event (myocardial infarction, unstable angina, coronary revascularisation, coronary artery disease, arrhythmias, transient ischaemic attacks, stroke, sudden death or cardiovascular related death, or congestive heart failure).We identified 22 trials; all were double blinded and placebo controlled; two included participants with active cardiovascular disease and 11 enrolled participants with a history of cardiovascular disease. Rates of treatment emergent, cardiovascular serious adverse events were 0.63% (34/5431) in the varenicline groups and 0.47% (18/3801) in the placebo groups. The summary estimate for the risk difference, 0.27% (95% confidence interval -0.10 to 0.63; P = 0.15), based on all 22 trials, was neither clinically nor statistically significant. For comparison, the relative risk (1.40, 0.82 to 2.39; P = 0.22), Mantel-Haenszel odds ratio (1.41, 0.82 to 2.42; P = 0.22), and Peto odds ratio (1.58, 0.90 to 2.76; P = 0.11), all based on 14 trials with at least one event, also indicated a non-significant difference between varenicline and placebo groups.This meta--analysis--which included all trials published to date, focused on events occurring during drug exposure, and analysed findings using four summary estimates-found no significant increase in cardiovascular serious adverse events associated with varenicline use. For rare outcomes, summary estimates based on absolute effects are recommended and estimates based on the Peto odds ratio should be avoided.

View details for DOI 10.1136/bmj.e2856

View details for Web of Science ID 000303818500002

View details for PubMedID 22563098
Cardiology Rx for Change: Improving Clinical Attention to Tobacco Use and Secondhand Smoke Exposure in Cardiology CLINICAL CARDIOLOGY Prochaska, J. J., Benowitz, N. L., Glantz, S. A., Hudmon, K. S., Grossman, W. 2011; 34 (12): 738-743
Abstract

Heart disease is the leading cause of tobacco-related death in smokers and of deaths due to secondhand smoke (SHS) exposure in nonsmokers. This study centers on the development and evaluation of an evidence-based model curriculum for improving clinical attention to tobacco use and SHS exposure in cardiology.We hypothesized that the curriculum would be associated with improvements in clinician tobacco-related knowledge, attitudes, confidence, and counseling behaviors from pre-to post-training and at the 3-month follow-up.The 1-hour Cardiology Rx for Change curriculum was evaluated with 22 cardiology fellows and 77 medical residents with consistent training effects observed between the 2 groups.Trainees' tobacco treatment knowledge increased significantly from pre- to post-training (t[81] = 6.51, P<0.001), and perceived barriers to providing cessation treatment decreased significantly (t[81] = -3.97, P<0.001). The changes, however, were not sustained at the 3-month follow-up, suggesting the need for booster training efforts. From pretraining to 3-month follow-up, the training was associated with significant sustained gains in clinician confidence for treating tobacco dependence (t[61] = 3.69, P = 0.001) and with improvements in clinicians assessing patients' readiness to quit smoking (from 61% to 79%, t[59] = 3.69,P<0.001) and providing assistance with quitting (from 47% to 59%, t[59] = 2.12, P = 0.038). Asking patients about tobacco use, advising cessation, and arranging follow-up also increased over time, but not significantly. All participants (100%) recommended the curriculum for dissemination to other training programs.Available online via http://rxforchange.ucsf.edu, Cardiology Rx for Change offers a packaged training tool for improving treatment of tobacco use and SHS exposure in cardiology care.

View details for DOI 10.1002/clc.20982

View details for Web of Science ID 000297632500003

View details for PubMedID 21987417
An online survey of tobacco use, intentions to quit, and cessation strategies among people living with bipolar disorder BIPOLAR DISORDERS Prochaska, J. J., Reyes, R. S., Schroeder, S. A., Daniels, A. S., Doederlein, A., Bergeson, B. 2011; 13 (5-6): 466-473
Abstract

Tobacco use is prevalent among people living with bipolar disorder. We examined tobacco use, attempts to quit, and tobacco-related attitudes and intentions among 685 individuals with bipolar disorder who smoked ≥ 100 cigarettes in their lifetime. Data were collected online through the website of the Depression and Bipolar Support Alliance, a mood disorder peer-support network. The sample was 67% female, 67% aged 26 to 50, and 89% Caucasian; 87% were current smokers; 92% of current smokers smoked daily, averaging 19 cigarettes/day (SD=11). The sample began smoking at a mean age of 17 years (SD=6) and smoked a median of 7 years prior to bipolar disorder diagnosis. Among current smokers, 74% expressed a desire to quit; intent to quit smoking was unrelated to current mental health symptoms [χ(2) (3)=5.50, p=0.139]. Only 33% were advised to quit smoking by a mental health provider, 48% reported smoking to treat their mental illness, and 96% believed being mentally healthy was important for quitting. Ex-smokers (13% of sample) had not smoked for a median of 2.7 years; 48% quit 'cold turkey.' Most ex-smokers (64%) were in poor or fair mental health when they quit smoking. At the time of the survey, however, more ex-smokers described their mental health as in recovery than current smokers [57% versus 40%; χ(2) (3)=11.12, p=0.011]. Most smokers living with bipolar disorder are interested in quitting. The Internet may be a useful cessation tool for recruiting and potentially treating smokers with bipolar disorder who face special challenges when trying to quit and rarely receive cessation treatment from their mental health providers.

View details for DOI 10.1111/j.1399-5618.2011.00944.x

View details for Web of Science ID 000297029600003

View details for PubMedID 22017216
Smoking and Mental Illness - Breaking the Link NEW ENGLAND JOURNAL OF MEDICINE Prochaska, J. J. 2011; 365 (3): 196-198
View details for Web of Science ID 000292915500002

View details for PubMedID 21774707
Treating tobacco dependence in clinically depressed smokers: Effect of smoking cessation on mental health functioning AMERICAN JOURNAL OF PUBLIC HEALTH Prochaska, J. J., Hall, S. M., Tsoh, J. Y., Eisendrath, S., Rossi, J. S., Redding, C. A., Rosen, A. B., Meisner, M., Humfleet, G. L., Gorecki, J. A. 2008; 98 (3): 446-448
Abstract

We analyzed data from a randomized trial of 322 actively depressed smokers and examined the effect of smoking cessation on their mental health functioning. Only 1 of 10 measures at 4 follow-up time points was significant: participants who successfully stopped smoking reported less alcohol use than did participants who continued smoking. Depressive symptoms declined significantly over time for participants who stopped smoking and those who continued smoking; there were no group differences. Individuals in treatment for clinical depression can be helped to stop smoking without adversely affecting their mental health functioning.

View details for DOI 10.2105/AJPH.2006.101147

View details for Web of Science ID 000253742500014

View details for PubMedID 17600251
A meta-analysis of smoking cessation interventions with individuals in substance abuse treatment or recovery JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Prochaska, J. J., Delucchi, K., Hall, S. A. 2004; 72 (6): 1144-1156
Abstract

This meta-analysis examined outcomes of smoking cessation interventions evaluated in 19 randomized controlled trials with individuals in current addictions treatment or recovery. Smoking and substance use outcomes at posttreatment and long-term follow-up (> or = 6 months) were summarized with random effects models. Intervention effects for smoking cessation were significant at posttreatment and comparable for participants in addictions treatment and recovery; however, intervention effects for smoking cessation were nonsignificant at long-term follow-up. Smoking cessation interventions provided during addictions treatment were associated with a 25% increased likelihood of long-term abstinence from alcohol and illicit drugs. Short-term smoking cessation effects look promising, but innovative strategies are needed for long-term cessation. Contrary to previous concerns, smoking cessation interventions during addictions treatment appeared to enhance rather than compromise long-term sobriety.

View details for DOI 10.1037/0022-006X.72.6.1144

View details for Web of Science ID 000225801700021

View details for PubMedID 15612860
Development and acceptability testing of a Facebook smoking cessation intervention for sexual and gender minority young adults INTERNET INTERVENTIONS-THE APPLICATION OF INFORMATION TECHNOLOGY IN MENTAL AND BEHAVIOURAL HEALTH Vogel, E. A., Belohlavek, A., Prochaska, J. J., Ramo, D. E. 2019; 15: 87–92
View details for DOI 10.1016/j.invent.2019.01.002

View details for Web of Science ID 000458336900011
National trends in stunting, thinness and overweight among Chinese school-aged children, 1985-2014 INTERNATIONAL JOURNAL OF OBESITY Song, Y., Agardh, A., Ma, J., Li, L., Lei, Y., Stafford, R. S., Prochaska, J. J. 2019; 43 (2): 402–11
Abstract

We sought to examine changes in regional and sex disparities in stunting, thinness, and overweight among Chinese school-aged children from 1985 to 2014.We analyzed data on 1,489,953 children aged 7-18 years in the Chinese National Survey on Students' Constitution and Health. Stunting, thinness, and overweight were defined according to WHO anthropomorphic definitions. After adjustment for age, socioeconomic status, and school, logistic regression was used to estimate the prevalence of stunting, thinness, and overweight by region and sex over 30 years' time.From 1985 to 2014, the prevalence of stunting progressively decreased from 16.4% in 1985 to 2.3% in 2014, thinness prevalence also declined overtime, from 8.4 to 4.0% and overweight prevalence continually increased from 1.1% in 1985 to 20.4% in 2014 in Chinese school-aged children. Stunting and thinness were more common in rural areas, although urban/rural differences declined over time. Overweight was a greater problem in urban than rural areas, and this difference increased over time. Some provinces showed high levels of stunting, thinness, and overweight. The stunting prevalence of boys was higher than girls from 1985 and 1995, but lower than girls for the past 15 years. Thinness was consistently more common in boys than girls across regions and time. Overweight continuously increased for boys and girls; however, the increase was more rapid in boys.Over the past 30 years, Chinese children have shifted in anthropomorphic measures indicating a shift from problems of under-nutrition to measures consistent with over-nutrition, particularly in urban areas and among boys. Some regions are burdened by problems of both under- and over-nutrition. Regional and sex-specific guidelines and public health policies for childhood nutrition are needed in China.

View details for DOI 10.1038/s41366-018-0129-7

View details for Web of Science ID 000457698600018

View details for PubMedID 29915362
Place-Based Inequity in Smoking Prevalence in the Largest Cities in the United States. JAMA internal medicine Leas, E. C., Schleicher, N. C., Prochaska, J. J., Henriksen, L. 2019
View details for DOI 10.1001/jamainternmed.2018.5990

View details for PubMedID 30615029
Associations between marijuana use and tobacco cessation outcomes in young adults JOURNAL OF SUBSTANCE ABUSE TREATMENT Vogel, E. A., Rubinstein, M. L., Prochaska, J. J., Ramo, D. E. 2018; 94: 69–73
Abstract

Marijuana and tobacco co-use is common among young adults, and findings are mixed regarding the association between marijuana use and smoking cessation outcomes. This study examined the longitudinal relationships between marijuana use and smoking cessation outcomes among young adults (aged 18-25 years; N = 500) enrolled in a 3-month smoking cessation intervention on Facebook. At baseline and 3, 6, and 12 months, participants reported their marijuana use and their smoking behaviors (seven-day point prevalence abstinence from smoking, cigarettes per day, quit attempts) and readiness to quit. Longitudinal analyses controlled for experimental condition and adjusted for baseline stage of change, baseline average cigarettes per day, sex, alcohol use, and age participants began smoking regularly. Use of marijuana by young adult smokers was associated with a lower likelihood of reduced smoking (OR = 0.71, 95% CI [0.51, 0.98], p = .036) and a lower likelihood of abstaining from smoking (OR = 0.56, 95% CI [0.35, 0.90], p = .017) in the past seven days, as assessed over 12 months of follow-up. Use of marijuana was not significantly associated with perceptions of or engagement in the smoking cessation intervention, stage of change for quitting smoking, or tobacco quit attempts (all p's > 0.08). Study findings indicate that while marijuana use is unrelated to motivation to quit tobacco and engage in cessation interventions, marijuana use is associated with less success in reducing and abstaining from tobacco. Additional support and targeted tobacco cessation strategies to address challenges associated with marijuana co-use may be needed.

View details for DOI 10.1016/j.jsat.2018.08.010

View details for Web of Science ID 000447229800011

View details for PubMedID 30243420

View details for PubMedCentralID PMC6190592
Evaluating the Impact of Eliminating Copayments for Tobacco Cessation Pharmacotherapy MEDICAL CARE Young-Wolff, K. C., Adams, S. R., Klebaner, D., Adams, A. S., Campbell, C. I., Satre, D. D., Prochaska, J. J. 2018; 56 (11): 912–18
Abstract

We examined the impact of the Affordable Care Act-mandated elimination of tobacco cessation pharmacotherapy (TCP) copayments on patient use of TCP, overall and by income.Electronic health record data captured any and combination (eg, nicotine gum plus patch) TCP use among adult smokers newly enrolled in Kaiser Permanente Northern California (KPNC). KPNC eliminated TCP copayments in 2015. We included current smokers newly enrolled in the first 6 months of 2014 (before copayment elimination, N=16,199) or 2015 (after elimination, N=16,469). Multivariable models estimated 1-year changes in rates of any TCP fill, and of combination TCP fill, and tested for differences by income (<$50k, $50≥75k, ≥$75k). Through telephone surveys in 2016 with a subset of smokers newly enrolled in 2014 (n=306), we assessed barriers to TCP use, with results stratified by income.Smokers enrolled in KPNC in 2015 versus 2014 were more likely to have a TCP fill (9.1% vs. 8.2%; relative risk, 1.19; 95% confidence interval, 1.11-1.27), and combination TCP fill, among those with any fill (42.3% vs. 37.9%; relative risk, 1.12; 95% confidence interval, 1.02-1.23); findings were stronger for low-income smokers. Low-income patients (<$50k) were less likely to report that clinicians discussed smoking treatments with them (58%) compared with higher income smokers ($50≥75k, 67%; ≥$75k, 83%), and were less aware that TCP was free (40% vs. 53% and 69%, respectively, P-values<0.05).The Affordable Care Act's copayment elimination was associated with a modest increase in TCP use and a greater effect among low-income smokers. Uptake may have been enhanced if promoted to patients directly and via providers.

View details for DOI 10.1097/MLR.0000000000000987

View details for Web of Science ID 000447699000005

View details for PubMedID 30234768
Tobacco Cessation in Oncology Care. Oncology Kaiser, E. G., Prochaska, J. J., Kendra, M. S. 2018: 1–9
Abstract

Globally, tobacco use is a major modifiable risk factor and leading cause of many forms of cancer and cancer death. Tobacco use contributes to poorer prognosis in cancer care. This article reviews the current state of tobacco cessation treatment in oncology. Effective behavioral and pharmacological treatments exist for tobacco cessation, but are not being widely used in oncology treatment settings. Comprehensive tobacco treatment increases success with quitting smoking and can improve oncological and overall health outcomes. This article describes the components of a model treatment program, which includes automatic referrals for all current tobacco users and recent quitters, motivational interviewing during initial and follow-up contacts, combined behavioral and pharmacological interventions for cessation, and systematic follow-up phone calls for relapse prevention.

View details for DOI 10.1159/000489266

View details for PubMedID 29920482
Using Facebook to address smoking and heavy drinking in young adults: Protocol for a randomized, controlled trial CONTEMPORARY CLINICAL TRIALS Ramo, D. E., Kaur, M., Corpuz, E. S., Satre, D. D., Delucchi, K., Brown, S. A., Prochaska, J. J. 2018; 68: 52–60
Abstract

Tobacco and alcohol often are used simultaneously by young adults, and their co-use is associated with greater health consequences than from single use. Social media platforms offer low cost and highly accessible channels to reach and engage young people in substance use interventions. The current trial seeks to compare the Facebook Tobacco Status Project (TSP) smoking cessation intervention to an intervention targeting both tobacco use and heavy episodic drinking (TSP + ALC) among young adults who use both substances.This randomized clinical trial will evaluate the feasibility and initial efficacy of TSP + ALC compared to TSP with 225 US young adult smokers reporting heavy drinking. Participants will be recruited online and randomized to one of two conditions (TSP or TSP + ALC), both with assignment to a Facebook group tailored to readiness to quit smoking. Groups will receive a 90-day intervention including daily Facebook postings and weekly live counseling sessions. The TSP + ALC group will include content related to alcohol use. All participants will be offered a 2-week introductory supply of nicotine patch. Participants will complete baseline, 3-, 6-, and 12-month online assessments of substance use and other health risk behaviors. The primary efficacy outcome is biochemically-verified 7-day point prevalence abstinence. Secondary outcomes include alcohol and tobacco use, combined use, and thoughts about each substance.This trial examines an innovative and scalable approach to engaging young adults online in tobacco and alcohol use treatment. Study findings will inform digital health interventions and best practices for treating multiple substance use in young adults.

View details for DOI 10.1016/j.cct.2018.02.014

View details for Web of Science ID 000431163300007

View details for PubMedID 29510223

View details for PubMedCentralID PMC5937713
Internet gaming disorder: A sign of the times, or time for our attention? ADDICTIVE BEHAVIORS Faust, K. A., Prochaska, J. J. 2018; 77: 272–74
View details for DOI 10.1016/j.addbeh.2017.07.009

View details for Web of Science ID 000417661000041

View details for PubMedID 28720303
Do you vape? Leveraging electronic health records to assess clinician documentation of electronic nicotine delivery system use among adolescents and adults PREVENTIVE MEDICINE Young-Wolff, K. C., Klebaner, D., Folck, B., Carter-Harris, L., Salloum, R. G., Prochaska, J. J., Fogelberg, R., Tan, A. L. 2017; 105: 32–36
Abstract

Use of electronic nicotine delivery systems (ENDS) has increased substantially over the past decade. However, unlike smoking, which is systematically captured by clinicians through routine screening and discrete documentation fields in the electronic health record (EHR), unknown is the extent to which clinicians are documenting patients' use of ENDS. Data were gathered from medical visits with patients aged 12 and older (N=9,119; 55% male) treated in a large, integrated healthcare system. We used natural language processing to assess the incidence rates of clinician documentation of patients' ENDS use in unstructured tobacco comments in the EHR, and the words most frequently documented in relation to ENDS, from 2006-2015. ENDS documentation in the EHR increased dramatically over time (from 0.01 to 9.5 per 10,000 patients, p<0.0001), particularly among adults aged 18-24 and 25-44. Most prevalent were "e-cig," "electronic cigarettes", and "vape," with much variation in spelling and phrasing of these words. Records of adolescent and young adult patients were more likely to contain the word "vape", and less likely to have "e-cig" and "electronic cigarette" than records of adults (ps<0.0001). The relatively low observed number of patients with ENDS terms in the EHR suggested vast under documentation. While healthcare providers are increasingly documenting patients' use of ENDS in the EHR, overall documentation rates remain low. Discrete EHR fields for standard screening and documentation of ENDS that reflect the language used by patients would provide more complete longitudinal population-level surveillance of ENDS use and its association with short- and long-term health outcomes.

View details for DOI 10.1016/j.ypmed.2017.08.009

View details for Web of Science ID 000413328800006

View details for PubMedID 28823688

View details for PubMedCentralID PMC5796533
The flip side of Natural American Spirit: corporate social responsibility advertising. Tobacco control Epperson, A. E., Prochaska, J. J., Henriksen, L. 2017
View details for DOI 10.1136/tobaccocontrol-2016-053576

View details for PubMedID 28237942
Latino Adults' Perspectives on Treating Tobacco Use Via Social Media. JMIR mHealth and uHealth Anguiano, B., Brown-Johnson, C., Rosas, L. G., Pechmann, C., Prochaska, J. J. 2017; 5 (2)
Abstract

Latinos are the largest minority group in the United States, and in California they outnumber non-Hispanic whites. Smoking cessation programs tailored for Latino culture, and this population's specific smoking patterns, are needed. Online social networks for smoking cessation have high potential for Latinos, but have not been tested to date.Building a research program on social media apps for cancer prevention in diverse populations, this qualitative study assessed acceptability of tobacco treatment that was distributed via social media for Latino smokers.We conducted three focus groups with Latino adults who were former and current smokers recruited from Santa Clara County, California in 2015 (N=32). We assessed participants' smoking histories, attempts to quit, social media exposure, and receptivity to a social media-based smoking cessation intervention. Audio transcripts were translated and coded for themes.Participants reported factors driving their tobacco use and motivations to quit, and emphasized the importance of community and family in influencing their smoking initiation, cravings and triggers, attempts to quit, and abstinence. Participants valued the communal aspect of social media and suggested strategically tailoring groups based on key features (eg, age, gender, language preference). Participants reported preferring visual, educational, and motivational messages that were connected with existing services.Participants generally voiced acceptability of a social media-delivered intervention to help them quit smoking, viewed the intervention as well-equipped for catering to the strong community orientation of Latinos, and suggested that the platform was able to address variation within the population through strategic group creation. As a group member reflected, "Podemos hacerlo juntos" (We can do it together).

View details for DOI 10.2196/mhealth.6684

View details for PubMedID 28179217

View details for PubMedCentralID PMC5322200
Applying novel technologies and methods to inform the ontology of self-regulation Behaviour Research and Therapy Eisenberg, I. W., Bissett, P. G., Enkavi, A. Z., Poldrack, R. A. 2017: 46–57
Abstract

Self-regulation is a broad construct representing the general ability to recruit cognitive, motivational and emotional resources to achieve long-term goals. This construct has been implicated in a host of health-risk behaviors, and is a promising target for fostering beneficial behavior change. Despite its clear importance, the behavioral, psychological and neural components of self-regulation remain poorly understood, which contributes to theoretical inconsistencies and hinders maximally effective intervention development. We outline a research program that seeks to define a neuropsychological ontology of self-regulation, articulating the cognitive components that compose self-regulation, their relationships, and their associated measurements. The ontology will be informed by two large-scale approaches to assessing individual differences: first purely behaviorally using data collected via Amazon's Mechanical Turk, then coupled with neuroimaging data collected from a separate population. To validate the ontology and demonstrate its utility, we will then use it to contextualize health risk behaviors in two exemplar behavioral groups: overweight/obese adults who binge eat and smokers. After identifying ontological targets that precipitate maladaptive behavior, we will craft interventions that engage these targets. If successful, this work will provide a structured, holistic account of self-regulation in the form of an explicit ontology, which will better clarify the pattern of deficits related to maladaptive health behavior, and provide direction for more effective behavior change interventions.

View details for DOI 10.1016/j.brat.2017.09.014

View details for PubMedCentralID PMC5801197
Associations with E-cigarette use among Asian American and Pacific Islander young adults in California. Preventive medicine reports Maglalang, D. D., Brown-Johnson, C., Prochaska, J. J. 2016; 4: 29-32
Abstract

With attention to the rapidly growing market of electronic nicotine delivery systems (ENDS/e-cigarettes) and the fastest growing US ethnic minority group, the current study explored associations between awareness, perceived risks, and use of ENDS among Asian American and Pacific Islander (AAPI) young adults. AAPI young adults (ages 18-25) in California were recruited via social media, college classes, listservs for AAPI-serving non-profits, and snowball sampling to complete an anonymous survey between 2014 and 2015. The sample (N = 501) was 57% women, 15% LGBTQIA; with a mean age of 21; 26% foreign-born; identifying as Filipino (29%), Chinese (24%), Vietnamese (14%), mixed-AAPI heritage (13%), or 21% other. Nearly half the sample (44%) reported ever ENDS use; 11% were current users. Current ENDS use was twofold greater for: Filipino and Vietnamese compared to Chinese respondents; men versus women; LGBTQIA-identified respondents; those vocationally trained; and employed. Awareness of ENDS from peers/friends was most common and was associated with ever though not current ENDS use. Most respondents perceived ENDS as harmful (62%); low compared to high risk perception was associated with a three-fold greater likelihood of ever use and six-fold greater likelihood of current use. Popular flavors were fruit (49%, e.g., lychee, taro) and candy/sweets (26%). Current users viewed ENDS as a healthier alternative or quit aid for conventional cigarettes (42%); recreation/social use (33%) also was common. Findings indicate ENDS visibility among AAPI young adults in California with affinity for flavors and many engaging in trial and current use for harm reduction and recreational/social aims.

View details for DOI 10.1016/j.pmedr.2016.05.011

View details for PubMedID 27413658
Correlates of nicotine withdrawal severity in smokers during a smoke-free psychiatric hospitalization PREVENTIVE MEDICINE Soyster, P., Anzai, N. E., Fromont, S. C., Prochaska, J. J. 2016; 92: 176-182
Abstract

Psychiatric hospitals are increasingly adopting smoke-free policies. Tobacco use is common among persons with mental illness, and nicotine withdrawal (NW), which includes symptoms of depression, anxiety, anger/irritability, and sleep disturbance, may confound psychiatric assessment and treatment in the inpatient setting. This study aimed to characterize NW and correlates of NW severity in a sample of smokers hospitalized for treatment of mental illness in California. Participants (N=754) were enrolled between 2009 and 2013, and averaged 17 (SD=10) cigarettes/day prior to hospitalization. Though most (70%) received nicotine replacement therapy (NRT) during hospitalization, a majority (65%) reported experiencing moderate to severe NW. In a general linear regression model, NW symptoms were more severe for women, African American patients, and polysubstance abusers. Though invariant by psychiatric diagnostic category, greater NW was associated with more severe overall psychopathology and greater cigarette dependence. The full model explained 46% of the total variation in NW symptom severity (F [19, 470]=23.03 p<0.001). A minority of participants (13%) refused NRT during hospitalization. Those who refused NRT reported milder cigarette dependence and stated no prior use of NRT. Among smokers hospitalized for mental illness, NW severity appears multidetermined, related to cigarette dependence, demographic variables, psychiatric symptom severity, and other substance use. Assessment and treatment of NW in the psychiatric hospital is clinically warranted and with extra attention to groups that may be more vulnerable or naïve to cessation pharmacotherapy.

View details for DOI 10.1016/j.ypmed.2016.01.026

View details for Web of Science ID 000388380400025

View details for PubMedID 26892910
Health-related quality of life among veterans in addictions treatment: identifying behavioral targets for future intervention QUALITY OF LIFE RESEARCH Oppezzo, M. A., Michalek, A. K., Delucchi, K., Baiocchi, M. T., Barnett, P. G., Prochaska, J. J. 2016; 25 (8): 1949-1957
Abstract

US veterans report lower health-related quality of life (HRQoL) relative to the general population. Identifying behavioral factors related to HRQoL that are malleable to change may inform interventions to improve well-being in this vulnerable group.The current study sought to characterize HRQoL in a largely male sample of veterans in addictions treatment, both in relation to US norms and in association with five recommended health behavior practices: regularly exercising, managing stress, having good sleep hygiene, consuming fruits and vegetables, and being tobacco free.We assessed HRQoL with 250 veterans in addictions treatment (96 % male, mean age 53, range 24-77) using scales from four validated measures. Data reduction methods identified two principal components reflecting physical and mental HRQoL. Model testing of HRQoL associations with health behaviors adjusted for relevant demographic and treatment-related covariates.Compared to US norms, the sample had lower HRQoL scores. Better psychological HRQoL was associated with higher subjective social standing, absence of pain or trauma, lower alcohol severity, and monotonically with the sum of health behaviors (all p < 0.05). Specifically, psychological HRQoL was associated with regular exercise, stress management, and sleep hygiene. Regular exercise also related to better physical HRQoL. The models explained >40 % of the variance in HRQoL.Exercise, sleep hygiene, and stress management are strongly associated with HRQoL among veterans in addictions treatment. Future research is needed to test the effect of interventions for improving well-being in this high-risk group.

View details for DOI 10.1007/s11136-016-1236-3

View details for Web of Science ID 000380005900009

View details for PubMedID 26886926
Mapping Engagement in Twitter-Based Support Networks for Adult Smoking Cessation. American journal of public health Lakon, C. M., Pechmann, C., Wang, C., Pan, L., Delucchi, K., Prochaska, J. J. 2016; 106 (8): 1374-1380
Abstract

We examined engagement in novel quit-smoking private social support networks on Twitter, January 2012 to April 2014. We mapped communication patterns within 8 networks of adult smokers (n = 160) with network ties defined by participants' tweets over 3 time intervals, and examined tie reciprocity, tie strength, in-degree centrality (popularity), 3-person triangles, 4-person cliques, network density, and abstinence status. On average, more than 50% of ties were reciprocated in most networks and most ties were between abstainers and nonabstainers. Tweets formed into more aggregated patterns especially early in the study. Across networks, 35.00% (7 days after the quit date), 49.38% (30 days), and 46.88% (60 days) abstained from smoking. We demonstrated that abstainers and nonabstainers engaged with one another in dyads and small groups. This study preliminarily suggests potential for Twitter as a platform for adult smoking-cessation interventions.

View details for DOI 10.2105/AJPH.2016.303256

View details for PubMedID 27310342
Reporting of cigar use among adolescent tobacco smokers ADDICTIVE BEHAVIORS Rait, M. A., Prochaska, J. J., Rubinstein, M. L. 2016; 53: 206-209
View details for DOI 10.1016/j.addbeh.2015.06.035

View details for Web of Science ID 000367278800033
"You have the right to protect your health": Perceptions of Secondhand Smoke and Exposure Mitigation Strategies in Low-Income Patients With Heart Disease, San Francisco, 2011-2012. Preventing chronic disease Brown-Johnson, C. G., Oppezzo, M., Benowitz, N. L., Prochaska, J. J. 2016; 13: E116-?
Abstract

We examined the understanding of the harms of secondhand smoke (SHS) exposure among low-income, hospitalized adults with cardiovascular disease. Participants were 15 nonsmokers reporting daily SHS exposure and 15 light or nondaily cigarette smokers. We coded responses from audiotaped semistructured interviews for themes. No participant spontaneously identified heart risks related to SHS exposure. Strategies to avoid SHS included verbal requests to not smoke and physically avoiding smoke; both smokers and nonsmokers prioritized politeness over urgency. Most participants thought a blood test quantifying SHS exposure would be clinically useful. Health education, assertiveness communication training, and protective policies (eg, smoke-free multiunit housing) also were supported.

View details for DOI 10.5888/pcd13.150593

View details for PubMedID 27560724
Smokers with serious mental illness and requests for nicotine replacement therapy post-hospitalisation TOBACCO CONTROL Schuck, R. K., Dahl, A., Hall, S. M., Delucchi, K., Fromont, S. C., Hall, S. E., Bonas, T., Prochaska, J. J. 2016; 25 (1): 27-32
View details for DOI 10.1136/tobaccocontrol-2014-051712

View details for Web of Science ID 000366868900011

View details for PubMedID 25209524
Retrospective analysis of changing characteristics of treatment-seeking smokers: implications for further reducing smoking prevalence. BMJ open Leyro, T. M., Crew, E. E., Bryson, S. W., Lembke, A., Bailey, S. R., Prochaska, J. J., Henriksen, L., Fortmann, S. P., Killen, J. D., Killen, D. T., Hall, S. M., David, S. P. 2016; 6 (6)
Abstract

The goal of the current study was to empirically compare successive cohorts of treatment-seeking smokers who enrolled in randomised clinical trials in a region of the USA characterised by strong tobacco control policies and low smoking prevalence, over the past three decades.Retrospective treatment cohort comparison.Data were collected from 9 randomised clinical trials conducted at Stanford University and the University of California, San Francisco, between 1990 and 2013.Data from a total of 2083 participants were included (Stanford, n=1356; University of California San Francisco, n=727).One-way analysis of variance and covariance, χ(2) and logistic regression analyses were used to examine relations between nicotine dependence, cigarettes per day, depressive symptoms and demographic characteristics among study cohorts.Similar trends were observed at both settings. When compared to earlier trials, participants in more recent trials smoked fewer cigarettes, were less nicotine-dependent, reported more depressive symptoms, were more likely to be male and more likely to be from a minority ethnic/racial group, than those enrolled in initial trials (all p's<0.05). Analysis of covariances revealed that cigarettes per day, nicotine dependence and current depressive symptom scores were each significantly related to trial (all p's<0.001).Our findings suggest that more recent smoking cessation treatment-seeking cohorts in a low prevalence region were characterised by less smoking severity, more severe symptoms of depression and were more likely to be male and from a minority racial/ethnic group.

View details for DOI 10.1136/bmjopen-2015-010960

View details for PubMedID 27357195
Feasibility and Quit Rates of the Tobacco Status Project: A Facebook Smoking Cessation Intervention for Young Adults JOURNAL OF MEDICAL INTERNET RESEARCH Ramo, D. E., Thrul, J., Chavez, K., Delucchi, K. L., Prochaska, J. J. 2015; 17 (12)
View details for DOI 10.2196/jmir.5209

View details for Web of Science ID 000367900700001
Recruitment of adolescents for a smoking study: use of traditional strategies and social media. Translational behavioral medicine Rait, M. A., Prochaska, J. J., Rubinstein, M. L. 2015; 5 (3): 254-259
Abstract

Engaging and retaining adolescents in research studies is challenging. Social media offers utility for expanding the sphere of research recruitment. This study examined and compared traditional and Facebook-based recruitment strategies on reach, enrollment, cost, and retention. Substance users aged 13-17 years were recruited through several methods, including social media, a study website, fliers, talks in schools, bus ads, and referrals. Study involvement included a one-time visit and semiannual follow-up surveys. 1265 individuals contacted study personnel; 629 were ineligible; 129 declined; and 200 participants enrolled. Facebook drew the greatest volume but had a high rate of ineligibles. Referrals were the most successful and cost-effective ($7 per enrolled participant); school talks were the least. Recruitment source was unrelated to retention success. Facebook may expand recruitment reach, but had greater financial costs and more ineligible contacts, resulting in fewer enrollees relative to traditional interpersonal recruitment methods. Referrals, though useful for study engagement, did not provide a differential benefit in terms of long-term retention.

View details for DOI 10.1007/s13142-015-0312-5

View details for PubMedID 26327930
Smoking cessation and the cardiovascular patient. Current opinion in cardiology Prochaska, J. J., Benowitz, N. L. 2015; 30 (5): 506-511
Abstract

Smoking remains the leading cause of preventable morbidity and mortality. Our review highlights research from 2013 to 2015 on the treatment of cigarette smoking, with a focus on heart patients and cardiovascular outcomes.Seeking to maximize the reach and effectiveness of existing cessation medications, current tobacco control research has demonstrated the safety and efficacy of combination treatment, extended use, reduce-to-quit strategies, and personalized approaches to treatment matching. Further, cytisine has gained interest as a lower-cost strategy for addressing the global tobacco epidemic. On the harm reduction front, snus and electronic nicotine delivery systems are being widely distributed and promoted with major gaps in knowledge of the safety of long-term and dual use. Quitlines, comparable in outcome to in-person treatment, make cessation counseling available on a national scale, though use rates remain relatively low. Employee reward programs are gaining attention given the high costs of tobacco use to employers; sustaining quit rates postpayment, however, has proven challenging.Evidence-based cessation treatments exist. Broader dissemination, adoption, and implementation are key to addressing the tobacco epidemic. The cardiology team has a professional obligation to advance tobacco control efforts and can play an important role in achieving a smoke-free future.

View details for DOI 10.1097/HCO.0000000000000204

View details for PubMedID 26196657
Validity and reliability of the internalized stigma of smoking inventory: An exploration of shame, isolation, and discrimination in smokers with mental health diagnoses AMERICAN JOURNAL ON ADDICTIONS Brown-Johnson, C. G., Cataldo, J. K., Orozco, N., Lisha, N. E., Hickman, N. J., Prochaska, J. J. 2015; 24 (5): 410-418
Abstract

De-normalization of smoking as a public health strategy may create shame and isolation in vulnerable groups unable to quit. To examine the nature and impact of smoking stigma, we developed the Internalized Stigma of Smoking Inventory (ISSI), tested its validity and reliability, and explored factors that may contribute to smoking stigma.We evaluated the ISSI in a sample of smokers with mental health diagnoses (N = 956), using exploratory and confirmatory factor analysis, and assessed construct validity.Results reduced the ISSI to eight items with three subscales: smoking self-stigma related to shame, felt stigma related to social isolation, and discrimination experiences. Discrimination was the most commonly endorsed of the three subscales. A multivariate generalized linear model predicted 21-30% of the variance in the smoking stigma subscales. Self-stigma was greatest among those intending to quit; felt stigma was highest among those experiencing stigma in other domains, namely ethnicity and mental illness-based; and smoking-related discrimination was highest among women, Caucasians, and those with more education.Smoking stigma may compound stigma experiences in other areas. Aspects of smoking stigma in the domains of shame, isolation, and discrimination were related to modeled stigma responses, particularly readiness to quit and cigarette addiction, and were found to be more salient for groups where tobacco use is least prevalent.The ISSI measure is useful for quantifying smoking-related stigma in multiple domains. (Am J Addict 2015;24:410 -418).

View details for DOI 10.1111/ajad.12215

View details for Web of Science ID 000358620400006
Treating Tobacco Dependence at the Intersection of Diversity, Poverty, and Mental Illness: A Randomized Feasibility and Replication Trial. Nicotine & tobacco research Hickman, N. J., Delucchi, K. L., Prochaska, J. J. 2015; 17 (8): 1012-1021
Abstract

In an ethnically-diverse, uninsured psychiatric sample with co-occurring drug/alcohol addiction, we evaluated the feasibility and reproducibility of a tobacco treatment intervention. The intervention previously demonstrated efficacy in insured psychiatric and nonpsychiatric samples with 20.0%-25.0% abstinence at 18 months.Daily smokers, recruited in 2009-2010 from psychiatric units at an urban public hospital, were randomized to usual care (on-unit nicotine replacement plus quit advice) or intervention, which added a Transtheoretical-model tailored, computer-assisted intervention, stage-matched manual, brief counseling, and 10-week post-hospitalization nicotine replacement.The sample (N = 100, 69% recruitment rate, age M = 40) was 56% racial/ethnic minority, 65% male, 79% unemployed, and 48% unstably housed, diagnosed with unipolar (54%) and bipolar (14%) depression and psychotic disorders (46%); 77% reported past-month illicit drug use. Prior to hospitalization, participants averaged 19 (SD = 11) cigarettes/day for 23 (SD = 13) years; 80% smoked within 30 minutes of awakening; 25% were preparing to quit. Encouraging and comparable to effects in the general population, 7-day point prevalence abstinence for intervention versus control was 12.5% versus 7.3% at 3 months, 17.5% versus 8.5% at 6 months, and 26.2% versus 16.7% at 12 months. Retention exceeded 80% over 12 months. The odds of abstinence increased over time, predicted by higher self-efficacy, greater perceived social status, and diagnosis of psychotic disorder compared to unipolar depression.Findings indicate uninsured smokers with serious mental illness can engage in tobacco treatment research with quit rates comparable to the general population. A larger investigation is warranted. Inclusion of diverse smokers with mental illness in clinical trials is supported and encouraged.

View details for DOI 10.1093/ntr/ntv034

View details for PubMedID 26180227
Engaging veterans with substance abuse disorders into a research trial: success with study branding, networking, and presence TRANSLATIONAL BEHAVIORAL MEDICINE Michalek, A. K., Kan, D., Prochaska, J. 2015; 5 (2): 167-176
Abstract

Recruiting and retaining clients in health interventions can be challenging especially when targeting multiple behavior change in high-risk populations. To inform the methods of trials working with similarly complex clinical populations, we describe multi-pronged efforts to recruit and retain a representative sample. In a two-group RCT, veterans were recruited from a Veteran Affairs Medical Center. The goal was to enroll 200 participants over a 25-month period, and to exceed 70 % follow-up for all treatment arms. To meet these goals, a four-pronged strategy was developed: branding, outreach/networking, onsite presence, and incentives. In month 1, 32 % of the proposed sample size was met (n = 64), and by month 2, 45 % (n = 90); the recruitment goal (n = 200) was achieved 13 months ahead of schedule. Retention exceeds 90 % at all time points out to 18 months. The multipronged recruitment and retention plan was efficient, cost effective, and may generalize to other health promotion initiatives.

View details for DOI 10.1007/s13142-014-0302-z

View details for Web of Science ID 000356788700006

View details for PubMedID 26029279
Scientist-Practitioner Training at the Internship and Postdoctoral Level: Reflections Over Three Decades TRAINING AND EDUCATION IN PROFESSIONAL PSYCHOLOGY Munoz, R. F., Sorensen, J. L., Arean, P. A., Lieberman, A. F., Fields, L., Gruber, V. A., Hall, S. M., Kramer, J. H., Leykin, Y., McBurnett, K., McQuaid, J. R., Pfiffner, L. J., Prochaska, J. J., Scheidt, S. D., Shumway, M., Tsoh, J. Y., Van Horn, P., Sosa, H., McNiel, D. E. 2015; 9 (2): 105-112
View details for DOI 10.1037/tep0000058

View details for Web of Science ID 000354607000005
Gender differences in a randomized controlled trial treating tobacco use among adolescents and young adults with mental health concerns. Nicotine & tobacco research Prochaska, J. J., Fromont, S. C., Ramo, D. E., Young-Wolff, K. C., Delucchi, K., Brown, R. A., Hall, S. M. 2015; 17 (4): 479-485
Abstract

Treatment of tobacco use in mental health settings is rare despite high rates of comorbidity. With a focus on early intervention, we evaluated a tobacco treatment intervention among adolescents and young adults recruited from outpatient, school-based, and residential mental health settings and tested for gender differences.Intervention participants received computerized motivational feedback at baseline, 3 months, and 6 months and were offered 12 weeks of cessation counseling and nicotine patches. Usual care participants received a self-help guide and brief cessation advice. We examined 7-day point prevalence abstinence with biochemical confirmation at 3, 6, and 12 months; smoking reduction; and 24-hr quit attempts.At baseline, the sample (N = 60, 52% female, mean age = 19.5±2.9 years, 40% non-Hispanic Caucasian) averaged 7±6 cigarettes/day, 62% smoked daily, 38% smoked ≤ 30min of waking, 12% intended to quit in the next month, 47% had a parent who smoked, and 3 of 5 of participants' closest friends smoked on average. During the 12-month study, 47% of the sample reduced their smoking, 80% quit for 24 hr, and 11%, 13%, and 17% confirmed 7-day point prevalence abstinence at 3-, 6-, and 12-month follow-up, respectively, with no differences by treatment condition (ps > .400). Over time, abstinence was greater among girls (adjusted odds ratio [AOR] = 8.9) than among boys, and abstinence was greater for lighter smokers than heavier smokers (AOR = 4.5) (p < .05). No mental health or other measured variables predicted abstinence.Adolescent and young adult smokers with mental health concerns are a challenging group to engage and to effectively treat for tobacco addiction, particularly heavier smokers and boys. Innovative approaches are needed.

View details for DOI 10.1093/ntr/ntu205

View details for PubMedID 25762759
Symptom severity and readiness to quit among hospitalized smokers with mental illness. Psychiatric services Anzai, N., Young-Wolff, K. C., Prochaska, J. J. 2015; 66 (4): 443-444
View details for DOI 10.1176/appi.ps.201400181

View details for PubMedID 25828988
Smoking cessation abstinence goal in treatment-seeking smokers ADDICTIVE BEHAVIORS Hall, S. M., Shi, Y., Humfleet, G. L., Munoz, R. F., Reus, V. I., Prochaska, J. J. 2015; 42: 148-153
Abstract

Baseline abstinence goal is a robust predictor of cigarette abstinence. However, important questions about goal remain unanswered. These include variables correlating with goal, changes in goal, relationship of goal and abstinence status over time, and predictors of change. The current study aimed to address these questions.Participants were treatment-seeking volunteers in two clinical trials. In Clinical Trial 1 (N=402), participants smoked ≥10 cigarettes per day (CPD) and were ≥50years of age. In Clinical Trial 2 (N=406), participants smoked ≥10 CPD, smoked within 30min of arising, and were ≥18years of age. The outcome variables were biochemically verified 7-day abstinence from cigarettes at weeks 12, 24, 52, and 104. Abstinence goal, demographic, psychological, and smoking related variables were assessed via standard instruments.At baseline, the greater the desire to quit and one's expectations of success, and the lesser the educational level, the more likely participants were to have a quit forever goal. Throughout the two-year study, abstinence from cigarettes and a lower educational level were correlated with a goal of quit forever; 37% of participants changed goal. There were no predictors of goal change. Abstinence goal was related to abstinence status across the study period. The goal predicted abstinence status at subsequent assessments, even when status was controlled.Lesser educational levels were consistent predictors of a more stringent goal. Abstinence goal changes over time. These findings suggest that repeated counseling about goal is advisable and participants would benefit from such counseling, independent of demographic characteristics and smoking status.

View details for DOI 10.1016/J.addbeh.2014.11.012

View details for Web of Science ID 000348555100028

View details for PubMedID 25462664
A mixed-methods study of young adults' receptivity to using Facebook for smoking cessation: if you build it, will they come? American journal of health promotion Ramo, D. E., Liu, H., Prochaska, J. J. 2015; 29 (4): e126-35
Abstract

To determine whether young adults are interested in a Facebook intervention for smoking cessation and to inform the design of such an intervention.Mixed-methods.Participants throughout the United States were recruited through Facebook.Young adults aged 18 to 25 years who had smoked at least once in the past month.Participants (N = 570) completed an online survey of tobacco and social media use. A subset of 30 survey completers, stratified by motivation to quit smoking, agreed to participate in a structured interview over online chat. Themes were identified by using grounded theory.Approximately a third of the full sample (31%) reported they would want to get help to quit smoking by using Facebook. Interest in using Facebook to quit was greater among those who were more motivated to quit (χ(2) = 75.2, p < .001), had made a quit attempt in the past year (χ(2) = 16.0, p < .001), and had previously used the Internet for assistance with a quit attempt (χ(2) = 6.2, p = .013). In qualitative interviews, social support and convenience were identified as strengths of a Facebook intervention, while privacy was the main issue of concern.Nearly one in three young adult smokers on Facebook expressed interest in using Facebook for quitting smoking. Social media approaches that respect privacy and tailor to readiness to quit are likely to maximize participation.

View details for DOI 10.4278/ajhp.130326-QUAL-128

View details for PubMedID 24575728
Applying linguistic methods to understanding smoking-related conversations on Twitter TOBACCO CONTROL Sanders-Jackson, A., Brown, C. G., Prochaska, J. J. 2015; 24 (2): 136-138
Abstract

Social media, such as Twitter, have become major channels of communication and commentary on popular culture, including conversations on our nation's leading addiction: tobacco. The current study examined Twitter conversations following two tobacco-related events in the media: (1) President Obama's doctor announcing that he had quit smoking and (2) the release of a photograph of Miley Cyrus (a former Disney child star) smoking a cigarette. With a focus on high-profile individuals whose actions can draw public attention, we aimed to characterise tobacco-related conversations as an example of tobacco-related public discourse and to present a novel methodology for studying social media.Tweets were collected 11-13 November 2011 (President Obama) and 1-3 August 2011 (Miley Cyrus) and analysed for relative frequency of terms, a novel application of a linguistic methodology.The President Obama data set (N=2749 tweets) had conversations about him quitting tobacco as well as a preponderance of information on political activity, links to websites, racialised terms and mention of marijuana. Websites and terms about Obama's smoke-free status were most central to the conversation. In the Miley Cyrus data (N=4746 tweets), terms that occurred with the greatest relative frequency were positive, emotional and supportive of quitting (eg, love, and please), with words such as 'love' most central to the conversation.People are talking about tobacco-related issues on Twitter, and semantic network analysis can be used to characterise on-line conversations. Future interventions may be able to harness social media and major current events to raise awareness of smoking-related issues.

View details for DOI 10.1136/tobaccocontrol-2013-051243

View details for Web of Science ID 000350337500013

View details for PubMedID 24227540
Correlates and Prevalence of Menthol Cigarette Use Among Adults With Serious Mental Illness NICOTINE & TOBACCO RESEARCH Young-Wolff, K. C., Hickman, N. J., Kim, R., Gali, K., Prochaska, J. J. 2015; 17 (3): 285-291
Abstract

With a focus on protecting vulnerable groups from initiating and continuing tobacco use, the FDA has been considering the regulation of menthol in cigarettes. Using a large sample of adult smokers with serious mental illness (SMI) in the San Francisco Bay Area, we examined demographic and clinical correlates of menthol use, and we compared the prevalence of menthol use among our study participants to that of adult smokers in the general population in California.Adult smokers with SMI (N = 1,042) were recruited from 7 acute inpatient psychiatric units in the San Francisco Bay Area. Demographic, tobacco, and clinical correlates of menthol use were examined with bivariate and multivariate logistic regression analyses, and prevalence of menthol use was compared within racial/ethnic groups to California population estimates from the 2008-2011 National Survey on Drug Use and Health.A sample majority (57%) reported smoking menthol cigarettes. Multivariate logistic regression analyses indicated that adult smokers with SMI who were younger, who had racial/ethnic minority status, who had fewer perceived interpersonal problems, and who had greater psychotic symptoms also had a significantly greater likelihood of menthol use. Smokers with SMI had a higher prevalence of menthol use relative to the general population in California overall (24%).Individuals with SMI-particularly those who are younger, have racial/ethnic minority status, and have been diagnosed with a psychotic disorder-are vulnerable to menthol cigarette use. FDA regulation of menthol may prevent initiation and may encourage cessation among smokers with SMI.

View details for DOI 10.1093/ntr/ntu141

View details for Web of Science ID 000350949600003

View details for PubMedID 25190706
Prevalence and correlates of electronic-cigarette use in young adults: Findings from three studies over five years ADDICTIVE BEHAVIORS Ramo, D. E., Young-Wolff, K. C., Prochaska, J. J. 2015; 41: 142-147
Abstract

We aimed to examine prevalence and correlates of past-month electronic cigarette ("e-cigarette") use and use of e-cigarettes to aid a cessation attempt in three samples of young adult smokers recruited online in 2009-2010 (Study 1), 2010-2011 (Study 2), and 2013 (Study 3).Participants were young adults aged 18 to 25 who smoked at least one cigarette in the previous month (Study 1, N=1987 and Study 2, N=570) or smoked 3 or more days each week and used Facebook 4 or more days per week (Study 3, N=79). We examined both past-month e-cigarette use and ever use of e-cigarettes to quit conventional cigarettes.Prevalence of past-month use of e-cigarettes was higher in each subsequent study: Study 1 (6%), Study 2 (19%), and Study 3 (41%). In multivariate analyses, significant correlates of past-month e-cigarette use were identified for Study 1 (male sex OR=2.1, p=.03; past-year quit attempt OR=1.6, p=.03) and Study 2 (male sex, OR=1.7, p=.03; younger age OR=0.88, p=.05), but not Study 3. In multivariate analyses, significant correlates of ever use of e-cigarette to quit conventional cigarettes were identified for Study 1 (education, OR=1.2, p=.02; smoking within 30min of waking, OR=2.8, p=.02; past year quit attempt OR=4.1, p=.02), and Study 3 (desire to quit smoking, OR=1.3, p=.02), but not Study 2.E-cigarette use is increasingly common among young adults, particularly men. E-cigarette use for quitting conventional cigarettes appears more common among those more nicotine dependent and interested in quitting.

View details for DOI 10.1016/j.addbeh.2014.10.019

View details for Web of Science ID 000347496500024

View details for PubMedID 25452058

View details for PubMedCentralID PMC4314311
Electronic cigarettes in jails: a panacea or public health problem? JAMA psychiatry Young-Wolff, K. C., Karan, L. D., Prochaska, J. J. 2015; 72 (2): 103-104
View details for DOI 10.1001/jamapsychiatry.2014.2224

View details for PubMedID 25471086
Validity of self-reported adult secondhand smoke exposure TOBACCO CONTROL Prochaska, J. J., Grossman, W., Young-Wolff, K. C., Benowitz, N. L. 2015; 24 (1): 48-53
Abstract

Exposure of adults to secondhand smoke (SHS) has immediate adverse effects on the cardiovascular system and causes coronary heart disease. The current study evaluated brief self-report screening measures for accurately identifying adult cardiology patients with clinically significant levels of SHS exposure in need of intervention.A cross-sectional study conducted in a university-affiliated cardiology clinic and cardiology inpatient service.Participants were 118 non-smoking patients (59% male, mean age=63.6 years, SD=16.8) seeking cardiology services.Serum cotinine levels and self-reported SHS exposure in the past 24 h and 7 days on 13 adult secondhand exposure to smoke (ASHES) items.A single item assessment of SHS exposure in one's own home in the past 7 days was significantly correlated with serum cotinine levels (r=0.41, p<0.001) with sensitivity ≥75%, specificity >85% and correct classification rates >85% at cotinine cut-off points of >0.215 and >0.80 ng/mL. The item outperformed multi-item scales, an assessment of home smoking rules, and SHS exposure assessed in other residential areas, automobiles and public settings. The sample was less accurate at self-reporting lower levels of SHS exposure (cotinine 0.05-0.215 ng/mL).The single item ASHES-7d Home screener is brief, assesses recent SHS exposure over a week's time, and yielded the optimal balance of sensitivity and specificity. The current findings support use of the ASHES-7d Home screener to detect SHS exposure and can be easily incorporated into assessment of other major vital signs in cardiology.

View details for DOI 10.1136/tobaccocontrol-2013-051174

View details for Web of Science ID 000346264200015

View details for PubMedID 23997071
The Tobacco Status Project (TSP): Study protocol for a randomized controlled trial of a Facebook smoking cessation intervention for young adults. BMC public health Ramo, D. E., Thrul, J., Delucchi, K. L., Ling, P. M., Hall, S. M., Prochaska, J. J. 2015; 15 (1): 897-?
Abstract

Tobacco use remains the leading cause of premature morbidity and mortality in the United States. Young adults are less successful at quitting, use cessation treatment less often than smokers of other ages, and can be a challenge to retain in treatment. Social media, integrated into the lives of many young adults, represents a promising strategy to deliver evidence-based smoking cessation treatment to a large, diverse audience. The goal of this trial is to test the efficacy of a stage-based smoking cessation intervention on Facebook for young adults age 18 to 25 on smoking abstinence, reduction in cigarettes smoked, and thoughts about smoking abstinence.This is a randomized controlled trial. Young adult smokers throughout the United States are recruited online and randomized to either the 3 month Tobacco Status Project intervention on Facebook or a referral to a smoking cessation website. The intervention consists of assignment to a secret Facebook group tailored to readiness to quit smoking (precontemplation, contemplation, preparation), daily Facebook contacts tailored to readiness to quit smoking, weekly live counseling sessions, and for those in preparation, weekly Cognitive Behavioral Therapy counseling sessions on Facebook. Primary outcome measure is biochemically-verified 7-day point prevalence abstinence from smoking at posttreatment (3 months), 6, and 12 months. Secondary outcome measures are reduction of 50 % or more in cigarettes smoked, 24 h quit attempts, and commitment to abstinence at each time point. A secondary aim is to test, within the TSP condition, the effect of a monetary incentive at increasing engagement in the intervention.This randomized controlled trial is testing a novel Facebook intervention for treating young adults' tobacco use. If efficacious, the social media intervention could be disseminated widely and expanded to address additional health risks.ClinicalTrials.gov: NCT02207036 , May 13, 2014.

View details for DOI 10.1186/s12889-015-2217-0

View details for PubMedID 26374203
Multiple risk-behavior profiles of smokers with serious mental illness and motivation for change. Health psychology Prochaska, J. J., Fromont, S. C., Delucchi, K., Young-Wolff, K. C., Benowitz, N. L., Hall, S., Bonas, T., Hall, S. M. 2014; 33 (12): 1518-1529
Abstract

Objective: Individuals with serious mental illness (SMI) are dying on average 25 years prematurely. The leading causes are chronic preventable diseases. In the context of a tobacco-treatment trial, this exploratory study examined the behavioral risk profiles of adults with SMI to identify broader interventional needs. Method: Recruited from five acute inpatient psychiatry units, participants were 693 adult smokers (recruitment rate = 76%, 50% male, 45% Caucasian, age M = 39, 49% had income < $10,000) diagnosed with mood disorders (71%), substance-use disorders (63%), posttraumatic stress disorder (39%), psychotic disorders (25%), and attention deficit-hyperactivity disorder (25%). The Staging Health Risk Assessment, the primary measure used in this study, screened for risk status and readiness to change 11 health behaviors, referencing the period prior to acute hospitalization. Results: Participants averaged 5.2 (SD = 2.1) risk behaviors, including smoking (100%), high-fat diet (68%), inadequate fruits/vegetables (67%), poor sleep (53%), physical inactivity (52%), and marijuana use (46%). The percent prepared to change ranged from 23% for tobacco and marijuana to 76% for depression management. Latent class analysis differentiated three risk groups: the global higher risk group included patients elevated on all risk behaviors; the global lower risk group was low on all risks; and a mood and metabolic risk group, characterized by inactivity, unhealthy diet, sleep problems, and poor stress and depression management. The global higher risk group (11% of sample) was younger, largely male, and had the greatest number of risk behaviors and mental health diagnoses; had the most severe psychopathologies, addiction-treatment histories, and nicotine dependence; and the lowest confidence for quitting smoking and commitment to abstinence. Conclusion: Most smokers with SMI engaged in multiple risks. Expanding targets to treat co-occurring risks and personalizing treatment to individuals' multibehavioral profiles may increase intervention relevance, interest, and impact on health. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

View details for DOI 10.1037/a0035164

View details for PubMedID 24467257
Tobacco retailer proximity and density and nicotine dependence among smokers with serious mental illness. American journal of public health Young-Wolff, K. C., Henriksen, L., Delucchi, K., Prochaska, J. J. 2014; 104 (8): 1454-1463
Abstract

Objectives. We examined the density and proximity of tobacco retailers and associations with smoking behavior and mental health in a diverse sample of 1061 smokers with serious mental illness (SMI) residing in the San Francisco Bay Area of California. Methods. Participants' addresses were geocoded and linked with retailer licensing data to determine the distance between participants' residence and the nearest retailer (proximity) and the number of retailers within 500-meter and 1-kilometer service areas (density). Results. More than half of the sample lived within 250 meters of a tobacco retailer. A median of 3 retailers were within 500 meters of participants' residences, and a median of 12 were within 1 kilometer. Among smokers with SMI, tobacco retailer densities were 2-fold greater than for the general population and were associated with poorer mental health, greater nicotine dependence, and lower self-efficacy for quitting. Conclusions. Our findings provide further evidence of the tobacco retail environment as a potential vector contributing to tobacco-related disparities among individuals with SMI and suggest that this group may benefit from progressive environmental protections that restrict tobacco retail licenses and reduce aggressive point-of-sale marketing.

View details for DOI 10.2105/AJPH.2014.301917

View details for PubMedID 24922145
Frequent marijuana use is associated with greater nicotine addiction in adolescent smokers DRUG AND ALCOHOL DEPENDENCE Rubinstein, M. L., Rait, M. A., Prochaska, J. J. 2014; 141: 159-162
Abstract

Marijuana and tobacco are the substances used most commonly by adolescents and co-occurring use is common. Use of one substance may potentiate the addictive properties of the other. The current study examined the severity of nicotine addiction among teen smokers as a function of co-occurring marijuana use.Participants were 165 adolescents (13-17 years old) who reported smoking at least 1 cigarette per day (CPD) in the past 30 days. General linear models examined the association of marijuana use with multiple measures of nicotine addiction including the Modified Fagerström Tolerance Questionnaire (mFTQ), Hooked on Nicotine Checklist (HONC), ICD-10, and the Nicotine Dependence Syndrome Scale (NDSS).The adolescent sample (mean age=16.1 years, SD=0.95) averaged 3.0 CPD (SD=3.0) for 1.98 years (SD=1.5). Most (79.5%) also smoked marijuana in the past 30 days. In models controlling for age, daily smoking status, and years of tobacco smoking, frequency of marijuana use accounted for 25-44% of the variance for all four measures of adolescent nicotine dependence.Marijuana use was associated with greater reported nicotine addiction among adolescent smokers. The findings suggest a role of marijuana in potentiating nicotine addiction and underscore the need for treatments that address both smoked substances.

View details for DOI 10.1016/j.drugalcdep.2014.05.015

View details for Web of Science ID 000339149300025

View details for PubMedID 24928480
PTSD symptomatology and readiness to quit smoking among women with serious mental illness. Addictive behaviors Young-Wolff, K. C., Fromont, S. C., Delucchi, K., Hall, S. E., Hall, S. M., Prochaska, J. J. 2014; 39 (8): 1231-1234
Abstract

Posttraumatic stress disorder (PTSD) is a risk factor for tobacco addiction. The majority of research on PTSD and smoking has been conducted with men, particularly combat veterans, and little is known about the association among women. In a clinical sample of women civilian smokers with serious mental illness (SMI), we examined the prevalence of PTSD symptomatology and associations with physical and mental health functioning, co-occurring substance use, nicotine dependence, and readiness to quit smoking.376 adult women smokers aged 18-73 were recruited from 7 acute inpatient psychiatry units and screened by diagnostic interview for current PTSD symptomatology (PTSD(+)). In multiple regressions, we examined the associations of screening PTSD(+) with physical and mental health functioning; past-month drug use; past-year substance use disorders; nicotine dependence and readiness to quit smoking.Nearly half the sample (43%) screened PTSD(+), which was significantly associated with the use of stimulants (OR=1.26) and opiates (OR=1.98), drug use disorders (OR=2.01), and poorer mental health (B=-2.78) but not physical health functioning. PTSD(+) status was unrelated to nicotine dependence, but predicted greater desire to quit smoking (B=2.13) and intention to stop smoking in the next month (OR=2.21). In multivariate models that adjusted for substance use disorders, physical and mental health functioning, and nicotine dependence, screening PTSD(+) remained predictive of greater desire and intention to quit smoking.PTSD symptomatology was common in our sample of women smokers with SMI and associated with not only worse substance use and mental health, but also greater readiness to quit smoking, suggesting the need for and potential interest in integrative PTSD-addiction treatment among women.

View details for DOI 10.1016/j.addbeh.2014.03.024

View details for PubMedID 24813548
Maximizing Retention With High Risk Participants in a Clinical Trial AMERICAN JOURNAL OF HEALTH PROMOTION Kim, R., Hickman, N., Gali, K., Orozco, N., Prochaska, J. J. 2014; 28 (4): 268-274
Abstract

To describe effective retention strategies in a clinical trial with a high risk, low-income, and vulnerable patient population with serious mental illness.Follow-up assessments were conducted for a randomized clinical tobacco treatment trial at 3, 6, and 12 months postbaseline. Initial follow-up rates of <40% at 3 months led to implementation of proactive retention strategies including obtaining extensive contact information; building relationships with case managers and social workers; contacting jails and prisons; text messaging, e-mailing, and messaging via social networking sites; identifying appointments via electronic medical record; and field outreach to treatment facilities, residences, and parks.Large urban public hospital.Participants were current smokers recruited from 100% smoke-free locked psychiatry units.Assessments covered demographics, substance use, and mental health functioning.Retention rates were plotted over time in relation to key retention strategies. Chi-square and t-tests were used to examine participant predictors of retention at each follow-up. At the 12-month follow-up, the retention strategies that most frequently led to assessment completion were identified.The sample (N = 100) was 65% male; age x = 39.5 years (SD = 11.3); 44% non-Hispanic white; 46% on Medicaid and 34% uninsured; 79% unemployed; and 48% unstably housed. Proactive retention strategies dramatically increased follow-up rates, concluding at 3 months = 82.65%, 6 months = 89.69%, and 12 months = 92.78%. Married and divorced/separated/widowed participants, those with higher income, and participants with alcohol or illicit drug problems had increased retention from 3- to 12-month follow-up.Follow-up rates improved as proactive methods to contact participants were implemented. Dedicated research staff, multiple methods, community networking, and outreach within drug treatment settings improved retention.

View details for DOI 10.4278/ajhp.120720-QUAN-355

View details for Web of Science ID 000343855500009

View details for PubMedID 23875989
Facebook Recruitment of Young Adult Smokers for a Cessation Trial: Methods, Metrics, and Lessons Learned. Internet interventions Ramo, D. E., Rodriguez, T. M., Chavez, K., Sommer, M. J., Prochaska, J. J. 2014; 1 (2): 58-64
Abstract

Further understanding is needed of the functionalities and efficiency of social media for health intervention research recruitment. Facebook was examined as a mechanism to recruit young adults for a smoking cessation intervention. An ad campaign targeting young adult smokers tested specific messaging based on market theory and successful strategies used to recruit smokers in previous clinical trials (i.e. informative, call to action, scarcity, social norms), previously successful ads, and general messaging. Images were selected to target smokers (e.g., lit cigarette), appeal to the target age, vary demographically, and vary graphically (cartoon, photo, logo). Facebook's Ads Manager was used over 7 weeks (6/10/13 - 7/29/13), targeted by age (18-25), location (U.S.), and language (English), and employed multiple ad types (newsfeed, standard, promoted posts, sponsored stories) and keywords. Ads linked to the online screening survey or study Facebook page. The 36 different ads generated 3,198,373 impressions, 5,895 unique clicks, at an overall cost of $2,024 ($0.34/click). Images of smoking and newsfeed ads had the greatest reach and clicks at the lowest cost. Of 5,895 unique clicks, 586 (10%) were study eligible and 230 (39%) consented. Advertising costs averaged $8.80 per eligible, consented participant. The final study sample (n=79) was largely Caucasian (77%) and male (69%), averaging 11 cigarettes/day (SD=8.3) and 2.7 years smoking (SD=0.7). Facebook is a useful, cost-effective recruitment source for young adult smokers. Ads posted via newsfeed posts were particularly successful, likely because they were viewable via mobile phone. Efforts to engage more ethnic minorities, young women, and smokers motivated to quit are needed.

View details for PubMedID 25045624

View details for PubMedCentralID PMC4100621
Cardiovascular Events Associated With Smoking Cessation Pharmacotherapies A Network Meta-Analysis CIRCULATION Mills, E. J., Thorlund, K., Eapen, S., Wu, P., Prochaska, J. J. 2014; 129 (1): 28-?
Abstract

Stopping smoking is associated with many important improvements in health and quality of life. The use of cessation medications is recommended to increase the likelihood of quitting. However, there is historical and renewed concern that smoking cessation therapies may increase the risk of cardiovascular disease events associated within the quitting period. We aimed to examine whether the 3 licensed smoking cessation therapies-nicotine replacement therapy, bupropion, and varenicline-were associated with an increased risk of cardiovascular disease events using a network meta-analysis.We searched 10 electronic databases, were in communication with authors of published randomized, clinical trials (RCTs), and accessed internal US Food and Drug Administration reports. We included any RCT of the 3 treatments that reported cardiovascular disease outcomes. Among 63 eligible RCTs involving 21 nicotine replacement therapy RCTs, 28 bupropion RCTs, and 18 varenicline RCTs, we found no increase in the risk of all cardiovascular disease events with bupropion (relative risk [RR], 0.98; 95% confidence interval [CI], 0.54-1.73) or varenicline (RR, 1.30; 95% CI, 0.79-2.23). There was an elevated risk associated with nicotine replacement therapy that was driven predominantly by less serious events (RR, 2.29; 95% CI, 1.39-3.82). When we examined major adverse cardiovascular events, we found a protective effect with bupropion (RR, 0.45; 95% CI, 0.21-0.85) and no clear evidence of harm with varenicline (RR, 1.34; 95% CI, 0.66-2.66) or nicotine replacement therapy (RR, 1.95; 95% CI, 0.26-4.30).Smoking cessation therapies do not appear to raise the risk of serious cardiovascular disease events.

View details for DOI 10.1161/CIRCULATIONAHA.113.003961

View details for Web of Science ID 000336726300008

View details for PubMedID 24323793
Young adults who smoke cigarettes and marijuana: Analysis of thoughts and behaviors ADDICTIVE BEHAVIORS Ramo, D. E., Delucchi, K. L., Liu, H., Hall, S. M., Prochaska, J. J. 2014; 39 (1): 77-84
Abstract

Smoking both cigarettes and marijuana is increasingly common among young adults, yet little is known about use patterns, motivations, or thoughts about abstinence. In a U.S. sample, this study explored young adults' severity of cigarette and marijuana co-use, quit attempts, and thoughts about use.Young adults age 18-to-25 who had smoked at least one cigarette in the past 30 days completed an anonymous online survey.Of 1987 completed surveys, 972 participants reported both past-month cigarette and marijuana use (68% male, 71% Caucasian, mean age 20.4 years [SD=2.0]). Frequency of use, temptations to use, measures of dependence, decisional balance, and past-year quit attempts were associated across the two substances (all p<.05), but not motivation to quit. Relative to marijuana, participants reported greater desire and a later stage of change for quitting cigarettes and were more likely to endorse a cigarette abstinence goal, yet they had lower expectancy of success with quitting cigarettes and with staying quit (all p<.001).Cigarette and marijuana use, temptations to use, and pros/cons of using were related in this young adult sample. Differences in motivation and thoughts about abstinence, however, suggest that young adults may be more receptive to interventions for tobacco than marijuana use. Use patterns and cognitions for both substances should be considered in prevention and intervention efforts.

View details for DOI 10.1016/j.addbeh.2013.08.035

View details for Web of Science ID 000329560300010

View details for PubMedID 24090626
Systematic review and meta-analysis of opioid antagonists for smoking cessation. BMJ open David, S. P., Chu, I. M., Lancaster, T., Stead, L. F., Evins, A. E., Prochaska, J. J. 2014; 4 (3)
View details for DOI 10.1136/bmjopen-2013-004393

View details for PubMedID 24633528
Systematic review and meta-analysis of opioid antagonists for smoking cessation. BMJ open David, S. P., Chu, I. M., Lancaster, T., Stead, L. F., Evins, A. E., Prochaska, J. J. 2014; 4 (3)
Abstract

This meta-analysis sought to evaluate the efficacy of opioid antagonists in promoting long-term smoking cessation. Post-treatment abstinence was examined as a secondary outcome and effects on withdrawal symptoms, craving and reduced consumption were also explored.The search strategy for this meta-analysis included clinical trials (published and unpublished data) in the Cochrane Tobacco Addiction Group Specialized Register and MEDLINE.Adult smokers.We included randomised trials comparing opioid antagonists to placebo or an alternative therapy for smoking cessation and reported data on abstinence for a minimum of 6 months.Outcomes included smoking abstinence at long-term follow-up (primary); abstinence at end of treatment (secondary); and effects on withdrawal, craving and smoking consumption (exploratory).8 trials with a total of 1213 participants were included. Half the trials examined the benefit of adding naltrexone versus placebo to nicotine replacement therapy (NRT). There was no significant difference between naltrexone and placebo alone (relative risk (RR) 1.00; 95% CI 0.66 to 1.51) or as an adjunct to NRT (RR 0.95; 95% CI 0.70 to 1.30), with an overall pooled estimate of RR 0.97; 95% CI 0.76 to 1.24. Findings for naltrexone effects on withdrawal, craving and reduced smoking were equivocal.The findings indicate no beneficial effect of naltrexone alone or as an adjunct to NRT on short-term or long-term smoking abstinence. While further trials may narrow the confidence limits, they are unlikely to appreciably alter the conclusion.

View details for DOI 10.1136/bmjopen-2013-004393

View details for PubMedID 24633528
Menthol use among smokers with psychological distress: findings from the 2008 and 2009 National Survey on Drug Use and Health TOBACCO CONTROL Hickman, N. J., Delucchi, K. L., Prochaska, J. J. 2014; 23 (1): 7-13
Abstract

The Food and Drug Administration is considering regulation of menthol cigarettes. While persons with mental distress are known to smoke cigarettes at high rates, little is known about their use of menthol. The authors examined the association of psychological distress and menthol use in a national sample of adult smokers.Data were from the 2008 and 2009 National Survey on Drug Use and Health. Past month smokers (N=24,157) were categorised for menthol or non-menthol use. Psychological distress was categorised as none/mild, moderate or severe on the Kessler six-item scale.The prevalence of menthol use was higher among individuals with severe psychological distress, women, young adults, African-Americans, Native Hawaiians/Pacific Islanders, persons with fewer years of education and lower income, and the unmarried and uninsured. In a multivariate model controlling for socio-demographic factors, smoking intensity and time to first cigarette, smokers with severe (adjusted OR (AOR) 1.23, 95% CI 1.04 to 1.46, p=0.02) but not moderate (AOR 1.03, 95% CI 0.92 to 1.15, p=0.58) psychological distress were significantly more likely to smoke menthols compared with smokers with none/mild distress.An elevated prevalence of menthol use was found among persons with severe psychological distress, suggesting another group that could potentially benefit from the regulation of menthol cigarettes.

View details for DOI 10.1136/tobaccocontrol-2012-050479

View details for Web of Science ID 000328550800014

View details for PubMedID 22821797
Online Comments on Smoking Bans in Psychiatric Hospitals Units JOURNAL OF DUAL DIAGNOSIS Brown-Johnson, C. G., Sanders-Jackson, A., Prochaska, J. J. 2014; 10 (4): 204-211
Abstract

Individuals with mental health concerns are disproportionately affected by and suffer the negative consequences of tobacco use disorder, perhaps because smoking has historically been part of psychiatry's culture. In the early 1990s, psychiatric inpatient facilities were exempted from U.S. hospital smoking bans, in response to public outcry with national media attention. Almost 2 decades later, the current study characterizes online conversation about psychiatric hospital smoking bans. Previous commenting studies have demonstrated commenting's negativity, documenting the "nasty effect" wherein negative comments color perceptions of neutral articles. Thus, we focused particular attention on cited barriers to implementing health-positive smoke-free policies.We collected online comments (N = 261) responding to popular media articles on smoking bans in inpatient psychiatry between 2013 and 2014 and conducted an inductive and exploratory qualitative content analysis.Verifying previous studies documenting the prevalence of negative commenting, of the comments explicitly supporting or refuting psychiatry smoking bans, there were over twice as many con comments (n = 44) than pro (n = 18). Many commenters argued for access to outdoor smoking areas and warned of patient agitation and risk posed to care workers. Identified content themes included psychiatric medication and negative side effects, broken mental health systems and institutions, denigration of the health risks of tobacco in the context of mental illness, typical pro-smoking arguments about "smokers' rights" and alternatives (including e-cigarettes), addiction, and stigma.The current findings provide a platform to begin to understand how people talk about mental health issues and smoking. Our analysis also raised complex issues concerning forces that impact U.S. patients with serious mental illness but over which they have little control, including medication, the U.S. health system, stigma, perceptions that life with chronic serious mental illness is not worth living, and psychological and physical pain of coping with mental illness. In consideration of identified barriers raised in opposition to smoking bans in inpatient psychiatry, efforts should emphasize patient stakeholder involvement; patient, visitor, and staff protection from smoke exposure; the effectiveness of nicotine replacement for managing withdrawal; and the lack of evidence that cigarettes are therapeutic.

View details for DOI 10.1080/15504263.2014.961883

View details for Web of Science ID 000343988600005

View details for PubMedID 25391278
Endgame: engaging the tobacco industry in its own elimination. European journal of clinical investigation Ioannidis, J. P., Henriksen, L., Prochaska, J. J. 2013; 43 (12): 1366-1370
Abstract

A billion deaths from tobacco are expected by 2100. Many policy interventions such as increased taxation, restrictions on advertisement, smoking bans, as well as behavioral interventions, such as pharmacological and psychological treatments for smoking cessation, decrease tobacco use, but they reach their limits. Endgame scenarios focusing on tobacco supply rather than demand are increasingly discussed, but meet with resistance by the industry and even by many tobacco control experts. A main stumbling block that requires more attention is what to do with the tobacco industry in endgame scenarios. This industry has employed notoriously talented experts in law, business, organization, marketing, advertising, strategy, policy, and statistics and has tremendous lobbying power. Performance-based regulatory approaches can pose a legal obligation on manufacturers to decrease - and eventually - eliminate tobacco products according to specified schedules. Penalties and rewards can make such plans both beneficial for public health and attractive to the companies that do the job well. We discuss caveats and reality checks of engaging the tobacco industry to eliminate its current market and change focus. Brainstorming is warranted to entice the industry to abandon tobacco for other profit goals. To get the dialogue started, we propose the wild possibility of hiring former tobacco companies to reduce the costs of healthcare, thereby addressing concurrently two major challenges to public health.

View details for DOI 10.1111/eci.12172

View details for PubMedID 24117211
Clinical Management of Tobacco Dependence in Inpatient Psychiatry: Provider Practices and Patient Utilization PSYCHIATRIC SERVICES Leyro, T. M., Hall, S. M., Hickman, N., Kim, R., Hall, S. E., Prochaska, J. J. 2013; 64 (11): 1161-1165
Abstract

This investigation examined predictors of utilization of nicotine replacement therapy (NRT) during a smoke-free psychiatric hospitalization.Smokers (N=324) were recruited from smoke-free adult inpatient psychiatric units. Exploratory analyses examined correlates of NRT provision and utilization.The prevalence of NRT use was 51% overall and was greater among patients offered NRT on admission (58%) versus later (34%), among patients with more severe depression and nicotine withdrawal, and among those who reported perceptions that NRT decreases nicotine withdrawal, provides a nicotine substitute, and helps with quitting smoking (p<.05, all comparisons). Although the ratio of nicotine patch dose to usual cigarettes per day was 1.2±.7, the ratio was negatively correlated with time to first cigarette (Spearman's ρ=-.30, p<.01), suggesting potential underdosing of more dependent smokers.During smoke-free psychiatric hospitalizations, clinical management of nicotine withdrawal may be enhanced by offering patients NRT directly on admission, educating patients on the benefits of NRT, and increasing the dosage for more dependent smokers.

View details for DOI 10.1176/appi.ps.201200574

View details for Web of Science ID 000327303800014

View details for PubMedID 24185538
Subjective Social Status and Substance Use Severity in a Young Adult Sample PSYCHOLOGY OF ADDICTIVE BEHAVIORS Finch, K. A., Ramo, D. E., Delucchi, K. L., Liu, H., Prochaska, J. J. 2013; 27 (3): 901-908
Abstract

Subjective social status (SSS), an individual's subjective view of standing in society, has been shown to better predict health outcomes compared to objective measures of socioeconomic status (SES), including educational attainment and income. This study examines the relationship between SSS and severity of tobacco, alcohol, and marijuana use after controlling for objective measures of SES. Young adults (N = 1,987) aged 18-25 who reported smoking at least one cigarette in the past 30 days were recruited and surveyed anonymously online. Three separate structural equation models examined whether SSS was associated with severity of tobacco, alcohol, and marijuana use, controlling for personal and household income, years of education, employment status, and parental education. Household income (b = .31), employment status (b = .07), years of education (b = .09), and parental education (b = .16) were positively associated with SSS (all p values < .001); personal income was not significantly associated with SSS (p = .11). All three models adequately fit the data. SSS was negatively associated with severity of tobacco (b = -.13, p < .001) and marijuana use (b = -36, p = .02), but not alcohol use severity (b = .01, p = .56). Among young adults, higher subjective social status is associated with less severe tobacco and marijuana use, whereas alcohol use severity appears to be similar across socioeconomic class.

View details for DOI 10.1037/a0032900

View details for Web of Science ID 000324779800038

View details for PubMedID 23915371
Tobacco Use and Its Treatment Among Young People in Mental Health Settings: A Qualitative Analysis NICOTINE & TOBACCO RESEARCH Prochaska, J. J., Fromont, S. C., Wa, C., Matlow, R., Ramo, D. E., Hall, S. M. 2013; 15 (8): 1427-1435
Abstract

BACKGROUND: Youth with psychiatric disorders are at increased risk of tobacco use. Outpatient mental health settings have received little investigation for delivering tobacco treatment. This study obtained formative data to guide development of a tobacco cessation program for transitional age youth with co-occurring psychiatric disorders with a focus on outpatient mental health settings. METHODS: Applying qualitative methods, we analyzed transcripts from interviews with 14 mental health clients (aged 16-23) and 8 mental health providers. RESULTS: The youth identified internal (nicotine addiction and mood), social, parental, and media influences to their use of tobacco. Providers' viewed youth tobacco use as a normative developmental process, closely tied to management of psychiatric symptoms, supported by parents, and of lower priority relative to youth alcohol and illicit drug use. Youth and providers believed that clinicians can do more to address tobacco use in practice and emphasized nonjudgmental support and nondirective approaches. Top recommended quitting strategies, however, differed notably for the youth (cold turkey, support from friends, physical activity, hobbies) and providers (cessation pharmacotherapy, cessation groups, treatment referrals). CONCLUSIONS: Mental health providers' greater prioritization of other substances and view of youth smoking as developmentally normative and a coping strategy for psychopathology are likely contributing to the general lack of attention to tobacco use currently. Integrating care within mental health settings would serve to reach youth in an arena where clinical rapport is already established, and study findings suggest receptivity for system improvements. Of consideration, however, is the apparent disconnect between provider and youth recommended strategies for supporting cessation.

View details for DOI 10.1093/ntr/nts343

View details for Web of Science ID 000322093700012

View details for PubMedID 23322765
Validity and reliability of the nicotine and marijuana interaction expectancy (NAMIE) questionnaire DRUG AND ALCOHOL DEPENDENCE Ramo, D. E., Liu, H., Prochaska, J. J. 2013; 131 (1-2): 166-170
Abstract

The co-occurring use of tobacco and marijuana among young people is a concern, yet little research has examined processes of co-use. Understanding expectancies around use of the two substances will help identify intervention targets. This study examined psychometric properties of the Nicotine and Marijuana Interaction Expectancy (NAMIE) questionnaire based on three modified scales of the Nicotine and Other Substance Interaction Expectancy (NOSIE) questionnaire.An anonymous online survey recruited participants (N=1152) age 18-25 (mean age 20 years, 67% male, 72% Caucasian) who reported use of cigarettes and marijuana in the past 30 days. Analyses examined reliability and validity of the NAMIE.A confirmatory factor analysis indicated good model fit for a 3-factor model. Scales were marijuana increases tobacco use and urges, tobacco increases marijuana use and urges, and smoking to cope with marijuana urges. Subscales correlated significantly with measures of cigarette smoking (r=.08 to .27, p<.01) and nicotine dependence (r=-.07 to -.20, p<.01), marijuana use (r=.08 to .29, p<.01) and dependence (r=.27 to .42, p<.01), percent of days using both cigarettes and marijuana in the past 30 days (r=.15 to .30, p<.01), thoughts about tobacco and marijuana abstinence (r=-.09 to .44, p<.01), and motivation to quit using marijuana (F=9.43, p<.001). When entered into a regression model, variables of use and thoughts about use remained significant.The NAMIE was well-adapted for use with a marijuana-using community sample of young adult smokers.

View details for DOI 10.1016/j.drugalcdep.2012.12.018

View details for Web of Science ID 000321414200022

View details for PubMedID 23339969
Marijuana and Tobacco Co-Use in Young Adults: Patterns and Thoughts About Use JOURNAL OF STUDIES ON ALCOHOL AND DRUGS Ramo, D. E., Delucchi, K. L., Hall, S. M., Liu, H., Prochaska, J. J. 2013; 74 (2): 301-310
Abstract

We examined the frequency and intensity of tobacco use and thoughts about abstinence among young adults in the United States as a function of their use of marijuana. We hypothesized that heavier marijuana use would be associated with heavier tobacco use and fewer attempts to quit smoking, and we explored relationships between marijuana use and ratings of intentions and thoughts related to quitting tobacco.This was a cross-sectional survey consisting of online recruitment and anonymous self-report. Participants were English literate, were between the ages of 18 and 25 years, and reported past-month tobacco use. More than half (53%) had smoked marijuana in the past 30 days. Tobacco use (quantity/frequency, Heavy Smoking Index, past-year quit attempt), thoughts about tobacco use (outcome expectancies, desire, self-efficacy, difficulty of quitting, abstinence goal, pros and cons, stage of change), alcohol use, and other drug use were assessed.Compared with those who smoked only tobacco, cousers were younger and had smoked for fewer years; had higher household income; were more likely to be male, multiethnic, and nondaily smokers; and reported greater alcohol and other drug use. The variable of days using marijuana in the past 30 days was associated with multiple measures of tobacco use intensity/frequency. Only one association was significant between marijuana use and tobacco-related cognitions: Cousers had a lower likelihood of planning to quit tobacco for good (odds ratio = 0.75, 95% CI [0.58, 0.98]).Findings support the association between tobacco and marijuana use among young people but speak to the importance of addressing tobacco cognitions in young adult smokers regardless of level of marijuana use.

View details for Web of Science ID 000315138200013

View details for PubMedID 23384378
Counseling Nondaily Smokers about Secondhand Smoke as a Cessation Message: A Pilot Randomized Trial NICOTINE & TOBACCO RESEARCH Schane, R. E., Prochaska, J. J., Glantz, S. A. 2013; 15 (2): 334-342
Abstract

Nondaily smoking represents a substantial and growing fraction of smokers, many of whom do not consider themselves smokers or at risk of tobacco-related diseases and, so, may be less responsive to counseling content contained in traditional cessation interventions. This study compares the effects brief counseling interventions (<20 min) focused on the harm smoking does to themselves (harm to self, HTS) versus the harm their secondhand smoke (SHS) does to others (harm to others, HTO) among nondaily smokers.Randomized trial of 52 nondaily smokers (smoked in the past week, but not daily) recruited between September 2009 and June 2010; 40 completed the study. We measured changes in motivation and smoking status at 3 months postintervention.There was a difference in quitting between the two groups, with 9.5% (2 out of 21) for HTS and 36.8% (7 out of 19) for HTO subjects reporting not smoking any cigarettes in the prior week (p = .06 by Fisher exact test and .035 by likelihood-ratio chi-square). Motivation and self-efficacy increased from baseline to 3-month follow-up, but not differentially by intervention group.Consistent with findings from research conducted by the tobacco industry as early as the 1970s that concluded that social smokers feel immune from the personal health effects of tobacco but are concerned about the consequences of their SHS on others, educating nondaily smokers about the dangers of SHS to others appears to be a more powerful cessation message than traditional smoking cessation counseling that emphasizes the harmful consequences to the smoker.

View details for DOI 10.1093/ntr/nts126

View details for Web of Science ID 000313826600004

View details for PubMedID 22592447
Opioid antagonists for smoking cessation COCHRANE DATABASE OF SYSTEMATIC REVIEWS David, S. P., Lancaster, T., Stead, L. F., Evins, A. E., Prochaska, J. J. 2013
Abstract

The reinforcing properties of nicotine may be mediated through release of various neurotransmitters both centrally and systemically. People who smoke report positive effects such as pleasure, arousal, and relaxation as well as relief of negative affect, tension, and anxiety. Opioid (narcotic) antagonists are of particular interest to investigators as potential agents to attenuate the rewarding effects of cigarette smoking.To evaluate the efficacy of opioid antagonists in promoting long-term smoking cessation. The drugs include naloxone and the longer-acting opioid antagonist naltrexone.We searched the Cochrane Tobacco Addiction Group Specialised Register for trials of naloxone, naltrexone and other opioid antagonists and conducted an additional search of MEDLINE using 'Narcotic antagonists' and smoking terms in April 2013. We also contacted investigators, when possible, for information on unpublished studies.We considered randomised controlled trials comparing opioid antagonists to placebo or an alternative therapeutic control for smoking cessation. We included in the meta-analysis only those trials which reported data on abstinence for a minimum of six months. We also reviewed, for descriptive purposes, results from short-term laboratory-based studies of opioid antagonists designed to evaluate psycho-biological mediating variables associated with nicotine dependence.We extracted data in duplicate on the study population, the nature of the drug therapy, the outcome measures, method of randomisation, and completeness of follow-up. The main outcome measure was abstinence from smoking after at least six months follow-up in patients smoking at baseline. Abstinence at end of treatment was a secondary outcome. We extracted cotinine- or carbon monoxide-verified abstinence where available. Where appropriate, we performed meta-analysis, pooling risk ratios using a Mantel-Haenszel fixed-effect model.Eight trials of naltrexone met inclusion criteria for meta-analysis of long-term cessation. One trial used a factorial design so five trials compared naltrexone versus placebo and four trials compared naltrexone plus nicotine replacement therapy (NRT) versus placebo plus NRT. Results from 250 participants in one long-term trial remain unpublished. No significant difference was detected between naltrexone and placebo (risk ratio (RR) 1.00; 95% confidence interval (CI) 0.66 to 1.51, 445 participants), or between naltrexone and placebo as an adjunct to NRT (RR 0.95; 95% CI 0.70 to 1.30, 768 participants). The estimate was similar when all eight trials were pooled (RR 0.97; 95% CI 0.76 to 1.24, 1213 participants). In a secondary analysis of abstinence at end of treatment, there was also no evidence of any early treatment effect, (RR 1.03; 95% CI 0.88 to 1.22, 1213 participants). No trials of naloxone or buprenorphine reported abstinence outcomes.Based on data from eight trials and over 1200 individuals, there was no evidence of an effect of naltrexone alone or as an adjunct to NRT on long-term smoking abstinence, with a point estimate strongly suggesting no effect and confidence intervals that make a clinically important effect of treatment unlikely. Although further trials might narrow the confidence intervals they are unlikely to be a good use of resources.

View details for DOI 10.1002/14651858.CD003086.pub3

View details for Web of Science ID 000321124000022

View details for PubMedID 23744347
Reliability and Validity of Young Adults' Anonymous Online Reports of Marijuana Use and Thoughts About Use PSYCHOLOGY OF ADDICTIVE BEHAVIORS Ramo, D. E., Liu, H., Prochaska, J. J. 2012; 26 (4): 801-811
Abstract

With growing interest in online assessment of substance abuse behaviors, there is a need to formally evaluate the validity of the data gathered. The current investigation evaluated the reliability and validity of anonymous, online reports of young adults' marijuana use and related cognitions. Young adults age 18 to 25 who had smoked at least one cigarette in the past 30 days were recruited over 14 months to complete an anonymous online survey. Of 3,106 eligible cases, 1,617 (52%) completed the entire survey. Of those, 54% (n = 884) reported past-month marijuana use (65% male, 70% Caucasian, mean age was 20.4 years [SD = 2.0]). Prevalence of marijuana use was reported reliably across three similar items, and interitem correlations ranged from fair to excellent for measures of marijuana dependence symptoms and thoughts about marijuana use. Marijuana use frequency demonstrated good construct validity through expected correlations with marijuana use constructs, and nonsignificant correlations with thoughts about tobacco use. Marijuana frequency distinguished among stages of change for marijuana use and goals for use, but not among gender, ethnicity, or employment groups. Marijuana use and thoughts about use differed by stage of change in the hypothesized directions. Self-reported marijuana use and associated cognitions reported anonymously online from young adults are generally reliable and valid. Online assessments of substance use broaden the reach of addictions research.

View details for DOI 10.1037/a0026201

View details for Web of Science ID 000312682000013

View details for PubMedID 22082344
Correlates of tobacco dependence and motivation to quit among young people receiving mental health treatment DRUG AND ALCOHOL DEPENDENCE Grana, R. A., Ramo, D. E., Fromont, S. C., Hall, S. M., Prochaska, J. J. 2012; 125 (1-2): 127-131
Abstract

Young people with mental health concerns are at high-risk for initiation and continuation of tobacco use. To inform treatment needs, the current study sought to describe tobacco dependence, motivations to quit and associated sociodemographic factors among young people seen in mental health settings.Sixty adolescent and young adult smokers (age mean=19.5 years, range 13-25) receiving outpatient mental health treatment completed measures of tobacco dependence, motivation to quit smoking, mental health, and social environmental factors.Participants averaged 8.0 cigarettes per day (SD=6.6) and moderate nicotine dependence (mFTQ M=4.8, SD=1.6). Participants' mean rating (10-point scales) of perceived difficulty with avoiding relapse during a quit attempt was significantly higher (M=6.7, SD=2.6), than ratings of desire (M=5.1, SD=2.6) and perceived success (M=4.6, SD=2.6) with quitting. Over half (52%) did not intend to quit smoking in the next 6 months, and few (11%) were prepared to quit in the next 30 days. Mental health treatment and symptomatology measures were unrelated to level of dependence or motivation to quit. Among the social environmental factors, having close friends who smoke was associated with greater perceived difficulty with avoiding relapse during a quit attempt (r=0.25, p<0.01).In this sample of adolescent and young adult smokers in mental health treatment, moderate levels of tobacco dependence and motivation to quit were observed and found to be unrelated to mental health measures. Over half of the sample was not intending to quit smoking in the near future, supporting the need for treatment strategies aimed at increasing motivation.

View details for DOI 10.1016/j.drugalcdep.2012.04.005

View details for Web of Science ID 000308720700017

View details for PubMedID 22560677
Validity study of the K6 scale as a measure of moderate mental distress based on mental health treatment need and utilization INTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH Prochaska, J. J., Sung, H., Max, W., Shi, Y., Ong, M. 2012; 21 (2): 88-97
Abstract

The widely-used Kessler K6 non-specific distress scale screens for severe mental illness defined as a K6 score ≥ 13, estimated to afflict about 6% of US adults. The K6, as currently used, fails to capture individuals struggling with more moderate mental distress that nonetheless warrants mental health intervention. The current study determined a cutoff criterion on the K6 scale indicative of moderate mental distress based on mental health treatment need and assessed the validity of this criterion by comparing participants with identified moderate and severe mental distress on relevant clinical, impairment, and risk behavior measures. Data were analyzed from 50,880 adult participants in the 2007 California Health Interview Survey. Receiver operating characteristic curve analysis identified K6 ≥ 5 as the optimal lower threshold cut-point indicative of moderate mental distress. Based on the K6, 8.6% of California adults had serious mental distress and another 27.9% had moderate mental distress. Correlates of moderate and serious mental distress were similar. Respondents with moderate mental distress had rates of mental health care utilization, impairment, substance use and other risks lower than respondents with serious mental distress and greater than respondents with none/low mental distress. The findings support expanded use and analysis of the K6 scale in quantifying and examining correlates of mental distress at a moderate, yet still clinically relevant, level.

View details for DOI 10.1002/mpr.1349

View details for Web of Science ID 000304833500003

View details for PubMedID 22351472
Tobacco and marijuana use among adolescents and young adults: A systematic review of their co-use CLINICAL PSYCHOLOGY REVIEW Ramo, D. E., Liu, H., Prochaska, J. J. 2012; 32 (2): 105-121
Abstract

Tobacco (TOB) and marijuana (MJ) are the most widely used drugs among adolescents and young adults. The literature on their co-use, however, has not been systematically reviewed. We identified 163 English language articles published from 1999 to 2009 examining TOB and MJ co-use, correlates or consequences of co-use, or interventions for prevention or cessation of co-use with participants aging 13-25 years. Most studies (n=114, 70%) examined TOB and MJ co-use, and 85% of relationships studied indicated a significant association. Fifty-nine studies (36%) examined correlates or consequences of co-use. Factors consistently associated with increased likelihood of co-use, defined as significant associations in at least four studies, were African-American ethnicity, mental and physical health characteristics (e.g., high-intensity pleasure temperament), and school characteristics (e.g., good grades). The only consistent consequence of co-use was exacerbation of mental health symptoms. Few studies examined prevention (n=3) or cessation (n=2) interventions for TOB and MJ co-use, and the findings were stronger for prevention efforts. A sufficient literature base has documented that TOB and MJ use are strongly related in young people, yet few consistent correlates and consequences of co-use have been identified to inform intervention targets.

View details for DOI 10.1016/j.cpr.2011.12.002

View details for Web of Science ID 000300033800003

View details for PubMedID 22245559
A Test of Positive Affect Induction for Countering Self-Control Depletion in Cigarette Smokers PSYCHOLOGY OF ADDICTIVE BEHAVIORS Shmueli, D., Prochaska, J. J. 2012; 26 (1): 157-161
Abstract

The self-control strength model posits that exerting self-control on one task, such as resisting temptations, will deplete self-control and impair subsequent self-regulatory performance, such as controlling smoking. The current study examined interventions designed to replenish depleted self-control strength to prevent tobacco use by inducing positive affect. In a 2 × 2 design, 200 participants were randomized to either (1) resist eating from a plate of desserts (high temptation) or from a plate of raw vegetables (low temptation) and then (2) undergo a positive or neutral affect induction. Two inductions were compared (video vs. writing technique). Participants were then given a 10-min recess. Whether or not participants smoked during the recess, assessed by self-report and biochemical verification, served as the primary dependent variable. The interaction between depletion and exposure group was significant, Wald's χ² = 9.66, df = 3, p < .05. Among those assigned to resist desserts, 65.5% to 85% smoked if they were in the neutral video or writing conditions versus 10.5% in the positive affect video group. Positive affect elicited with a video was able to counteract the detrimental effects of self-control depletion on smoking behavior, while writing exercises were associated with smoking. Implications for tobacco cessation intervention are discussed.

View details for DOI 10.1037/a0023706

View details for Web of Science ID 000301556200018

View details for PubMedID 21553949
Broad Reach and Targeted Recruitment Using Facebook for an Online Survey of Young Adult Substance Use JOURNAL OF MEDICAL INTERNET RESEARCH Ramo, D. E., Prochaska, J. J. 2012; 14 (1)
Abstract

Studies of tobacco use and other health behaviors have reported great challenges in recruiting young adults. Social media is widely used by young adults in the United States and represents a potentially fast, affordable method of recruiting study participants for survey research.The present study examined Facebook as a mechanism to reach and survey young adults about tobacco and other substance use.Participants were cigarette users, age 18-25 years old, living throughout the United States and recruited through Facebook to complete a survey about tobacco and other substance use. Paid advertising using Facebook's Ad program over 13 months from 2010 Feb 28 to 2011 Apr 4 targeted by age (18-25), location (United States or California), language (English), and tobacco- and/or marijuana-related keywords. Facebook approved all ads.The campaign used 20 ads, which generated 28,683,151 impressions, yielding 14,808 clicks (0.7% of targeted Facebook members), at an overall cost of $6,628.24. The average cost per click on an ad was $0.45. The success of individual ads varied widely. There was a rise in both clicks and impressions as the campaign grew. However, the peak for clicks was 3 months before the peak for ad impressions. Of the 69,937,080 accounts for those age 18-25 in the United States, Facebook estimated that 2.8% (n = 1,980,240) were reached through tobacco and marijuana keywords. Our campaign yielded 5237 signed consents (35.4% of clicks), of which 3093 (59%) met criteria, and 1548 (50% of those who met criteria) completed the survey. The final cost per valid completed survey was $4.28. The majority of completed surveys came from whites (69%) and males (72%). The sample averaged 8.9 cigarettes per day (SD 7.5), 3.8 years of smoking (SD 2.9), with a median of 1 lifetime quit attempts; 48% did not intend to quit smoking in the next 6 months.Despite wide variety in the success of individual ads and potential concerns about sample representativeness, Facebook was a useful, cost-effective recruitment source for young-adult smokers to complete a survey about the use of tobacco and other substances. The current findings support Facebook as a viable recruitment option for assessment of health behavior in young adults.

View details for DOI 10.2196/jmir.1878

View details for Web of Science ID 000301925700020

View details for PubMedID 22360969
Prevalence and co-use of marijuana among young adult cigarette smokers: An anonymous online national survey. Addiction science & clinical practice Ramo, D. E., Prochaska, J. J. 2012; 7: 5-?
Abstract

There is elevated prevalence of marijuana use among young adults who use tobacco, but little is known about the extent of co-use generated from surveys conducted online. The purpose of the present study was to examine past-month marijuana use and the co-use of marijuana and tobacco in a convenience sample of young adult smokers with national US coverage.Young adults age 18 to 25 who had smoked at least one cigarette in the past 30 days were recruited online between 4/1/09 and 12/31/10 to participate in an online survey on tobacco use. We examined past 30 day marijuana use, frequency of marijuana use, and proportion of days co-using tobacco and marijuana by demographic characteristics and daily smoking status.Of 3512 eligible and valid survey responses, 1808 (51.5%) smokers completed the survey. More than half (53%, n = 960) of the sample reported past-month marijuana use and reported a median use of 18 out of the past 30 days (interquartile range [IR] = 4, 30). Co-use of tobacco and marijuana occurred on nearly half (median = 45.5%; IR = 13.1, 90.3) of the days on which either substance was used and was more frequent among Caucasians, respondents living in the Northeast or in rural areas, in nonstudents versus students, and in daily versus nondaily smokers. Residence in a state with legalized medical marijuana was unrelated to co-use or even the prevalence of marijuana use in this sample. Age and household income also were unrelated to co-use of tobacco and marijuana.These results indicate a higher prevalence of marijuana use and co-use of tobacco in young adult smokers than is reported in nationally representative surveys. Cessation treatments for young adult smokers should consider broadening intervention targets to include marijuana.

View details for DOI 10.1186/1940-0640-7-5

View details for PubMedID 23186143
Cigarette Smoking and Serious Psychological Distress: A Population-Based Study of California Adults NICOTINE & TOBACCO RESEARCH Sung, H., Prochaska, J. J., Ong, M. K., Shi, Y., Max, W. 2011; 13 (12): 1183-1192
Abstract

This study examines differences in smoking behaviors between adults with and without serious psychological distress (SPD) in California, which has the longest running comprehensive tobacco control program in the world.Cross-sectional data from the 2007 California Health Interview Survey on 50,880 noninstitutionalized adults were used to analyze smoking prevalence, cigarette consumption, and quit ratio. Persons with SPD were identified using the K6 scale, a clinically validated psychological screening instrument.About 3.8% of California adults screened positive for SPD in the past 30 days (acute SPD) and an additional 4.8% screened positive for SPD in the past 2-12 months (recent SPD). Persons with SPD were more likely to be current smokers than those without SPD (adjusted odds ratios [AOR] = 2.54, 95% CI = 2.02-3.19 for acute SPD and AOR = 2.20, 95% CI = 1.79-2.71 for recent SPD). Current smokers with acute SPD were more likely to smoke ≥20 cigarettes daily than those without SPD (AOR = 1.59, 95% CI = 1.06-2.39). The quit rate was lower among ever-smokers with acute (AOR = 0.46, 95% CI = 0.35-0.62) or recent SPD (AOR = 0.55, 95% CI = 0.42-0.71) than those without SPD. While persons with acute or recent SPD comprised 8.6% of adults, they consumed 19.2% of all cigarettes in California.In California, adults with SPD were more likely to be current smokers and to smoke heavily and less likely to quit than those without SPD. The findings underscore the need for effective smoking cessation strategies targeting this group.

View details for DOI 10.1093/ntr/ntr148

View details for Web of Science ID 000297376400003

View details for PubMedID 21849411
Using Extended Cognitive Behavioral Treatment and Medication to Treat Dependent Smokers AMERICAN JOURNAL OF PUBLIC HEALTH Hall, S. M., Humfleet, G. L., Munoz, R. F., Reus, V. I., Prochaska, J. J., Robbins, J. A. 2011; 101 (12): 2349-2356
Abstract

We evaluated smoking-cessation efficacy of an extended course of sustained-release bupropion (bupropion SR) and cognitive-behavioral treatment (CBT).Participants who smoked at least 10 cigarettes per day and who smoked within 30 minutes of arising (n = 406) completed a 12-week smoking-cessation treatment including group counseling, nicotine-replacement therapy, and bupropion SR. Participants were then randomly assigned to 1 of 5 conditions: (1) no further treatment, (2) active bupropion SR for 40 weeks, (3) placebo for 40 weeks, (4) active bupropion SR and 11 sessions of CBT for 40 weeks (A-CBT), or (5) placebo and 11 sessions of CBT for 40 weeks. Participants were assessed at baseline and at weeks 12, 24, 52, 64, and 104.A-CBT was not superior to the other 3 extended treatments. From weeks 12 through 104, all extended treatment conditions were superior to standard treatment. At weeks 64 and 104, the 2 CBT conditions produced significantly higher abstinence rates than did the other 3 conditions.Brief contact with providers can increase abstinence during treatment. CBT may increase long-term abstinence after extended treatment is terminated.

View details for DOI 10.2105/AJPH.2010.300084

View details for Web of Science ID 000297140900029

View details for PubMedID 21653904
Reliability and Validity of Self-Reported Smoking in an Anonymous Online Survey With Young Adults HEALTH PSYCHOLOGY Ramo, D. E., Hall, S. M., Prochaska, J. J. 2011; 30 (6): 693-701
Abstract

The Internet offers many potential benefits to conducting smoking and other health behavior research with young adults. Questions, however, remain regarding the psychometric properties of online self-reported smoking behaviors. The purpose of this study was to examine the reliability and validity of self-reported smoking and smoking-related cognitions obtained from an online survey.Young adults (N = 248) age 18 to 25 who had smoked at least 1 cigarette in the past 30 days were recruited online and completed a survey of tobacco and other substance use.Measures of smoking behavior (quantity and frequency) and smoking-related expectancies demonstrated high internal consistency reliability. Measures of smoking behavior and smoking stage of change demonstrated strong concurrent criterion and divergent validity. Results for convergent validity varied by specific constructs measured. Estimates of smoking quantity, but not frequency, were comparable to those obtained from a nationally representative household interview among young adults.These findings generally support the reliability and validity of online surveys of young adult smokers. Identified limitations may reflect issues specific to the measures rather than the online data collection methodology. Strategies to maximize the psychometric properties of online surveys with young adult smokers are discussed.

View details for DOI 10.1037/a0023443

View details for Web of Science ID 000297029200004

View details for PubMedID 21574709
SCREENING FOR UNDERSTANDING OF RESEARCH IN THE INPATIENT PSYCHIATRY SETTING JOURNAL OF EMPIRICAL RESEARCH ON HUMAN RESEARCH ETHICS Hickman, N. J., Prochaska, J. J., Dunn, L. B. 2011; 6 (3): 65-72
Abstract

People with mental illness constitute a substantial proportion of smokers and an important population for smoking cessation research. Obtaining informed consent in this population is a critical ethical endeavor. We examined performance on a three-item instrument (3Q) designed to screen for understanding of several key elements of research: study purpose, risks, and benefits. Patients were clinically diagnosed with primary unipolar depression (n = 40), a primary psychotic disorder (n = 32), both mood and psychotic disorders (n = 17), and primary bipolar disorder (n = 14). Among an ethnically diverse sample of 124 psychiatric inpatients approached for a smoking cessation trial, 107 (86%) performed adequately on the 3Q (i.e., obtained a score of at least 3 out of a possible 6). Patients were better able to identify the study risks and benefits than to describe the study purpose. The 3Q appears to be a useful tool for researchers working with vulnerable psychiatric patients.

View details for DOI 10.1525/jer.2011.6.3.65

View details for Web of Science ID 000295878900008

View details for PubMedID 21931239
Integrating Tobacco Treatment Into Mental Health Settings JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Prochaska, J. J. 2010; 304 (22): 2534-2535
View details for Web of Science ID 000285053300030

View details for PubMedID 21139117
A Population-Based Examination of Cigarette Smoking and Mental Illness in Black Americans NICOTINE & TOBACCO RESEARCH Hickman, N. J., Delucchi, K. L., Prochaska, J. J. 2010; 12 (11): 1125-1132
Abstract

This study examines the relation between tobacco use and cessation with lifetime and past year mental illness in a nationally representative sample of Blacks.This cross-sectional study analyzed nationally representative data from 3,411 adult Blacks participating in the 2001-2003 National Survey of American Life. Smoking prevalence and quit rates according to lifetime and past year Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition mental disorders were assessed by a modified version of the Composite International Diagnostic Interview.Compared with those without mental illness, respondents with a lifetime, past year, or past month mental illness had a higher smoking prevalence (20.6%, 35.6%, 36.0%, and 45.4%, respectively) and lower quit rate (40.5%, 31.2%, and 26.2%, respectively). The odds of being a current smoker among Blacks with mental illness in their lifetime, past year, and past month, after adjusting for age, gender, education, poverty, and marital status were 1.76 (95% CI = 1.39-2.22), 1.57 (95% CI = 1.22-2.03), and 2.20 (95% CI = 1.56-3.12), respectively. Mental illness also was associated with heavier smoking. Blacks with past year mental illness represented 18.1% of the sample, yet consumed 23.9% of cigarettes smoked by Black smokers. Past year (odds ratio [OR] = 0.72, 95% CI = 0.53-0.97) and past month (OR = 0.54, 95% CI = 0.29-0.98) mental illness were associated with a lower odds of quitting for at least 1 year.Findings indicate that mental illness is significantly associated with tobacco use in Blacks. Tobacco cessation interventions that address mental illness as a barrier to cessation are needed.

View details for DOI 10.1093/ntr/ntq160

View details for Web of Science ID 000283677600008

View details for PubMedID 20855413
Failure to treat tobacco use in mental health and addiction treatment settings: A form of harm reduction? DRUG AND ALCOHOL DEPENDENCE Prochaska, J. J. 2010; 110 (3): 177-182
Abstract

In mental health and addiction treatment settings, failure to treat tobacco dependence has been rationalized by some as a clinical approach to harm reduction. That is, tobacco use is viewed as a less harmful alternative to alcohol or illicit drug use and/or other self-harm behaviors. This paper examines the impact of providers' failure to treat tobacco use on patients' alcohol and illicit drug use and associated high-risk behaviors. The weight of the evidence in the literature indicates: (1) tobacco use is a leading cause of death in patients with psychiatric illness or addictive disorders; (2) tobacco use is associated with worsened substance abuse treatment outcomes, whereas treatment of tobacco dependence supports long-term sobriety; (3) tobacco use is associated with increased (not decreased) depressive symptoms and suicidal risk behavior; (4) tobacco use adversely impacts psychiatric treatment; (5) tobacco use is a lethal and ineffective long-term coping strategy for managing stress, and (6) treatment of tobacco use does not harm mental health recovery. Failure to treat tobacco dependence in mental health and addiction treatment settings is not consistent with a harm reduction model. In contrast, emerging evidence indicates treatment of tobacco dependence may even improve addiction treatment and mental health outcomes. Providers in mental health and addiction treatment settings have an ethical duty to intervene on patients' tobacco use and provide available evidence-based treatments.

View details for DOI 10.1016/j.drugalcdep.2010.03.002

View details for Web of Science ID 000280626200001

View details for PubMedID 20378281
Reaching young adult smokers through the Internet: Comparison of three recruitment mechanisms NICOTINE & TOBACCO RESEARCH Ramo, D. E., Hall, S. M., Prochaska, J. J. 2010; 12 (7): 768-775
Abstract

While young adults have the highest prevalence of cigarette smoking of any adult age group, studies of tobacco and other substance use have reported challenges in recruiting this age group. The Internet may be a useful tool for reaching young adult smokers. The present study compared three Internet-based recruitment methods for young adult smokers to complete a survey about tobacco and other substance use: Craigslist advertisements, other Internet advertisements, and E-mail invitations through a survey sampling service.Recruitment campaigns invited young adults aged 18-25 years who had smoked at least one cigarette in the past 30 days to complete an online survey. Recruitment methods were compared across recruitment numbers, costeffectiveness, and demographic and smoking characteristics of recruited participants.In 6 months, 920 people gave online consent to determine eligibility to complete the survey, of which 336 (36.5%) were eligible, and 201 (59.8%) completed the survey. While Internet advertisements yielded the largest proportion of recruited participants and completed surveys overall, Craigslist and sampling strategies were more successful at targeting young adult smokers who went on to complete the survey and were more costeffective. Participants differed in demographic and substance use characteristics across the three recruitment mechanisms.We identified success at reaching young adults who have smoked cigarettes recently through the Internet, though costs, participant eligibility, proportion of completed surveys, and respondent characteristics differed among the three methods. A multipronged approach to Internet recruitment is most likely to generate a broad diverse sample of young adult smokers.

View details for DOI 10.1093/ntr/ntq086

View details for Web of Science ID 000279485400011

View details for PubMedID 20530194
Effect of Smoking Scenes in Films on Immediate Smoking A Randomized Controlled Study AMERICAN JOURNAL OF PREVENTIVE MEDICINE Shmueli, D., Prochaska, J. J., Glantz, S. A. 2010; 38 (4): 351-358
Abstract

The National Cancer Institute has concluded that exposure to smoking in movies causes adolescent smoking and there are similar results for young adults.This study investigated whether exposure of young adult smokers to images of smoking in films stimulated smoking behavior.100 cigarette smokers aged 18-25 years were randomly assigned to watch a movie montage composed with or without smoking scenes and paraphernalia followed by a 10-minute recess. The outcome was whether or not participants smoked during the recess. Data were collected and analyzed in 2008 and 2009.Smokers who watched the smoking scenes were more likely to smoke during the break (OR=3.06, 95% CI=1.01, 9.29). In addition to this acute effect of exposure, smokers who had seen more smoking in movies before the day of the experiment were more likely to smoke during the break (OR=6.73, 95% CI=1.00, 45.25, comparing the top to bottom 5th percentiles of exposure). Level of nicotine dependence (OR=1.71, 95% CI=1.27, 2.32 per point on the Fagerström Test for Nicotine Dependence scale); contemplation (OR=9.07, 95% CI=1.71, 47.99) and precontemplation (OR=7.30, 95% CI=1.39, 38.36) stages of change; and impulsivity (OR=1.21, 95% CI=1.03, 1.43) were also associated with smoking during the break. Participants who watched the montage with smoking scenes and those with a higher level of nicotine dependence were also more likely to have smoked within 30 minutes after the study.There is a direct link between viewing smoking scenes and immediate subsequent smoking behavior. This finding suggests that individuals attempting to limit or quit smoking should be advised to refrain from or reduce their exposure to movies that contain smoking.

View details for DOI 10.1016/j.amepre.2009.12.025

View details for Web of Science ID 000276419500001

View details for PubMedID 20307802
Cigarette Smoking is a Risk Factor for Alzheimer's Disease: An Analysis Controlling for Tobacco Industry Affiliation JOURNAL OF ALZHEIMERS DISEASE Cataldo, J. K., Prochaska, J. J., Glantz, S. A. 2010; 19 (2): 465-480
Abstract

To examine the relationship between smoking and Alzheimer's disease (AD) after controlling for study design, quality, secular trend, and tobacco industry affiliation of the authors, electronic databases were searched; 43 individual studies met the inclusion criteria. For evidence of tobacco industry affiliation, http://legacy.library.ucsf.edu was searched. One fourth (11/43) of individual studies had tobacco-affiliated authors. Using random effects meta-analysis, 18 case control studies without tobacco industry affiliation yielded a non-significant pooled odds ratio of 0.91 (95% CI, 0.75-1.10), while 8 case control studies with tobacco industry affiliation yielded a significant pooled odds ratio of 0.86 (95% CI, 0.75-0.98) suggesting that smoking protects against AD. In contrast, 14 cohort studies without tobacco-industry affiliation yielded a significantly increased relative risk of AD of 1.45 (95% CI, 1.16-1.80) associated with smoking and the three cohort studies with tobacco industry affiliation yielded a non-significant pooled relative risk of 0.60 (95% CI 0.27-1.32). A multiple regression analysis showed that case-control studies tended to yield lower average risk estimates than cohort studies (by -0.27 +/- 0.15, P=0.075), lower risk estimates for studies done by authors affiliated with the tobacco industry (by -0.37 +/- 0.13, P=0.008), no effect of the quality of the journal in which the study was published (measured by impact factor, P=0.828), and increasing secular trend in risk estimates (0.031/year +/- 0.013, P=0.02). The average risk of AD for cohort studies without tobacco industry affiliation of average quality published in 2007 was estimated to be 1.72 +/- 0.19 (P< 0.0005). The available data indicate that smoking is a significant risk factor for AD.

View details for DOI 10.3233/JAD-2010-1240

View details for Web of Science ID 000276616000008

View details for PubMedID 20110594
Smoking Cessation: An Integral Part of Lung Cancer Treatment ONCOLOGY Cataldo, J. K., Dubey, S., Prochaska, J. J. 2010; 78 (5-6): 289-301
Abstract

Lung cancer is the leading cause of cancer death in the US. About 50% of lung cancer patients are current smokers at the time of diagnosis and up to 83% continue to smoke after diagnosis. A recent study suggests that people who continue to smoke after a diagnosis of early-stage lung cancer almost double their risk of dying. Despite a growing body of evidence that continued smoking by patients after a lung cancer diagnosis is linked with less effective treatment and a poorer prognosis, the belief prevails that treating tobacco dependence is useless. With improved cancer treatments and survival rates, smoking cessation among lung cancer patients has become increasingly important. There is a pressing need to clarify the role of smoking cessation in the care of lung cancer patients.This paper will report on the benefits of smoking cessation for lung cancer patients and the elements of smoking cessation treatment, with consideration of tailoring to the needs of lung cancer patients.Given the significant benefits of smoking cessation and that tobacco dependence remains a challenge for many lung cancer patients, cancer care providers need to offer full support and intensive treatment with a smoking cessation program that is tailored to lung cancer patients' specific needs.A tobacco dependence treatment plan for lung cancer patients is provided.

View details for DOI 10.1159/000319937

View details for Web of Science ID 000281517800001

View details for PubMedID 20699622
Intentions to quit smoking among youth in substance abuse treatment DRUG AND ALCOHOL DEPENDENCE Ramo, D. E., Prochaska, J. J., Myers, M. G. 2010; 106 (1): 48-51
Abstract

Smoking cessation interventions for adolescents in substance abuse treatment have shown promise. However, a better understanding of the correlates of substance use disordered (SUD) youths' intentions toward smoking cessation will help tailor cessation interventions to this population. The current study examined tobacco use, smoking-related self-efficacy, substance use and intentions to quit using alcohol and illicit drugs as correlates of intentions to quit smoking among youth in SUD treatment.Participants were 178 adolescents who were in inpatient (n=90) or outpatient (n=88) SUD treatment and had smoked at least once in the past 30 days. The sample was 44% female, 72% non-Hispanic Caucasian, with a mean age of 16.2 years (SD=1.2). Participants rated the likelihood that they would be nonsmokers in the next year (9-point scale).SUD youth intention to quit smoking averaged 4.9 out of 10 (SD=3.2), comparable to intention to quit drinking (M=5.3, SD=3.6), but lower than their intention to quit using drugs (M=6.0, SD=3.4). Teens' intentions to quit smoking were associated with nicotine dependence (r=-.30, p<.01) and smoking cessation related self-efficacy (r=.36, p<.01), but not with pretreatment substance use severity (r=-.15). Controlling for nicotine dependence, teens' intentions to quit smoking were positively related to smoking cessation self-efficacy (pr=.26, p<.01) and intention to quit using illicit drugs (pr=.15, p<.05), but unrelated to intention to quit drinking.Findings highlight the appropriateness of addressing adolescent tobacco use during SUD treatment, but emphasize the importance of assessing intention and other cognitions for each substance, as they may differ markedly.

View details for DOI 10.1016/j.drugalcdep.2009.07.004

View details for Web of Science ID 000273935800007

View details for PubMedID 19699041
The benefits and challenges of multiple health behavior change in research and in practice PREVENTIVE MEDICINE Prochaska, J. J., Nigg, C. R., Spring, B., Velicer, W. F., Prochaska, J. O. 2010; 50 (1-2): 26-29
Abstract

The major chronic diseases are caused by multiple risks, yet the science of multiple health behavior change (MHBC) is at an early stage, and factors that facilitate or impede scientists' involvement in MHBC research are unknown. Benefits and challenges of MHBC interventions were investigated to strengthen researchers' commitment and prepare them for challenges.An online anonymous survey was e-mailed to listservs of the Society of Behavioral Medicine between May 2006 and 2007. Respondents (N=69) were 83% female; 94% held a doctoral degree; 64% were psychologists, 24% were in public health; and 83% targeted MHBC in their work.A sample majority rated 23 of the 24 benefits, but only 1 of 31 challenge items, as very to extremely important. Those engaged in MHBC rated the total benefits significantly higher than respondents focused on single behaviors, F(1,69)=4.21, p<.05, and rated the benefits significantly higher than the challenges: paired t(57)=7.50, p<.001. The two groups did not differ in ratings of challenges.It appears that individuals focused solely on single behaviors do not fully appreciate the benefits that impress MHBC researchers; it is not that substantial barriers are holding them back. Benefits of MHBC interventions need emphasizing more broadly to advance this research area.

View details for DOI 10.1016/j.ypmed.2009.11.009

View details for Web of Science ID 000275278700005

View details for PubMedID 19948184
Ten critical reasons for treating tobacco dependence in inpatient psychiatry. Journal of the American Psychiatric Nurses Association Prochaska, J. J. 2009; 15 (6): 404-409
View details for DOI 10.1177/1078390309355318

View details for PubMedID 20336177
Extended treatment of older cigarette smokers ADDICTION Hall, S. M., Humfleet, G. L., Munoz, R. F., Reus, V. I., Robbins, J. A., Prochaska, J. J. 2009; 104 (6): 1043-1052
Abstract

Tobacco dependence treatments achieve abstinence rates of 25-30% at 1 year. Low rates may reflect failure to conceptualize tobacco dependence as a chronic disorder. The aims of the present study were to determine the efficacy of extended cognitive behavioral and pharmacological interventions in smokers > or = 50 years of age, and to determine if gender differences in efficacy existed.Open randomized clinical trial.A free-standing, smoking treatment research clinic.A total of 402 smokers of > or = 10 cigarettes per day, all 50 years of age or older.Participants completed a 12-week treatment that included group counseling, nicotine replacement therapy (NRT) and bupropion. Participants, independent of smoking status, were then assigned randomly to follow-up conditions: (i) standard treatment (ST; no further treatment); (ii) extended NRT (E-NRT; 40 weeks of nicotine gum availability); (iii) extended cognitive behavioral therapy (E-CBT; 11 cognitive behavioral sessions over a 40-week period); or (iv) E-CBT plus E-NRT (E-combined; 11 cognitive behavioral sessions plus 40 weeks nicotine gum availability).Primary outcome variable was 7-day point prevalence cigarette abstinence verified biochemically at weeks 24, 52, 64 and 104.The most clinically important findings were significant main effects for treatment condition, time and the treatment x time interaction. The E-CBT condition produced high cigarette abstinence rates that were maintained throughout the 2-year study period [(week 24 (58%), 52 (55%), 64 (55%) and 104 (55%)], and was significantly more effective than E-NRT and ST across that period. No other treatment condition was significantly different to ST. No effects for gender were found.Extended cognitive behavioral treatments can produce high and stable cigarette abstinence rates for both men and women. NRT does not add to the efficacy of extended CBT, and may hamper its efficacy. Research is needed to determine if these results can be replicated in a sample with a greater range of ages, and improved upon with the addition of medications other than NRT.

View details for DOI 10.1111/j.1360-0443.2009.02548.x

View details for Web of Science ID 000265882800024

View details for PubMedID 19392908
Stage-Tailored Tobacco Cessation Treatment in Inpatient Psychiatry PSYCHIATRIC SERVICES Prochaska, J. J., Hall, S. E., Hall, S. M. 2009; 60 (6): 848-848
View details for Web of Science ID 000266493800020

View details for PubMedID 19487360
Resisting Tempting Foods and Smoking Behavior: Implications From a Self-Control Theory Perspective HEALTH PSYCHOLOGY Shmueli, D., Prochaska, J. J. 2009; 28 (3): 300-306
Abstract

Individuals may desire to diet or restrain from eating certain foods while attempting to quit smoking out of concern for weight gain. However, previous research and clinical tobacco treatment guidelines suggest that concurrent dieting may undermine attempts to quit smoking. The current study applied the self-control strength model, which posits that self-regulation relies on a limited strength that is consumed with use, to test whether resisting tempting sweets would lead to a greater likelihood of subsequent smoking.Participants were 101 cigarette smokers randomly assigned to resist eating either from a tempting plate of sweets or from a plate of less tempting vegetables. All participants were then given a 10-min recess.Whether participants smoked during the break, measured with a breath carbon monoxide sample, served as the primary dependent variable.As predicted, participants who resisted sweets were more likely to smoke during the break (53.2%) than those who resisted vegetables (34.0%), chi2(1, N = 101) = 3.65 p < .05.The findings support the tenets of the self-control strength model and suggest the mechanism by which dietary restraint may harm efforts at quitting smoking.

View details for DOI 10.1037/a0013826

View details for Web of Science ID 000266084800005

View details for PubMedID 19450035
Designing for dissemination: development of an evidence-based tobacco treatment curriculum for psychiatry training programs. Journal of the American Psychiatric Nurses Association Prochaska, J. J., Fromont, S. C., Hudmon, K. S., Cataldo, J. K. 2009; 15 (1): 24-31
Abstract

Psychiatry training programs provide a unique arena for affecting professional norms and increasing access to tobacco cessation services among smokers with mental illness. Psychiatry Rx for Change emphasizes evidence-based patient-oriented tobacco treatments relevant for tobacco users with psychiatric disorders. Following Diffusion of Innovations theory and the RE-AIM framework, the curriculum is being disseminated to psychiatry residency and graduate psychiatric nursing programs in the Western United States with plans to study curriculum adoption, implementation, and maintenance on a broad scale. Psychiatry Rx for Change aims to increase the likelihood that smokers with co-occurring disorders will receive evidence-based cessation treatment.

View details for DOI 10.1177/1078390308329536

View details for PubMedID 19587844
Treatment of Smokers with Co-Occurring Disorders: Emphasis on Integration in Mental Health and Addiction Treatment Settings ANNUAL REVIEW OF CLINICAL PSYCHOLOGY Hall, S. M., Prochaska, J. J. 2009; 5: 409-431
Abstract

This article reviews the research on the treatment of cigarette smoking in individuals who have comorbid mental illnesses or non-nicotinic addictions. The prevalence of smoking in mentally ill and substance-abusing populations is presented, as well as reasons for this high prevalence. The historical role of cigarettes and tobacco in mental illness and addiction is reviewed to help the reader better understand the pervasiveness of smoking in these disorders and the relative absence of intervention efforts in mental heath and addiction treatment settings. The article then discusses the several reasons for integrating smoking treatment into mental health and addiction settings. The outcome research for adult and adolescent comorbid smokers is reviewed, and barriers to treatment are discussed. The review closes with a brief discussion of models of integration and thoughts about prevention.

View details for DOI 10.1146/annurev.clinpsy.032408.153614

View details for Web of Science ID 000268072000019

View details for PubMedID 19327035
Evaluation of an Evidence-Based Tobacco Treatment Curriculum for Psychiatry Residency Training Programs ACADEMIC PSYCHIATRY Prochaska, J. J., Fromont, S. C., Leek, D., Hudmon, K. S., Louie, A. K., Jacobs, M. H., Hall, S. M. 2008; 32 (6): 484-492
Abstract

Smokers with mental illness and addictive disorders account for nearly one in two cigarettes sold in the United States and are at high risk for smoking-related deaths and disability. Psychiatry residency programs provide a unique arena for disseminating tobacco treatment guidelines, influencing professional norms, and increasing access to tobacco cessation services among smokers with mental illness. The current study evaluated the Rx for Change in Psychiatry curriculum, developed for psychiatry residency programs and focused on identifying and treating tobacco dependence among individuals with mental illness.The 4-hour curriculum emphasized evidence-based, patient-oriented cessation treatments relevant for all tobacco users, including those not yet ready to quit. The curriculum was informed by comprehensive literature review, consultation with an expert advisory group, faculty interviews, and a focus group with psychiatry residents. This study reports on evaluation of the curriculum in 2005-2006, using a quasi-experimental design, with 55 residents in three psychiatry residency training programs in Northern California.The curriculum was associated with improvements in psychiatry residents' knowledge, attitudes, confidence, and counseling behaviors for treating tobacco use among their patients, with initial changes from pre- to posttraining sustained at 3-months' follow-up. Residents' self-reported changes in treating patients' tobacco use were substantiated through systematic chart review.The evidence-based Rx for Change in Psychiatry curriculum is offered as a model tobacco treatment curriculum that can be implemented in psychiatry residency training programs and disseminated widely, thereby effectively reaching a vulnerable and costly population of smokers.

View details for Web of Science ID 000262780000007

View details for PubMedID 19190293
Physical activity as a strategy for maintaining tobacco abstinence: A randomized trial PREVENTIVE MEDICINE Prochaska, J. J., Hall, S. M., Humfleet, G., Munoz, R. F., Reus, V., Gorecki, J., Hu, D. 2008; 47 (2): 215-220
Abstract

For smoking cessation, physical activity (PA) may help manage withdrawal symptoms, mood, stress, and weight; yet studies of PA as an aid for smoking cessation have been mixed. This study examined: (1) the impact of an extended relapse prevention program on increasing moderate to vigorous PA (MVPA) in adults enrolled in a tobacco cessation treatment trial; (2) whether changes in MVPA were associated with sustained abstinence from smoking; and (3) mechanisms by which MVPA may support sustained abstinence from smoking.In a randomized controlled trial conducted from 2003-2006 in San Francisco, California, 407 adult smokers received a 12 week group-based smoking cessation treatment with bupropion and nicotine patch with the quit date set at week 3. At week 12, participants were randomized to no further treatment or to 40 weeks of bupropion or placebo with or without an 11-session relapse prevention intervention of which 2 sessions (held at weeks 16 and 20) focused on PA. Participants receiving the PA intervention (n=163) received a pedometer, counseling to increase steps 10% biweekly towards a 10,000 steps/day goal, and personalized reports graphing progress with individualized goals. The International Physical Activity Questionnaire assessed weekly minutes of MVPA at baseline and weeks 12 and 24. Sustained abstinence from tobacco at week 24 was validated with expired carbon monoxide.In a repeated mixed model analysis, intervention participants significantly increased their MVPA relative to control participants, F(1,475)=3.95, p=.047. Pedometer step counts also increased significantly, t(23)=2.36, p=.027, though only 15% of intervention participants provided 6 weeks of pedometer monitoring. Controlling for treatment condition, increased MVPA predicted sustained smoking abstinence at week 24, odds ratio=1.84 (95% CI: 1.07, 3.05). Among participants with sustained abstinence, increased MVPA was associated with increased vigor (r=0.23, p=.025) and decreased perceived difficulty with staying smoke-free (r=-0.21, p=.038).PA promotion as an adjunct to tobacco treatment increases MVPA levels; changes in MVPA predict sustained abstinence, perhaps by improving mood and self-efficacy.

View details for DOI 10.1016/j.ypmed.2008.05.006

View details for Web of Science ID 000258560300013

View details for PubMedID 18572233
Evaluating the validities of different DSM-IV-based conceptual constructs of tobacco dependence ADDICTION Hendricks, P. S., Prochaska, J. J., Humfleet, G. L., Hall, S. M. 2008; 103 (7): 1215-1223
Abstract

To compare the concurrent and predictive validities of two subsets of DSM-IV criteria for nicotine dependence (tolerance and withdrawal; withdrawal; difficulty controlling use; and use despite harm) to the concurrent and predictive validity of the full DSM-IV criteria.Analysis of baseline and outcome data from three randomized clinical trials of cigarette smoking treatment.San Francisco, California.Two samples of cigarette smokers (n = 810 and 322), differing with regard to baseline characteristics and treatment received, derived from three randomized clinical trials.DSM-IV nicotine dependence criteria were measured at baseline with a computerized version of the Diagnostic Interview Schedule for DSM-IV (DIS-IV). Additional baseline measures included the Fagerström Test of Nicotine Dependence (FTND), number of cigarettes smoked per day, breath carbon monoxide (CO) level, the Minnesota Nicotine Withdrawal Scale (MNWS), the Michigan Nicotine Reinforcement Questionnaire (M-NRQ) and the Profile of Mood States (POMS). Seven-day point-prevalence abstinence was assessed at week 12.Full DSM-IV criteria displayed greater concurrent validity than either of the two subsets of criteria. However, DSM-IV symptoms accounted for only a nominal amount of the variance in baseline smoking-related characteristics and were unrelated to smoking abstinence at week 12. Cigarettes smoked per day was the only significant predictor of abstinence at week 12.Although the findings do not provide a compelling alternative to the full set of DSM-IV nicotine dependence criteria, its poor psychometric properties and low predictive power limit its clinical and research utility.

View details for DOI 10.1111/j.1360-0443.2008.02232.x

View details for Web of Science ID 000256684400024

View details for PubMedID 18554351
Tobacco use among individuals with schizophrenia: What role has the tobacco industry played? SCHIZOPHRENIA BULLETIN Prochaska, J. J., Hall, S. M., Bero, L. A. 2008; 34 (3): 555-567
Abstract

Rates of tobacco use among individuals diagnosed with schizophrenia have been estimated as high as 80%. A variety of hypotheses have been proposed to explain the high rate of tobacco use among this vulnerable group. This study examined the tobacco industry's efforts to establish and promulgate beliefs about schizophrenic individuals' need to smoke and the hazards of quitting. The current study analyzed previously secret tobacco industry documents. The initial search was conducted during January-July 2005 in the Legacy Tobacco Documents Library. The search yielded 280 records dating from 1955 to 2004. Documents indicate the tobacco industry monitored or directly funded research supporting the idea that individuals with schizophrenia were less susceptible to the harms of tobacco and that they needed tobacco as self-medication. The tobacco industry promoted smoking in psychiatric settings by providing cigarettes and supporting efforts to block hospital smoking bans. The tobacco industry engaged in a variety of direct and indirect efforts that likely contributed to the slowed decline in smoking prevalence in schizophrenia via slowing nicotine dependence treatment development for this population and slowing the rate of policy implementation vis-à-vis smoking bans on psychiatric units.

View details for DOI 10.1093/schbul/sbm117

View details for Web of Science ID 000255156500019

View details for PubMedID 17984298
Changes in psychiatric patients' thoughts about quitting smoking during a smoke-free hospitalization NICOTINE & TOBACCO RESEARCH Shmueli, D., Fletcher, L., Hall, S. E., Hall, S. M., Prochaska, J. J. 2008; 10 (5): 875-881
Abstract

Though exempted from national bans of tobacco smoking in hospitals, some psychiatric facilities have voluntarily gone 100% smoke free with little reported difficulty in clinical management. The impact of smoking restrictions on psychiatric patients' thoughts about quitting smoking, however, is not known. This study investigates changes in thoughts about quitting smoking for patients hospitalized in a smoke-free psychiatric inpatient facility. Participants were 100 smokers recruited from a university-based adult inpatient psychiatry unit. The present study focused on participants' reported desire to quit smoking, their expectancy of success and anticipated difficulty with quitting, and their smoking abstinence goal. Assessments were conducted at hospital intake and shortly before hospital discharge. Follow-up assessments were conducted by phone at 1 week, 1 month, and 3 months post-hospitalization to measure smoking behavior. Although no cessation treatment was provided in this observational study, from admission to discharge, participants reported an increased expectancy of success with quitting and a decreased expectancy of difficulty with staying quit. They also were more likely to endorse a smoking-related goal. Psychiatric diagnosis was not related to thoughts about abstinence. Furthermore, participants' thoughts about abstinence at discharge were significantly related to their subsequent smoking behavior. Hospitalization in a smoke-free environment is associated with increases in patients' expectancies about quitting and staying smoke free.

View details for DOI 10.1080/14622200802027198

View details for Web of Science ID 000256055900014

View details for PubMedID 18569762
Investigation into the cause of death of a 56-year-old man with serious mental illness AMERICAN JOURNAL OF PSYCHIATRY Prochaska, J. J., Schane, R., Leek, D., Hall, S. E., Hall, S. M. 2008; 165 (4): 453-456
View details for DOI 10.1176/appi.ajp.2007.07091455

View details for Web of Science ID 000254577800010

View details for PubMedID 18381915
Methods of quantifying change in multiple risk factor interventions 28th Annual Meeting of the Society-of-Behavioral-Medicine Prochaska, J. J., Velicer, W. F., Nigg, C. R., Prochaska, J. O. ACADEMIC PRESS INC ELSEVIER SCIENCE. 2008: 260–65
Abstract

Risky behaviors such as smoking, alcohol abuse, physical inactivity, and poor diet are detrimental to health, costly, and often co-occur. Greater efforts are being targeted at changing multiple risk behaviors to more comprehensively address the health needs of individuals and populations. With increased interest in multiple risk factor interventions, the field will need ways to conceptualize the issue of overall behavior change.Analyzing data from over 8000 participants in four multibehavioral interventions, we present five different methods for quantifying and reporting changes in multiple risk behaviors.The methods are: (a) the traditional approach of reporting changes in individual risk behaviors; (b) creating a combined statistical index of overall behavior change, standardizing scores across behaviors on different metrics; (c) using a behavioral index; (d) calculating an overall impact factor; and (e) using overarching outcome measures such as quality of life, related biometrics, or cost outcomes. We discuss the methods' interpretations, strengths, and limitations.Given the lack of consensus in the field on how to examine change in multiple risk behaviors, we recommend researchers employ and compare multiple methods in their publications. A dialogue is needed to work toward developing a consensus for optimal ways of conceptualizing and reporting changes in multibehavioral interventions.

View details for DOI 10.1016/j.ypmed.2007.07.035

View details for Web of Science ID 000255668000013

View details for PubMedID 18319099
Multiple health behavior change research: An introduction and overview PREVENTIVE MEDICINE Prochaska, J. J., Spring, B., Nigg, C. R. 2008; 46 (3): 181-188
Abstract

In 2002, the Society of Behavioral Medicine's special interest group on Multiple Health Behavior Change was formed. The group focuses on the interrelationships among health behaviors and interventions designed to promote change in more than one health behavior at a time. Growing evidence suggests the potential for multiple-behavior interventions to have a greater impact on public health than single-behavior interventions. However, there exists surprisingly little understanding of some very basic principles concerning multiple health behavior change (MHBC) research. This paper presents the rationale and need for MHBC research and interventions, briefly reviews the research base, and identifies core conceptual and methodological issues unique to this growing area. The prospects of MHBC for the health of individuals and populations are considerable.

View details for DOI 10.1016/j.ypmed.2008.02.001

View details for Web of Science ID 000255668000001

View details for PubMedID 18319098
Does Smoking Intervention Influence Adolescent Substance Use Disorder Treatment Outcomes? SUBSTANCE ABUSE Myers, M. G., Prochaska, J. J. 2008; 29 (2): 81-88
Abstract

Although tobacco use is reported by the majority of substance use disordered (SUD) youth, little work has examined tobacco focused interventions with this population. The present study is an initial investigation of the effect of a tobacco use intervention on adolescent SUD treatment outcomes. Participants were adolescents in SUD treatment taking part in a cigarette smoking intervention efficacy study, assessed at baseline and followed up at 3- and 6-months post-intervention. Analyses compared treatment and control groups on days using alcohol and drugs and proportion abstinent from substance use at follow up assessments. Adolescents in the treatment condition reported significantly fewer days of substance use and were somewhat more likely to be abstinent at 3-month follow up. These findings suggest that tobacco focused intervention may enhance SUD treatment outcome. The present study provides further evidence for the value of addressing tobacco use in the context of treatment for adolescent SUD's.

View details for DOI 10.1080/08897070802093361

View details for Web of Science ID 000207708200009

View details for PubMedID 19042327
Older versus younger treatment-seeking smokers: Differences in smoking behavior, drug and alcohol use, and psychosocial and physical functioning NICOTINE & TOBACCO RESEARCH Hall, S. M., Humfleet, G. L., Gorecki, J. A., Munoz, R. F., Reus, V. I., Prochaska, J. J. 2008; 10 (3): 463-470
Abstract

Quitting smoking benefits older individuals, yet few recent studies have described older smokers. The goal of this paper was to test a series of hypotheses about differences between smokers aged 50 years or older (50+) and those younger than age 50 (<50) presenting to the same treatment facility during 2002-2004 for participation in two randomized clinical trials: one exclusively for smokers aged 50+, and a second open to smokers aged 18 or older. As predicted, smokers aged 50+ were more tobacco dependent, had better psychological functioning, and had poorer physical functioning than those aged <50. Contrary to predictions, we found no differences in motivation to quit cigarette smoking or in alcohol use. Women aged 50+ were less likely to report marijuana use than women aged <50, and less likely than men to receive a positive diagnosis for alcohol abuse. Despite higher scores on measures of tobacco dependence, older smokers were less likely to be diagnosed as tobacco dependent or as having tobacco withdrawal using DSM-IV criteria. Rates of DSM-IV alcohol abuse and dependence were high in both age groups but were higher for smokers aged <50. We found no striking differences between studies in reasons for exclusion, but in both the proportion of individuals excluded due to current antidepressant use was high. Implications for the assessment and treatment of older adults are discussed.

View details for DOI 10.1080/14622200801901922

View details for Web of Science ID 000253763400010

View details for PubMedID 18324565
Cognitive interviews for measurement evaluation of the Fagerstrom Test for Nicotine Dependence (FTND) in smokers with schizophrenia spectrum disorders ADDICTIVE BEHAVIORS Prochaska, J. J., Leek, D. N., Hall, S. E., Hall, S. M. 2007; 32 (4): 793-802
Abstract

People diagnosed with schizophrenia have among the highest known rates of tobacco use. While the Fagerström Test for Nicotine Dependence (FTND) is the most widely used measure of nicotine dependence, recent research has questioned its applicability for individuals with schizophrenia. The current study employed cognitive interviews to evaluate the FTND with smokers diagnosed with schizophrenia spectrum disorders, recruited from an acute inpatient psychiatry setting, and a comparison group of smokers recruited from the community. The groups were comparable on tobacco use variables and FTND scores. Detailed qualitative cognitive interviews indicated all subjects understood the FTND items. For both groups, the FTND missed nocturnal smoking, reported as weekly by 80% of patients and 47% of controls. Finishing other people's cigarettes also was under-reported on the FTND. Restrictions to smoking were common across groups. The cognitive interview methodology proved useful for understanding how individuals interpreted and answered the FTND items. Overall, the qualitative findings identified limitations in the FTND for both groups, with the limitations generally more pronounced among patients with schizophrenia.

View details for DOI 10.1016/j.addbeh.2006.06.016

View details for Web of Science ID 000244399000011

View details for PubMedID 16839695
Medical students' use of the Stages of Change Model in tobacco cessation counseling JOURNAL OF GENERAL INTERNAL MEDICINE Prochaska, J. J., Teherani, A., Hauer, K. E. 2007; 22 (2): 223-227
Abstract

Many medical schools have incorporated the Stages of Change Model into their curricula with specific application to tobacco cessation.This study examined the extent to which medical students were prepared to provide stage-based interventions to treat nicotine dependence.Using a quasi-experimental design, medical students' counseling interactions were evaluated with a standardized patient portraying a smoker in either the precontemplation or preparation stage of change.Participants were 147 third-year medical students at the University of California, San Francisco.Checklists completed by standardized patients evaluated students' clinical performance. Surveys administered before and after the encounters assessed students' knowledge, attitudes, confidence and previous experience with treating smoking.Most students asked about tobacco use (89%), advised patients of the health benefits of quitting (74%), and assessed the patient's readiness to quit (76%). The students were more likely to prescribe medications and offer referrals to patients in the preparation than in the precontemplation stage of change (P < 0.001); however, many students had difficulty identifying patients ready to quit, and few encouraged patients to set a quit date or arranged follow-up to assess progress. Students' tobacco-related knowledge, but not their attitudes, confidence, or previous experience predicted their clinical performance.The findings indicated evidence of students tailoring their counseling strategies to the patients' stage of change; however, they still could do more to assist their patients in quitting. Additional training and integration of cessation counseling into clinical rotations are needed.

View details for DOI 10.1007/s11606-006-0040-0

View details for Web of Science ID 000244521900010

View details for PubMedID 17356990
Addressing nicotine dependence in psychodynamic psychotherapy: Perspectives from residency training ACADEMIC PSYCHIATRY Prochaska, J. J., Fromont, S. C., Banys, P., Eisendrath, S. J., Horowitz, M. J., Jacobs, M. H., Hall, S. M. 2007; 31 (1): 8-14
Abstract

According to APA treatment recommendations, psychiatrists should assess and intervene in tobacco use with all of their patients who smoke. The ease with which this occurs may vary by treatment model. This study examined perspectives in residency training to identify a framework for addressing nicotine dependence within psychodynamic psychotherapy.The authors collected data from a focus group of psychiatry residents and interviews with psychiatry residency faculty with expertise in psychodynamic psychotherapy. The transcribed interviews were analyzed for key themes and synthesized.Though the residents reported hesitancy to address patients' tobacco use, specifically in psychodynamic psychotherapy, the consensus from the expert faculty consultants was that tobacco interventions can and should be incorporated. The faculty provided suggestions, consistent with a psychodynamic formulation, for assessing patients' tobacco use and their interest in quitting, providing cessation treatment and/or referrals, and following up with patients to address relapse.The findings provide a useful framework, consistent with a psychodynamic model, for assessing and treating tobacco use with patients. Additional training and supervision likely are needed to increase residents' confidence and comfort with implementing these strategies.

View details for Web of Science ID 000243600000003

View details for PubMedID 17242046
Treatment for cigarette smoking among depressed mental health outpatients: A randomized clinical trial AMERICAN JOURNAL OF PUBLIC HEALTH Hall, S. M., Tsoh, J. Y., Prochaska, J. J., Eisendrath, S., Rossi, J. S., Redding, C. A., Rosen, A. B., Meisner, M., Humfleet, G. L., Gorecki, J. A. 2006; 96 (10): 1808-1814
Abstract

Using a brief contact control, we tested the efficacy of a staged care intervention to reduce cigarette smoking among psychiatric patients in outpatient treatment for depression.We conducted a randomized clinical trial that included assessments at baseline and at months 3, 6, 12, and 18. Three hundred twenty-two patients in mental health outpatient treatment who were diagnosed with depression and smoked > or =1 cigarette per day participated. The desire to quit smoking was not a prerequisite for participation. Staged care intervention participants received computerized motivational feedback at baseline and at 3, 6, and 12 months and were offered a 6-session psychological counseling and pharmacological cessation treatment program. Brief contact control participants received a self-help guide and referral list of local smoking-treatment providers.As we hypothesized, abstinence rates among staged care intervention participants exceeded those of brief contact control participants at months 12 and 18. Significant differences favoring staged care intervention also were found in occurrence of a quit attempt and stringency of abstinence goal.The data suggest that individuals in psychiatric treatment for depression can be aided in quitting smoking through use of staged care interventions and that smoking cessation interventions used in the general population can be implemented in psychiatric outpatient settings.

View details for DOI 10.2105/AJPH.2005.080382

View details for Web of Science ID 000240891200023

View details for PubMedID 17008577
Training in tobacco treatments in psychiatry: A national survey of psychiatry residency training directors ACADEMIC PSYCHIATRY Prochaska, J. J., Fromont, S. C., Louie, A. K., Jacobs, M. H., Hall, S. M. 2006; 30 (5): 372-378
Abstract

Nicotine dependence is the most prevalent substance abuse disorder among adult psychiatric patients and is a leading cause of death and disability. This study examines training in tobacco treatment in psychiatry residency programs across the United States.The authors recruited training directors to complete a survey of their program's curriculum related to tobacco treatment, attitudes related to treating tobacco in psychiatry, and perceptions of residents' skills for addressing nicotine dependence in psychiatric patients.Respondents were representative of the national pool. Half of the programs provided training in tobacco treatments for a median duration of 1 hour. Content areas covered varied greatly. Programs with tobacco-related training expressed more favorable attitudes toward addressing tobacco in psychiatry and were more likely to report confidence in their residents' skills for treating nicotine dependence. Programs without tobacco training reported a lack of faculty expertise on tobacco treatments. Most training directors reported moderate to high interest in evaluating a model tobacco curriculum for psychiatry and stated they would dedicate an average of 4 hours of curriculum time.The findings demonstrate the need for and interest in a model tobacco treatment curriculum for psychiatry residency training. Training psychiatrists offers the potential of delivering treatment to one of the largest remaining groups of smokers: patients with mental disorders.

View details for Web of Science ID 000241026900003

View details for PubMedID 17021144
Comparing intervention outcomes in smokers treated for single versus multiple behavioral risks HEALTH PSYCHOLOGY Prochaska, J. J., Velicer, W. F., Prochaska, J. O., Delucchi, K., Hall, S. M. 2006; 25 (3): 380-388
Abstract

This study examined treatment outcomes among smokers with single versus multiple behavioral risks. Data were drawn from smokers (N = 2,326) participating in 3 population-based, multibehavioral studies targeting cigarette smoking, high-fat diets, and high-risk sun exposure. Outcomes were compared for participants at risk for smoking only (13%), smoking plus 1 additional risk factor (37%), and smoking plus 2 additional risk factors (50%). The smoking only group tended to be female, older, more educated, lighter smokers, in the preparation stage of change for smoking, with more previous quit attempts and longer periods of abstinence. At 12 and 24 months follow-up, treatment of 1 or 2 coexisting risk factors did not decrease the effectiveness of smoking cessation treatment, and treatment for the coexisting factors was effective.

View details for DOI 10.1037/0278-6133.25.3.380

View details for Web of Science ID 000237761300015

View details for PubMedID 16719610
Return to smoking following a smoke-free psychiatric hospitalization AMERICAN JOURNAL ON ADDICTIONS Prochaska, J. J., Fletcher, L., Hall, S. E., Hall, S. M. 2006; 15 (1): 15-22
Abstract

This study examined the smoking behaviors and motivations of 100 patients hospitalized in a smoke-free psychiatry unit. The sample averaged nineteen cigarettes per day and had a history of repeated failed quit attempts, yet 65% expressed interest in quitting. During hospitalization, nicotine replacement was provided to 70% of smokers to manage nicotine withdrawal. Provider counseling for smoking cessation, however, was rare, and all patients returned to smoking within five weeks of hospital discharge. The inpatient setting provides a potential site for initiating tobacco dependence treatment; however to maintain abstinence following hospital discharge, greater support is needed.

View details for DOI 10.1080/10550490500419011

View details for Web of Science ID 000234991900004

View details for PubMedID 16449089
How prepared are psychiatry residents for treating nicotine dependence? ACADEMIC PSYCHIATRY Prochaska, J. J., Fromont, S. C., Hall, S. M. 2005; 29 (3): 256-261
Abstract

Nicotine dependence is the most prevalent substance abuse disorder among adult psychiatric patients and a leading cause of death and disability. The authors examined the extent to which psychiatry residents are prepared to treat nicotine dependence in clinical practice.Residents from five psychiatry residency programs in northern California completed an anonymous survey of their knowledge, attitudes, and behaviors regarding treating nicotine dependence among their patients.Respondents (N = 105, 60% female) represented all 4 years of residency training. Residents' smoking status was 11% current, 17% former, and 72% never. Knowledge scores averaged 54% correct. Confidence ratings averaged 3 (SD = 0.6) on a 5-point scale. Seventy six percent rated their overall ability to help patients quit using tobacco as fair or poor. The percent reporting often or always engaging in the National Cancer Institute's 5-A intervention for smoking cessation was: 58% ask; 29% advise; 17% assess; 18% assist; and 13% arrange follow up. Most residents reported none or inadequate tobacco cessation training during medical school (74%) or residency (79%), and nearly all (94%) reported moderate to high interest in learning more about helping patients quit smoking.Psychiatry residents appear unprepared to treat nicotine dependence, but report considerable interest in this area. The findings demonstrate the need for and interest in tobacco cessation curricula in psychiatry residency training.

View details for Web of Science ID 000231596700005

View details for PubMedID 16141120
Preliminary evidence of the association between the history of childhood attention-deficit/hyperactivity disorder and smoking treatment failure NICOTINE & TOBACCO RESEARCH Humfleet, G. L., Prochaska, J. J., Mengis, M., Cullen, J., MUNOZ, R., Reus, V., Hall, S. M. 2005; 7 (3): 453-460
Abstract

Smoking rates are elevated among individuals with attention-deficit/hyperactivity disorder (ADHD). The association of ADHD diagnosis and smoking treatment outcome has not been examined. The present study examined abstinence rates among 428 adult smokers participating in two randomized controlled trials. Treatments included nicotine replacement, antidepressants, and psychological interventions. Childhood ADHD was assessed retrospectively by diagnostic interview. In a survival analysis, ADHD status predicted time to relapse after controlling for gender, history of depression, and baseline smoking variables. Only 1 of 47 participants with a history of childhood ADHD remained abstinent by week 52, compared with 18% of those who had no history of childhood ADHD (adjusted OR=0.36, 95% CI=0.28-0.45). The current findings provide preliminary evidence for an association between childhood ADHD and smoking cessation treatment failure. Further investigation is warranted.

View details for DOI 10.1081/14622200500125310

View details for Web of Science ID 000232105700015

View details for PubMedID 16085513
Predictors of health functioning in two high-risk groups of smokers DRUG AND ALCOHOL DEPENDENCE Prochaska, J. J., Sorensen, J. L., Hall, S. M., Rossi, J. S., Redding, C. A., Rosen, A. B., Eisendrath, S. J., Meisner, M. R. 2005; 78 (2): 169-175
Abstract

The relative and combined health effects of cigarette smoking, heroin use, and depression were examined in 322 clinically depressed smokers and 117 opioid-dependent smokers participating in two studies of the San Francisco Treatment Research Center. Opioid-dependent smokers averaged 16 years (S.D.=9) of heroin use; 3% of depressed smokers used opiates in the past 6 months. Cigarettes per day (M=15, S.D.=10) and Beck Depression (BDI-II) scores (M=21, S.D.=11) were comparable between the two groups. Health functioning was assessed using the Medical Outcomes Study Short Form (SF-36). Adjusting for demographic differences, depressed smokers reported better physical but poorer emotional health relative to opioid-dependent smokers. Both groups scored significantly lower than published norms (p<.05). Within groups, severity of depressive symptoms, tobacco use, and opiate use were independent predictors of lower health functioning (p<.05). Examining risk-related subgroups based on depression scores (BDI-II> or =20), cigarettes per day (> or =1 pack), and opiate use, number of risk factors was monotonically related to health functioning in both samples. Individuals with two or more risk factors scored the lowest (p<.05). Severity of depressive symptoms, tobacco use, and opiate use contributed individually and collectively to lower health functioning. Blended treatments that target multiple risk factors are needed to improve health outcomes.

View details for DOI 10.1016/j.drugalcdep.2004.10.012

View details for Web of Science ID 000229049300008

View details for PubMedID 15845320
Acceptance of nicotine dependence treatment among currently depressed smokers NICOTINE & TOBACCO RESEARCH Haug, N. A., Hall, S. M., Prochaska, J. J., Rosen, A. B., Tsoh, J. Y., Humfleet, G., Delucchi, K., Rossi, J. S., Redding, C. A., Eisendrath, S. 2005; 7 (2): 217-224
Abstract

This study reports on baseline characteristics associated with acceptance and refusal of available smoking treatment among currently depressed smokers in a psychiatric outpatient clinic who were enrolled in a larger clinical trial. The sample (N=154) was 68% female and 72% White, with a mean age of 41.4 years and average smoking rate of 17 cigarettes/day. All participants were assigned to a repeated contact experimental condition; received a stage-based expert system program to facilitate treatment acceptance; and were then offered smoking treatment, consisting of behavioral counseling, nicotine patch, and bupropion. Acceptors (n=53) were defined as those accepting behavioral counseling and pharmacological treatment at some point during the 18-month study, whereas refusers (n=101) received only the expert system. The number of days to treatment acceptance was significantly predicted by stage of change, with those in preparation entering treatment more quickly than contemplators or precontemplators. In a logistic regression, the variables most strongly associated with accepting treatment were current use of psychiatric medication and perceived success for quitting. Severity of depressive symptoms, duration of depression history, and history of recurrent depression were not related to treatment acceptance. Findings have implications for the psychiatric assessment and treatment of smokers in clinical settings. Psychiatric medication may play a significant role in smoking cessation treatment acceptance by currently depressed smokers.

View details for Web of Science ID 000229117300005

View details for PubMedID 16036278
Identification and treatment of substance misuse on an inpatient psychiatry unit PSYCHIATRIC SERVICES Prochaska, J. J., Gill, P., Hall, S. E., Hall, S. M. 2005; 56 (3): 347-349
Abstract

This chart review study examined identification and treatment of substance misuse on an inpatient psychiatry ward before and after the hospital's administration made changes to increase attention to patients' substance misuse. Before the ward changes, 113 of 250 inpatients (45 percent) were identified as misusing substances. Misusers were significantly more likely to be younger, male, single, and cigarette smokers. After the ward changes, substance misuse was more than twice as likely to be addressed in treatment planning and discharge diagnoses, and referrals to substance abuse treatment were nearly twice as likely to be made. Changes in assessment of and treatment planning for psychiatric inpatients may increase attention to substance misuse.

View details for Web of Science ID 000227538000016

View details for PubMedID 15746511
Coeducational and single-sex physical education in middle schools: impact on physical activity. Research quarterly for exercise and sport McKenzie, T. L., Prochaska, J. J., Sallis, J. F., LaMaster, K. J. 2004; 75 (4): 446-449
View details for PubMedID 15673045
Coeducational and single-sex physical education in middle schools: Impact on physical activity RESEARCH QUARTERLY FOR EXERCISE AND SPORT McKenzie, T. L., Prochaska, J. J., Sallis, J. F., LaMaster, K. J. 2004; 75 (4): 444-447
View details for Web of Science ID 000225825500013
Depressed smokers and stage of change: implications for treatment interventions DRUG AND ALCOHOL DEPENDENCE Prochaska, J. J., Rossi, J. S., Redding, C. A., Rosen, A. B., Tsoh, J. Y., Humfleet, G. L., Eisendrath, S. J., Meisner, M. R., Hall, S. M. 2004; 76 (2): 143-151
Abstract

Tobacco Dependence among smokers with psychiatric disorders has been under-addressed by the mental health, addictions, and tobacco control communities. This study examined depressed smokers' readiness to quit and the applicability of the Stages of Change framework to a psychiatric sample. Currently depressed smokers (N=322) were recruited from four outpatient psychiatric clinics. Participants averaged 16 cigarettes per day (S.D.=10) and 24 years (S.D.=13) of smoking. The majority (79%) reported intention to quit smoking with 24% ready to take action in the next 30 days. Individuals in the preparation stage reported more prior quit attempts, a greater commitment to abstinence, increased recognition of the cons of smoking, and greater use of the processes of change. Precontemplators were least likely to identify a goal related to their smoking behavior. Depressive symptom severity and history of recurrent depressive episodes were unrelated to readiness to quit. This study is one of the first to examine the smoking behaviors of currently depressed psychiatric outpatients. The level and longevity of their tobacco use underscore the need for cessation interventions. The consistency in hypothesized patterns among theoretical constructs of the Stages of Change model supports the transfer of stage-tailored interventions to this clinical population.

View details for DOI 10.1016/j.drugalcdep.2004.04.017

View details for Web of Science ID 000225056900004

View details for PubMedID 15488338
Treatment of tobacco use in an inpatient psychiatric setting PSYCHIATRIC SERVICES Prochaska, J., Gill, P., Hall, S. M. 2004; 55 (11): 1265-1270
Abstract

Despite high rates of tobacco use among psychiatric patients, such patients are one of the least studied groups of smokers, and little is known about their access to cessation treatment. This study examined delivery of tobacco cessation services in a smoke-free inpatient psychiatric setting.Medical records of 250 psychiatric inpatients who were admitted from 1998 to 2001 were randomly selected and systematically reviewed.A total of 105 patients (42 percent) were identified as current smokers; the mean+/-SD number of cigarettes that they smoked per day was 21+/-15. Smokers evidenced statistically greater agitation and irritability compared with nonsmokers. None of the smokers received a diagnosis of nicotine dependence or withdrawal, and smoking status was not included in treatment planning for any patient. Nicotine replacement therapy was prescribed for 59 smokers (56 percent); of these patients, 54 (92 percent) used it. Smokers who were not given a prescription for nicotine replacement therapy were more than twice as likely as nonsmokers and smokers who were given a prescription for this therapy to be discharged from the hospital against medical advice. Only one smoker was encouraged to quit smoking, referred for cessation treatment, or provided with nicotine replacement therapy on discharge.Psychiatric inpatients smoke at high rates, yet interventions to treat this deadly addiction are rare. Furthermore, nicotine withdrawal left unaddressed may compromise psychiatric care.

View details for Web of Science ID 000224778600010

View details for PubMedID 15534015
Viability of parks and recreation centers as sites for youth physical activity promotion. Health promotion practice Moody, J. S., Prochaska, J. J., Sallis, J. F., McKenzie, T. L., Brown, M., Conway, T. L. 2004; 5 (4): 438-443
Abstract

This descriptive study explored the potential for public parks and recreation centers as intervention sites for promoting physical activity among youth. Directors (55% women) of 44 recreation centers in San Diego County completed a survey of their centers' physical activity programming for youths ages 3 to 17 years (response rate = 60%). On an average weekday, 373 (SD = 782) youths participated in physical activity at a center. More boys attended than girls (p <.05). Some centers sponsored after-school programs at elementary (41%) and middle (11%) schools but not at high schools (0%). Primary barriers to providing physical activity programs were inadequate staffing (54%), funding (39%), and facilities (32%). Girls and low-income youth were identified as the most difficult populations to reach. Directors reported considerable interest in collaborating on interventions to improve youth activity programs. Public parks and recreation centers are understudied settings with the potential for substantial involvement in efforts to promote youth physical activity.

View details for PubMedID 15358916
Evaluation of a two-year middle-school physical education intervention: M-SPAN MEDICINE AND SCIENCE IN SPORTS AND EXERCISE McKenzie, T. L., Sallis, J. F., Prochaska, J. J., Conway, T. L., Marshall, S. J., Rosengard, P. 2004; 36 (8): 1382-1388
Abstract

School physical education (PE) is highly recommended as a means of promoting physical activity, and randomized studies of health-related PE interventions in middle schools have not been reported. We developed, implemented, and assessed an intervention to increase physical activity during middle-school PE classes.Twenty-four middle schools (approximately 25,000 students, 45% nonwhite) in Southern California participated in a randomized trial. Schools were assigned to intervention (N = 12) or control (N = 12) conditions, and school was the unit of analysis. A major component of the intervention was a 2-yr PE program, which consisted of curricular materials, staff development, and on-site follow-up. Control schools continued usual programs. Student activity and lesson context were observed in 1849 PE lessons using a validated instrument during baseline and intervention years 1 and 2.The intervention significantly (P = 0.02) improved student moderate to vigorous physical activity (MVPA) in PE, by approximately 3 min per lesson. Effects were cumulative; by year 2 intervention schools increased MVPA by 18%. Effect sizes were greater for boys (d = 0.98; large) than girls (d = 0.68; medium).A standardized program increased MVPA in middle schools without requiring an increase in frequency or duration of PE lessons. Program components were well received by teachers and have the potential for generalization to other schools. Additional strategies may be needed for girls.

View details for DOI 10.1249/MSS.0000135792.20353.4D

View details for Web of Science ID 000223119300017

View details for PubMedID 15292747
A randomized controlled trial of single versus multiple health behavior change: Promoting physical activity and nutrition among adolescents HEALTH PSYCHOLOGY Prochaska, J. J., Sallis, J. F. 2004; 23 (3): 314-318
Abstract

Targeting multiple behaviors for change may provide significant health benefits. This study compared interventions targeting physical activity and nutrition (PAN) concurrently versus physical activity (PA) alone. Adolescents (N=138) were randomized to the PAN or PA intervention or control condition (n=46 per group). Primary outcomes were change in PA accelerometer and 3-day dietary recording from baseline to 3-month follow-up. The PAN and PA interventions were efficacious in supporting boys' (p<.001) but not girls' (p=.663) PA relative to the control condition. Dietary change was minimal. Although the findings do not reveal a decrement to PA promotion when a nutrition intervention was added, neither do they reveal any additional benefit. More studies comparing single versus multibehavioral interventions are needed.

View details for DOI 10.1037/0278-6133.23.3.314

View details for Web of Science ID 000221120800012

View details for PubMedID 15099173
Reliability and validity of a fruit and vegetable screening measure for adolescents JOURNAL OF ADOLESCENT HEALTH Prochaska, J. J., Sallis, J. F. 2004; 34 (3): 163-165
Abstract

We developed and evaluated a brief measure of fruit and vegetable consumption for adolescents. The measure was reliable and significantly correlated with 3-day food record data. Correct classification rate (63%) and specificity (63%) were good. Sensitivity (33%) was lower. The measure is recommended, although improvements in classification are still needed.

View details for DOI 10.1016/j.jadohealth.2003.07.001

View details for Web of Science ID 000189118800003

View details for PubMedID 14967337
A longitudinal study of children's enjoyment of physical education PEDIATRIC EXERCISE SCIENCE Prochaska, J. J., Sallis, J. F., Slymen, D. J., McKenzie, T. L. 2003; 15 (2): 170-178
View details for Web of Science ID 000182825800006
Environmental interventions for eating and physical activity - A randomized controlled trial in middle schools AMERICAN JOURNAL OF PREVENTIVE MEDICINE Sallis, J. F., McKenzie, T. L., Conway, T. L., Elder, J. P., Prochaska, J. J., Brown, M., Zive, M. M., Marshall, S. J., Alcaraz, J. E. 2003; 24 (3): 209-217
Abstract

Our objective was to evaluate the effects of environmental, policy, and social marketing interventions on physical activity and fat intake of middle school students on campus.Twenty-four middle schools were randomly assigned to intervention or control conditions. Baseline measures were collected in spring 1997, and interventions were conducted during the 1997-1998 and 1998-1999 school years SETTING/PARTICIPATION: The schools had mean enrollments of 1109, with 44.5% nonwhite students. Over 2 years, physical activity interventions were designed to increase physical activity in physical education classes and throughout the school day. Nutrition interventions were designed to provide and market low-fat foods at all school food sources, including cafeteria breakfasts and lunches, a la carte sources, school stores, and bag lunches. School staff and students were engaged in policy change efforts, but there was no classroom health education.Primary outcomes were measured by direct observation and existing records.Randomized regression models (N =24 schools) revealed a significant intervention effect for physical activity for the total group (p <0.009) and boys (p <0.001), but not girls (p <0.40). The intervention was not effective for total fat (p <0.91) or saturated fat (p <0.79). Survey data indicated that the interventions reduced reported body mass index for boys (p <0.05).Environmental and policy interventions were effective in increasing physical activity at school among boys but not girls. The interventions were not effective in reducing fat intake at school. School environmental and policy interventions have the potential to improve health behavior of the student population, but barriers to full implementation need to be better understood and overcome.

View details for DOI 10.1016/S0749-3797(02)00646-3

View details for Web of Science ID 000182213700001

View details for PubMedID 12657338
Sources of dietary fat in middle schools PREVENTIVE MEDICINE Zive, M. M., Elder, J. P., Prochaska, J. J., Conway, T. L., Pelletier, R. L., Marshall, S., Sallis, J. F. 2002; 35 (4): 376-382
Abstract

The current study uses an ecological approach to describe the food environment at 24 middle schools and multiple food sources' dietary fat contribution.Five consecutive days were sampled for collection of school meals, a la carte, and student store data. Bag lunch contents were observed on 3 days. Measurement included grams of saturated and total fat plus sales or participation data.Average total fat grams per meal were 21 g (SD = 2) for bag lunches, 14 g (SD = 5) for Type A breakfast, and 31 g (SD = 8) for Type A lunches. Average fat grams per item were 13 g (SD = 3) for a la carte and 6 g (SD = 2) for student stores. Students purchased or brought to school a mean of 26 g (SD = 3) of total and 8 g (SD = 1) of saturated fat. Contributions to total fat grams were 42% by Type A lunches, 27% by a la carte foods, 25% by bag lunches, 3% by Type A breakfast, and 2% by student stores. Findings for saturated fat were similar.Middle school students eat excessive amounts of fat at school, and multiple sources of food must be considered to understand the school food environment.

View details for DOI 10.1006/pmed.2002.1089

View details for Web of Science ID 000178188300011

View details for PubMedID 12453715
Association of parent and peer support with adolescent physical activity RESEARCH QUARTERLY FOR EXERCISE AND SPORT Prochaska, J. J., Rodgers, M. W., Sallis, J. F. 2002; 73 (2): 206-210
View details for Web of Science ID 000176240200011

View details for PubMedID 12092896
Preliminary evaluation of a multicomponent program for nutrition and physical activity change in primary care: PACE+ for adults PREVENTIVE MEDICINE Calfas, K. J., Sallis, J. F., Zabinski, M. F., Wilfley, D. E., Rupp, J., Prochaska, J. J., Thompson, S., Pratt, M., Patrick, K. 2002; 34 (2): 153-161
Abstract

Patient-centered Assessment and Counseling on Exercise plus nutrition (PACE+) is an intervention based in primary care settings to help patients change physical activity and dietary behaviors.One hundred seventy-three adults were assessed before and after a 4-month intervention. All patients completed a computerized assessment and created tailored "action plans" to change one physical activity and one nutrition behavior that they then discussed with their provider. After the visit, subjects were randomized to one of four extended intervention conditions: control, mail only, infrequent phone and mail, and frequent phone and mail. Self-report of five target behaviors (moderate and vigorous physical activity stage of change, dietary fat, fruit/vegetable intake, and overeating behaviors) was collected at baseline and 4 months. Acceptability measures were also taken.Participants in all conditions improved on all behaviors over time, supporting the utility of the computer and provider counseling components. The extended intervention did not produce differential results with respect to mode (phone or mail) or intensity (frequent or infrequent). However, for each behavior, participants who targeted the behavior to change improved significantly more than those who did not target the behavior. Acceptability of the intervention was high.Primary care-based, interactive health communication to improve physical activity and dietary behavior is feasible and has promising initial results.

View details for DOI 10.1006/pmed.2001.0964

View details for Web of Science ID 000173788200007

View details for PubMedID 11817910
Physical activity levels of Barbadian youth and comparison to a US sample INTERNATIONAL JOURNAL OF BEHAVIORAL MEDICINE Prochaska, J. J., Sallis, J. F., Griffith, B., Douglas, J. 2002; 9 (4): 360-372
Abstract

This is the first study to report on physical activity levels of young people in Barbados. The Self-Administered Physical Activity Checklist was administered to 1,579 children aged 8 to 18 years. The majority of youth (69%) reported at least 60 min of physical activity on the previous school day. Boys and younger students reported greater physical activity than girls and older students (p < .001). Participation in physical education was low among primary (30%) and secondary (18%) school students, and youth reported the majority of their physical activity took place after school (58%). Physical activity levels and patterns were similar to those of U.S. youth. Gender and grade differences in physical activity could put girls and older youth at higher risk for health problems such as obesity. Policy recommendations to support youth physical activity in Barbados include mandatory daily physical education and after-school physical activity programs.

View details for Web of Science ID 000179479400005

View details for PubMedID 12508670
Screening measure for assessing dietary fat intake among adolescents PREVENTIVE MEDICINE Prochaska, J. J., Sallis, J. F., Rupp, J. 2001; 33 (6): 699-706
Abstract

Clinical preventive guidelines recommend that health care providers counsel adolescents on nutrition. Brief, accurate, and reproducible dietary assessments are needed. The purpose of the current pair of studies was to develop a dietary fat screening measure for use with adolescents.Two measures were developed-a 21-item and a 4-category measure. The measures differed in the level at which fat consumption was assessed (food item vs food group). Study 1 (N = 231, age M = 15 years, 57% female, 41% Euro-American) evaluated reliability. Study 2 (N = 59, age M = 14 years, 63% female, 37% Euro-American) evaluated construct validity and correct classification rates.Internal consistencies (alpha > 0.70) and test-retest reliabilities (ICC > 0.60) were adequate for both measures. Neither measure correlated with total fat assessed by a 3-day food record (P > 0.05). The 21-item measure correlated significantly with percentage of calories from fat (r = 0.36, P <.01). Correct classification rate (71%) and sensitivity (81%) of the 21-item measure were good. Specificity (47%) was lower, indicating some subjects with a low-fat diet were misclassified by the screening measure.The 21-item measure is quick to complete and score, is inexpensive to reproduce, and has demonstrated reliability and validity. The measure could be clinically useful, but further improvements should be attempted to improve specificity.

View details for DOI 10.1006/pmed.2001.0951

View details for Web of Science ID 000173102800025

View details for PubMedID 11716669
Depression and stages of change for smoking in psychiatric outpatients 62nd Annual Meeting of the College-on-Problems-of-Drug-Dependence Acton, G. S., Prochaska, J. J., Kaplan, A. S., Small, T., Hall, S. M. PERGAMON-ELSEVIER SCIENCE LTD. 2001: 621–31
Abstract

This article reports on the relations between depression and stages of change for smoking cessation. A convenience sample of 205 psychiatric outpatients (68% female, mean age 41) completed measures of depression Primary Care Evaluation of Mental Disorders [PRIME-MD] and Beck Depression Inventory-II [BDI-II]), all transtheoretical model constructs related to smoking (stages and processes of change, pros and cons of smoking, and situational temptations), and thoughts about abstinence. As hypothesized, patients who had never smoked showed substantially lower rates of currently diagnosed major depressive disorder (MDD) than those who had ever smoked. Patients in early stages of change did not show more MDD or depressive symptoms but, as hypothesized, showed more negative thoughts about abstinence. Findings are consistent with the documented association between smoking and depression and suggest the appropriateness of building smoking cessation interventions based on the transtheoretical model of change for use with psychiatric populations.

View details for Web of Science ID 000171105700001

View details for PubMedID 11676374
A multicomponent program for nutrition and physical activity change in primary care - PACE+ for adolescents ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Patrick, K., Sallis, J. F., Prochaska, J. J., Lydston, D. D., Calfas, K. J., Zabinski, M. F., Wilfley, D. E., Saelens, B. E., Brown, D. R. 2001; 155 (8): 940-946
Abstract

Most adolescents do not meet national recommendations for nutrition and physical activity. However, no studies of physical activity and nutrition interventions for adolescents conducted in health care settings have been published. The present study was an initial evaluation of the PACE+ (Patient-centered Assessment and Counseling for Exercise plus Nutrition) program, delivered in primary care settings.Adolescents aged 11 to 18 years (N = 117) were recruited from 4 pediatric and adolescent medicine outpatient clinics. Participants' mean (SD) age was 14.1 (2.0) years, 37% were girls, and 43% were ethnic minorities.Behavioral targets were moderate physical activity, vigorous physical activity, fat intake, and fruit and vegetable intake. All patients completed a computerized assessment, created tailored action plans to change behavior, and discussed the plans with their health care provider. Patients were then randomly assigned to receive no further contact or 1 of 3 extended interventions: mail only, infrequent telephone and mail, or frequent telephone and mail.Brief, validated, self-report measures of target behaviors were collected at baseline and 4 months later.All outcomes except vigorous physical activity improved over time, but adolescents who received the extended interventions did not have better 4-month outcomes than those who received only the computer and provider counseling components. Adolescents who targeted a behavior tended to improve more than those who did not target the behavior, except for those who targeted vigorous physical activity.A primary care-based interactive health communication intervention to improve physical activity and dietary behaviors among adolescents is feasible. Controlled experimental research is needed to determine whether this intervention is efficacious in changing behaviors in the short- and long-term.

View details for Web of Science ID 000170237100013

View details for PubMedID 11483123
A physical activity screening measure for use with adolescents in primary care 46th Annual Meeting of the American-College-of-Sports-Medicine Prochaska, J. J., Sallis, J. F., Long, B. AMER MEDICAL ASSOC. 2001: 554–59
Abstract

To develop a reliable and valid physical activity screening measure for use with adolescents in primary care settings.We conducted 2 studies to evaluate the test-retest reliability and concurrent validity of 6 single-item and 3 composite measures of physical activity. Modifications were based on the findings of the 2 studies, and a best measure was evaluated in study 3. Accelerometer data served as the criterion standard for tests of validity.In study 1 (N = 250; mean age, 15 years; 56% female; 36% white), reports on the composite measures were most reliable. In study 2 (N = 57; mean age, 14 years; 65% female; 37% white), 6 of the 9 screening measures correlated significantly with accelerometer data. Subjects, however, had great difficulty reporting bouts of activity and distinguishing between intensity levels. Instead, we developed a single measure assessing accumulation of 60 minutes of moderate to vigorous physical activity. Evaluated in study 3 (N = 148; mean age, 12 years; 65% female; 27% white), the measure was reliable (intraclass correlation, 0.77) and correlated significantly (r = 0.40, P<.001) with accelerometer data. Correct classification (63%), sensitivity (71%), and false-positive rates (40%) were reasonable.The "moderate to vigorous physical activity" screening measure is recommended for clinical practice with adolescents.

View details for Web of Science ID 000168417000005

View details for PubMedID 11343497
The association of school environments with youth physical activity AMERICAN JOURNAL OF PUBLIC HEALTH Sallis, J. F., Conway, T. L., Prochaska, J. J., McKenzie, T. L., Marshall, S. J., Brown, M. 2001; 91 (4): 618-620
Abstract

This study assessed the association of school environmental characteristics with student physical activity on campus.Physical activity areas (n = 137) at 24 public middle schools were assessed for area type, size, and improvements (e.g., basketball courts). Student physical activity and the presence of equipment and supervision were directly observed before school, after lunch, and after school.Environmental characteristics explained 42% of the variance in the proportion of girls who were physically active and 59% of the variance for boys.School environments with high levels of supervision and improvements stimulated girls and boys to be more physically active.

View details for Web of Science ID 000170345100015

View details for PubMedID 11291375
PACE+ - Interactive communication technology for behavior change in clinical settings AMERICAN JOURNAL OF PREVENTIVE MEDICINE Prochaska, J. J., Zabinski, M. F., Calfas, K. J., Sallis, J. F., Patrick, K. 2000; 19 (2): 127-131
Abstract

Interactive health communication technologies have the potential to eliminate or greatly reduce many of the barriers to delivery of preventive services. This paper describes the process of developing and evaluating interactive health communication programs for primary care settings. We present as examples the Patient-centered Assessment and Counseling for Exercise plus Nutrition (PACE+) programs, designed to promote physical activity and healthy nutrition with adolescents and adults.The PACE+ programs use interactive communication technology to screen multiple behaviors, prioritize areas for intervention, and initiate intervention. Patient information is synthesized for ease of use by clinicians. The patient completes the program on a computer in the clinic waiting room before the provider encounter. Acceptability of the program was evaluated with adolescents (n=252), adults (n=285), and their health care providers.The PACE+ programs were developed, evaluated, modified, and re-evaluated. Feasibility testing indicated that a diverse group of adolescents and adults found the PACE+ computer programs acceptable. Modifications to shorten and refine the programs were identified.Development of interactive health technologies is an iterative process dependent on feedback from intended users and systems of care. Interactive health communication technologies can be incorporated into clinical settings.

View details for Web of Science ID 000088449800010

View details for PubMedID 10913904
Examination of the factor structure of physical activity behaviors JOURNAL OF CLINICAL EPIDEMIOLOGY Prochaska, J. J., Sallis, J. F., Sarkin, J. A., Calfas, K. J. 2000; 53 (8): 866-874
Abstract

Multiple physical activity recommendations exist for behaviors that vary in type and intensity (e.g., vigorous physical activity, strengthening exercises, moderate physical activity). The present study examined underlying dimensions of physical activity behaviors and determined the extent to which factors correspond to national health recommendations. Fifteen variables were drawn from six self-report measures and subjected to factor analysis with quartimax rotation. Participants were 547 university seniors (56% female; 60% Caucasian; mean age = 25 years). TV watching, the only index of sedentary behavior, did not load highly with other items, and was analyzed separately. Three interpretable factors were found: variables related to vigorous physical activity loaded highly on Factor 1; flexibility and strengthening items loaded highly on Factor 2; and moderate and housework activity loaded highly on Factor 3. Factors corresponded closely to national recommendations. Unweighted factor scores and TV watching correlated significantly with physiological indicators of fitness, supporting construct validity.

View details for Web of Science ID 000088908400014

View details for PubMedID 10942871
A review of correlates of physical activity of children and adolescents MEDICINE AND SCIENCE IN SPORTS AND EXERCISE Sallis, J. F., Prochaska, J. J., Taylor, W. C. 2000; 32 (5): 963-975
Abstract

Understanding the factors that influence physical activity can aid the design of more effective interventions. Previous reviews of correlates of youth physical activity have produced conflicting results.A comprehensive review of correlates of physical activity was conducted, and semiquantitative results were summarized separately for children (ages 3-12) and adolescents (ages 13-18). The 108 studies evaluated 40 variables for children and 48 variables for adolescents.About 60% of all reported associations with physical activity were statistically significant. Variables that were consistently associated with children's physical activity were sex (male), parental overweight status, physical activity preferences, intention to be active, perceived barriers (inverse), previous physical activity, healthy diet, program/facility access, and time spent outdoors. Variables that were consistently associated with adolescents' physical activity were sex (male), ethnicity (white), age (inverse), perceived activity competence, intentions, depression (inverse), previous physical activity, community sports, sensation seeking, sedentary after school and on weekends (inverse), parent support, support from others, sibling physical activity, direct help from parents, and opportunities to exercise.These consistently related variables should be confirmed in prospective studies, and interventions to improve the modifiable variables should be developed and evaluated.

View details for Web of Science ID 000086723700014

View details for PubMedID 10795788
Correlates of physical activity in a national sample of girls and boys in Grades 4 through 12 HEALTH PSYCHOLOGY Sallis, J. F., Prochaska, J. J., Taylor, W. C., Hill, J. O., Geraci, J. C. 1999; 18 (4): 410-415
Abstract

Psychological, biological, social, and physical environmental variables were examined for their association with physical activity of young people. A national sample of 1,504 parents and children in Grades 4-12 were interviewed by telephone. Twenty-two potential determinants were assessed along with an 11-item child physical activity index (alpha = .76). Hierarchical multiple regressions were conducted separately for 6 age-sex subgroups. Percentage of variance explained ranged from 18% for boys in Grades 4-6 to 59% for girls in Grades 10-12. Three variables had strong and consistent associations with the child physical activity index that generalized across subgroups: use of afternoon time for sports and physical activity, enjoyment of physical education, and family support for physical activity. These 3 variables should be targeted for change to promote physical activity in all groups of young people.

View details for Web of Science ID 000081525500012

View details for PubMedID 10431943

Associate Professor of Medicine (Stanford Prevention Research Center)

Medicine - Stanford Prevention Research Center

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