Bárbara Piñeiro

Gender differences in use and expectancies of E-cigarettes: Online survey results

INTRODUCTION Given the rapid increase in e-cigarette use, it is important to understand factors that may contribute to their initiation and maintenance. Because gender differences in tobacco use, product preferences, and expectancies are well established, similar gender differences may exist with e-cigarettes. The aim of this study was to identify gender differences among e-cigarette users in patterns of use, reasons for initiation and maintenance, and outcome expectancies regarding e-cigarettes. METHODS Participants (N=1815) completed an online survey from August through November, 2013. We assessed sociodemographics, smoking and e-cigarette history and use, and expectancies about e-cigarettes. RESULTS We found gender differences in type of e-cigarette used, flavors used, nicotine dosage, source of information about e-cigarettes, place of purchase, and use of e-cigarettes where smoking is prohibited. In addition, males were more likely to report initiating e-cigarette use to quit smoking due to health concerns, whereas females were more likely to report initiation based on recommendations from family and friends. Males reported higher attributions for maintenance of e-cigarette use related to positive reinforcement (enjoyment), whereas females reported higher negative reinforcement attributions (stress reduction or mood management). Males reported more positive expectancies about e-cigarettes, including taste, social facilitation, and energy, whereas women rated e-cigarettes higher for weight control. Males also reported greater addiction-related e-cigarette expectancy than females. CONCLUSIONS Many of the gender differences with e-cigarettes parallel those previously found with traditional cigarette smoking. Although effect sizes associated with these differences were small, the results may help advance research and intervention development with respect to e-cigarette initiation, maintenance and cessation.

Smoking cessation interventions within the context of Low-Dose Computed Tomography lung cancer screening: A systematic review

The integration of smoking cessation interventions (SCIs) within the context of lung cancer screening programs is strongly recommended by screening guidelines, and is a requirement for Medicare coverage of screening in the US. In Europe, there are no lung cancer screening guidelines, however, research trials are ongoing, and prominent professional societies have begun to recommend lung cancer screening. Little is known about the types and efficacy of SCIs among patients receiving low-dose computed tomography (LDCT) screening. This review addresses this gap. Based on a systematic search, we identified six empirical studies published prior to July 1, 2015, that met inclusion criteria for our review: English language, SCI for LDCT patients, and reported smoking-related outcomes. Three randomized studies and three single-arm studies were identified. Two randomized controlled trials (RCTs) evaluated self-help SCIs, whereas one pilot RCT evaluated the timing (before or after the LDCT scan) of a combined (counseling and pharmacotherapy) SCI. Among the single-arm trials, two observational studies evaluated the efficacy of combined SCI, and one retrospectively assessed the efficacy of clinician-delivered smoking assessment, advice, and assistance. Given the limited research to date, and particularly the lack of studies reporting results from RCTs, assumptions that SCIs would be effective among this population should be made with caution. Findings from this review suggest that participation in a lung screening trial promotes smoking cessation and may represent a teachable moment to quit smoking. Findings also suggest that providers can take advantage of this potentially teachable moment, and that SCIs have been successfully implemented in screening settings. Continued systematic and methodologically sound research in this area will help improve the knowledge base and implementation of interventions for this population of smokers at risk for chronic disease.

Gender differences in personality patterns and smoking status after a smoking cessation treatment.

BackgroundThe lack of conclusive results and the scarce use of the Millon Clinical Multiaxial Inventory-III (MCMI-III) in the study of the relationship between smoking and personality are the reasons that motivated the study reported here. The aim of the present study was to analyze the influence of personality patterns, assessed with the MCMI-III, and of nicotine dependence on treatment outcomes at the end of the treatment and at 12 months follow-up in men and women smokers receiving cognitive-behavioral treatment for smoking cessation.MethodsThe sample was made up of 288 smokers who received cognitive-behavioral treatment for smoking cessation. Personality patterns were assessed with the Millon Clinical Multiaxial Inventory-III (MCMI-III). Abstinence at the end of the treatment and at 12-month follow-up was validated with the test for carbon monoxide in expired air.ResultsThe results showed significant differences by personality patterns that predict nicotine dependence (Narcissistic and Antisocial in men and Schizoid in women). At the end of the treatment it is more likely that quit smoking males with a Compulsive pattern and less likely in those scoring high in Depressive, Antisocial, Sadistic, Negativistic, Masochistic, Schizotypal and Borderline. In women, it is less likely that quit smoking those with the Schizoid pattern. At 12 months follow-up it is more likely that continue abstinent those males with a high score in the Compulsive pattern. Furthermore, nicotine dependence was an important variable for predicting outcome at the end of the treatment and smoking status at 12 months follow-up in both men and women.ConclusionsWe found substantial differences by gender in some personality patterns in a sample of smokers who received cognitive-behavioral treatment for smoking cessation. We should consider the existence of different personality patterns in men and women who seek treatment for smoking cessation.

Axis II Disorders and Cigarette Smoking Among Adults From the General Population

The present study examined whether personality disorders (PDs) are associated with cigarette smoking, and the possible influence of nicotine dependence, sociodemographic variables, and the presence of any lifetime Axis I mental disorder in these relationships. The sample was made up of 1,081 adult participants from the Spanish general population and was stratified by smoking status (519 smokers and 562 nonsmokers). PDs were assessed by means of the International Personality Disorder Examination Questionnaire, Module DSM-IV. Results indicated that participants with a paranoid, a narcissistic, a borderline, an antisocial, or an obsessive-compulsive PD had a higher probability for being smokers and for being nicotine-dependent. The only exception was the schizoid PD, because participants with this Axis II disorder had a lower probability for being nicotine-dependent smokers. The association between PDs and smoking was maintained even after adjusting for all covariates. Findings are discussed in relation to the influence of Axis II disorders on smoking cessation interventions.

The association between probable personality disorders and smoking cessation and maintenance.

INTRODUCTION Although it has been suggested that persons with psychopathological disorders experience greater difficulty in quitting smoking, the few studies that have analyzed personality disorders in smokers have failed to produce conclusive results. The aim of this study was to examine whether the presence of probable personality disorders was associated with the achievement of abstinence at the end of a smoking cessation treatment, as well as the maintenance of abstinence at 6 and 12 months of follow-up. METHODS The sample comprised 290 smokers (41% men and 59% women) who participated in a psychological smoking cessation treatment and who were followed for a year. Abstinence was tested by measuring carbon monoxide in exhaled air. RESULTS Participants with a probable borderline, antisocial or avoidant personality disorder were less likely to quit smoking at the end of the treatment, whereas probable schizoid personality disorder predicted better maintenance of abstinence at 6 and 12 months. In addition, smoking 25 or more cigarettes before starting the treatment decreased the likelihood of maintaining abstinence at 6 and 12 months of follow-up. CONCLUSIONS This study revealed differential (and opposing) relationships between specific personality disorders and smoking cessation outcomes, illustrating the need to consider Axis II disorders separately when predicting treatment outcomes.

Smoking habit profile and health-related quality of life

BACKGROUND Few studies have investigated the relationship between smoking and health-related quality of life (HRQOL), and the results are not consistent. The aim of this study is to explore the association between smoking and HRQOL. METHOD Cross-sectional study of 714 Spanish adults (44.7% never smokers and 55.3% smokers) without diagnosis of physical or mental disorder. Each participant provided information about different sociodemographic variables and data on HRQOL. Smokers also reported smoking-related information about smoking-related variables. RESULTS Nicotine dependence was not associated with the physical dimension of HRQOL, but in the mental component, nicotine dependent smokers showed worse HRQOL than never smokers (p = 0.004) and than non-nicotine dependent smokers (p = 0.014). There were no differences between no-nicotine dependent smokers and never smokers. Smoking status (non smokers vs. smokers), number of cigarettes smoked per day, stage of change, quit attempts in the past year or age of smoking onset were not related to HRQOL. CONCLUSIONS In subjects without physical or mental diseases, only nicotine dependent smokers showed a significant impairment in the mental component of HRQOL. Therefore, it is important to consider nicotine dependence in the relationship between smoking and HRQOL.

Tobacco-related health disparities across the cancer care continuum

BACKGROUND Use of tobacco is the leading preventable cause of death in the United States. Racial/ethnic minorities and individuals of low socioeconomic status disproportionately experience tobacco-related disease and illness. Unique challenges and circumstances exist at each point in the cancer care continuum that may contribute to the greater cancer burden experienced by these groups. METHODS We reviewed tobacco-related disparities from cancer prevention to cancer survivorship. We also describe research that seeks to reduce tobacco-related disparities. RESULTS Racial/ethnic minorities and low-income individuals experience unique social and environmental contextual challenges such as greater environmental cues to smoke and greater levels of perceived stress and social discrimination. Clinical practice guidelines support the effectiveness of pharmacotherapy and behavioral counseling for racial and ethnic minorities, yet smoking cessation rates are lower in this group when compared with non-Hispanic whites. Superior efficacy for culturally adapted interventions has not yet been established. CONCLUSIONS To reduce health disparities in this population, a comprehensive strategy is needed with efforts directed at each point along the cancer care continuum. Strategies are needed to reduce the impact of contextual factors such as targeted tobacco marketing and social discrimination on smoking initiation and maintenance. Future efforts should focus on increasing the use of evidence-based cessation treatment methods and studying its effectiveness in these populations. Attention must also be focused on improving treatment outcomes by reducing smoking in diverse racial and ethnic patient populations.

Motivation to quit as a predictor of smoking cessation and abstinence maintenance among treated Spanish smokers

INTRODUCTION Although quitting motivation predicts smoking cessation, there have been inconsistent findings regarding motivation predicting long-term maintenance of abstinence. Moreover, most such research has been conducted in North America and the United Kingdom. The aim of this study was to examine motivation to quit as a predictor of smoking cessation and of abstinence maintenance in a Spanish sample. METHOD The sample comprised 286 Spanish smokers undergoing psychological treatment for smoking cessation. Motivation to quit was assessed pre-treatment and post-treatment with the Readiness to Quit Ladder. Abstinence post-treatment and at 6month follow-up was biochemically verified. RESULTS Participants with higher levels of pre-treatment and post-treatment motivation were more likely to be abstinent at the end of the treatment (OR=1.36) and at 6month follow-up (OR=4.88). Among abstainers at the end of the treatment (61.9%), higher levels of motivation to quit post-treatment predicted maintaining abstinence at 6months (OR=2.83). Furthermore, participants who failed to quit smoking reported higher levels of motivation to quit post-treatment than they had pretreatment (p<.001). CONCLUSIONS Motivation to quit smoking predicted short and long-term cessation, and also predicted long-term maintenance of abstinence. These results have implications for understanding motivational processes of smoking cessation in general, while extending research to Spanish smokers. They may also help in the design of cessation and relapse-prevention interventions. Specifically, the results suggest that motivational enhancement is important throughout the cessation and maintenance periods.

Systematic Transcreation of Self-Help Smoking Cessation Materials for Hispanic/Latino Smokers: Improving Cultural Relevance and Acceptability

Smoking-related illnesses are the leading causes of death among Hispanics/Latinos. Yet, there are few smoking cessation interventions targeted for this population. The goal of this study was to “transcreate” an existing, previously validated, English language self-help smoking cessation intervention, titled Forever Free®: Stop Smoking for Good, for Spanish-speaking smokers. Rather than simply translating the materials, our transcreation process involved culturally adapting the intervention to enhance acceptability and receptivity of the information. We utilized a multiphase qualitative approach (focus groups and learner verification interviews) to develop a linguistically and culturally relevant intervention for the diverse sub-ethnic groups of Hispanic/Latino smokers. Focus group findings indicated a need to underscore several additional cultural characteristics and themes such as the need to address familism and unique stressors faced by immigrants and to provide information regarding nicotine replacement therapy. Learner verification findings indicated a need to further emphasize financial and social benefits of quitting smoking and to discuss how family and friends can support the quit attempt. These steps led to the development of a Spanish-language smoking cessation intervention titled, Libre del cigarillo, por mi familia y por mí: Guía para dejar de fumar, that is currently being tested in a national randomized controlled trial.

Abstract A09: Transcreating self-help smoking cessation intervention materials for Hispanic/Latino smokers: Focus group and learner verification findings

There is a dearth of evidence-based smoking-cessation interventions for Hispanic/Latino smokers, especially for individuals with limited or no English proficiency. Hispanics/Latinos make up 17% of the national population, and in some Hispanic sub-ethnic groups, such as Puerto Ricans and Cubans, smoking prevalence rates are over 30% (greatly exceeding rates of non-Hispanic Whites at 18.1%). Thus, we sought to transcreate our existing validated English-language “Stop Smoking for Good” self-help smoking cessation intervention for Spanish-speaking smokers. The transcreation process involves a series of steps involving translating the text into another language, as well as infusing culturally relevant context, photos, and themes. To begin, focus groups were conducted to assess reactions to the existing English-language materials (10 booklets and 9 pamphlets), and to gather suggestions to adapt content for the intended audience. Specifically, we aimed to identify culturally relevant smoking cessation barriers as well as elements that would increase acceptability in this population. Focus group participants (N=23) were bilingual Hispanic/Latino smokers representing diverse sub-ethnic groups. A key theme that emerged was familism, defined by the sense of attachment, loyalty and collective well-being among the nuclear as well as extended family. This finding prompted us to develop an additional booklet aimed at providing family and friends with the tools necessary to support their loved one9s quit attempt. Other findings included: religion and spirituality as a coping mechanism; the role of coffee as a trigger for smoking; and difficulties for immigrants that serve as stressors for smoking, such as language barriers, being separated from one9s family, and financial problems. Format change suggestions were also reported by participants and included a desire for color images, preference for a bright color palette, and interactive activities. Focus group findings then informed the development of a Spanish-language version of the booklets entitled, “Libre del cigarrillo, por mi familia y por mi.” Subsequently, learner verification interviews (N=10) were conducted with Spanish-speaking Hispanic/Latino smokers who preferred their health education materials in Spanish to assess the appeal and acceptability of the revised content and visual modifications. Overall, participants responded favorably to the revised content. The learner verification process also revealed a need to: expand the explanation of quitting aids, include additional culturally salient daily stressors, and further emphasize the financial benefits of quitting smoking. We will present additional qualitative results from the focus groups and learner verification interviews as well as the finalized Spanish-language version of the booklets. The final version of the Spanish-language materials will be tested in a randomized controlled trial. Citation Format: Diana B. Diaz, Luis M. Monsalve, Thomas H. Brandon, Barbara Pineiro, Lauren R. Meltzer, Cathy D. Meade, Karen O. Brandon, Marina Unrod, Vani N. Simmons. Transcreating self-help smoking cessation intervention materials for Hispanic/Latino smokers: Focus group and learner verification findings. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A09.