Irene Tamí-Maury

Long-term outcomes of a cell phone-delivered intervention for smokers living with HIV/AIDS

BACKGROUND People living with human immunodeficiency virus (HIV)/AIDS (PLWHA) have a substantially higher prevalence of cigarette smoking compared to the general population. In addition, PLWHA are particularly susceptible to the adverse health effects of smoking. Our primary objective was to design and test the efficacy over 12 months of a smoking cessation intervention targeting PLWHA. METHODS Participants were enrolled from an urban HIV clinic with a multiethnic and economically disadvantaged patient population. Participants received smoking cessation treatment either through usual care (UC) or counseling delivered by a cell phone intervention (CPI). The 7-day point prevalence abstinence was evaluated at 3, 6, and 12 months using logistic regression and generalized linear mixed models. RESULTS We randomized 474 HIV-positive smokers to either the UC or CPI group. When evaluating the overall treatment effect (7-day abstinence outcomes from 3-, 6-, and 12-month follow-ups), participants in the CPI group were 2.41 times (P = .049) more likely to demonstrate abstinence compared to the UC group. The treatment effect was strongest at the 3-month follow-up (odds ratio = 4.3, P < .001), but diminished at 6 and 12 months (P > .05). CONCLUSIONS Cell phone-delivered smoking cessation treatment has a positive impact on abstinence rates compared to a usual care approach. Future research should focus on strategies for sustaining the treatment effect in the long term.

Poly-Tobacco Use Among HIV-Positive Smokers: Implications for Smoking Cessation Efforts

INTRODUCTION Poly-tobacco use is defined as cigarette and other tobacco consumption with either product used daily or nondaily. While concurrent use of different types of tobacco has been documented within the general population, less is known about poly-tobacco use among HIV-positive smokers and its impact on smoking cessation efforts. OBJECTIVE To characterize the profile of poly-tobacco users (PTU) in a sample of HIV-positive smokers participating in a cessation program. METHODS The study sample consisted of 474 HIV-positive smokers enrolled in a 2-group randomized controlled trial of cigarette smoking cessation comparing a cell phone-based intervention to usual care. Prevalence was determined, and risk factors for poly-tobacco use were evaluated using logistic regression. RESULTS In this cohort of HIV-positive cigarette smokers, 21.6% of participants were PTU, with cigars (73.4%) the most common tobacco product consumed. Among PTU, 73.5% used other form(s) of tobacco some days, and 26.5% use them every day. Perceived discrimination and unemployment were significantly associated with poly-tobacco use after adjusting for other demographic, behavioral, and psychosocial factors. Analysis showed that participants in the cell phone group (vs. usual care) were more likely to report 24-hr abstinence, both among monocigarette users (16.6% vs. 6.3%, p < .001) and PTU (18.5% vs. 0%, p < .001). CONCLUSION Poly-tobacco use prevalence among adult HIV-positive smokers was considerably higher than in the general population. Special attention must be placed on concurrent use of cigarettes and cigars among HIV-positive smokers. Because PTU are a unique population less likely to succeed in brief smoking cessation interventions, effective cessation programs are needed.

Mediators of a smoking cessation intervention for persons living with HIV/AIDS

BACKGROUND Cigarette smoking among persons living with HIV (PLWH) is a pressing public health concern, and efforts to evaluate cessation treatments are needed. The purpose of the present study was to assess potential mechanisms of a cell phone-delivered intervention for HIV-positive smokers. METHODS Data from 350 PLWH enrolled in a randomized smoking cessation treatment trial were utilized. Participants were randomized to either usual care (UC) or a cell phone intervention (CPI) group. The independent variable of interest was treatment group membership, while the dependent variable of interest was smoking abstinence at a 3-month follow-up. The hypothesized treatment mechanisms were depression, anxiety, social support, quit motivation and self-efficacy change scores. RESULTS Abstinence rates in the UC and CPI groups were 4.7% (8 of 172) and 15.7% (28 of 178), respectively. The CPI group (vs. UC) experienced a larger decline in depression between baseline and the 3-month follow-up, and a decline in anxiety. Self-efficacy increased for the CPI group and declined for the UC group. Quit motivation and social support change scores did not differ by treatment group. Only self-efficacy met the predefined criteria for mediation. The effect of the cell phone intervention on smoking abstinence through change in self-efficacy was statistically significant (p<0.001) and accounted for 17% of the total effect of the intervention on abstinence. CONCLUSIONS The findings further emphasize the important mechanistic function of self-efficacy in promoting smoking cessation for PLWH. Additional efforts are required to disentangle the relationships between emotional, distress motivation, and efficacious smoking cessation treatment.

Social and Cultural Context of Betel Quid Consumption in Taiwan and Implications for Prevention and Cessation Interventions

ABSTRACT Background: In Taiwan, betel quid chewing is a part of social life for chewers. Betel quid itself, with or without tobacco, is a Group 1 human carcinogen. Betel quid chewing has become a severe health threat in Taiwan. Objectives: The aim of the present study was to identify the individual, social, contextual, and cultural factors related to initiation, continuous use, and cessation of betel quid chewing. Methods: Four focus groups and 15 in depth face-to-face interviews were conducted in 2013 with current and former users of betel quid, members of a community organization located in central Taiwan. A thematic analysis identified themes evident across all groups. Results: Study participants (N = 41) were 66% male and 34% female; mean age was 40.34 ± 9.23 years. Participants stated that betel quid initiation usually occurs during childhood and that the most frequent reasons for chewing were: to follow cultural/social traditions, to achieve an energetic feeling, and to avoid boredom. Participants perceived betel quid chewing as an addiction and a risk factor for cancer and other health-related conditions. The most frequently mentioned barriers to quitting betel quid included: peer pressure and selected withdrawal symptoms. Conclusions: For the development of culturally relevant and effective cessation interventions for betel quid in Taiwan, it is critical to understand and address perceptions of betel quid chewing and barriers to cessation.

A pilot study to assess tobacco use among sexual minorities in Houston, Texas

BACKGROUND AND OBJECTIVES To assess tobacco use among lesbian, gay, bisexual, and transgender (LGBT) individuals from the 2014 Houston Pride Parade and Festival in Houston, Texas (TX). METHODS Cross-sectional study using convenience sample of LGBT individuals (n = 99) examining tobacco use, sexual orientation, and other socio-demographic factors through survey participation. RESULTS Findings showed a high prevalence of tobacco and electronic cigarettes use. White LGBT individuals had greater odds of using any type of tobacco product. DISCUSSION AND CONCLUSIONS Despite a high smoking prevalence among the surveyed LGBT individuals, this study sample did not identify tobacco use as a health issue. SCIENTIFIC SIGNIFICANCE Supports the need for further investigation on tobacco-related disparities among LGBT individuals in Houston, TX.

A symbol of connectedness between the self and the tribal home: Betel quid in the lives of indigenous Taiwanese

BACKGROUND Betel quid chewing plays a significant role in the development of oral cancer, yet the high prevalence of betel quid use remains a serious health problem in Taiwan, especially among indigenous Taiwanese. PURPOSE The present study aimed to understand the reasons behind betel-quid chewing among indigenous Taiwanese people by examining the larger context of their culture and traditions. METHODS This descriptive, qualitative study recruited ten regular betel quid indigenous chewers using purposive and snowball sampling. Four of the participants were interviewed individually and the remaining six comprised a focus group. Data were collected using in-depth interviews with semi-structured guidelines and analyzed using qualitative content analysis following the process of open coding, identifying codes, giving meaningful names to codes, putting similar codes in categories, and grouping categories into themes. RESULTS Most of the participants associated betel quid with significant aspects of life, with betel quid symbolizing social belonging. In indigenous cultures, betel nut embodies the enduring companionship of lifelong friends. For the study participants, chewing betel quid was associated with symbolic meanings associated with the following five themes: betel quid chewing helps reinforce self-identity and sense of belonging; betel quid is considered a traditional symbol of love and marriage; betel quid reflects the celebration of simple abundance in indigenous life; betel quid represents an attitude toward life that accentuates the importance of learning to live in everlasting harmony with the environment and nature; and betel quid chewing is used to cure physical ailments and mitigate dental problems. CONCLUSIONS / IMPLICATIONS FOR PRACTICE Beliefs related to chewing betel quid deeply impact the attitudes of indigenous people toward this behavior. Because chewing betel quid is an essential part of Taiwanese indigenous community life, the cultural and symbolic meanings of this practice must be taken into consideration when drafting related policies and developing cessation programs in order to help indigenous betel-quid chewers effectively reduce the risk of developing oral cancers.

Community-based participatory research through virtual communities

ABSTRACT Over the last quarter century many new cyberspace platforms have emerged that facilitate communication across time, geographical distance and now even language. Whereas brick-and-mortar communities are defined by geographically local characteristics, a virtual community is an online community of individuals who socialize and connect around a common interest or theme using the Internet. Community-based participatory research (CBPR) is a public health approach that requires equitable partnerships between community members and researchers. Virtual communities abound on the Internet today, yet their application to CBPR is rarely considered. We examine three case studies to explore the advantages and challenges of virtual communities for CBPR, as well as several of the online tools CBPR practitioners can use to facilitate virtual community participation. There is a potential utility of virtual communities in supporting CBPR efforts as they reduce the effects of geographical barriers, maximize the growth potential of the community, and provide portable and affordable channels for real-time communication. Some caveats indicated in our case studies are: technological challenges, difficulty in crediting members’ contributions and determining ownership of content, no face-to-face interaction may hinder relationship formation, cohesion, and trust resulting in lower engagement. The paper concludes with recommendations for the use of virtual communities in CBPR projects, such as in the coordination of statewide health care policy initiatives and in the dissemination of best public health practices.

A Pilot Study for Linking Adolescent Patients to an Interactive Tobacco Prevention Program

Context: The American Academy of Pediatrics and professional guidelines recommend intervening with adolescents about avoiding tobacco use in the health-care setting. Barriers in the clinical setting limit consistent provision of this critical service. Objectives: This pilot study compared 2 approaches for referring adolescents to an evidence-based tobacco prevention and cessation program in the outpatient setting. Secondary aims assessed tobacco use, knowledge, and program evaluation. Design, Setting, and Participants: The study setting was a medical and dental clinic. Participants aged 13 to 18 received tobacco advice and instructions to work through “A Smoking Prevention Interactive Experience.” The program addresses health concerns of adolescents about tobacco use and is founded on behavioral change theories. The link to access it is featured on the website of the National Cancer Institute’s Research-Tested Interventions. Participants (N = 197) were randomized to 1 of 2 approaches (ie, a program link via e-mail or referral by a printed card). Results: The program was accessed by 57% (112 of 197) of participants. Both referral approaches were equally effective. Non-Hispanics were twice as likely to access the program as Hispanics (adjusted odds ratio = 2.1, 95% confidence interval = 1.2-3.8, P < .05). Over 95% of participants identified themselves as nonusers of tobacco and evaluated the program as beneficial in increasing knowledge and motivation to remain tobacco-free. Conclusion: Linking adolescent patients to an evidence-based tobacco prevention/cessation program at a community health clinic was highly promising and feasible. We present conclusions for future research.

Nicotine and Tobacco Use Prevention among Youth and Families

OBJECTIVE To review the importance of and evidence-based strategies to prevent tobacco use and promote tobacco cessation in the pediatric setting. DATA SOURCES Literature review of evidence-based resources on tobacco use and prevention/cessation interventions in the pediatric/adolescent population. CONCLUSION Knowledge of the impact of tobacco use on cancer risk, second- and third-hand smoke carcinogenesis, and newer methods of tobacco delivery is necessary to select appropriate and effective prevention and cessation strategies. IMPLICATIONS FOR NURSING PRACTICE Systematic evaluation of both parents and children for tobacco use can identify patients that will benefit from tobacco cessation interventions. Patients and families need education and support so they can make good decisions and adhere to recommendations for prevention and cessation of tobacco use.