Jessica L. Burris

Disparities in mental health between rural and nonrural cancer survivors: a preliminary study

Objective: While much research has sought to identify disparities in cancer incidence, survival, and treatment, little research has sought to identify disparities in mental health (MH) outcomes among cancer survivors. The present study aims to identify disparities in MH outcomes between rural and nonrural cancer survivors.

Clinical strategies to enhance the efficacy of nicotine replacement therapy for smoking cessation: a review of the literature.

A number of smoking cessation pharmacotherapies have led to increases in quitting and thus to significant benefits to public health. Among existing medications, nicotine replacement therapy (NRT) has been available the longest, has the largest literature base in support, and is the only option for over-the-counter access. While the short-term efficacy of NRT is well documented in clinical trials, long-term abstinence rates associated with using NRT are modest, as most smokers will relapse. This literature review examines emerging clinical strategies to improve NRT efficacy. After an initial overview of NRT and its FDA-approved indications for use, we review randomized trials in which clinical delivery of NRT was manipulated and tested, in an attempt to enhance efficacy, through (1) duration of use (pre-quit and extended use), (2) amount of use (high-dose and combination NRT), (3) tailoring to specific smoker groups (genotype and phenotype), or (4) use of NRT for novel purposes (relapse prevention, temporary abstinence, cessation induction). Outcomes vary within and across topic area, and we highlight areas that offer stronger promise. Combination NRT likely represents the most promising strategy moving forward; other clinical strategies offer conflicting evidence but deserve further testing (pre-quit NRT or tailored treatment) or offer potential utility but are in need of further, direct tests. Some areas, though based on a limited set of studies, do not offer great promise (high-dose and extended treatment NRT). We conclude with a brief discussion of emergent NRT products (e.g., oral nicotine spray, among others), which may ultimately offer greater efficacy than current formulations. In order to further lower the prevalence of smoking, novel strategies designed to optimize NRT efficacy are needed.

Use of formal and informal mental health resources by cancer survivors: differences between rural and nonrural survivors and a preliminary test of the theory of planned behavior

Objective: Previous research has identified rural residence as a risk factor for poorer mental health (MH) outcomes in cancer survivors. This may be due to less use of various MH resources due to poorer access and less favorable attitudes and social norms related to MH resource utilization. The present study sought to examine use of MH resources in rural and nonrural survivors and identify factors associated with MH resource use.

New directions in the management of chronic pain: Self-regulation theory as a model for integrative clinical psychology practice

The next generation of empirically derived clinical health psychology involves use of self-regulation theory for understanding and treating chronic pain. Temporomandibular disorders serve as a model to illustrate how increasing self-regulatory strength facilitates small, behavioral changes that positively influence the underlying physiological factors known to be important in the etiology and maintenance of chronic pain conditions. For individuals with chronic temporomandibular disorders, physical self-regulation is an integrative clinical health psychology intervention that decreases both physical and psychological symptoms via improvements in self-regulatory strength and autonomic nervous system regulation. Suggestions for the application of self-regulation to other chronic pain disorders and future research directions are provided.

Physical and mental health status and health behaviors of survivors of multiple cancers: a national, population-based study.

BackgroundLittle is known about the unique experience of adults with a history of multiple cancer diagnoses (i.e., survivors of multiple cancers).PurposeThis research assessed the health status and health behaviors of survivors of multiple cancers.MethodsThe health status and health behaviors of 8,734 survivors of multiple cancers, 47,562 survivors of a single cancer, and 348,229 non-cancer controls were compared using weighted data from the 2009 Behavioral Risk Factor Surveillance System.ResultsSurvivors of multiple cancers reported poorer physical and mental health status outcomes (e.g., more mental distress and greater activity limitations) than survivors of a single cancer (all p’s < 0.001) who reported poorer outcomes than controls (all p’s < 0.001). Survivors of multiple cancers reported unhealthier behaviors than survivors of a single cancer and healthier behaviors than controls on most health behavior outcomes (e.g., alcohol use, tobacco use, and diet) (all p’s < 0.001).ConclusionsData suggest the need for clinical interventions to enhance physical and mental health status and to increase adoption of healthier behaviors in survivors of multiple cancers.

A Closer Look at Unmet Needs at the End of Primary Treatment for Breast Cancer: A Longitudinal Pilot Study

This study describes the nature of unmet needs (UN) as women with breast cancer transition from “patient” to “survivor.” Data are from a longitudinal study of 90 women with stage I–III breast cancer. Data were collected 2–3 weeks before, and 10 weeks after, completion of radiation. A modified Cancer Survivors’ Unmet Needs (CaSUN) instrument measured UN. Most participants reported ≥1 unmet need at baseline (80.00%) and follow-up (69.31%), with UN across physical, healthcare, information, psychosocial, and survivorship domains. Total number of UN declined over time, t(87) = 3.00, p < .01. UN likely to persist from baseline to follow-up involved cancer recurrence concerns, stress management, household responsibilities, and others not acknowledging/understanding cancer. Younger women (p = .01) and those with more severe (p < .01), life-interfering (p = .01) symptoms had greater burden of UN. This study highlights the dynamics of UN in the weeks before and after primary treatment. Future studies should identify long-term consequences of persistent UN.

Attitudes Toward Information About Genetic Risk for Cognitive Impairment After Cancer Chemotherapy: Breast Cancer Survivors Compared With Healthy Controls

PURPOSE The trend toward personalized medicine will involve cancer treatment increasingly being tailored to the genetic characteristics of individuals. However, the availability of genetic information does not imply this information is desired or would impact treatment decision making. METHODS One hundred sixty breast cancer survivors (BC group) and 205 healthy controls (HC group) were randomly assigned to respond to two different clinical scenarios varying in genetic-related risk of cognitive impairment (CI; little v very likely) and severity of CI (little v moderate problem) after chemotherapy. Ratings of the importance of being told this genetic information (information importance) and the likelihood this information would affect their decision to receive chemotherapy (information impact) were obtained. RESULTS Results indicated the importance ascribed to genetic information was greatest when CI likelihood and severity were both high or low (P < .05). Information impact ratings were not sensitive to differences in CI likelihood or severity; the BC group was less likely to indicate genetic information would affect their decision to receive chemotherapy than the HC group (P < .001). CONCLUSION Results suggest lessened enthusiasm for genetic information that maintains or increases uncertainty about a specific course of action and highlight the importance of including clinically relevant groups in treatment decision-making research that employs hypothetical scenarios. Although women generally believe it is important to receive genetic information, they might benefit from assistance (eg, decision aid) in the difficult task of integrating information about survival and risk for adverse late effects from cancer treatment.

Brief, Instructional Smokeless Tobacco Use Among Cigarette Smokers Who Do Not Intend to Quit: A Pilot Randomized Clinical Trial

INTRODUCTION Low-nitrosamine smokeless tobacco (SLT) may have efficacy for smoking reduction and cessation, but its public health impact depends on how smokers use it. METHODS This pilot study explored brief, instructional low-nitrosamine SLT use among smokers unmotivated to quit. Participants (N = 57) were randomized to either a free 2-week supply of Camel Snus group or a no-supply group. Of those randomized to use Camel Snus, half were told to use it to cope with smoking restrictions (Snus to Cope), and the remaining half were advised to use it to reduce smoking (Snus to Reduce). Participants were assessed before, during, and immediately after the intervention. RESULTS Many Snus to Cope and Snus to Reduce participants reported daily use of Camel Snus, although the amount of use was low. Snus to Cope (18.4%) and Snus to Reduce (37.6%) participants reported a decline in number of cigarettes used per day, which was not reported by the control participants (p < .001). Intention to quit smoking and intention to quit all tobacco use (ps < .001) increased to a greater extent among Snus to Cope and Snus to Reduce participants than among control participants. CONCLUSIONS This study replicates previous work that shows that low-nitrosamine SLT use can lead to reduced smoking and increased intention to quit, and it adds direct evidence to suggest that the function of low-nitrosamine SLT use-either to cope with smoking restrictions or to reduce smoking-can have a differential impact on smoking behavior. Overall, the results highlight the importance of messaging and, more specifically, marketing of low-nitrosamine SLT to smokers.

Snus undermines quit attempts but not abstinence: a randomised clinical trial among US smokers

Background Observational studies and a few clinical trials suggest that use of low nitrosamine smokeless tobacco (snus) can facilitate smoking cessation. To better understand the real-world impact of snus on smoking behaviour, a large-scale, long-term clinical trial of naturalistic snus use among smokers is needed. Study design A nationwide clinical trial compared abstinence outcomes among smokers who were randomised to receive free samples of snus versus not. Participants (N=1236) were recruited throughout the US and assessed for 1 year following a 6-week naturalistic sampling period, with high retention throughout. Primary outcomes included self-reported quit attempts, floating abstinence (any 7-day period of non-smoking) and 7-day point-prevalence abstinence at 6 months and 12 months. Secondary outcomes were changes in smoking, motivation and confidence to quit and adverse events. No tobacco industry support was provided. Results Within snus group, 82% used at least once, and 16% were using regularly at end of sampling period. Compared to control participants, smokers in the snus group were less likely to make any quit attempt (RR=0.83; 95% CI 0.70 to 1.00), and any 24 h quit attempt (RR=0.77; 95% CI 0.63 to 0.95). There were no group differences on any measure of abstinence. Conclusions Provision of snus in a naturalistic context resulted in minimal uptake, and as a whole, undermined quit attempts and did not increase smoking abstinence. Results do not support the unguided, free provision of snus among smokers not motivated to quit as a means to facilitate quit attempts. Trial registration number NCT01509586, Results.

A mechanistic test of nicotine replacement therapy sampling for smoking cessation induction.

Studies that explore the mechanisms of treatment effect are needed in the area of smoking cessation induction, the primary goal of which is to promote the occurrence of a quit attempt among individuals who report little interest in smoking cessation. This study tested the mediational effect of 5 psychological variables (motivation to quit, abstinence self-efficacy, knowledge of nicotine replacement therapy (NRT), and both positive and negative attitudes toward NRT) on the relationship between NRT sampling and smoking outcomes. Adults who reported low levels of intention to quit in the next month (n = 593) were recruited for a nationwide randomized clinical trial of NRT sampling. Participants provided self-report data via telephone interview on multiple occasions, with the final follow-up at 6 months. Motivation to quit, and to a lesser degree, abstinence self-efficacy at the end of the 6-week intervention best accounted for the effect of NRT sampling as a promoter of quit attempts, smoking reduction, and 7-day point prevalence abstinence. Providing smokers with free NRT samples, in addition to encouraging them to engage in temporary abstinence, results in meaningful change in motivation and self-efficacy, which in turn influence smoking outcomes. Cessation induction interventions should aim to increase motivation to quit and abstinence self-efficacy, above and beyond any efforts to increase knowledge or prompt attitudinal shifts. (PsycINFO Database Record