Kristine K. Browning

Factors influencing cotinine half-life during smoking abstinence in African American and Caucasian women

Cotinine, the proximate metabolite of nicotine, has been identified as an indicator of smoke constituent exposure. Higher cotinine levels in African American cigarette smokers have been identified. Because African Americans experience disproportionate smoking-related morbidity and mortality, it is important to examine potential factors influencing these higher levels of cotinine. The current study examined selected factors of ethnicity, menthol cigarette preference, body composition and alcohol-use history on cotinine half-life in 6 days of smoking abstinence in African American and Caucasian women. A 7-day inpatient protocol was conducted in the General Clinical Research Center, in which day 1 was ad lib smoking and days 2-7 were smoking abstinence (n = 32). Plasma cotinine was measured every 8 h throughout. Average cotinine half-life was 21.3 h, similar to previously reported 18-20 h. Three women exhibited >14 ng/ml cotinine after 136 h of smoking abstinence. Host factors explaining 52.0% of variance in cotinine half-life and associated with longer half-life were being an African American menthol smoker, fewer years of alcohol use and greater lean body mass. Among menthol smokers, baseline cotinine level and cotinine half-life were not significantly different in Caucasian and African American women. Intra-individual cotinine half-life variation and CYP2A6 genotype were examined in substudies. To improve accuracy in correctly classifying non-smokers with cotinine levels, a period of at least 7 days of smoking abstinence may be warranted.

A pilot test of a combined tobacco dependence treatment and lung cancer screening program.

Lung cancer screening with computed tomography has demonstrated a significant reduction in mortality. While these findings are important for the lung cancer research field, the most important risk factor for lung cancer, i.e. smoking, should not be ignored. We performed a pilot study to examine the feasibility of delivering a program that included both tobacco dependence treatment and lung cancer screening. The objectives of this study were to: (1) estimate the proportion of smokers who complied with a 12-week treatment protocol that included both tobacco dependence treatment and lung cancer screening, (2) obtain preliminary estimates of abstinence and quit attempts at 4 and 6 months, and (3) obtain preliminary estimates of the cognitive social health information processing (C-SHIP) constructs and how they change following the intervention. In this randomized pilot study, 18 volunteers completed a 12-week protocol: half received the tobacco dependence treatment program before a CT scan (BCT) and the other received the CT scan first, followed by the treatment program (ACT). The treatment protocol included both nurse-delivered telephone counseling and either nicotine replacement therapy or varenicline. Only one person did not complete all follow-up evaluations. At 4 months post enrollment, the carbon monoxide confirmed quit rates were 33.3% in the BCT arm and 22.2% in the ACT arm (27.8% overall), and all but one had made a 24-h attempt to quit. At 6 months the confirmed abstinence decreased to 22.1% in the BCT arm and 11.1% in the ACT arm (16.7% overall), and 72.2% of participants had made a 24-h quit attempt. These preliminary results suggest that it might be better to deliver treatment before the screening test. Future randomized trials with a larger sample size are needed to confirm these findings.

Tobacco use and cessation in HIV-infected individuals.

Smoking prevalence estimates among HIV-infected individuals range from 40% to 84%, much higher than the overall US adult prevalence. To date, few tobacco dependence treatment trials have been conducted among HIV-infected smokers. Recommendations for future research include examining underlying factors that contribute to persistent smoking and barriers to abstinence, identifying ways to increase motivation for quit attempts, increasing the number of multicentered 2-arm tobacco dependence treatment trials, and using highly efficacious first-line pharmacotherapy in tobacco dependence treatment intervention studies. Addressing these research gaps will help to reduce the tobacco-related disease burden of HIV-infected individuals in the future.

Beliefs about tobacco among appalachian current and former users

Higher risks of tobacco-related morbidity and mortality in Appalachians provided the impetus for this qualitative study. The purpose was to describe beliefs about tobacco use and cessation among current and former tobacco users in rural Appalachia using focus groups. Findings included themes of nicotine addiction and pros and cons of tobacco use. The importance of family and personal independence in relation to tobacco were evident. Participants identified helpful tobacco treatment strategies. Similarities to treatment needs of tobacco users in general underscore the point that rural Appalachians require best practice tobacco treatment integrating unique cultural aspects of family and personal independence.

Safety of Varenicline Among Smokers Enrolled in the Lung HIV Study

INTRODUCTION The prevalence of smoking is high among the human immunodeficiency virus (HIV)-infected population, yet there are few studies of tobacco dependence treatment in this population. This paper reports the safety of varenicline versus nicotine replacement therapy (NRT) and describes preliminary results about the effectiveness of varenicline versus NRT in HIV-infected smokers. METHODS Participants completed 12 weeks of telephone counseling and either varenicline or NRT. Varenicline was encouraged as the preferred intervention; NRT was used for those unable/unwilling to take varenicline. Adverse events (AEs), related to pharmacotherapy, were monitored. Biochemically confirmed abstinence at 3 months was examined. Inverse probability of treatment weighted logistic regression models was fit to compare participants on varenicline to those on NRT. RESULTS Among participants on varenicline (n = 118), the most common AEs were nausea, sleep problems, and mood disturbances. One person reported suicidal ideation; there were no cardiovascular complications. There were no differences in the varenicline AE profile between participants on combination antiretroviral therapy (ART) and those not on ART. The percentages of confirmed abstainers were 11.8% in the NRT group and 25.6% in the varenicline group. The odds of being abstinent were 2.54 times as great in the varenicline group compared with the NRT group in the propensity weighted model (95% CI 1.43-4.49). CONCLUSIONS In this preliminary study, the safety profile of varenicline among HIV-infected smokers resembles findings among smokers without HIV. In addition, varenicline may be more effective at promoting abstinence in this population. Future randomized clinical trials are warranted.

The Self-regulation Model of Illness applied to smoking behavior in lung cancer.

Thirteen to 20% of lung cancer patients continue to smoke after diagnosis. Guided by Self-regulation Theory, the purpose of this study was to examine illness perceptions over time in a sample of lung cancer patients. This prospective 1-group descriptive longitudinal design study included participants 18 years or older, with a lung cancer diagnosis within the past 60 days who self-reported smoking within the past 7 days. At baseline, patients completed a sociodemographics and tobacco use history questionnaire. The Illness Perception Questionnaire-Revised (IPQ-R) was repeated at 3 time points (baseline, 2-4 weeks, and 6 months). Fifty-two participants provided data for the IPQ-R at baseline, 47 at 2 to 4 weeks, and 29 at 6 months. Differences between mean scores for each illness representation attribute of the IPQ-R at repeated time points were calculated by within-subjects repeated-measures analysis of variance and Wilcoxon Signed-Rank Tests. Identity (baseline vs 2-4 weeks: P = .026; baseline vs 6 months: P = .005) and acute/chronic timeline (P = .018) mean scores significantly increased over time; personal and treatment control mean scores significantly decreased over time (P = .007 and P = .047, respectively). Understanding the context in which a patient perceives disease and smoking behavior may contribute to developing interventions that influence behavior change.

Nursing research in tobacco use and special populations.

Smoking is responsible for approximately one in five deaths in the United States per year. The Surgeon General’s 1964 report first linked smoking as a cause of cancer. Since then cigarette smoking has had a steady decline to its current estimate of 19.8%. There are, however, some special populations where smoking continues to occur at a higher prevalence than the general population. This chapter discusses tobacco dependence among the following special populations: low socioeconomic status including Medicaid, hard-core smokers, rural, and homeless; immigrants; and persons living with HIV. For each population, there is an overview of the disparities in tobacco use, special challenges unique to that population, and exploration of current research on tailoring of tobacco dependence treatment. Each of the special populations discussed present unique challenges with tobacco dependence treatment that will require careful examination before disparities will ultimately decrease. Eliminating disparities has been marked as an important research agenda item as noted in Healthy People 2010. Nurse researchers are well positioned to combine their clinical expertise and knowledge of patient psychosocial needs with investigation of patient-focused research questions in each of these special populations.

Cognitive Interviews With Women Cancer Survivors to Assess Content Validity of the Self-Efficacy to Communicate About Sex and Intimacy (SECSI) Scale

household annual income (53%), and were living with the father of their babies (51%). There were no differences in serum levels of interleukin (IL)-8 between T1 and T2. Perceived neighborhood crime at T1 was associated with higher serum cytokine levels of IL-8 at T2, B = .100, 95% confidence interval (CI) = [0.1, 0.2], p < .05, when controlling for covariates (low levels of education, unemployment, low household annual income, body mass index, state anxiety at T2, serum cortisol levels at T2 and IL-8 levels at T1). Neighborhood violent crime rates were not related to IL-8 levels. These findings suggest that perceptions of neighborhood crime in the second trimester of pregnancy, and not objective measures of neighborhood crime, relate to systemic inflammation in the third trimester among African American women. Nurses should inquire about women’s perceptions of their neighborhoods and make referrals for community support groups for women who report high neighborhood crime.

Feasibility of Mind–Body Movement Programs for Cancer Survivors

PURPOSE/OBJECTIVES To evaluate mind-body movement exercise (MBME) classes (yoga, tai chi, and Qigong) for cancer survivors. 
. DESIGN A single-group, repeated-measures design.
. SETTING The Ohio State University Wexner Medical Center-Arthur G. James Cancer Hospital in Columbus.
. SAMPLE 33 adult cancer survivors, with any cancer diagnosis, participating in MBME classes.
. METHODS The researchers sought to examine feasibility of multiple data collection time points and data collection measures; acceptability; and changes to physical, emotional, and biometric measures over time, as a result of participation in MBME classes.
. MAIN RESEARCH VARIABLES Quality of life, sleep, depressive symptomatology, fatigue, stress, upper body strength, gait and balance, body mass index, heart rate, and blood pressure.
. FINDINGS The current study was feasible because survivors were willing to participate and completed most of the questionnaires. Participants found these classes to be beneficial not only for exercise, but also for social support and social connectedness. Poor sleep quality was consistently reported by participants. MBME classes should be recommended to survivors and are beneficial for oncology practices to offer.
. CONCLUSIONS Conducting MBME research with cancer survivors is feasible, and participants find the MBME acceptable and a way of addressing health and managing cancer-related symptoms.
. IMPLICATIONS FOR NURSING Nurses should help patients and caregivers identify locations and times when MBME class participation is possible, assess MBME class participation during each clinic visit to promote continued involvement and to understand if positive effects are occurring, and continue to provide support for MBME classes throughout the survivorship experience.