Medicine and Health Sciences Commons^™

An Analysis Of The Clear Horizons Program In Perry County, Kentucky On Smoking Cessation, Julia Kollitz

Lewis Honors College Thesis Collection

Perry County is an Appalachian county located in southeastern Kentucky. The population is 28,473 people (United States Census Bureau, 2020). It is a predominately white community, with 95.9% of people falling in this category, which is higher than the national percentage of 75.8% (United States Census Bureau, 2020). Being a rural county, this community uses few news sources, with the primary outlet being WYMT Eastern Kentucky News. This news outlet is a subset of CBS (WYMT, 2023). When comparing statewide and nationwide data, Perry County does consistently worse. They have a high school graduation rate that is lower than the …

A Cluster Randomized Controlled Trial For A Multi-Level, Clinic-Based Smoking Cessation Program With Women In Appalachian Communities: Study Protocol For The "Break Free" Program, Joanne G. Patterson, Tia N. Borger, Jessica L. Burris, Mark Conaway, Robert Klesges, Amie Ashcraft, Lindsay Hauser, Connie Clark, Lauren Wright, Sarah Cooper, Merry C. Smith, Mark B. Dignan, Stephenie Kennedy-Rea, Electra D. Paskett, Roger Anderson, Amy K. Ferketich

Psychology Faculty Publications

BACKGROUND: The cervical cancer burden is high among women living in Appalachia. Cigarette smoking, a cervical cancer risk factor, is also highly prevalent in this population. This project aims to increase smoking cessation among women living in Appalachia by embedding a smoking cessation program within a larger, integrated cervical cancer prevention program.

METHODS: The broader program, the Take CARE study, is a multi-site research collaborative designed to address three risk factors for cervical cancer incidence and mortality: tobacco use, human papillomavirus (HPV) infection, and cervical cancer screening. Break Free is a primary care clinic-based implementation program that aims to promote …

Smoking-Induced Sex Differences In Clinical Outcomes In Patients Undergoing Mechanical Thrombectomy For Stroke, Jacqueline A. Frank, Kara Jo Swafford, Jill M. Roberts, Amanda L. Trout, Ann M. Stowe, Douglas E. Lukins, Stephen Grupke, Keith R. Pennypacker, Justin F. Fraser

Neurology Faculty Publications

OBJECTIVE: Ischemic stroke is the fifth leading cause of death in the United States. Smoking accelerates the onset of stroke by 10 years. The effects of smoking status on percent change in National Institutes of Health Stroke Scale (NIHSS) score, infarct volume, and edema volume were examined following mechanical thrombectomy for large vessel occlusion in patients with acute ischemic stroke.

METHODS: Subjects (N = 90; >18 years old) were divided into 3 groups based on smoking status: current smokers, previous smokers (defined as having quit >6 months before the ischemic event), and nonsmokers. Percent change in NIHSS score was …

The Emerging Global Tobacco Treatment Workforce: Characteristics Of Tobacco Treatment Specialists Trained In Council-Accredited Training Programs From 2017 To 2019, Christine E. Sheffer, Abdulmohsen Al-Zalabani, Andrée Aubrey, Rasha Bader, Claribel Beltrez, Susan Bennett, Ellen Carl, Caroline Cranos, Audrey Darville, Jennifer Greyber, Maher Karam-Hage, Feras Hawari, Tresza Hutcheson, Victoria Hynes, Chris Kotsen, Frank Leone, Jamie Mcconaha, Heather Mccary, Crystal Meade, Cara Messick

Nursing Faculty Publications

Tobacco use is projected to kill 1 billion people in the 21st century. Tobacco Use Disorder (TUD) is one of the most common substance use disorders in the world. Evidence-based treatment of TUD is effective, but treatment accessibility remains very low. A dearth of specially trained clinicians is a significant barrier to treatment accessibility, even within systems of care that implement brief intervention models. The treatment of TUD is becoming more complex and tailoring treatment to address new and traditional tobacco products is needed. The Council for Tobacco Treatment Training Programs (Council) is the accrediting body for Tobacco Treatment Specialist …

Tobacco Screening Among Adults In Primary Care: Evaluation Of The Use Of The 5a’S Framework For Treating Tobacco Dependence, Alexis Owens

DNP Projects

Abstract

Background: Tobacco use in the United States is the chief cause of preventable disease and death. Preventing and identifying tobacco use through screening and education is essential to assist users to quit and to decrease overall tobacco associated health risks.

Purpose: The purpose of this study was to assess the integration of the 5A’s tobacco engagement framework into the workflow at one Primary Care Center. Study objectives included determining baseline tobacco screening data prior to 5A’s education, providing providers and support staff education on the 5A’s process, reviewing and interpreting pre/post data of the 5A’s process, and identification of …

Intention To Quit Smoking And Polytobacco Use Among College Student Smokers, Karen M. Butler, Melinda J. Ickes, Mary Kay Rayens, Amanda T. Wiggins, Kristin Ashford, Ellen J. Hahn

Nursing Faculty Publications

Little is known about polytobacco use in college students. One nationally representative survey indicated 51.3% of tobacco-using college students used more than one product, which may increase risk of tobacco-related disease and premature death. The purpose of this study was to examine the association of intention to quit smoking (ITQS) cigarettes with polytobacco use status, controlling for frequency of tobacco product use and cigarette smoking intensity as measured by cigarettes per day (CPD). Data are from a larger quasi-experimental study conducted at a large state university in the Southeastern United States. Analysis is based on the combined sample of current …

The Effects Of Tobacco Policy On Tobacco Treatment In Psychiatric Institutions, Terrence A. Sharper Ii

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Introduction: Tobacco use among those with mental illnesses is substantially higher than the general population. To avoid tobacco related comorbidities, tobacco policies are an important aspect for control of tobacco use, exposure, and to support tobacco treatment.

Aim: To conduct a systematic literature review of tobacco treatment policies in psychiatric institutions and examine the knowledge, availability of resources, and perceived barriers for treating tobacco use among managers.

Method: There were two main parts used to examine tobacco treatment policies in psychiatric facilities. First, a review of the literature summarized the effect of different tobacco-free policies on tobacco treatment delivery in …

A Randomized Controlled Trial Of A Faith-Placed, Lay Health Advisor Delivered Smoking Cessation Intervention For Rural Residents, Nancy E. Schoenberg, Christina R. Studts, Brent J. Shelton, Meng Liu, Richard Clayton, Jordan Baeker Bispo, Nell Fields, Mark Dignan, Thomas Cooper

Behavioral Science Faculty Publications

Introduction. Rural US residents smoke at higher rates than urban or suburban residents. We report results from a community-based smoking cessation intervention in Appalachian Kentucky.

Study design. Single-blind, group-randomized trial with outcome measurements at baseline, 17 weeks and 43 weeks.

Setting/participants. This faith-placed CBPR project was located in six counties of rural Appalachian Kentucky. A total of 590 individual participants clustered in 28 churches were enrolled in the study.

Intervention. Local lay health advisors delivered the 12-week Cooper/Clayton Method to Stop Smoking program, leveraging sociocultural factors to improve the cultural salience of the program for Appalachian smokers. Participants met with …

Gender, Smoking And Tobacco Reduction And Cessation: A Scoping Review, Joan L. Bottorff, Rebecca Haines-Saah, Mary T. Kelly, John L. Oliffe, Iris Torchalla, Nancy Poole, Lorraine Greaves, Carole A. Robinson, Mary H. H. Ensom, Chizimuzo T.C. Okoli, J. Craig Phillips

Nursing Faculty Publications

Considerations of how gender-related factors influence smoking first appeared over 20 years ago in the work of critical and feminist scholars. This scholarship highlighted the need to consider the social and cultural context of women's tobacco use and the relationships between smoking and gender inequity. Parallel research on men's smoking and masculinities has only recently emerged with some attention being given to gender influences on men's tobacco use. Since that time, a multidisciplinary literature addressing women and men's tobacco use has spanned the social, psychological and medical sciences. To incorporate these gender-related factors into tobacco reduction and cessation interventions, our …

Tobacco Treatment For Individuals With Substance Abuse And Psychiatric Disorders, Chizimuzo T.C. Okoli

Nursing Presentations

Overview of this presentation:

• Discuss smoking among persons with substance use and mental illness
• Present smoking cessation outcomes from an evidence-based program for persons with substance use disorders and mental Illness
• Conclusion with current and future Projects

Evidence-Based Smoking Cessation Treatment For Disparate Populations, Chizimuzo T.C. Okoli

Nursing Presentations

Overview of this presentation:

• Describe Research Group and Program of Research among disparate Populations
• Discuss smoking among persons with substance use and mental illness
• Present smoking cessation outcomes from evidence-based programs for persons with substance use disorders and mental Illness
• Conclusion with current and future Projects

The Vancouver General Hospital Smoking Cessation Clinic: Outcomes From A Specialist Cessation Service Within Cardiology, Milan Khara, Chizimuzo T.C. Okoli

Nursing Presentations

PURPOSE: The purpose of our study is to examine pilot treatment outcomes of an outpatient Smoking Cessation Clinic (SCC) provided within Cardiology Services.

RELEVANCE/CONTEXT: Populations with cardiac conditions often continue to smoke at high rates (up to 62%), even after experiencing life-threatening cardiac events. Smoking cessation can greatly reduce the risk of further occurrence of a cardiac event and associated mortality. However few Cardiology services in Canada offer smoking cessation services and few Cardiologists refer smoking patients to such services. The Vancouver General Hospital’s SCC is housed within Cardiology Services and offers a longitudinal approach to smoking cessation. This …

Smoking Cessation Outcomes Among Individuals With A History Of Psychotic Disorders As Compared To Those Without, Chizimuzo T.C. Okoli, Milan Khara

Nursing Presentations

Background: Psychotic disorders (e.g., Schizophrenia, schizoaffetive disorder) are associated with a higher smoking prevalence (relative to other psychiatric disorders) and smoking attributable mortality. Until recently, little has been done to address the disproportionate smoking in this population. The objectives of our study are to: 1) describe the characteristics of smokers with a history of psychiatric disorders (i.e., none, psychotic, and depressive/anxiety) and 2) examine smoking cessation/reduction outcomes by history of psychiatric disorders.

Methods: Retrospective analyses were conducted from charts of 982 participants accessing a tailored, evidence-based, tobacco treatment program within mental health and addictions services in Vancouver, Canada. Demographics, tobacco …

Understanding And Treating Smoking Among Individuals With A Mental Illness, Chizimuzo T.C. Okoli

Nursing Presentations

• Background and significance

• Reasons for smoking among individuals living with a mental illness

• Smoking cessation treatment for individuals living with a mental illness

Outcomes Of A Tailored Smoking Cessation Program For Individuals With A Substance Use And/Or Psychiatric Disorder, Chizimuzo T.C. Okoli, Milan Khara

Nursing Presentations

BACKGROUND: Tobacco use remains a significant cause of morbidity and mortality globally. Although there has been a steady decline in the overall smoking prevalence in North America during the last decade some subsets of the population continue to smoke at high rates, particularly individuals with a history of substance use disorders (SUD) and/or psychiatric disorders (PD). Studies suggest that individuals with SUD’s and PD’s often have disproportionately higher smoking-related mortality. Studies further suggest that in clinical samples an estimated 75% of individuals with PD and up to 90% of individuals with PD concurrently smoke. This high prevalence of smoking among …

Tobacco Use Dependence And Approaches To Treatment, Audrey Darville, Chizimuzo T.C. Okoli

Nursing Presentations

Counseling Demonstrates a Dose-Response Effect/Comes in Many Forms

• Brief advice during a “window of opportunity” can increase quit attempts by 40%

• Medication combined with counseling doubles the success rate

• Quitlines: proactive fax to quitline most effective

• Online (becomeanex.org, smokefree.gov, mylastdip.com)

• Cooper Clayton Classes at many local health departments; schedules and provision of medication varies

• I-Phone apps/text to quit

Tailoring NRT to the tobacco user

• Studies show efficacy in smokers and smokeless tobacco users (Ebbert, et al, 2010)

• Combining patch with shorter acting form of NRT has been shown to be safe and effective (Stead, et al, Cochrane Review, 2008; Kozlowski, …

Smoking Cessation Outcomes Among Individuals With Substance Use And/Or Psychiatric Disorders, Milan Khara, Chizimuzo T.C. Okoli

Nursing Faculty Publications

Objectives: The population of individuals with substance use (SUD) and/or psychiatric disorders (PD) has a high prevalence of smoking and a consequent increase in tobacco-related morbidity and mortality when compared to the general population. The aim of this study is to examine the outcomes of a program in a real-life setting which takes a tailored approach to smoking cessation among individuals with SUD and/or PD.

Methods: A retrospective chart review of tailored tobacco dependence treatment was performed on individuals with histories of SUD and/or PD attending a Tobacco Dependence Clinic (TDC) program in Vancouver, British Columbia, Canada. Participants of the …

Smoking Cessation Among Persons With Co-Occurring Substance Use Disorder And Mental Illness, Chizimuzo T.C. Okoli, Milan Khara

Chizimuzo T.C. Okoli

Aims: A history of either a substance use disorder (SUD) or psychiatric disorder (PD) is associated with tobacco use. However, there is limited information available on tobacco dependence treatment outcomes among individuals with co-occurring SUD and PD. Methods: Data from 202 participants enrolled in a tobacco dependence treatment program in an outpatient clinic setting were analysed. Findings: In multivariate analysis, having a history of SUD only (OR =.11, 95% CI = .02–.76) and having a co-occurring SUD and PD (OR = .13, 95% CI = .02–.81), as compared to having neither, were significant predictors of a lower likelihood of achieving …

Men's Smoking Cessation Interventions: A Brief Review, Chizimuzo T.C. Okoli, Iris Torchalla, John L. Oliffe, Joan L. Bottorff

Chizimuzo T.C. Okoli

Background: Smoking is associated with adverse health effects and significant disease burden among men, making it an important men's health issue. Conversely, smoking cessation is associated with significant reductions in smoking-attributable risk. However, few studies have examined men-specific smoking cessation programs. The aim of our study was to conduct a comprehensive review of the literature to identify men-specific smoking cessation programs to make recommendations about future efforts to develop, implement and evaluate men-centered smoking cessation interventions.

Methods: A comprehensive search of the COCHRANE Library, MEDLINE, and PsycINFO and SIGLE databases was performed. Out of 873 studies that we retrieved from …

The Relationship Between Secondhand Tobacco Smoke (Shs) Exposure And Smoking Behaviours: Designing A Program Of Research, Chizimuzo T.C. Okoli

Chizimuzo T.C. Okoli

Overview

- Background and Significance

- Study 1: Literature Review Study

- Study 2: SHS Exposure, Nicotine Dependence, and Smoking Cessation

- Study 3: Hair Nicotine as a Measure of SHS Exposure

- Study 4: Effects of Nicotine Exposure from SHS Among Bar and Restaurant Workers

- Study 5: Nicotine Dependence Symptoms among Young Never-Smokers Exposed to SHS

- Study 6: An Examination of the Relationship between Adolescents’ Initial Smoking Experience and their Exposure to Peer and Family Member Smoking

Conclusions and Future Directions

Expecting To Quit: A Best-Practices Review Of Smoking Cessation Interventions For Pregnant And Postpartum Girls And Women, Lorraine Greaves, Nancy Poole, Chizimuzo T.C. Okoli, Natalie Hemsing, Annie Qu, Lauren Bialystok, Renée O’Leary

Chizimuzo T.C. Okoli

This report examines interventions designed to reduce or eliminate smoking during pregnancy. It considers these interventions using a “better practices” methodology designed by Moyer, Cameron, Garcia, and Maule (2002, p. 124) for intervention studies published prior to 2003, and a systematic review methodology from the National Institute for Health and Clinical Excellence (NICE) (2006) in the UK for those studies published after 2003. We contextualize the results of these analyses in the wider literature on women’s health, women-centred care, and women’s tobacco use to better interpret them. These results build on those in the first edition of Expecting to Quit …

Treatment Outcomes From The Tdc: A Look At Smoking Cessation Among Patients With Co-Occurring Disorders, Chizimuzo T.C. Okoli

Chizimuzo T.C. Okoli

Summary of Key Findings •Smoking abstinence at end of program:

–Intent to treat analysis: 32.2%(83/258) –Among program completers: 41.3%(83/201)

•Significant predictors of abstinence : –Having an alcohol, heroin (or other opioid) or marijuana use history was a significant predictor of being less likely to quit smoking when compared to having no history of substance use disorder. –Having a lower CO level at program enrolment was a significant predictor of being more likely to quit –Attending the TDC program for a longer duration was a significant predictor of being more likely to quit.

Smoking Cessation Outcomes Among Individuals With Co-Occurring Substance Use Disorder History And Mental Illness, Chizimuzo T.C. Okoli

Chizimuzo T.C. Okoli

BACKGROUND: A history of substance use disorder and/or mental illness is associated with tobacco use. However, there is limited information available on tobacco dependence treatment outcomes in such populations. OBJECTIVES: To examine the effects of a history of substance use disorder and/or mental illness on smoking cessation outcomes. METHODS: Data from 202 participants enrolled in a tobacco treatment program were analyzed. Information on sociodemographics, tobacco use and quit attempt history, social supports for quitting, Fagerstrom Test for Nicotine Dependence scores, importance and confidence in quitting smoking, expired carbon monoxide level, substance use history, mental health history, and previous pharmacotherapy use …

Intensive Treatment Of Tobacco Dependence In An Out - Patient Addictions Services Setting, Milan Khara, Chizimuzo T.C. Okoli

Chizimuzo T.C. Okoli

BACKGROUND

• Drug treatment populations are disproportionately affected by morbidity and mortality attributable to tobacco use. However, with appropriately intensive intervention, individuals in drug treatment settings can succeed in their efforts towards smoking cessation.

• The Tobacco Dependence Clinic (TDC) is a program that provides smoking cessation counseling and up to 26 weeks of free pharmacotherapy for clients through Vancouver Coastal Health Addiction Services, British Columbia, Canada.

• The purpose of this study is to provide evaluation data (in terms of program completion and smoking cessation outcomes) from the TDC.

Smoking Cessation In Patients With Substance Use Disorders: The Vancouver Coastal Health Tobacco Dependence Clinic, Milan Khara, Chizimuzo T.C. Okoli

Chizimuzo T.C. Okoli

Summary of Key Findings •Smoking abstinence at end of program:

–Intent to treat analysis: 32.2%(83/258) –Among program completers: 41.3%(83/201)

•Significant predictors of abstinence : –Having an alcohol, heroin (or other opioid) or marijuana use history was a significant predictor of being less likely to quit smoking when compared to having no history of substance use disorder. –Having a lower CO level at program enrolment was a significant predictor of being more likely to quit –Attending the TDC program for a longer duration was a significant predictor of being more likely to quit.

The Tobacco Dependence Clinic (Tdc): Providing Smoking Cessation For A Drug Treatment Population, Milan Khara, Chizimuzo T.C. Okoli, Deanna Barlow, Catherine Hanley

Chizimuzo T.C. Okoli

BACKGROUND: Drug treatment populations are disproportionately affected by tobacco use morbidity and mortality. However, with adequate intervention, individuals in drug treatment settings can succeed in their efforts towards smoking cessation. The Tobacco Dependence Clinic (TDC) is a program that provides smoking cessation counseling and pharmacotherapy for clients through the Addiction Services program of the Vancouver Coastal Health Authority, British Columbia, Canada. OBJECTIVES: To a) describe smoking cessation services and programs provided by the TDC, and b) evaluate 26 week smoking cessation outcomes of drug treatment clients in the TDC. METHODS: Participants of the TDC program receive a structured 8 week …

Smoking Cessation And Drug Treatment: Identifying Gaps, Milan Khara, Chizimuzo T.C. Okoli, Ric M. Procyshyn, Joy Johnson, Alasdair Barr, Lorraine Greaves

Chizimuzo T.C. Okoli

BACKGROUND: An estimated 70% - 90% of individuals in drug treatment con-currently smoke cigarettes. Although individuals in drug treatment settings are motivated and can succeed in smoking cessation, there is still a lack of systematic knowledge regarding the long-term abstinence, methods employed for successful cessation, and the barriers to smoking cessation in this population.

OBJECTIVES: To: a) describe types of smoking cessation interventions (i.e., cognitive-behavioral and/or pharmacotherapy) employed in drug treatment settings, b) determine the effectiveness of such interventions, and c) identify gaps in knowledge regarding smoking cessation interventions among the drug treatment populations

METHODS: A comprehensive review of the …

Action Required: Revisiting Better Practices In Smoking Cessation Interventions For Pregnant Girls And Women, Chizimuzo T.C. Okoli, Lorraine Greaves, Joan Bottorff, Lenora Marcellus, Charmaine Enns, Richard Stanwick

Chizimuzo T.C. Okoli

Background

Despite considerable medical and research attention, smoking in pregnancy remains a serious public health problem, especially among young and disadvantaged women in high income countries and general populations of women in low and middle income countries. Facilitating successful and enduring smoking cessation during pregnancy and preventing relapse is therefore an ongoing public health challenge globally

Objectives

This Canadian project is aimed at better breaking the cycle of smoking during pregnancy, or quitting and relapsing during postpartum; especially for young, disadvantaged women. Equally, it will address the apparent blockages to effective uptake by health professionals, of research evidence and better …

Action Required: Revisiting Better Practices In Smoking Cessation Interventions For Pregnant Girls And Women (2008), Chizimuzo T.C. Okoli, Lorraine Greaves, Joan Bottorff, Lenora Marcellus, Charmaine Enns, Richard Stanwick

Chizimuzo T.C. Okoli

Background

•Despite considerable efforts by health care professionals, and an overall reduction in smoking prevalence, it is estimated that approximately 20% to 30% of pregnant women still smoke during pregnancy

•To date, smoking cessation interventions to reduce smoking during pregnancy and postpartum have been relatively unsuccessful. Despite the influx of research examining smoking and pregnancy over the last five years, the prevalence of smoking among pregnant and postpartum women has only slightly decreased

•Advice to quit smoking by health care providers, is associated with increased smoking cessation attempts in the general population. Also, studies have shown that smoking cessation interventions …