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Background: Digital smoking cessation interventions may reduce racial disparities in cessation because they are low cost, scalable, and can provide support at any place or time. Despite their promise, whether Black adults engage with and benefit from these tools is largely unknown. In a secondary analysis of a randomized trial, we explored the efficacy of an acceptance and commitment therapy (ACT)-based website (WebQuit) for smoking cessation compared to a US clinical practice guidelines-based website (Smokefree.gov) among Black adults. Methods: A total of 316 Black adult smokers were enrolled in the trial between May 2017 and September 2018 and received access to WebQuit or Smokefree for 12 months. Participants self-reported on 30-day and 7-day abstinence from cigarette smoking at 3, 6, and 12-months. Treatment engagement was objectively measured and compared between arms. Participants also reported on their willingness to accept cues to smoke without smoking. Results: WebQuit versus Smokefree participants engaged more with their website (higher number of logins, Incidence Rate Ratio (IRR) = 2.21; 95% CI: 1.70, 2.89). Complete-case 30-day point prevalence abstinence (PPA) at 12-months was 34% for WebQuit vs. 29% for Smokefree (OR= 1.22 95% CI: 0.73, 2.04). Increases in participants’ willingness to accept cues to smoke mediated the intervention effect on abstinence from cigarette smoking at 12 months. Conclusions: This study addressed the lack of research on the utilization and efficacy of digital interventions for helping Black adults quit smoking. WebQuit participants engaged more with their website and quit smoking at a somewhat higher rate relative to Smokefree participants, albeit nonsignificant. Findings suggest high acceptability of ACT-based digital interventions to enable Black adult smokers to engage and sustain behavior changes. Trial Registration: ClinicalTrials.gov Identifier: NCT01812278.

There are no known efficacious digital smoking cessation interventions for Hispanic/Latinx adults who smoke. This study is a secondary analysis using data from a randomized trial to evaluate whether Acceptance and Commitment Therapy (ACT) delivered via a smartphone app (iCanQuit) would be more efficacious for smoking cessation than the US Clinical Practice (USCPG)-based app (QuitGuide) in a sample of Hispanic/Latinx participants.

Background The Hutchinson Study of High School Smoking randomized trial was designed to rigorously evaluate a proactive, personalized telephone counseling intervention for adolescent smoking cessation. Methods Fifty randomly selected Washington State high schools were randomized to the experimental or control condition. High school junior smokers were proactively identified (N = 2151). Trained counselors delivered the motivational interviewing plus cognitive behavioral skills training telephone intervention to smokers in experimental schools during their senior year of high school. Participants were followed up, with 88.8% participation, to outcome ascertainment more than 1 year after random assignment. The main outcome was 6-months prolonged abstinence from smoking. All statistical tests were two-sided. Results The intervention increased the percentage who achieved 6-month prolonged smoking abstinence among all smokers (21.8% in the experimental condition vs 17.7% in the control condition, difference = 4.0%, 95% confidence interval [CI] = -0.2 to 8.1, P = .06) and in particular among daily smokers (10.1% vs 5.9%, difference = 4.1%, 95% CI = 0.8 to 7.1, P= .02). There was also generally strong evidence of intervention impact for 3-month, 1-month, and 7-day abstinence and duration since last cigarette (P = .09, .015, .01, and .03, respectively). The intervention effect was strongest among male daily smokers and among female less-than-daily smokers. Conclusions Proactive identification and recruitment of adolescents via public high schools can produce a high level of intervention reach; a personalized motivational interviewing plus cognitive behavioral skills training counseling intervention delivered by counselor-initiated telephone calls is effective in increasing teen smoking cessation; and both daily and less-than-daily teen smokers participate in and benefit from telephonebased smoking cessation intervention. J Natl Cancer Inst 2009;101:1378-1392 DOI: 10.1093/jnci/djp317

Background Effective smoking cessation for youth is urgently needed, but the literature guiding such efforts is nascent. We evaluated the implementation of a proactive intervention for adolescent smoking cessation that incorporated motivational interviewing (MI) and cognitive behavioral skills training (CBST). Methods We proactively identified 1058 smokers via classroom survey of enrolled juniors in 25 experimental high schools. After parental consent was obtained, trained counselors telephoned participants to invite their participation and deliver personalized smoking cessation counseling that combined MI and CBST. Implementation quality was assessed via weekly supervision of counselors, monitoring of counselor adherence to protocol via review of 5% of each counselor's calls, and formal evaluation of counselor fidelity to MI via review of a random sample of 19.8% of counseling calls using the Motivational Interviewing Treatment Integrity Code. Results Among identified smokers, 948 (89.6%) were eligible for intervention by age ([greater than or equal to]18 years) or parental consent, 736 (70%) agreed to participate in telephone counseling, 691 (65%) completed one or more counseling calls, and 499 (47%) completed all planned calls. Telephone delivery of the personalized MI and CBST counseling intervention to a general population of adolescents was done with greater than 90% adherence to the intervention protocol. Review of the random sample of counselors' calls demonstrated that more than 85% of counselors' calls met or exceeded benchmark scores for four of six evaluated behaviors: MI spirit (99.1%), empathy (96.2%), ratio of reflections to questions (97.2%), and MI adherent (85.7%). Conclusion An effective proactive telephone counseling intervention consisting of MI and CBST can be successfully implemented with reach and fidelity in a general population of adolescent smokers. J Natl Cancer Inst 2009;101:1393-1405 DOI: 10.1093/jnci/djp318

Noninvoluting congenital hemangiomas (NICHs) persist in a high-flow state into childhood and often require surgical excision. The inherent vascular nature of these tumors make effective surgical treatment challenging. Here we report on a patient that underwent intraoperative glue embolization and complete excision of a large gluteal NICH. Concurrent glue embolization followed by complete excision allows for decreased intraoperative blood loss and easier discrimination between the tumor and surrounding structures. Treating difficult vascular tumors with a multidisciplinary approach and subsequent intraoperative glue embolization with surgical excision allows for an effective, single-stage approach to NICHs.

Telehealth coaching for weight loss has high population-level reach but limited efficacy. To potentially improve on this limitation, the purpose of this study was to determine the preliminary efficacy of the first known telephone coaching acceptance and commitment therapy (ACT) intervention for weight loss. A two-arm, stratified, individually randomized pilot trial comparing ACT (n= 53) with standard behavioral therapy (SBT; n= 52) was used for this study. Both interventions were delivered in 25 telephone coaching calls (15–20 min each) over a 12 month period. Weight was measured at baseline and 3, 6, and 12 month postrandomization follow-ups. Recruited from 32 U.S. states, participants were of mean age 40.7, 42% male, 34% racial/ethnic minority, and mean baseline body mass index of 34.3. Fractions of 10% or more scale-reportedweight loss: 15% for ACT versus 4% for SBT at 3 month follow-up (N= 86; odds ratio [OR] = 4.61; 95% confidence interval [CI]: 0.79, 26.83), 24% for ACT versus 13% for SBT at 6 month follow-up (N= 72; OR = 2.45; 95% CI: 0.65, 9.23), 30% for ACT versus 30% for SBT at 12 month follow-up (N= 57; OR = 0.93; 95% CI: 0.28, 3.09). Fractions of 10% or more self-reportedweight loss at 12 month follow-up: 25% for ACT versus 15% for SBT (N= 75; OR = 2.38; 95% CI: 0.68, 8.34). The conclusion of the study was the preliminary evidence that telephone coaching ACT may be efficacious for weight loss.Telephone coaching for weight loss reaches many people but has achieved very limited levels of weight loss. A program called acceptance and commitment therapy (ACT) is promising as an in-person weight loss program. However, ACT had not been tested before as a telephone coaching program. We conducted a 1 year telephone coaching study of 105 adults with overweight/obesity comparing ACT with standard behavioral therapy (SBT) coaching. The results showed that ACT telephone coaching had very encouraging levels of weight loss success compared to (SBT) coaching. These results suggest that telephone coaching ACT may be useful for weight loss.

Poor long-term recovery outcomes after treatment (e.g., readmission to inpatient treatment) are common among individuals with substance use disorder (SUD). In-person mindfulness-based treatments (MBTs) are efficacious for SUDs and may improve recovery outcomes. However, existing MBTs for SUD have limited public health reach, and thus scalable delivery methods are needed. A digitally-delivered MBT for SUD may hold promise.

IMPORTANCE: Smoking is a leading cause of premature death globally. Smartphone applications for smoking cessation are ubiquitous and address barriers to accessing traditional treatments, yet there is limited evidence for their efficacy. OBJECTIVE: To determine the efficacy of a smartphone application for smoking cessation based on acceptance and commitment therapy (ACT) vs a National Cancer Institute smoking cessation application based on US clinical practice guidelines (USCPG). DESIGN, SETTING, AND PARTICIPANTS: A 2-group, stratified, double-blind, individually randomized clinical trial was conducted from May 27, 2017, to September 28, 2018, among 2415 adult cigarette smokers (n = 1214 for the ACT-based smoking cessation application group and n = 1201 for the USCPG-based smoking cessation application group) with 3-, 6-, and 12-month postrandomization follow-up. The study was prespecified in the trial protocol. Follow-up data collection started on August 26, 2017, and ended at the last randomized participant’s 12-month follow-up survey on December 23, 2019. Data were analyzed from February 25 to April 3, 2020. The primary analysis was performed on a complete-case basis, with intent-to-treat missing as smoking and multiple imputation sensitivity analyses. INTERVENTIONS: iCanQuit, an ACT-based smoking cessation application, which taught acceptance of smoking triggers, and the National Cancer Institute QuitGuide, a USCPG-based smoking cessation application, which taught avoidance of smoking triggers. MAIN OUTCOMES AND MEASURES: The primary outcome was self-reported 30-day point prevalence abstinence (PPA) at 12 months after randomization. Secondary outcomes were 7-day PPA at 12 months after randomization, prolonged abstinence, 30-day and 7-day PPA at 3 and 6 months after randomization, missing data imputed with multiple imputation or coded as smoking, and cessation of all tobacco products (including e-cigarettes) at 12 months after randomization. RESULTS: Participants were 2415 adult cigarette smokers (1700 women [70.4%]; 1666 White individuals [69.0%] and 868 racial/ethnic minorities [35.9%]; mean [SD] age at enrollment, 38.2 [10.9] years) from all 50 US states. The 3-month follow-up data retention rate was 86.7% (2093), the 6-month retention rate was 88.4% (2136), and the 12-month retention rate was 87.2% (2107). For the primary outcome of 30-day PPA at the 12-month follow-up, iCanQuit participants had 1.49 times higher odds of quitting smoking compared with QuitGuide participants (28.2% [293 of 1040] vs 21.1% [225 of 1067]; odds ratio [OR], 1.49; 95% CI, 1.22-1.83; P < .001). Effect sizes were very similar and statistically significant for 7-day PPA at the 12-month follow-up (OR, 1.35; 95% CI, 1.12-1.63; P = .002), prolonged abstinence at the 12-month follow-up (OR, 2.00; 95% CI, 1.45-2.76; P < .001), abstinence from all tobacco products (including e-cigarettes) at the 12-month follow-up (OR, 1.60; 95% CI, 1.28-1.99; P < .001), 30-day PPA at 3-month follow-up (OR, 2.20; 95% CI, 1.68-2.89; P < .001), 30-day PPA at 6-month follow-up (OR, 2.03; 95% CI, 1.63-2.54; P < .001), 7-day PPA at 3-month follow-up (OR, 2.04; 95% CI, 1.64-2.54; P < .001), and 7-day PPA at 6-month follow-up (OR, 1.73; 95% CI, 1.42-2.10; P < .001). CONCLUSIONS AND RELEVANCE: This trial provides evidence that, compared with a USCPG-based smartphone application, an ACT-based smartphone application was more efficacious for quitting cigarette smoking and thus can be an impactful treatment option. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02724462

As the 21st century nears, a problem is emerging in law schools across America. At best, some law schools are ignoring the significance of personal injury law practice in their [...]

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Cigarette smoking remains the leading preventable cause of death and disability in the United States and frequently co-occurs with anxiety and depressive symptoms. A novel and integrative, theory-driven approach to address the heterogeneity of mood-related symptoms associated with cigarette use is to focus on transdiagnostic processes, such as distress tolerance, that underpin both mood-related symptoms and smoking behavior. The current study sought to develop and examine the feasibility, acceptability, and initial efficacy of a digitally delivered integrated personalized feedback intervention (PFI) that addresses smoking-distress tolerance relations.

Physical pain is highly prevalent among military veterans. As stress can impact pain, COVID-19-related stressors may have heightened pain among veterans. A prospective analysis of pain could advance understanding of how veterans fared during COVID-19 and lend knowledge of risk factors important beyond the pandemic. The present study employs growth mixture modeling with a sample of U.S. veterans high in pain (N=1230) followed from just before COVID-19 (February 2020) to 12 months later (February 2021; 81.7% retention). We explored heterogeneous pain trajectories as well as baseline and COVID-19-related predictors of pain. Results revealed four pain trajectory classes: (1) Chronic Pain(17.3% of sample); (2) Decreasing Pain(57.2% of sample); (3) Stable Mild Pain(19.8% of sample); and (4) Increasing Pain(5.7% of sample). Those with childhood trauma exposure were especially likely to report chronic pain. Female and racial/ethnic minority veterans were also relatively likely to fare poorly in pain. Loneliness was associated with subsequent pain among several classes. Most veterans in our sample fared better than expected in terms of pain. However, as those with childhood trauma and certain disadvantaged groups were less likely to fare well, we add to the important literature on disparities in pain. Clinicians should identify whether loneliness and other factors impacted pain during COVID-19 among their patients to inform ongoing, person-centered pain management approaches.

The fast adoption of smartphone applications (apps) by behavioral scientists pose a new host of opportunities as well as knowledge and interdisciplinary challenges. Therefore, this brief report will discuss the lessons we have learned during the development and testing of smartphone apps for behavior change, and provide the reader with guidance and recommendations about this design and development process. We hope that the guidance and perspectives presented in this brief report will empower behavioral scientists to test the efficacy of smartphone apps for behavior change, further advance the contextual behavioral etiology of behavioral disorders and help move the field towards personalized behavior change technologies.

Mobile technologies are growing rapidly around the world to broad demographics of society. These technologies hold great promise for their integration with Single Case Designs (SCDs) and the study of individuals in their natural environment. This paper discusses the theoretical, methodological and analytic implications of these tools for the advancement of the contextual behavioral etiology of behavioral disorders, and their remediation. We hope this paper will highlight the scientific advantages of combining mobile technologies and SCDs and encourage their adoption among CBS scientists.

Throughout its history the strategy and tactics of contextual behavioral science (CBS) research have had distinctive features as compared to traditional behavioral science approaches. Continued progress in CBS research can be facilitated by greater clarity about how its strategy and tactics can be brought to bear on current challenges. The present white paper is the result of a 2 1/2-year long process designed to foster consensus among representative producers and consumers of CBS research about the best strategic pathway forward. The Task Force agreed that CBS research should be multilevel, process-based, multidimensional, prosocial, and pragmatic, and provided 33 recommendations to the CBS community arranged across these characteristics. In effect, this report provides a detailed research agenda designed to maximize the impact of CBS as a field. Scientists and practitioners are encouraged to mount this ambitious agenda.