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Medicaid recipients are vulnerable to increased morbidity and mortality secondary to high tobacco use prevalence and barriers to accessing tobacco treatment. The purpose of the pilot study was to explore managed care administrators' perceptions of the facilitators and barriers to tobacco treatment for Medicaid recipients.Focus groups with key informants (n = 14) from managed care organizations were conducted in fall 2018. Participants included case, integrated care, quality and field care managers, and individuals working in provider and network relations.Facilitators to tobacco treatment were universal quality reporting requirements, access to medications, and the role of case management in identifying and engaging tobacco users in treatment. Barriers included bias regarding smokers' ability to quit, communication challenges, and competing priorities.The analysis provided data to support the development of a policy brief and recommendations to the Department for Medicaid Services for enhancing tobacco dependence treatment.

Introduction Most smoking cessation approaches are modeled on heavy daily smoking. With increasing prevalence of nondaily smoking, it may be necessary to modify these approaches for nondaily smokers. Aims To provide information about beliefs and attitudes relevant to smoking cessation for nondaily smokers. Methods Secondary analysis of two prospective studies on young adult smokers (18–24 years of age) provided brief advice to quit smoking. Measures include baseline levels of constructs relevant to smoking cessation counseling and perceived benefits of and barriers to smoking cessation. Results Participants (n = 40 nondaily, 122 daily smokers) were predominantly White (70% and 84%, respectively), gender-balanced (50% and 43% female), full-time college students (89% and 95%). At baseline, nondaily smokers reported lower levels of nicotine dependence (p < .001; nondaily: Fagerström Test for Nicotine Dependence (FTND) = 0.8 ± 1.5, daily: FTND = 3.1 ± 1.9), lower urge to smoke (p < .001), greater self-efficacy when facing external smoking stimuli (p = .03), expecting to experience fewer positive effects (reduced negative affect, p = Conclusions Constructs relevant to smoking cessation for daily smokers were less salient to young nondaily smokers, compared with moderately addicted young daily smokers, as indicated by responses to standardized scales and by the generation of fewer benefits and barriers in counseling. Interventions may need to find novel ways to engage nondaily smokers, particularly young adult, in smoking cessation efforts. Implications This study is unique in eliciting benefits and barriers from nondaily smokers as they are about to make a quit attempt. This is a critically important point in time, as this is the point in time in which an action plan is formed and can be informed and enhanced by smoking cessation support. Our study further allowed direct comparison to daily smokers undergoing the same procedures, which allowed the identification of unique factors that may impact nondaily smokers in their quit attempt, which may guide intervention efforts. Use of a mixed method design further strengthen the rigor of this study.

Tobacco dependence is a prevalent, chronic, and complex addiction that often leads to long-term disease and death. However, few healthcare providers are sufficiently trained and feel comfortable in delivering tobacco dependence treatment. The purpose of the study was to examine the effectiveness of an accredited online Tobacco Treatment Specialist (TTS) training program that uses a novel, asynchronous approach. We compared the characteristics of participants who completed the program to those who did not complete the program. Changes in knowledge and attitudes in providing tobacco dependence treatment were measured, and satisfaction with the program and intent to pursue national certification were assessed. Participants who were more likely to complete the program were those who discussed quitting less frequently with patients prior to course enrollment. These participants had a significant increase in knowledge and high satisfaction with the course. Approximately half of participants who completed the program indicated that they would pursue obtaining a national certificate in tobacco dependence treatment in the next 2 years.

PURPOSE: Smoking after a cancer diagnosis is linked to cancer-specific and all-cause mortality, among other adverse outcomes. Yet, 10%-20% of US cancer survivors are current smokers. Implementation of evidence-based tobacco treatment in cancer care facilities is widely recommended, yet rarely accomplished. This study focuses on the early outcomes of a population-based tobacco treatment program integrated within an National Cancer Institute–designated cancer center. METHODS AND MATERIALS: The sample consists of 26,365 patients seen at the cancer center during the first 18 months of program implementation. The study is a retrospective chart review of patients' tobacco use and, among current users, patients' treatment referral response. RESULTS: More than 99% of patients were screened for tobacco use. Current (past month) use was observed in 21.05% of patients; cigarettes were the most popular product. Only 17.22% of current users accepted a referral for tobacco treatment; among current users who declined, the majority were not ready to quit (65.84%) or wanted to quit on their own (27.01%). Multiple demographic variables were associated with tobacco use and treatment referral response outcomes. CONCLUSION: Despite cancer diagnosis presenting a teachable moment for tobacco cessation, patients with cancer may not be ready to quit or engage with treatment. Clinically proven strategies to increase motivation, prompt quit attempts, and encourage treatment use should be key components of tobacco treatment delivery to patients with cancer.

Objectives: To provide initial insight into how the COVID-19 pandemic could affect smoking behaviors and cessation efforts that were underway at its onset. Methods: An additional survey was added t...

Electronic cigarettes, commonly known as electronic nicotine delivery systems (ENDS), e-cigarettes, or vapes, are growing in use and popularity. E-cigarettes are not one distinct type of product. These devices have evolved from the initial “cigarette-alike” designs to larger tank-style devices and most recently, smaller “mod-pods” that can be easily hidden. E-cigarettes can deliver nicotine at levels similar to conventional cigarettes. As with conventional cigarettes, e-cigarettes expose users to chemicals and particulates that affect many biological systems including the heart, lungs, and circulation. Most e-cigarettes contain and emit potentially toxic but highly variable substances. Only by using them in total abstinence from combustible tobacco products can users reduce (not eliminate) their exposure to these harmful chemicals. However, most adults smoking e-cigarettes are dual users, meaning they smoke both conventional and e-cigarettes. This review of the current cardiovascular-specific literature related to e-cigarette use explores what is known (and unknown) about the short- and long-term effects of using these devices. Specifically, the effects of nicotine, oxidizing agents, and particulates in e-cigarettes are examined in the context of cardiovascular and lung health. The goal is to assist clinicians when discussing e-cigarettes with their patients and to help them analyze the impact of use on cardiovascular health. Recommendations are provided related to clinical treatment and research to address gaps in the literature.

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 (TTS) training programs. Between 2016 and 2019, n = 7761 trainees completed Council-accredited TTS training programs. Trainees were primarily from North America (92.6%) and the Eastern Mediterranean (6.1%) and were trained via in-person group workshops in medical and academic settings. From 2016 to 2019, the number of Council-accredited training programs increased from 14 to 22 and annual number of trainees increased by 28.5%. Trainees have diverse professional backgrounds and work in diverse settings but were primarily White (69.1%) and female (78.7%) located in North America. Nearly two-thirds intended to implement tobacco treatment services in their setting, two-thirds had been providing tobacco treatment for 1 year or less, and 20% were sent to training by their employers. These findings suggest that the training programs are contributing to the development of a new workforce of TTSs as well as the development of new programmatic tobacco treatment services in diverse settings. Developing strategies to support attendance from demographically and geographically diverse professionals might increase the proportion of trainees from marginalized groups and regions of the world with significant tobacco-related inequities.

Background Competency standards for tobacco treatment specialists and training have been formalized by the Association for Treating Tobacco Use and Dependence (ATTUD). To increase access to formalized TTS training in remote regions, we developed a novel online-only format incorporating video technologies. The purposes of the study were to: 1) evaluate and compare knowledge and skill acquisition using synchronous video-conferencing versus uploaded video content reviewed asynchronously; and 2) assess the fidelity of evaluating tobacco treatment specialist trainee knowledge and skills using standardized case presentations. Methods An observational pilot study design was used to evaluate the effectiveness of synchronous versus asynchronous online evaluation strategies. Twenty trainees were randomly assigned to synchronous (Zoom; n = 11) and asynchronous (YouTube; n = 9) groups to demonstrate skills using a standardized case scenario. All trainees then completed a written case study. Two independent raters evaluated the groups using a rubric and checklist. Results There were no significant differences in total mean scores between the two groups using the rubric. Intra-class correlation coefficient (ICC) between raters for total rubric scores were 0.68 in the synchronous group and 0.33 in the asynchronous group. For the checklist, trainees in the synchronous group had higher mean scores (19.1) than the asynchronous group (16.6; p=.03). Checklist ICC scores differed significantly between groups; 0.80 for synchronous and 0.41 for asynchronous. For the written case, there was a larger, but non-significant, increase in scores for the asynchronous group (1.5 versus 0.3 points). All participants achieved a passing written case score. Conclusions There was moderate to strong agreement between raters when using the synchronous method while the asynchronous method yielded weak agreement. Synchronous (Zoom) evaluation yielded higher mean assessment skill scores than asynchronous (YouTube) assessment. The synchronous evaluation trended toward lower variability in scores when compared to the written case; the standard evaluation used for all participants.

Aims The existence of smokers who are resistant to smoking cessation treatment has long been noted in the literature. There has been ongoing debate as to whether the proportion of these smokers is increasing as smoking prevalence rates stagnate. Studies define hardcore smokers inconsistently and within the context of specific illnesses, addiction, population, and/or theoretical paradigms. This review examines the existing literature related to hardcore smokers to develop a better understanding of what is known and not known about this group to guide smoking cessation treatment. Methods PubMed MESH search and review of research publications from 1998 to 2012 (N = 61). Results Inconsistent definitions of hardcore smoking make it difficult to estimate prevalence rates and to identify specific characteristics of persistent smokers. Generally, persistent smokers have higher levels of nicotine dependence, are disproportionately from lower socioeconomic groups, start smoking at an earlier age, and are more likely to have a psychological co-morbidity. Discussion Defining some smokers as hardcore is limiting. Targeted and tailored interventions for smoking cessation for persistent smoking have demonstrated effectiveness in a small number of studies. Treatment access barriers need to be addressed to improve the reach and effectiveness of cessation with persistent smokers. Efforts to limit early age initiation of tobacco use are a critical element in averting persistent smoking.

This article describes a 3-pronged compliance strategy to implement a tobacco-free campus policy at 1 large, land grant public university in the South, and evaluates its impact on outcomes and costs. Although there has been a recent wave of tobacco-free colleges, policy restrictiveness and implementation vary, and compliance remains a challenge. The 3 Ts strategy (Tell-Treat-Train) involves regular, consistent communications, access to tobacco treatment medications and counseling, and ongoing training of supervisors and student leaders. Administrative support, access to tobacco treatment, campus buy-in, sustained communications, and careful implementation planning are critical to instituting a tobacco-free university policy.

Repetitive thought (RT) involves frequent or prolonged thoughts about oneself and one’s world, encompassing discrete forms such as trait worry, rumination, processing, and reminiscing. These forms of RT can be described using three basic, underlying qualities: total propensity for RT of all types, valence (positive versus negative content), and purpose (searching or uncertainty versus solving or certainty). The adaptiveness of discrete forms with regard to health is likely to be related to these qualities, particularly valence and total propensity. The present study confirmed the model and identified the relationship of these qualities of RT to subjective psychological, physical, and cognitive health in older adults aged 60-94 (N = 179). As predicted, more negatively valenced trait RT was associated with worse psychological, physical, and cognitive health. More total propensity for RT was associated only with worse psychological health. Searching purpose was associated only with worse cognitive health. In turn, negatively valenced RT was predicted by poorer executive functions, suggesting that such functions may be important for directing this quality of RT. The valence of older adults’ RT is important insofar as it may contribute to their sense of good or ill health. However, the propensity for all kinds of RT to associate with poorer psychological health may reflect the co-occurrence of negative and positive RT, such as rumination and emotional processing. Although RT has not been extensively investigated in older adults, it appears to play an important role in their subjective health.

Electronic cigarettes (e-cigarettes) use a heating element to vaporize nicotine and other ingredients, simulating the visual, sensory, and behavioral aspects of smoking without the combustion of tobacco. An ever-growing number of companies around the world manufacture a wide variety of e-cigarette brands, despite scant information on the safety of the ingredients for human inhalation. This article provides an overview of the history, production, and marketing of e-cigarettes, the contents of e-cigarettes and vapor, how they are used, public health concerns, and implications for nursing practice, research, and policy development.

INTRODUCTION We examined the association between time since implementation of a smoke-free law and cessation behaviors among current and former smokers. METHODS A quasiexperimental, three-group design assessed smoking and cessation behaviors via brief telephone interviews with 295 randomly selected current and former smokers who had quit since a smoke-free law took effect in their community. Participants lived in one of four communities that had implemented a smoke-free law in the preceding 6-8 months (n = 106), 18 months (n = 87), or 36 months (n = 102). RESULTS Compared with those living in communities with relatively new smoke-free laws (6-8 months), those in communities with more established laws (18 and 36 months) were more likely to (a) be former smokers and (b) report a longer time since smoking their last cigarette. Compared with the 6- to 8-month group, those in the 36-month group were more likely to have tried to quit since the law was implemented. DISCUSSION Smoke-free laws may have a delayed effect on cessation among adults. The longer a smoke-free law is in effect, the more likely adults will attempt to quit smoking and become former smokers. Maintaining the integrity of smoke-free laws over time is an important population-based quit strategy.