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Examining vulnerability to smokeless tobacco use among adolescents and adults with major depressive disorder
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Abstracts / Drug and Alcohol Dependence 146 (2015) e34–e117
Clinician beliefs and behaviors regarding screening and brief intervention for drug use of their community health center patients Anjani Reddy, Lillian Gelberg, Ron Andersen University of California Los Angeles, Los Angeles, CA, United States Aims: Integration of behavioral health including substance use problems into primary care is an essential benefit that federally qualified health centers (FQHCs) will offer as part of the Affordable Care Act (ACA). This study explores FQHC primary care clinicians’ beliefs and behaviors in integrating drug use assessment and treatment into their practices with a screening, brief intervention and referral to treatment (SBIRT) protocol. Methods: We administered a 10-min questionnaire to 68 primary care clinicians of 5 FQHCs in Los Angeles. Results: Clinicians expressed limited confidence in their ability to deal with illicit drug use of their patients, scoring on average 3.31 on a five point Likert scale. Two-thirds reported assessing for drug use regularly ‘at every visit’ and/or ‘at annual visits’. Median response for how often they counsel regarding drug use (on a five point Likert Scale from ‘Never’ to ‘Always’), was 4 (‘Usually’). Regarding their perspectives on the best practical resource for addressing drug use in their clinics, 45.6% named primary care clinicians. A minority (29.4%) of clinicians had completed a clinical rotation dealing with substance use, and 27.2% reported that more than 10 h of their training was devoted to substance use problems. Having a substance use rotation was associated with greater confidence in SBIRT (p < 0.01). More hours of substance use training was associated with greater confidence (p = 0.01) and routinely addressing substance use in their patients (p = 0.04). Conclusions: Our findings suggest that clinician confidence and practices in substance use care are not optimal, but are associated with increased substance use education. Further work should examine whether improving clinicians’ education/training at community health centers, improves substance use care practices. Financial support: This study is part of the UCLA Quit Using Drugs Intervention Trial (QUIT), which has been funded by National Institute on Drug Abuse (R01DA022445). Dr. Anjani Reddy is a National Research Service Award Fellow. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.580 Examining vulnerability to smokeless tobacco use among adolescents and adults with major depressive disorder Ryan Redner 1,2 , Thomas J. White 1,2 , S.T. Higgins 1,2,3 , Valerie Harder 2,3 1 Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States 2 Psychiatry, University of Vermont, Burlington, VT, United States 3 Psychology, University of Vermont, Burlington, VT, United States
Aims: Smoking prevalence is unevenly distributed in the U.S. population, with those with mental illness, other substance use disorders, and lower socioeconomic status being especially vulnerable. Less research has been conducted on the association between these same vulnerabilities and smokeless tobacco (ST) use. The present study examined ST use among adolescents and adults with major depressive disorder in the National Survey on Drug Use and Health (NSDUH).
Methods: Utilizing the most recent (2011) NSDUH, we compared odds for current cigarette smoking and ST use among adolescents and adults meeting criteria for past year major depressive disorder to the general population, after adjusting for potential confounding influences of sociodemographic and other substance use characteristics. Results: Odds for current cigarette smoking among those classified with major depressive disorder were increased among adolescents (OR = 1.33 [0.97, 1.83], p = 0.021) and adults (OR with 99% CI = 1.70 [1.40, 2.07], p < .0005), while odds for current ST use did not differ among adolescents (OR = 0.90 [0.46, 1.76], p = 0.678) and were lower among adults (OR = 0.68 [0.46, 1.00], p = 0.01). Conclusions: Major depressive disorder is associated with increased risk for smoking but not ST use among adolescents and adults demonstrating heterogeneity in predictors of vulnerability to use of different tobacco products. Financial support: This research was supported by National Institutes of Health (NIH) Institutional Training Grant T32DA07242, Centers of Biomedical Research Excellence Center Grant P20GM103644, and Fogarty International Center/NIH Grant K01TW008410. While the research reported in this publication was supported by NIH, FDA, and Fogarty International Center, the content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies and institutes. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.581 Depression, nicotine withdrawal, and smoking urges in smoking cessation Holly H. Reid 1,2 , David M. Ledgerwood 2 1
Psychology, Wayne State University, Detroit, MI, United States 2 Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, United States Aims: Nicotine withdrawal and urges have the potential for making smoking cessation more difficult. Depressed smokers may be disproportionately affected by withdrawal and urges, leading to greater difficulty in quitting. This study assessed whether elevated depression among 81 nicotine dependent smokers predicted changes in withdrawal and urges to smoke throughout smoking treatment. Methods: Data were collected as part of a randomized trial comparing contingency management and standard smoking cessation. Two linear mixed model analyses were conducted. Withdrawal (Minnesota Nicotine Withdrawal Scale) and urge rating (Questionnaire of Smoking Urges) data from a baseline week and four treatment weeks were included as dependent variables. High and low depression scores were based on participant Beck Depression Inventory-II scores, and included as a fixed factor. Time-point was the within-subject factor. Results: Depressed (N = 18) and non-depressed participants (N = 63) differed on age (p < .05), but no other demographic or smoking related variables (all ps > .05). The mixed model predicting changes in nicotine withdrawal revealed main effects for depression (p < .01) and time (p < .01). The mixed model predicting changes in smoking urges also revealed main effects for depression (p < .05) and time (p < .01), as well as a depression by time interaction (p < .05). Depressed smokers reported increased withdrawal and urges in the first week of treatment (following the baseline week) before reporting progressive reductions in withdrawal and urges, whereas non-depressed smokers reported consistent
Abstracts / Drug and Alcohol Dependence 146 (2015) e34–e117
Clinician beliefs and behaviors regarding screening and brief intervention for drug use of their community health center patients Anjani Reddy, Lillian Gelberg, Ron Andersen University of California Los Angeles, Los Angeles, CA, United States Aims: Integration of behavioral health including substance use problems into primary care is an essential benefit that federally qualified health centers (FQHCs) will offer as part of the Affordable Care Act (ACA). This study explores FQHC primary care clinicians’ beliefs and behaviors in integrating drug use assessment and treatment into their practices with a screening, brief intervention and referral to treatment (SBIRT) protocol. Methods: We administered a 10-min questionnaire to 68 primary care clinicians of 5 FQHCs in Los Angeles. Results: Clinicians expressed limited confidence in their ability to deal with illicit drug use of their patients, scoring on average 3.31 on a five point Likert scale. Two-thirds reported assessing for drug use regularly ‘at every visit’ and/or ‘at annual visits’. Median response for how often they counsel regarding drug use (on a five point Likert Scale from ‘Never’ to ‘Always’), was 4 (‘Usually’). Regarding their perspectives on the best practical resource for addressing drug use in their clinics, 45.6% named primary care clinicians. A minority (29.4%) of clinicians had completed a clinical rotation dealing with substance use, and 27.2% reported that more than 10 h of their training was devoted to substance use problems. Having a substance use rotation was associated with greater confidence in SBIRT (p < 0.01). More hours of substance use training was associated with greater confidence (p = 0.01) and routinely addressing substance use in their patients (p = 0.04). Conclusions: Our findings suggest that clinician confidence and practices in substance use care are not optimal, but are associated with increased substance use education. Further work should examine whether improving clinicians’ education/training at community health centers, improves substance use care practices. Financial support: This study is part of the UCLA Quit Using Drugs Intervention Trial (QUIT), which has been funded by National Institute on Drug Abuse (R01DA022445). Dr. Anjani Reddy is a National Research Service Award Fellow. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.580 Examining vulnerability to smokeless tobacco use among adolescents and adults with major depressive disorder Ryan Redner 1,2 , Thomas J. White 1,2 , S.T. Higgins 1,2,3 , Valerie Harder 2,3 1 Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, United States 2 Psychiatry, University of Vermont, Burlington, VT, United States 3 Psychology, University of Vermont, Burlington, VT, United States
Aims: Smoking prevalence is unevenly distributed in the U.S. population, with those with mental illness, other substance use disorders, and lower socioeconomic status being especially vulnerable. Less research has been conducted on the association between these same vulnerabilities and smokeless tobacco (ST) use. The present study examined ST use among adolescents and adults with major depressive disorder in the National Survey on Drug Use and Health (NSDUH).
Methods: Utilizing the most recent (2011) NSDUH, we compared odds for current cigarette smoking and ST use among adolescents and adults meeting criteria for past year major depressive disorder to the general population, after adjusting for potential confounding influences of sociodemographic and other substance use characteristics. Results: Odds for current cigarette smoking among those classified with major depressive disorder were increased among adolescents (OR = 1.33 [0.97, 1.83], p = 0.021) and adults (OR with 99% CI = 1.70 [1.40, 2.07], p < .0005), while odds for current ST use did not differ among adolescents (OR = 0.90 [0.46, 1.76], p = 0.678) and were lower among adults (OR = 0.68 [0.46, 1.00], p = 0.01). Conclusions: Major depressive disorder is associated with increased risk for smoking but not ST use among adolescents and adults demonstrating heterogeneity in predictors of vulnerability to use of different tobacco products. Financial support: This research was supported by National Institutes of Health (NIH) Institutional Training Grant T32DA07242, Centers of Biomedical Research Excellence Center Grant P20GM103644, and Fogarty International Center/NIH Grant K01TW008410. While the research reported in this publication was supported by NIH, FDA, and Fogarty International Center, the content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies and institutes. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.581 Depression, nicotine withdrawal, and smoking urges in smoking cessation Holly H. Reid 1,2 , David M. Ledgerwood 2 1
Psychology, Wayne State University, Detroit, MI, United States 2 Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, United States Aims: Nicotine withdrawal and urges have the potential for making smoking cessation more difficult. Depressed smokers may be disproportionately affected by withdrawal and urges, leading to greater difficulty in quitting. This study assessed whether elevated depression among 81 nicotine dependent smokers predicted changes in withdrawal and urges to smoke throughout smoking treatment. Methods: Data were collected as part of a randomized trial comparing contingency management and standard smoking cessation. Two linear mixed model analyses were conducted. Withdrawal (Minnesota Nicotine Withdrawal Scale) and urge rating (Questionnaire of Smoking Urges) data from a baseline week and four treatment weeks were included as dependent variables. High and low depression scores were based on participant Beck Depression Inventory-II scores, and included as a fixed factor. Time-point was the within-subject factor. Results: Depressed (N = 18) and non-depressed participants (N = 63) differed on age (p < .05), but no other demographic or smoking related variables (all ps > .05). The mixed model predicting changes in nicotine withdrawal revealed main effects for depression (p < .01) and time (p < .01). The mixed model predicting changes in smoking urges also revealed main effects for depression (p < .05) and time (p < .01), as well as a depression by time interaction (p < .05). Depressed smokers reported increased withdrawal and urges in the first week of treatment (following the baseline week) before reporting progressive reductions in withdrawal and urges, whereas non-depressed smokers reported consistent