Disparities in Smoking Cessation Outcomes among Multi-ethnic Pregnant Smokers in San Bernardino County, CA: Findings from the Loma Linda University Health Comprehensive Tobacco Treatment Program

Smoking during pregnancy remains one of the most significant risk factors for poor birth outcomes. The Loma Linda University Health Comprehensive Tobacco Treatment Program (CTTP) is the largest maternal tobacco cessation program in San Bernardino County – the largest county in the contiguous US. CTTP is an eight week, incentivized, behavioral intervention for tobacco cessation for pregnant smokers. As part of program evaluation, we used a retrospective cohort design to assess smoking abstinence and to identify predictors of relapse/smoking after enrollment. Among CTTP cohort enrollees (n=233) from 2012-2013 we found: 1) a 28.4% 8 week point prevalence abstinence (PPA), and at a median of 9 months of follow-up after the PPA, 81.6% continued to indicate tobacco cessation, and 2) a high rate of relapse or loss to follow-up (56%). Our modeling of relapse/smoking after enrollment indicated that this was higher in young mothers, non-Hispanic mothers (White, Black), first/third trimester mothers, and rural mothers. The evaluation identified efficacy of the behavioral model at 8 weeks, but that relapse/smoking was occurring in disparity populations. Formative research is needed to expand the programmatic outreach and enrollment of mothers wanting to quit smoking.

Download Full-text

Teaching Tools to Teach Geriatric Medicine to Family Medicine Residents

Gerontology & Geriatrics: Research ◽

10.26420/gerontolgeriatrres.2021.1050 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Jaqua EE ◽

◽

Nguyen V ◽

Jubran A ◽

Park S ◽

...

Keyword(s):

Family Medicine ◽

Geriatric Medicine ◽

Relevant Information ◽

Beers Criteria ◽

San Bernardino County ◽

Teaching Tools ◽

Family Medicine Residency ◽

San Bernardino ◽

Loma Linda University ◽

Family Medicine Residents

Objective: To determine if pocket-sized, reference guides are helpful tools for teaching geriatric medicine to family medicine residents. Setting: Loma Linda University Healthcare Education Consortium, a family medicine residency in San Bernardino County, California. Participants: Family medicine residents that successfully completed the required geriatrics rotation between July 2019 and June 2020. Results: From the twelve family medicine residents, 100% believed their geriatric medicine rotation helped them to be successful in residency. The preferred study tool was the pocket guides, mainly the “Geriatric Medicine Pocket Guide” and “2019 AGS Beers Criteria”. For a more comprehensive reading, the study tool most used was search engines such as Up-to-date and Dynamed. Geriatrics at Your Fingertips (Reuben et al., 2016) and the “Guiding Principles for the Care of Older Adults with Multimorbidity Pocket Card” were not as helpful due to the perceived increased efforts to rapidly find clinically relevant information. Conclusion: Pocket guides, especially “Geriatric Medicine Pocket Guide” and “2019 AGS Beers Criteria”, are helpful teaching tools that can be used to augment geriatric medicine education in a family medicine residency.

Download Full-text

A Brief Report of Smoking Behaviors in Patients with Incidental Pulmonary Nodules: Associations with Communication and Risk Perception

Tobacco Use Insights ◽

10.1177/1179173x19839059 ◽

2019 ◽

Vol 12 ◽

pp. 1179173X1983905

Author(s):

Anne C Melzer ◽

Sara E Golden ◽

Renda Soylemez Wiener ◽

Jonathan M Iaccarino ◽

Christopher G Slatore

Keyword(s):

Repeated Measures ◽

Tobacco Cessation ◽

Stage Of Change ◽

Pulmonary Nodules ◽

Treatment Recommendation ◽

Final Visit ◽

Communication Quality ◽

Tobacco Treatment ◽

Smoking Behaviors

Introduction: Incidental pulmonary nodules (IPNs) are commonly found on routine chest imaging. Little is known about smoking behaviors among patients with IPNs or characteristics of patient-clinician communication that may contribute to these behaviors. We assessed the association of patient characteristics and communication quality with smoking behaviors and stage of change for tobacco cessation among patients with IPNs. Materials and methods: Prospective, repeated-measures, cohort study of current smokers and past-year quitters with IPNs treated within the Veterans Affairs Portland Health Care System. Eligible patients had newly reported, incidental nodules <3 cm planned for non-urgent computed tomography (CT) follow-up. Our primary outcomes were changes in amount smoked and stage of change for tobacco cessation throughout the follow-up period. We used multivariable-adjusted generalized estimating equations for analyses. Results: We identified 37 current smokers and 9 recent quitters. By the final visit, 8 of 36 (22%) baseline smokers had quit and 2 of 7 (29%) recent quitters had resumed smoking. Of 40 respondents, 23 (58%) reported receiving any tobacco treatment (recommendation to quit, medication, and/or behavioral treatment) at least once during follow-up. We found no significant associations of high-quality communication, patient distress, self-perceived risk of lung cancer, and self-reported clinician-recommended smoking cessation interventions with decrease in amount smoked or positive stage of change. Conclusions: Many smokers and recent quitters with IPNs quit during follow-up, though nearly half reported no quit support. We found no association between communication quality or quit support and decreased smoking. The intensity of tobacco treatment offered may have been insufficient to affect behavior.

Download Full-text

Hard to Reach or Just Not Enough? A Narrative Review of Inpatient Tobacco Cessation Programs in Pediatrics

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182413423 ◽

2021 ◽

Vol 18 (24) ◽

pp. 13423

Author(s):

Aysha Jawed ◽

Mandeep Jassal

Keyword(s):

Smoking Cessation ◽

Risk Factor ◽

Tobacco Cessation ◽

Significant Risk ◽

Significant Risk Factor ◽

Narrative Review ◽

Motivation To Change ◽

Diverse Range ◽

Quit Attempts

Caregiver smoking is a significant risk factor for children with acute and chronic diseases. Hospitalization presents an opportunity to explore caregiver smoking as a modifiable risk factor during a time of crisis when the motivation to change could be heightened. To date, there has not been a published review on inpatient smoking cessation interventions in pediatrics that focus on supporting caregivers of hospitalized children. The goals of this review were to identify and assess the reach and efficacy of tobacco cessation strategies implemented across inpatient units in pediatrics and mother-baby units. This review also proposes clinical and research implications along with program-building recommendations that can help inform future practice in tobacco cessation. A narrative review of the literature identified 14 peer-reviewed studies that described smoking cessation interventions between 2002 and 2021. There were five randomized controlled trials, seven prospective studies, and one retrospective study. The primary kinds of interventions were counseling to heighten caregiver contemplation to quit (n = 12), provision of Nicotine Replacement Therapy (NRT) medications (n = 7), and follow-up with the local Quitline (n = 12). A diverse range of deliverers implemented interventions across studies. Variation in defining quit attempts along with tobacco reduction and cessation outcomes contributed to mixed findings across studies.

Download Full-text

Severe dysfunctional tear syndrome patients and resolution of central corneal staining: retrospective cohort study

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2019-315573 ◽

2020 ◽

Vol 104 (12) ◽

pp. 1669-1675

Author(s):

Zhen Ling Teo ◽

Clarisse Chu ◽

Louis Tong

Keyword(s):

Risk Factors ◽

Dry Eye ◽

Unmet Need ◽

Significant Risk ◽

High Rate ◽

Treatment Modalities ◽

Tertiary Centre ◽

Grade 3 ◽

Corneal Staining

PurposeSevere dry eye is widely prevalent yet difficult to treat. This study aims to evaluate for improvement in epithelial status and the risk factors for lack of improvement in a cohort of patients in Singapore with severe dry eye.MethodsWe retrospectively identified 1712 patients with severe dry eye (≥grade 3 Delphi) in at least one eye, referred to a tertiary centre dry eye clinic from 2006 to 2017. We included patients with central corneal staining grade of ≥2 at referral and minimum follow-up duration of 6 months (n=407). An epithelial staining grade of <2 at the last visit was considered a significantly improved outcome.ResultsThe mean follow-up duration was 4.0±2.4 years, with 88.0% (358/407) of patients achieving significant improvement. Various treatment modalities including topical corticosteroids (32.4%), cyclosporine (52.8%) and punctal plugs (24.1%) were used. Risk factors for non-improvement of staining grade include autoimmune disease (OR 3.2, 95% CI: 1.7 to 6.1), rheumatoid arthritis (RA) (OR 3.4 (1.8 to 6.6)), graft-versus-host disease (GVHD) (OR 3.4 (1.0 to 11.7)), reduced baseline Schirmer’s test (OR 2.1 (1.2 to 3.9)) and reduced tear break up time (OR 2.0 (1.0 to 3.8)). On multivariate analyses, RA and GVHD were still significant risk factors. Gender, age and meibum viscosity were not significantly associated with epithelial staining grade improvement.ConclusionsOverall, a high rate of corneal epithelial improvement was achieved. Nevertheless, there is an unmet need for more effective measures to reduce epitheliopathy in severe dry eye, especially in patients with systemic immune-mediated disease.

Download Full-text

475. The Utility of Community-Academic Partnerships in Promoting the Equitable Delivery of COVID-19 Vaccines in Black Communities

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.674 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S339-S339

Author(s):

Jacinda Abdul-Mutakabbir ◽

Samuel Casey ◽

Veatrice Jews ◽

Andrea King ◽

Kelvin Simmons ◽

...

Keyword(s):

Single Dose ◽

Academic Community ◽

Mass Vaccination ◽

Vaccine Hesitancy ◽

Black Communities ◽

San Bernardino County ◽

Remote Site ◽

Vaccination Site ◽

San Bernardino ◽

Loma Linda University

Abstract Background In the U.S., non-Hispanic Black individuals are disproportionately represented amongst COVID-19 mortalities. The COVID-19 vaccines are poised to change this outcome; however, inequitable access and decades of medical mistreatment have resulted in healthcare mistrust and an associated low uptake within this group. Loma Linda University (LLU) houses the largest mass vaccination site in San Bernardino County (SBC) California; nevertheless, there has been a perpetual low representation of Black vaccinees. To increase the number of Black persons vaccinated, a selected team at LLU leveraged a community-academic partnership model to address vaccine hesitancy and increase access to the COVID-19 vaccines. The objective of this study was to evaluate the number of Black persons vaccinated in community settings compared to the mass clinic. Methods LLU developed a tiered approach to increase COVID-19 vaccinations within Black SBC communities. The first tier engaged faith leaders with the academic community in disseminating COVID-19 health information, the second included culturally representative LLU healthcare professionals in the delivery of COVID-19 educational webinars, and the third was to conduct low barrier, remote-site vaccination clinics, within targeted Black communities. Following these efforts, we compared the number of Black individuals vaccinated in the LLU mass clinic to those vaccinated in the community remote-site clinics. Results The remote-site COVID-19 vaccination clinics commenced in February 2021. From February 1 until April 30, 2021, 24,808 individuals were vaccinated in the LLU mass clinic with a first dose (Pfizer or Moderna) or single dose (Janssen) of a COVID-19 vaccine, however, only 908 (3.7%) were Black vaccinees. Contrastingly, the LLU remote site clinics vaccinated 1,542 individuals with a first or single dose of a COVID-19 vaccine. Of those vaccinees, 675 (44%) were Black. Conclusion The multi-tiered community approach (remote-site vaccination clinics) resulted in a necessary overrepresentation of Black vaccinees, previously underrepresented in the LLU traditional mass vaccination clinic effort (44% vs. 3.7%, respectively). Further research is warranted to examine the key elements to increase vaccinations amongst minoritized groups. COVID-19 Vaccination Comparisons Between Models This table includes data from the Loma Linda University Mass Vaccination Clinic and the Remote-Site Vaccination Efforts compared to the San Bernardino County Demographics Disclosures All Authors: No reported disclosures

Download Full-text

Using a Family Systems Approach to Treat Tobacco Use among Cancer Patients

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17062050 ◽

2020 ◽

Vol 17 (6) ◽

pp. 2050

Author(s):

Ellen Ruebush ◽

Sara Mitra ◽

Colleen Meyer ◽

Laurel Sisler ◽

Adam O. Goldstein

Keyword(s):

Electronic Health Record ◽

Tobacco Use ◽

Treatment Program ◽

Cancer Care ◽

Systems Approach ◽

Family Members ◽

Health Record ◽

Tobacco Treatment ◽

Quit Rate

Tobacco use treatment is an essential component of cancer care. Family members play a significant role in smoking behavior, but more research is needed regarding the development, implementation, and impact of family-based interventions in cancer care. The UNC Tobacco Treatment Program conducted an 18-month pilot study to examine the feasibility of implementing a family systems approach to treat tobacco use among patients at the North Carolina Cancer Hospital and to measure the impact of such an approach on patient abstinence. Implementation included four phases: (1) modifying the electronic health record and monthly report generated from the electronic health record; (2) training Tobacco Treatment Specialists to provide family counseling; (3) integrating family members into patients’ treatment; and (4) conducting six-month follow-up calls. During the course of the study, 42% (N = 221/532) of patients had family members integrated into their tobacco use treatment. Only 21 patients (4%) had family members present but not integrated into the treatment plan. At the six-month follow up time point, the seven-day point-prevalence quit rate for patients with family integration was 28% (N = 56/200), compared to 23% (N = 67/291) (p = 0.105) for patients without family integration. Integration of family members is clearly possible in an academic medical center’s oncology tobacco treatment program. Although pilot results were not statistically significant at 6 months, a potentially higher quit rate suggests a need for expanded research on methods to integrate family members in oncology settings for patients with tobacco-related cancers.

Download Full-text