UW-CTRI 2010 Research Report

OVERVIEW: This report summarizes 2010 research activity at the UW Center for Tobacco Research and Intervention, including published and in-press manuscripts, as well as new and ongoing grants, contracts and other research projects.

SUMMARY: In 2010, UW-CTRI has had: 

35 published papers
10 papers in press
4 new grants
7 active studies
9 completed studies

THANK YOU: UW-CTRI is grateful to its partners, the UW Department of Medicine, the UW School of Medicine and Public Health, the Wisconsin Department of Health Services, NIH, CDC, and the Robert Wood Johnson Foundation.

Published Papers

Note: Names in bold are current UW-CTRI employees.

1) Christiansen B, Brooks M, Keller PA, Theobald WE, Fiore MC. Closing Tobacco Disparities: Using Community Organizations to Increase Consumer Demand. American Journal of Preventive Medicine. 2012;38(3S):S397-S402. PMID:20176314.

Summary: Smokers in this pilot study found it acceptable to have their smoking addressed when seeking services from a community agency.

2) Galazyn M, Steinberg ML, Gandhi KK, Piper M, Williams JM. Reasons for Smoking Among Individuals With Schizophrenia (letter). Schizophrenia Research. 2010; [Epub ahead of print] PMID:20051315.

Summary: Findings indicate that individuals with schizophrenia or schizoaffective disorder may smoke for different reasons than those without serious mental illness.

3) Halperin AC, Smith SS, Heiligenstein E, Brown D, Fleming MF. Cigarette Smoking and Associated Health Risks Among Students at Five Universities. Nicotine and Tobacco Research. 2009;12(2):96-104. PMID:20018947. [PubMed - in process].

Summary: This study examines smoking patterns, tobacco dependence, and other health variables among students at five universities to better understand how to identify and address tobacco use and related risks in a college health clinic setting.

4) Johnson HM, Gossett LK, Piper ME, Aeschlimann SE, Korcarz CE, Baker TB, Fiore MC, Stein JH. Effects of Smoking and Smoking Cessation on Endothelial Function: 1-year Outcomes From a Randomized Clinical Trial. Journal of the American College of Cardiology. 2010; 55(18):188-95 PMID:20236788.

Summary: The purpose of this study was to determine whether smoking cessation improves flow-mediated dilation (FMD) of the brachial artery. The results indicated that, despite weight gain, smoking cessation leads to clear improvements in endothelial function.

5) Keller PA, Feltracco A, Bailey LA, et al. Changes in Tobacco Quitlines in the United States, 2005-2006. Preventing Chronic Disease. Mar 2010;7(2):A36. Epub 2010 Mar 15. PMCID: PMC2831790. 

Summary: The North American Quitline Consortium surveyed state quitlines between 2005 and 2006 about quitline services, funding, and use. Results showed that quitlines have the potential to serve a large percentage of American smokers.

6) Piper ME, Smith SS, Schlam TR, Fleming MF, Bittrich AA, Brown JL, Leitzke CJ, Zehner ME, Fiore MC, Baker TB. Psychiatric Disorders in Smokers Seeking Treatment for Tobacco Dependence: Relations with Tobacco Dependence and Cessation. Journal of Consulting and Clinical Psychology. 2010 Feb;78(1):13-23 PMCID: PMC2813467 [Available on 2011/2/1]. 

Summary: Researchers examined the relation of psychiatric disorders to tobacco dependence and cessation outcomes. At 6 months after quitting, those ever diagnosed with an anxiety disorder (OR = .72, p = .02) and those ever diagnosed with more than one psychiatric diagnosis (OR = .74, p = .03) had lower abstinence rates.

7) Redmond LA, Adsit R, Kobinsky KH, Theobald WE, Fiore MC. A Decade of Experience Promotion that Clinical Treatment of Tobacco Dependence in Wisconsin. Wisconsin Medical Journal. 2010;100(2): 71-78. PMID: 20443325 [PubMed - in process].

Summary: In the 10 years since the UW-CTRI Outreach Program was initiated, progress has been achieved in a number of tobacco-use parameters in Wisconsin, including more quit attempts; increased insurance coverage for cessation counseling and medications; and integration of the Wisconsin Tobacco Quit Line into routine primary care, with 100,000 Wisconsin smokers using the service.

8) Kobinsky KH, Redmond LA, Smith SS, Yepassis-Zembrou PL, Fiore MC. The Wisconsin Tobacco Quit Line's Fax to Quit Program: Participant Satisfaction and Effectiveness. Wisconsin Medical Journal, Vol. 109, No. 2, April 2010. PMID: 20443326 [PubMed - in process].

Summary: Smokers referred via Fax to Quit had higher quit rates than non-Fax to Quit participants. Fax to Quit participants also reported high customer satisfaction.

9) Sheffer MA, Redmond LA, Kobinsky KH, Keller PA, McAfee T, Fiore MC. Creating a Perfect Storm to Increase Consumer Demand for Wisconsin's Tobacco Quitline. American Journal of Preventive Medicine. 2010;38(3S)S343-346. PMID: 20176306 [PubMed in Process]. 

Summary: Consumer demand for quitline services can be markedly enhanced through policy and communication initiatives to increase the population reach of this evidence-based treatment.

10) Thibodeau L, Jorenby DE, Seal DW, Kim S-Y, Sosman JM. Pre-release Intent Predicts Smoking Behavior Post-release Following a Prison Smoking Ban. Nicotine and Tobacco Research. 2010;12(2):152-8. PMID: 20038510 

Summary: A convenience sample of 49 incarcerated men near release participated in two interviews. Descriptive analyses and multivariate modeling were conducted to determine associations with post-release smoking.

11) Roberts LJ, Japuntich SJ. Relationship Relevant and Family Friendly eHealth. Marriage and Family Review. 2010;45(6-8):629-653. 

Summary: As the reach of the Internet grows, eHealth is fast becoming a major adjunct to  traditional delivery of health information and support worldwide. This article applies a “marriage and family lens” to examine web-based technologies for health and well-being and suggests innovations to make eHealth both relationship relevant and family friendly.

12) Schneider K, Hedeker D, Bailey K, Cook J, Spring B. A Comment on Analyzing Addictive Behaviors Over Time. Nicotine and Tobacco Research. 2010 Jan 25. [Epub ahead of print] PMCID: PMC2847069. 

Summary: Results showed that while the generalized estimating equations (GEE) analysis found differences in smoking status between conditions, tests of the missing completely at random (MCAR) assumption demonstrated that it was not valid for this dataset. Additional analyses using tests that do not require the MCAR assumption found no differences between conditions. Thus, GEE is not an appropriate choice for this analysis.

13) Smith SS, Piper ME, Bolt DM, Fiore MC, Wetter DW, Cinciripini PM, Baker TB. Development of the Brief Wisconsin Inventory of Smoking Dependence Motives. Nicotine and Tobacco Research. 2010 Mar 15 [Epub ahead of print] PMCID: PMC2861888 [Available on 2011/5/1]. 

Summary: These analyses provide evidence that the 37-item Brief WISDM can be used in place of the original 68-item WISDM if researchers desire to reduce participant assessment burden.

14) Kokotailo PK, Williams JF, Behnke M, Levy S, Sims TH, Wunsch MJ, Simkin D, Smith K. Committee on Substance Abuse, Alcohol Use by Youth and Adolescents: A Pediatric Concern. Pediatrics. 2010 May; 125 (5):1078-87. 

Summary: Results of recent neuroscience research have substantiated the deleterious effects of alcohol on adolescent brain development and added even more evidence to support the call to prevent and reduce underaged drinking. This article addresses the role of pediatricians, schools and the media in reducing adolescent alcohol use.

15) Baker TB, Mermelstein R, Collins LM, Piper ME, Jorenby DE, Smith SS, Schlam TR, Cook JW, Fiore MC. New Methods for Tobacco Dependence Treatment Research. Annals of Behavioral Medicine. Dec. 3, 2010. [Epub ahead of print]

Summary: The authors present a phase-based cessation framework that partitions the cessation process into four distinct phases: (1) Motivation, (2) Precessation, (3) Cessation, and (4) Maintenance. Within this framework, it is possible to identify phase-specific challenges that a smoker would encounter while quitting smoking, intervention components that would address these phase-specific challenges, mechanisms via which such interventions would exert their effects, and optimal outcome measures linked to these phase-specific interventions. 

16) Collins LM, Baker TB, Mermelstein RJ, Piper ME, Jorenby DE, Smith SS, Schlam TR, Cook JW, Fiore MC. The Multiphase Optimization Strategy for Engineering Effective Tobacco Use Interventions. Annals of  Behavioral Medicine. Dec 4, 2010. [Epub ahead of print]

Summary: The multiphase optimization strategy (MOST) is a new methodological approach for building, optimizing, and evaluating multicomponent interventions. Conceptually rooted in engineering, MOST emphasizes efficiency and careful management of resources to move intervention science forward steadily and incrementally. The article also discusses considerations, challenges, and potential benefits associated with using MOST to improving intervention efficacy, effectiveness, and cost-effectiveness. 

17) Piper ME, Cook JW, Schlam TR, Jorenby DE, Baker TB. Anxiety Diagnoses In Smokers Seeking Cessation Treatment: Relations With Tobacco Dependence, Withdrawal, Outcome and Response to Treatment. Addiction, Oct. 2010. [Epub ahead of print]  

Summary: Researchers may have pinpointed a reason many smokers struggle to quit. Smokers with a history of anxiety disorders are less likely to quit smoking. Study results also showed that anxiety diagnoses were very common among participants—more than a third of 1,504 study participants met criteria for at least one anxiety diagnosis in their lifetime. Further research is needed to identify better counseling and medication treatments to help patients with anxiety disorders to quit smoking.

18) Piasecki TM, Piper ME, Baker TB, Hunt-Carter EE. WISDM Primary and Secondary Dependence Motives: Associations with Self-Monitored Motives for Smoking in Two College Samples. Drug and Alcohol Dependence. Epub Nov. 24, 2010.

Summary: Researchers explored the validity of the distinction between four primary-dependence motives (PDM) for tobacco dependence and nine secondary-dependence motives (SDM). In the study, college smokers self-monitored their reasons for smoking with electronic diaries. The results suggest that the PDM composite may reflect core motivational features of nicotine dependence. The relative prominence of primary motives in advanced or dependent use may be even clearer when motives for smoking are assessed in real time.

19) Piper ME, Loh W-Y, Smith SS, Japuntich SJ, Baker TB. Using Decision-Tree Analysis to Identify Risk Factors for Relapse to Smoking. Substance Use and Misuse. April 16, 2010. [Epub ahead of print] 

Summary: This research used classification-tree analysis and logistic-regression models to identify risk factors for relapsing to smoking during short- and long-term abstinence. Analyses suggest that relapse risk is produced by interactions of risk factors. In addition, early- and late-cessation outcomes reflect different vulnerability factors. The results illustrate the dynamic nature of relapse risk and suggest the importance of efficient modeling of interactions in relapse prediction.

20) Schlam TR, Japuntich SJ, Piper ME, Gloria R, Baker TB, Curtin JJ. Cognitive Conflict Following Appetitive Versus Negative Cues and Smoking Cessation Failure. Psychopharmacology. Nov. 9, 2010. [Epub ahead of print]

Summary: Participants completed the modified Simon task twice (while nicotine-deprived vs. not deprived). In the task, two photographs were displayed—one always neutral, the other positive, negative, smoking-relevant, or neutral. A probe then appeared to the left or right of center. Differences in relatively automatic responses to affective cues helped to distinguish smokers who are successful and unsuccessful in their smoking cessation attempts.

21) Boyle RG, Solberg LI, Fiore MC. Electronic Medical Records to Increase the Clinical Treatment of Tobacco Dependence: A Systematic Review. American Journal of Preventive Medicine. Volume 39 (6) Supplemental 1, Dec. 2010.

Summary: While the use of electronic medical records (EMRs) to prompt or provide feedback on the clinical treatment of tobacco dependence demonstrates some promising results, substantial additional research is needed to understand the effects of EMRs on provider and patient behavior.

22) Baker TB, Gustafson DH, Shaw B, Hawkins R, Pingree S, Roberts L, Strecher V. Relevance of CONSORT Reporting Criteria for Research on e-Health Information. Patient Education and Counseling. Sep. 13, 2010. [Epub ahead of print]. 

Summary: The Consolidated Standards of Reporting Trials (CONSORT) group released criteria for reporting critical information about randomized clinical trials to improve the quality and completeness of reporting in health-care research. E-Health research presents special challenges regarding the comprehensive and effective reporting of research information. However, the strategic application of CONSORT recommendations holds great promise for improving the quality and informativeness of eHealth research.

23) Gonzales D, Jorenby DE, Brandon TH, Artega C, Lee TC. Immediate Versus Delayed Quitting and Rates of Relapse Among Smokers Successfully Treated With Varenicline, Bupropion SR or Placebo. Addiction. Epub Sep. 1, 2010. 

Summary: Cumulative continuous abstinence increased for all treatments during weeks 3–8. Overall, Immediate Quitters (IQs) and Delayed Quitters (DQs) for varenicline were (24%; 20%) versus bupropion (18.0%; 11.6%) or placebo (10.2%; 7.5%). However, DQs as a proportion of successful quitters was similar for all treatments (varenicline 45%; bupropion 39%; placebo 42%) and accounted for approximately one-third of those remaining continuously abstinent for weeks 9–52. Even if smokers lack success early on, they can eventually quit.

24) Danlin Y, Peterson AN, Sheffer MA, Reid RJ, Schneider JK. Tobacco Outlet Density and Demographics: Analyzing the Relationships with a Spatial Regression Approach. Public Health. July 2010; 124(7):412-6. Epub June 11, 2010.

Summary: This research applied a spatial-analytical approach to assess the association between tobacco-outlet density and sociodemographic characteristics in New Jersey at the census tract level. The findings support the common wisdom in public-health research that tobacco outlets are more densely distributed in socio-economically disadvantaged areas. However, incorporating the spatial effects explicitly in the analysis provides less biased and more reliable results than traditional methods. 

25) Peterson NA, Schneider JE, Reid RJ, Sheffer MA, Morton CM. Tobacco Outlet Density and Demographics at the Tract-Level of Analysis In New Jersey: A Statewide Analysis. Drugs: Education, Prevention & Policy. Epub Sept. 7, 2010.

Summary: Results showed that outlet density was significantly related with demographics. Tracts with greater density of tobacco outlets tended to have lower median household income and higher percentages of African-American or Hispanic residents.

26) McCarthy DE, Piasecki TM, Jorenby DE, Lawrence DL, Shiffman S, Baker TB. A Multi-level Analysis of Non-significant Counseling Effects in a Randomized Smoking Cessation Trial. Addiction. Sept. 15, 2010. [Epub ahead of print]

Summary: Counseling prompted avoidance of access to cigarettes, improved quitting self-efficacy, reduced perceived difficulty of quitting over time and protected against guilt and demoralization following lapses. Quitting self-efficacy and perceived difficulty quitting may partially mediate counseling effects on abstinence. Smoking cessation counseling may work by supporting confidence about quitting and reducing perceived difficulty quitting. Counseling did not affect other targets that protect against relapse.

27) Cook J, Spring B, McChargue D, Doran N. Effects of Anhedonia on Days to Relapse Among Smokers With a History of Depression: A Brief Report. Nicotine and Tobacco Research. Epub Aug. 2010;12(9):978-982.

Summary: Despite the strong co-occurrence between lifetime prevalence of depression and smoking, a history of major depressive disorder (MDD history) does not reliably predict smoking cessation outcomes. This research examined whether anhedonia, a core feature of depression, increased risk for smoking relapse among MDD history smokers. Results showed that higher levels of anhedonia predicted reduced relapse latencies, both with and without pre-quit depressive-symptom severity included in the model.

28) Piasecki TM, Piper ME, Baker TB. Refining the Tobacco Dependence Phenotype Using the Wisconsin Inventory of Smoking Dependence Motives: II. Evidence From a Laboratory Self-Administration Assay. Journal of Abnormal Psychology. August 2010;119(3):513-23.

Summary: Relative to the standard Fagerstrom measurement tool, “Primary Dependence Motives” (PDM) were modestly better predictors of the number of puffs the smoker earned (by clicking a mouse 50 to 1500 times), and “Secondary Dependence Motives”  were considerably better predictors of withdrawal severity. This suggests that clinically significant tobacco dependence may consist of heavy, automatic use with craving as well as deprivation-contingent distress and craving related to negative reinforcement and/or environmental cues. 

29) Johnson HM, Piper ME, Jorenby DE, Fiore MC, Baker TB, Stein JH. Risk Factors for Subclinical Carotid Atherosclerosis Among Current Smokers. Preventive Cardiology. Fall 2010;13(4):166-71.

Summary: This study characterized the determinants of carotid atherosclerosis (disease of the arteries) in 1504 current smokers. Participants smoked a median 25 pack-years; 55% had plaque. Pack-years, age, male sex, nonwhite race, body mass index, blood pressure, small low-density lipoproteins (LDLs), and total high-density lipoproteins were independently associated with carotid intima-media thickness. Pack-years, age, body mass index, and small LDLs were independently associated with carotid plaque presence.

30) Hatsukami D, Markou A, Perkins KA, Lerman C, Munafo M, Niaura R, Baker TB, Chassin L. Relapse to Tobacco Use. How Tobacco Causes Disease: The Biology and Behavioral Basis for Tobacco-Attributable Disease. A Report of the Surgeon General. Chapter 4: Nicotine Addiction Past and Present. Washington, D.C.: U.S. Government Printing Office. Dec. 9, 2010.

Summary: Nicotine is the key chemical compound that causes and sustains the powerful addicting effects of commercial tobacco products in the brain. Evidence suggests there may be psychosocial, biologic, and genetic determinants associated with different trajectories observed among population subgroups as they move from experimentation to heavy smoking. Inherited genetic variation contributes to the differing patterns of smoking behavior and cessation.

31) Asthana A, Johnson HM, Piper ME, Fiore MC, Baker TB, Stein JH. Effects of Smoking Intensity and Cessation on Inflammatory Markers in a Large Cohort of Active Smokers. American Heart Journal. 2010 Sep;160(3):458-63.

Summary: Asha Asthana, a student of UW-CTRI Collaborator Dr. Jim Stein, analyzed data from the TTURC 2 Wisconsin Smokers’ Health Study, a five-year trial conducted by UW-CTRI and collaborators. Asthana and colleagues found that while C-reactive protein (CRP) and white blood cell (WBC) count are markers of risk for cardiovascular disease, and while smoking intensity is associated with increased WBC, smoking intensity is not related to CRP levels. Smoking cessation does not reduce CRP.

32) Beyer EJ, Keller PA, Bailey LA, Baker TB, Fiore MC. State-Level Factors Influencing Tobacco Cessation Quitline Spending In 2008. Preventive Medicine. 2010 Aug;51(2):191-2. Epub 2010 May 15.

Summary: Tobacco-cessation quitlines are an effective population-based smoking cessation treatment. However, quitline funding varies widely. States with a greater percentage of their population with at least a high school degree, and states that spent more per capita on tobacco-control programs overall, spent more per capita on quitline services. 

33) Piasecki TM, Piper ME, Baker TB. Tobacco Dependence: Insights From Investigations of Self-Reported Smoking Motives. Current Directions in Psychological Science. Epub Dec. 21, 2010.

Summary: Recent studies indicate that four subscales (Automaticity, Craving, Loss of Control, and Tolerance) represent the core features of tobacco dependence, and these have been dubbed the primary dependence motives. The remaining nine subscales, the secondary dependence motives, may be clinically relevant but index nonessential or auxiliary features of dependence.

34) Lindholm C, Adsit R, Bain P, Reber P, Brein T, Redmond L, Smith SS, Fiore MC. Seizing the Electronic Medical Record to Enhance the Delivery of Tobacco Dependence Treatments in Primary Care Settings: A Demonstration Project. Wisconsin Medical Journal.

Summary: This project demonstrated that a large health-care system can increase the delivery of tobacco-dependence treatment interventions by building on an existing electronic-health record (EHR) platform. The project showed that brief, evidence-based, tobacco-dependence interventions can be incorporated into primary care, especially when the EHR is used to improve clinic workflow.

35) Minami HM, McCarthy DE, Jorenby DE, Baker TB. An Ecological Momentary Assessment Analysis of Relations Among Coping, Affect, and Smoking Lapses. [Epub ahead of print] Addiction.

Summary: Multi-level models indicated that a single coping episode did not predict a change in smoking risk over the next 4 or 48 hours, but coping in men was associated with concurrent reports of increased smoking. Coping predicted improved positive and negative affect reported within 4 hours of coping, but these affective gains did not predict reduced likelihood of later smoking. Coping responses early in a quit attempt may help smokers trying to quit feel better, but may not help them stay smoke-free.

In Press

1) Hatsukami DK, Jorenby DE, Gonzales D, Rigotti NA, Glover ED, Oncken CA, Tashkin DP, Reus VI, Akhavain RC, Fahim REF, Kessler PD, Niknian M, Kalnik MK, Rennard SI. Immunogenicity and Smoking Cessation Outcomes for a Novel Nicotine Immunotherapeutic. Journal of Clinical Pharmacy and Therapeutics.

2) Baker TB, Hawkins R, Pingree S, Roberts L, McDowell HE, Shaw BR, Serlin R, Dillenburg L, Swoboda CM, Han J-Y, Stewart JA, Carmack-Taylor CL, Salnerk A, Schlam TR, McTavish F, Gustafson D. Optimizing eHealth Breast Cancer Interventions: Which Types of eHealth Services are Effective? Translational Behavioral Medicine. 

3) Gepner AD, Piper ME, Johnson HM, Fiore MC, Baker TB, Stein JH.  Effects of Smoking and Smoking Cessation on Lipids and Lipoproteins: Outcomes from a Randomized Clinical Trial. American Heart Journal.

4) Japuntich SJ, Piper ME, Leventhal AM, Bolt DM, Baker TB. The Effect of Five Smoking Cessation Pharmacotherapies on Smoking Cessation Milestones. Journal of Consulting and Clinical Psychology. 

5) Julius BR, Ward BA, Stein JH, McBride PE, Fiore MC, Baker TB, Nieto J, Colbert LH. Ambulatory Activity Associations with Cardiovascular and Metabolic Risk Factors in Smokers. Journal of Physical Activity and Health. NIHMSID: 241206.

6) Keller PA, Christiansen BA, Kim S-Y, Piper ME, Redmond LA. Increasing Consumer Demand Among Medicaid Enrollees for Tobacco Dependence Treatment: The Wisconsin Medicaid Covers It campaign. American Journal of Health Promotion. NIHMSID # 189673.

7) McCarthy DE, Baker TB, Minami HM, Yeh V. Applications of Contemporary Learning Theory in the Treatment of Drug Abuse. Invited chapter in S. Reilly and T. R. Schachtman (Eds.), Associative Learning and Conditioning: Human and Animal Applications. New York: Oxford University Press. 

8) Japuntich SJ, Leventhal AM, Piper ME, Bolt DM, Roberts LJ, Fiore MC, Baker TB. Relations Between Smoker Characteristics and Smoking Cessation Milestones. American Journal of Preventive Medicine.

9) Sheffer MA and Squier C. Chapter title is: Up in Smoke: A Recent History of Iowa Smokefree Legislation & Public Health Outcomes. Edited by Mark, J.A., Champagne Bolduc, J., & Quinn, N. (EDs.). Book title is: Needs and Capacity Assessment Strategies for Health Education and Health Promotion. Sudbury: Jones and Bartlett.

10) Sheffer MA, Gilmore GD, Squier CA. Restaurant Volatility and the Iowa City Smoke-free Restaurant Ordinance. American Journal of Health Promotion. 

New Studies

1) Study on Public Health ROI Resulting from State and Federal Policies. In this $200,000 Robert Wood Johnson Foundation study, Michael Fiore is collaborating with Frank Chaloupka of the University of Illinois-Chicago to examine the effects of policy changes, such as increases in tobacco taxes and smoke-free indoor air laws, and funding changes to state tobacco-control programs. Dr. Megan Sheffer will serve as lead scientist. They’ll measure changes in terms of the impact on cigarettes smoked, quit rates and prevalence—all framed as return on investment for public health. May 2010-April 2012. Robert Wood Johnson Foundation funded, (Fiore is the principal investigator).

2) Evaluation of two National Cancer Institute Web Sites. Tim Baker and Michael Fiore lead this evaluation of
www.SmokeFree.gov and www.women.smokefree.gov. The contract is for $650,000 and runs from Nov. 2010 to April 2012. Funded by Matthews Media Group.

3) Using the Electronic Health Record (EHR) Platform to Identify Smokers Visiting Primary Care Clinics, to Deliver Evidence-Based Tobacco Dependence Treatments, and to Link Those Smokers Electronically With a State-Based Cessation Quitline. For this $200,000 grant, Rob Adsit, Michael Fiore and colleagues at UW-CTRI will collaborate with Dean Clinic to design and implement a second generation of the tobacco cessation EHR module. Specifically, this will involve UW-CTRI working with the Dean Clinic clinical and IT team to modify this health system’s clinical module, algorithm and workflow to improve clinician performance, increase treatment interventions and improve patient outcomes. They’ll build and integrate a mechanism to allow clinicians to refer patients to the tobacco quitline directly from the EHR module. This component will involve working with the EHR vendor, Epic Systems Corp., and the Wisconsin Tobacco Quit Line vendor, Free and Clear, as well as Dean Clinic. Sept. 2010-Aug. 2011. NCI funded.

4) Nicotine Vaccine Phase 3 Study. Doug Jorenby is leading this clinical trial testing a nicotine vaccine administered by needle to smokers trying to quit. Nicotine vaccines are designed to stimulate the immune system to produce antibodies that bind to nicotine. A nicotine molecule attached to an antibody is too large to cross the blood-brain barrier. Therefore, vaccines block nicotine from reaching brain receptors and prevent the highly-addictive pleasure experienced by smokers and users of nicotine products. In previous studies, the vaccine has been well tolerated with a favorable adverse-event profile. This study is a Phase-3 trial looking at the effectiveness of the vaccine versus placebo. Feb. 2010-Aug. 2011. Nabi and NIDA funded.

Active Studies

1) UW Partnership to Assist and Serve Smokers (UW-PASS). A $9 million P-50 grant from the National Cancer Institute will provide five years of funding for UW-CTRI to study various quit-smoking treatments in primary-care clinics throughout Wisconsin. In this study, UW-CTRI will deliver seamless, cutting-edge treatments for all smokers, including those who are ready to quit and those who aren’t. Beginning in the summer of 2010, UW-CTRI will offer participation to patients who smoke and visit select primary-care clinics within three healthcare systems—Dean Health System, MercyCare Health System and Aurora Health Care. Medical assistants at partnering clinics will identify smokers and ask if they're interested in being contacted about a study. They will invite all smokers whether they are willing to quit or not. If the patient is interested, an e-mail is generated from the electronic medical record to UW-PASS staff, employed by UW-CTRI, who conduct screening, orientation, patient visits and follow up. The electronic medical records will be supported by Epic Systems Corp. and Cerner. UW-PASS includes three projects:

Project 1 focuses on increasing the smoker’s motivation to quit. This project will offer treatment strategies for smokers who aren’t ready to quit now but are willing to participate in treatment to help them get ready to quit. The hope is to increase their motivation  to quit smoking as well as to make actual quit attempts. Treatments include behavioral coaching, motivational interviewing, nicotine patches, and nicotine gum.

Typically, those who use nicotine-replacement medications (such as the nicotine patch or lozenge) quit smoking first, then use medications to stave off cravings and remain smoke free. Project 2 of UW-PASS will examine whether use of nicotine-replacement medication and behavioral coaching before actually quitting smoking helps the patient remain smoke-free. Project 2 will also test coaching types and lengths, including in-person coaching vs. telephone coaching.

Project 3 is designed to study ways to increase the number of patients who take quit-smoking medication at the proper dosage for the prescribed duration. Most smokers don’t use enough medication or use it the right way. The goal is to see what happens if a patient takes medication as prescribed vs. skipping doses or ceasing treatment prematurely. Adherence treatments include automated-adherence phone prompts, electronic monitoring/feedback and a cognitive-adherence intervention. Project 3 will also look at the outcomes of long-term coaching and medication.

Sept. 2009-Aug. 2014. NIH (NCI) P-50 grant (principal investigators are Baker & Fiore).

2) Menominee Smoking Cessation Clinical Trial. Stevens Smith is the principal investigator for this collaboration with the Menominee Indian Tribe of Wisconsin and investigators at UW-Milwaukee and the UW Carbone Cancer Center. The goal of this study is to test a culturally tailored treatment versus standard treatment in 150 American Indian smokers at the Menominee Tribal Clinic. The study also includes qualitative analyses of participant interviews that will help to inform future treatment improvements. Oct. 2008-Sept 2011. Funded by the Medical Education and Research Committee (MERC) of the Wisconsin Partnership Program at the UW School of Medicine and Public Health.

3) Veterans and Smoking Studies. Jessica Cook is leading a study at the William S. Middleton Memorial VA Hospital in Madison. The study tests the hypothesis that smokers with posttraumatic stress disorder (PTSD) and depression smoke cigarettes to improve aversive mood states and other mental health symptoms. The effect Cook is most interested in is whether smoking regulates anhedonia, a common feature of both PTSD and depression that is characterized by an inability to respond to pleasurable events. The first part of the study examines how nicotine influences mood responses to positive and negative stimuli. The second part of the study will be done at a critical point, 24 and 48 hours after being deprived of nicotine, which can be the peak of withdrawal. It’s then that the team will explore whether veterans with PTSD and depression have a more difficult time experiencing pleasure in response to rewarding events and whether they experience more withdrawal-related negative affect. Oct. 2007-Aug. 2012. NIH funded (NIDA).

4) Mindfulness Study. James Davis leads this study examining whether mindfulness meditation can more effectively assist participants who want to quit smoking. In the previous pilot study, Davis taught general mindfulness techniques. In the new study, he will ask participants to identify specific challenges—triggers, urges, depression, anxiety or impulsivity—so he can pair specific mindfulness techniques to help each individual attack those issues. Feb. 2008-Aug. 2013. NIH funded (NIDA).

5) Smoking Cessation-related Information, Motivation, and Behavioral Skills Specific to HIV-infected Smokers. James Sosman leads this study, which endeavors to describe the level of smoking and smoking-related information, motivation, and behavioral skills among a sample of Wisconsin HIV+ smokers. Identifying this information with regard to HIV+ smokers will inform the development of a smoking intervention tailored to HIV+ smokers. The goal of this study is to advance the understanding of unique issues regarding tobacco use and HIV/AIDS, as a first step to intervening on a major public health problem among a vulnerable population where few interventions currently focus—on groups who may have the most difficulty quitting smoking. Sept. 2009-April 2011. Funded by the UW Institute for Clinical and Translational Research (ICTR), which in turn is supported by grants from NIH.

6) CDC Fax to Quit. Michael Fiore and Megan Sheffer lead this study examining the effective ways of supporting clinics to enroll patients for services from the Wisconsin Tobacco Quit Line via fax. Some of the clinics are receiving training and technical assistance from UW-CTRI staff; other clinics in the study are receiving only program materials. Initial findings show that ongoing training and technical assistance boosts patient use of the Fax to Quit Program seven-fold. Sept. 2007-Aug. 2011. CDC funded.

7) Quit Line Study. Stevens Smith is leading this study that is testing three enhancements to the Wisconsin Tobacco Quit Line in a randomized clinical trial funded by a two-year, $1 million ARRA stimulus grant from the National Cancer Institute. The three enhancements being tested simultaneously include:

1) Combination nicotine replacement therapy (versus the nicotine patch alone).

2) Extended duration of medication (six weeks versus two).

3) An innovative counseling strategy to ensure callers are taking the appropriate doses of their  

    cessation medication for the recommended duration.

UW-CTRI appreciates support from the Wisconsin Department of Health Services (DHS), which sponsored TV ads promoting the Quit Line, which has had a positive effect on study recruitment. DHS also generously provides funding for baseline Quit Line services. Sept. 2009-Aug. 2011. NIH funded (NCI).

Completed Studies (Went into data analysis and preparation of papers in 2010)

1) Electronic Health Records (EHR). Rob Adsit and Michael Fiore led this effort to adapt the USPHS Clinical Practice Guideline 2008 recommendations and 5A model into an EHR platform/modules. Sept. 2009-Sept. 2010. NIH funded (NCI).

2) Assessing Adolescent Tobacco Dependence Using Quit Lines. Tammy Sims led this Quit Line study which recruited adolescent and young-adult smokers to compare the effectiveness of a quitline counseling intervention to mailed self-help materials in helping them quit. Another aim of the study is to characterize individual differences related to motivation to quit smoking, follow-through in a quit attempt, and quitting success by examining two motivational constructs:  motives for dependence and motives for cessation. Preliminary findings indicate that there was no statistically significant difference between youth who received telephone smoking cessation counseling when compared to youth who received mailed self-help materials. July 2005-Dec. 2010. NIH funded (NIDA).

3) Genetics Study. Tim Baker is the principal investigator examining how genes affect an individual’s susceptibility to nicotine addiction, dependence, and withdrawal. Researchers are comparing lighter smokers to the overall smoking population. July 2009-Aug. 2010. NIH funded (NIDA).

4) Salvation Army Partnership. Bruce Christiansen led this study that seeks to inform Salvation Army clients of resources that can improve their chances of quitting smoking and encourage them to take advantage of them. Researchers have found this type of outreach has a positive effect on the clients’ view of the Salvation Army. Sept. 2008-March 2010. Funded by the UW Institute for Clinical and Translational Research (ICTR), which in turn is supported by grants from NIH.

5) Transdisciplinary Tobacco-Use Research Center Grant 2 (TTURC 2). Tim Baker led this five-year NIH P-50 study examining the best ways to quit smoking and long-term health outcomes. Researchers found that combining a second medication with the nicotine lozenge gave smokers the best chance to quit. Also, quitting smoking had almost immediate positive effects on blood vessels. The study looked at the long-term effect that successful (and non-successful) quitting have on health and lifestyle. In an additional TTURC 2 study led by Sue Curry, researchers examined health-care cost benefits of quitting. April 2004-Aug. 2010. NIH-funded P-50 grant (NIDA).

6) CDC WI PREPARE Project. Jessica Cook is the principal investigator of this study, which was a validation study testing a new survey among Wisconsin Tobacco Quit Line callers. The Wisconsin Predicting Patients’ Relapse (WI-PREPARE) Questionnaire was published in the May 2009 issue of Nicotine and Tobacco Research, and may help clinicians more accurately predict smoking relapse and match patients with more optimal treatments than ever before. The WI-PREPARE uses  pre-existing questions from other instruments like the Fagerström Test of Nicotine Dependence (FTND) and the Wisconsin Inventory of Smoking Dependence Motives (WISDM-68). Although some of the WI-PREPARE questions have previously been used to predict relapse—strength of cravings, time to first cigarette in the morning and total cigarettes smoked— other questions are more novel for a relapse proneness questionnaire. For example, the WI-PREPARE includes items about exposure to other smokers, smoking restrictions in participants’ homes and workplaces, and education level. The research team is currently examining whether the addition of these novel items allows the WI-PREPARE to more accurately predict relapse among Wisconsin Tobacco Quit Line callers than the FTND, the standard dependence assessment tool. March 09-March 2010. CDC funded.

7) CDC QL/Pregnant Smoker Project. Kate Kobinsky leads this effort to assess factors associated with prenatal smokers' utilization of the Wisconsin Tobacco Quit Line. Quit Line utilization remains low despite the fact that these women are familiar with the Quit Line and believe it’s an effective cessation strategy; however, the Fax to Quit program shows promise to improve utilization. Oct. 08-Oct. 2010. CDC funded.

8) National Survey of State Quitlines. Paula Keller collaborated with Linda Bailey, Tim Baker and Michael Fiore to analyze data from the 2004-2008 North American Quitline Consortium surveys of state quitlines. They found that by 2006, all states had established quitline services and all states began offering multi-call, proactive telephone counseling to callers. Provision of free medications increased dramatically, from 21 percent of quitlines in 2004 to 70 percent in 2008. More states are also offering web coaching. Mean per capita funding for quitline services has increased over time, although reach remains relatively stable at 1-1.2 percent of adult smokers. March 2006-March 2010. Robert Wood Johnson Foundation funded.

9) Zip Code Project. Bruce Christiansen leads this effort to assess the impact of strategies that inform residents from a low-income part of Milwaukee about resources that are available to help them quit smoking—and to empower residents to take advantage of those resources. Oct. 2008-Nov. 2010. Funded by the Wisconsin Partnership Program at the UW School of Medicine and Public Health.