The effect of food deprivation on cigarette smoking in females

Studies have shown that food deprivation is associated with increases in the self-administration of nicotine and other substances in laboratory animals. However, little is known about the effects of food deprivation on substance use in humans. The purpose of the present study was to compare smoking rates, expired carbon monoxide levels, and smoking topography in 15 female participants during a state of acute food deprivation and in a non-deprived state. A within-subjects design was utilized to test the primary hypotheses that smoking rate and expired carbon monoxide levels would be greater among the participants in the food-deprived condition than in the non-deprived condition. Analyses indicated that expired carbon monoxide levels were significantly greater in the food-deprived condition than in the non-deprived condition (p = .05), although no differences were found in the total number of cigarettes smoked during the laboratory session. Analysis of smoking topography indicated that the time to first puff was significantly greater in the non-deprived condition (p = .03), while the sum of the interpuff intervals (p = .02) and the time to removal from the last puff were greater in the food-deprived condition (p = .03). The total time total smoking was marginally greater in the food-deprived condition (p = .10). Findings suggest that females may alter the manner in which they smoke during acute food deprivation

Weight concern and smoking in children

Studies have shown that weight concern is prevalent in children and that many children believe smoking can be used to control appetite and weight. However, little is known about the impact of the combination of these factors on smoking initiation in children. Initial research has indicated that weight concern predicts smoking initiation in adolescents, but these studies have not addressed the role of weight control outcome expectancies. The purpose of this study was to prospectively investigate the relationship between weight concern and smoking initiation, and to evaluate weight control outcome expectancies as a moderator of this relationship in children. Cross-sectional analyses were conducted to determine whether children who had tried smoking possessed greater concern about weight than those who had not. The impact of sex and race on these relationships were also examined. Results indicated that smokers endorsed greater weight concern, F(1, 708) = 6.71, p = .01, and dieting than non-smokers, F(1, 708) = 7.043, p = .008, and that black children had greater weight concern than white children, F(1, 708) = 3.999, p = .046. Dieting predicted smoking at five months, X²(3, N = 708) = 24.297, p = .000, and smokers had greater weight concern over time than non-smokers, F(2, 691) = 3.569, p = .029. Weight control outcome expectancies did not predict smoking at five months, and was not supported as a moderator of the relationship between weight concern and smoking

Cross-sectional Associations of Opiate Misuse/Opioid Use Disorder among Adults Experiencing Homelessness

The purpose of this manuscript is to determine the prevalence of opioid misuse/opioid use disorder (OUD) among adults experiencing homelessness and describe characteristics that account for significant variance in relation to opioid misuse in those who misuse and do not misuse opioids. From six homeless shelters in Oklahoma City, adults participated in a survey about their demographics, substance use, mental health, and physical health from July to August of 2016 (n = 569). For assessing substance use, participants responded about their opioid misuse and diagnosis of OUD, current smoking status, arrests due to drug possession or driving while intoxicated, and diagnosis with alcohol use disorder or another drug use disorder, excluding opiate use disorder. A cumulative score of mental health comorbidity was created based on affirmative responses for having been diagnosed with depression, post-traumatic stress disorder (PTSD), schizophrenia/schizoaffective disorder, bipolar disorder, or an anxiety disorder besides PTSD. For physical health, one item from the General Health Survey-Short Form assessed pain, one item from the Behavioral Risk Factor Surveillance Survey assessed health, and one item assessed history of concussion. Bivariate analyses and logistic regression models identified the association. Sixteen percent of participants reported having experienced opioid misuse/been diagnosed with OUD. Substance use behaviors and physical health accounted for significant variance among those who misuse compared to those that do not misuse opioids. The most robust positive association of opioid misuse included: being white, being a current smoker, being diagnosed with another drug disorder, and having a concussion history. Additional research among the homeless population with a focus on concussion history as it relates to substance use and mental health comorbidity is needed

Cumulative Risk Factors Associated with Food Insecurity among Adults who Experience Homelessness

There is a dearth of research on the determinants of food insecurity among adults who experience homelessness. According to cumulative risk theory, it is the accumulation of risk factors that places individuals in jeopardy for negative health consequences. Building on the cumulative risk theory, domain specific indices were created to examine the relationship between four cumulative risk factors and food insecurity among adults who experience homelessness. Adult participants were recruited from six area shelters in Oklahoma City (N = 565) during July – August of 2016. Participants who affirmatively responded to two to six items of the six-item USDA Food Security Scale-Short form were categorized as food insecure. Four indices of cumulative risk were created based on affirmative survey responses: poor health & risky health behaviors index, personal and sexual victimization index, household disruption, and financial strain. Covariate-adjusted logistic regression models predicted the odds of adults experiencing food insecurity. Seventy-eight percent of the sample experienced food insecurity. Higher scores for the poor health and risky health behaviors index predicted higher odds of experiencing food insecurity (OR = 1.80, CI: 1.51 – 2.14). Higher scores for the personal and sexual victimization index also predicted higher odds of experiencing food insecurity (OR = 1.57, CI: 1.20 – 2.04). To facilitate food security among adults experiencing homelessness, shelters and community-based programs need to consider homelessness and food insecurity to be multi-faceted public health problems that are interrelated

Exposure to Violence and Sleep Inadequacies among Men and Women Living in a Shelter Setting

Exposure to violence may explain sleep inadequacies reported by homeless adults, with women being potentially more susceptible to violence and sleep disturbances than men. This study examined the association between violence and sleep inadequacies among homeless adults and explored differences by sex. Adult participants were recruited from a shelter (n = 194; 71.1% men, Mage = 43.8+12.2). Participants self-reported victimization and/or witnessing violence (mugging, fight, and/or sexual assault) at the shelter, sleep duration (over an average 24 hours), insufficient sleep (days without sufficient rest/sleep), and unintentional daytime sleep (days with unintentional sleep) in the past month. Linear regressions were used to estimate associations between violence and sleep inadequacies, controlling for sex, age, race, months homeless, and depression. Moderation by sex was examined via an interaction term following mean-centering of variables. Overall, 20.6% of participants (n = 40) reported victimization since moving to the shelter. In the last month, participants reported witnessing an average of 2.9+5.1 acts of violence. Over the same timeframe, participants reported 6.9+2.0 hours of sleep nightly, 11.2+10.7 days of insufficient sleep, and 6.2+8.8 days with unintentional daytime sleep. In adjusted analyses, witnessing violence was associated with insufficient sleep (p = .001). Men and women differed only in age and race in unadjusted analyses; sex was not a significant moderator of any association between violence and sleep in adjusted analyses. Links between witnessing violence and sleep inadequacies should be considered in shelter health promotion efforts. Successful efforts to minimize violence may reduce insufficient sleep amongst both sexes

The Indirect Effect of Smoking Level in the Association Between Urban Stress and Readiness to Quit Smoking among Adults Experiencing Homelessness

Over 70% of adults experiencing homelessness are cigarette smokers, a fivefold greater rate than in the general U.S. population. Consequently, tobacco-related conditions are the leading causes of disease and death for this group. Adults experiencing homelessness tend to seek shelter in urban areas. Thus, they not only experience the daily stressors of being homeless, but they may additionally experience unique or additive urban stressors (e.g., stress related to using public services, crime and violence, and/or cultural conflicts with others). For some smokers, stress is known to increase smoking rates and decrease readiness to quit smoking. Likewise, increased smoking rates alone may lead to a lower likelihood of making a quit attempt. The current study examined the potential mediating role of smoking level in the association of urban stress and quit readiness among adults experiencing homelessness (N = 411). Two multinomial logistic regression analyses revealed that urban stress was positively associated with smoking level (p = 0.02). The odds ratio for one-unit increase in stress was 1.047 (CI.95:1.014, 1.082) for being a heavy vs. non-daily smoker. Furthermore, analyses revealed smoking level mediated the effect of stress on quit readiness (ab = -0.005, CI.95:-0.010, -0.002]). Homeless smokers who report high levels of stress might smoke at higher levels, which could attenuate quit readiness

Non-adherence to psychiatric medication in adults experiencing homelessness is associated with incurred concussions

This study investigated the relationship between concussions and medication adherence among 247 adults experiencing homelessness in Oklahoma City, Oklahoma, who were prescribed medication for a psychiatric disorder. Participants were asked whether they had “ever experienced a blow to the head that caused a concussion,” and medication adherence was measured by asking participants whether they had taken their psychiatric medication yesterday. The data were analyzed using univariate and multivariable logistic regressions. Results showed that more than half of the sample had a concussion history (61.9%), and homeless adults with a concussion history had higher odds of non-adherence to psychiatric medications compared with those who reported no concussion history [OR = 2.13 (95% CI = 1.08, 4.18)]. Findings suggest that medication non-adherence is associated with incurred concussions. Raising awareness among service providers of the relationship between traumatic brain injury and medication adherence may increase efforts to improve adherence in this underserved population

Health Literacy and Self-Rated Health among Homeless Adults

Poor health literacy reduces the efficacy of behavior change interventions, hampers management of health conditions, and attenuates understanding of the prevention and treatment of diseases. Poor health literacy has also been linked to fair/poor self-rated health in domiciled samples; however, there is a paucity of studies on the relation amongst homeless adults, who bear a disproportionate burden of disease and disability and require a high level of care and access to health services. Here, we examined the association between health literacy and self-rated health among a convenience sample of homeless adults. Participants were recruited from six homeless-serving agencies in Oklahoma City (N = 575; 63% men, Mage = 43.6+12.3). We used logistic regression to assess the association between health literacy (confidence completing medical forms: extremely/quite a bit versus somewhat/little bit/not at all) and self-rated health (poor/fair versus good/very good/excellent), controlling for age, subjective social status, education, race, sex, income, health insurance, employment, social security recipient status, diabetes diagnosis, high blood pressure diagnosis, and high cholesterol diagnosis. In the adjusted model, health literate homeless individuals had greater odds of endorsing good/very good/excellent self-rated health compared to those somewhat/a little bit/not at all confident completing medical forms (AOR = 2.02, [CI95% = 1.35-3.02]). Interventions targeted at adjusting reading level and comprehensibility of health information are needed for homeless individuals with poor/limited health literacy, which may ultimately impact their self-rated health. Shelters and homeless-serving agencies could host classes focused on practical skills for enhancing health literacy and/or provide navigation services

Anxiety Sensitivity and Sleep Problems among Homeless Adults

Anxiety sensitivity (AS) is a transdiagnostic individual difference factor, reflecting amplified fear about the negative consequences of anxiety-related autonomic arousal. AS has been linked to sleep problems and serious mental/physical health conditions in the domiciled population. No previous research has examined how AS affects sleep among homeless adults who are vulnerable to health disparities and living in harsh environments that may, by their nature, compromise sleep integrity. The purpose of this study was to investigate the association between AS and sleep-related problems among homeless adults. AS was significantly associated with more days of inadequate sleep (p < 0.001), fewer hours of sleep per day (p < 0.01), unintentionally falling asleep (p ≤ 0.01) in this convenience sample of predominately male homeless adults. See Tables 1 and 2. Results suggest that AS may be a risk factor conferring additional vulnerability to sleep- related problems among homeless adults. This project was completed with contributions from Michael S. Businelle from the Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center.Psychological, Health, and Learning Sciences, Department ofHonors Colleg