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

Using mHealth to Increase Treatment Utilization Among Recently Incarcerated Homeless Adults (Link2Care): Protocol for a Randomized Controlled Trial

Background: There is a significant revolving door of incarceration among homeless adults. Homeless adults who receive professional coordination of individualized care (ie, case management) during the period following their release from jail experience fewer mental health and substance use problems, are more likely to obtain stable housing, and are less likely to be reincarcerated. This is because case managers work to meet the various needs of their clients by helping them to overcome barriers to needed services (eg, food, clothing, housing, job training, substance abuse and mental health treatment, medical care, medication, social support, proof of identification, and legal aid). Many barriers (eg, limited transportation, inability to schedule appointments, and limited knowledge of available services) prevent homeless adults who were recently released from incarceration from obtaining available case management, crisis management, substance abuse, and mental health services. Objective: The aim of the Link2Care study is to assess the effectiveness of a smartphone app for increasing case management and treatment service utilization, and in turn reduce homelessness and rearrest. The goals of this research are to (1) assess the impact of an innovative smartphone app that will prompt and directly link recently incarcerated homeless adults to community-based case management services and resources and (2) utilize in-person and smartphone-based assessments to identify key variables (eg, alcohol or drug use, social support, psychological distress, and quality of life) that predict continued homelessness and rearrest. Methods: Homeless adults (N=432) who enroll in a shelter-based Homeless Recovery Program after release from the Dallas County Jail will be randomly assigned to one of the three treatment groups: (1) usual case management, (2) usual case management plus smartphone, and (3) usual case management with a study-provided smartphone that is preloaded with an innovative case management app (smartphone-based case management). Those assigned to smartphone-based case management will receive smartphones that prompt (twice weekly) connections to shelter-based case managers. The app will also offer direct links to case managers (available during normal business hours) and crisis interventionists (available 24 hours a day, 7 days a week) with the touch of a button. Results: Recruitment began in the spring of 2018, and data collection will conclude in 2021. Conclusions: This research represents an important step toward integrated service connection and health care service provision for one of the most underserved, high need, and understudied populations in the United States. Trial Registration: ClinicalTrials.gov NCT03399500; https://clinicaltrials.gov/ct2/show/NCT03399500 (Archived by WebCite at http://www.webcitation.org/6zSJwdgUS) Registered Report Identifier: RR1-10.2196/986

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

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

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

Varenicline Combined With Oral Nicotine Replacement Therapy and Smartphone-Based Medication Reminders for Smoking Cessation: Feasibility Randomized Controlled Trial

BACKGROUND: Varenicline and oral nicotine replacement therapy (NRT) have each been shown to increase the likelihood of smoking cessation, but their combination has not been studied. In addition, smoking cessation medication adherence is often poor, thus, challenging the ability to evaluate medication efficacy. OBJECTIVE: This study examined the effects of combined varenicline and oral NRT and smartphone medication reminders on pharmacotherapy adherence and smoking abstinence among adults enrolled in smoking cessation treatment. METHODS: A 2×2 factorial design was used. Participants (N=34) were randomized to (1) varenicline + oral NRT (VAR+NRT) or varenicline alone (VAR) and (2) smartphone medication reminder messages (REM) or no reminder messages (NREM) over 13 weeks. Participants assigned to VAR+REM received varenicline reminder prompts, and those assigned to VAR+NRT+REM also received reminders to use oral NRT. The other 2 groups (VAR+NREM and VAR+NRT+NREM) did not receive medication reminders. Participants were not blinded to intervention groups. All participants received tobacco cessation counseling. Smartphone assessments of smoking as well as varenicline and NRT use (if applicable) were prompted daily through the first 12 weeks after a scheduled quit date. Descriptive statistics were generated to characterize the relations between medication and reminder group assignments with daily smoking, daily varenicline adherence, and daily quantity of oral NRT used. Participants completed follow-up assessments for 26 weeks after the quit date. RESULTS: Participants were predominantly White (71%), and half were female (50%). On average, participants were 54.2 (SD 9.4) years of age, they smoked an average of 19.0 (SD 9.0) cigarettes per day and had smoked for 34.6 (SD 12.7) years. Descriptively, participants assigned to VAR+NRT reported more days of smoking abstinence compared to VAR (29.3 vs 26.3 days). Participants assigned to REM reported more days of smoking abstinence than those assigned to NREM (40.5 vs 21.8 days). Participants assigned to REM were adherent to varenicline on more days compared to those assigned to NREM (58.6 vs 40.5 days), and participants assigned to VAR were adherent to varenicline on more days than those assigned to VAR + NRT (50.7 vs 43.3 days). In the subsample of participants assigned to VAR+NRT, participants assigned to REM reported more days where ≥5 pieces of NRT were used than NREM (14.0 vs 7.4 days). Average overall medication adherence (assessed via the Medication Adherence Questionnaire) showed the same pattern as the daily smartphone-based adherence assessments. CONCLUSIONS: Preliminary findings indicated that smoking cessation interventions may benefit from incorporating medication reminders and combining varenicline with oral NRT, though combining medications may be associated with poorer adherence. Further study is warranted. TRIAL REGISTRATION: ClinicalTrials.gov NCT03722966; https://classic.clinicaltrials.gov/ct2/show/NCT03722966