Pain and smoking study (PASS): A comparative effectiveness trial of smoking cessation counseling for veterans with chronic pain

Introduction: Smoking is associated with greater pain intensity and pain-related functional interference in people with chronic pain. Interventions that teach smokers with chronic pain how to apply adaptive coping strategies to promote both smoking cessation and pain self-management may be effective. Methods: The Pain and Smoking Study (PASS) is a randomized clinical trial of a telephone-delivered, cognitive behavioral intervention among Veterans with chronic pain who smoke cigarettes. PASS participants are randomized to a standard telephone counseling intervention that includes five sessions focusing on motivational interviewing, craving and relapse management, rewards, and nicotine replacement therapy versus the same components with the addition of a cognitive behavioral intervention for pain management. Participants are assessed at baseline, 6, and 12 months. The primary outcome is smoking cessation. Results: The 371 participants are 88% male, a median age of 60 years old (range 24-82), and smoke a median of 15 cigarettes per day. Participants are mainly white (61%), unemployed (70%), 33% had a high school degree or less, and report their overall health as Fair (40%) to Poor (11%). Overall, pain was moderately high (mean pain intensity in past week = 5.2 (Standard Deviation (SD) = 1.6) and mean pain interference = 5.5 (SD = 2.2)). Pain-related anxiety was high (mean = 47.0 (SD = 22.2)) and self-efficacy was low (mean = 3.8 (SD = 1.6)). Conclusions: PASS utilizes an innovative smoking and pain intervention to promote smoking cessation among Veterans with chronic pain. Baseline characteristics reflect a socioeconomically vulnerable population with a high burden of mental health comorbidities

An Internet-Based Weight Loss Intervention Initiated by a Newspaper

Background: An estimated two-thirds of North Carolina residents are overweight or obese. Mass media, such as newspapers and the Internet, can be used to broadly convey health messages for weight loss. Context: Newspapers have traditionally been a primary source of health information for the general public. They may be uniquely suited to initiate and manage a community-based weight loss program by quickly reaching a broad readership. Methods: Participants in the 2005 Lose to Win weight loss challenge visited the Herald-Sun Web site and anonymously entered a nickname and identification number and reported their weight each week. Participants had access to weekly articles on diet and physical activity and 4 free educational seminars. Consequences: Of the 154 participants who self-reported weight at baseline and during the last week of the challenge, the mean weight lost was 5.9 lb. Interpretation: Results suggest that this challenge fostered health awareness and promoted weight loss in the community. Future interventions of this type should use strategies to increase participation and retention, improve the accuracy of reported weight, and evaluate long-term success of the program. This type of intervention may be a useful first step to reach residents who are interested in losing weight

Barriers to adopting a healthy lifestyle: insight from postpartum women

<p>Abstract</p> <p>Background</p> <p>Postpartum weight retention can contribute to obesity. There may be unique barriers to weight loss in this period.</p> <p>Findings</p> <p>Cases are presented for three postpartum women who declined to participate in a postpartum weight loss intervention.</p> <p>Despite their desire to engage in healthier behaviors, or partake in an intervention uniquely designed to promote healthy lifestyles for postpartum women, some find it too difficult to make such commitments. Barriers women face in adopting a healthier lifestyle in this period include 1) time availability; 2) prioritizing other competing life responsibilities above their own health; 3) support from family members, friends, and/or co-workers; and 4) lack of flexibility in the intervention structure. These illustrations describe their perspectives in the context of life balance, perceived health, and support, and reflect the multi-dimensional nature of their lives during the life cycle change of the postpartum period.</p> <p>Conclusion</p> <p>Postpartum women face difficult and complex challenges to prioritizing their health and their weight management.</p

Improving Care Coordination for Veterans Within VA and Across Healthcare Systems

The VA faces a plethora of care coordination challenges. Many Veterans have multiple conditions and providers, and many get a portion of their care in the community, a number that will only grow as recent legislation expands options for private care. These challenges have spawned new VA initiatives for redesigning care to meet them, described in this supplement in an editorial by Hosenfeld and colleagues. The VA Health Services Research and Development (HSR&D) service, in partnership with VA’s Office of Primary Care, and Office of Community Care, sponsored a State of the Art (SOTA) conference with the goals of (a) summarizing what is known about care coordination relevant to Veterans’ care; (b) identifying care coordination approaches ready for wider dissemination and implementation within VA; and (c) identifying a research agenda and recommendations, as appropriate, for increasing VA’s knowledge and use of evidence-based approaches for coordinating care. Held in March 2018, the SOTA was jointly planned by VA HSR&D and Offices of Primary Care, Community Care, Nursing Services, and Care Management and Social Work, and convened VA and non-VA health services researchers, clinicians, and policy makers. This supplement presents recommendations from the SOTA as well as original research papers on care coordination strategies within VA and between VA and non-VA providers

Body Image and Body Satisfaction Differ by Race in Overweight Postpartum Mothers

Body image (BI) and body satisfaction may be important in understanding weight loss behaviors, particularly during the postpartum period. We assessed these constructs among African American and white overweight postpartum women

Recommendations for the Evaluation of Cross-System Care Coordination from the VA State-of-the-art Working Group on VA/Non-VA Care

In response to widespread concerns regarding Veterans\u27 access to VA care, Congress enacted the Veterans Access, Choice and Accountability Act of 2014, which required VA to establish the Veterans Choice Program (VCP). Since the inception of VCP, more than two million Veterans have received care from community providers, representing approximately 25% of Veterans enrolled in VA care. However, expanded access to non-VA care has created challenges in care coordination between VA and community health systems. In March 2018, the VA Health Services Research and Development Service hosted a VA State of the Art conference (SOTA) focused on care coordination. The SOTA convened VA researchers, program directors, clinicians, and policy makers to identify knowledge gaps regarding care coordination within the VA and between VA and community systems of care. This article provides a summary and synthesis of relevant literature and provides recommendations generated from the SOTA about how to evaluate cross-system care coordination. Care coordination is typically evaluated using health outcomes including hospital readmissions and death; however, in cross-system evaluations of care coordination, measures such as access, cost, Veteran/patient and provider satisfaction (including with cross-system communication), comparable quality metrics, context (urban vs. rural), and patient complexity (medical and mental health conditions) need to be included to fully evaluate care coordination effectiveness. Future research should examine the role of multiple individuals coordinating VA and non-VA care, and how these coordinators work together to optimize coordination

I smoke to cope with pain: patients\u27 perspectives on the link between cigarette smoking and pain

BACKGROUND: For people with chronic pain, cigarette smoking is associated with greater pain intensity and impairment. Researchers have hypothesized a reciprocal relationship in which pain and smoking exacerbate each other, resulting in greater pain and increased smoking. This study aimed to qualitatively examine patient perspectives on this association. METHODS: A retrospective thematic analysis of smoking cessation counseling notes for 136 veterans in the Pain and Smoking Study, a tailored smoking cessation trial, was conducted. A validated codebook was applied to each counseling note by four independent coders using Atlas.ti (Atlas.ti, Berlin, Germany). Coders participated in a consensus-forming exercise with salient themes validated among the wider research team. KEY RESULTS: Participants averaged 60 years of age (range 28-77 years) and were 9% female. The median number of cigarettes smoked per day was 15, with a mean pain intensity score in the last week (from 0-10) of 5.1. While not all patients acknowledged a connection between pain and smoking, we found that (1) pain motivates smoking and helps manage pain-related distress, as a coping strategy and through cognitive distraction, and (2) pain motivates smoking but smoking does not offer pain relief. Concerns about managing pain without smoking was identified as a notable barrier to cessation. CONCLUSION: Many patients with chronic pain who smoke readily identified pain as a motivator of their smoking behavior and are reluctant to quit for this reason. Integrated interventions for smokers with pain should address these perceptions and expectancies and promote uptake of more adaptive self-management strategies for pain

Impact of Cigarette Smoking Status on Pain Intensity Among Veterans With and Without Hepatitis C

Objective: Chronic pain is a significant problem in patients living with hepatitis C virus (HCV). Tobacco smoking is an independent risk factor for high pain intensity among veterans. This study aims to examine the independent associations with smoking and HCV on pain intensity, as well as the interaction of smoking and HCV on the association with pain intensity. Design/Particpants: Cross-sectional analysis of a cohort study of veterans of Operations Enduring Freedom/Iraqi Freedom/New Dawn (OEF/OIF/OND) who had at least one visit to a Veterans Health Administration (VHA) primary care clinic between 2001 and 2014. Methods: HCV was identified using ICD-9 codes from electronic medical records (EMRs). Pain intensity, reported on a 0-10 numeric rating scale, was categorized as none/mild (0-3) and moderate/severe (4-10). Results: Among 654,841 OEF/OIF/OND veterans (median age [interquartile range] = 26 [23-36] years), 2,942 (0.4%) were diagnosed with HCV. Overall, moderate/severe pain intensity was reported in 36% of veterans, and 37% were current smokers. The adjusted odds of reporting moderate/severe pain intensity were 1.23 times higher (95% confidence interval [CI] = 1.14-1.33) for those with HCV and 1.26 times higher (95% CI = 1.25-1.28) for current smokers. In the interaction model, there was a significant Smoking Status x HCV interaction (P = 0.03). Among veterans with HCV, smoking had a significantly larger association with moderate/severe pain (adjusted odds ratio [OR] = 1.50, P \u3c 0.001) than among veterans without HCV (adjusted OR = 1.26, P \u3c 0.001). Conclusions: We found that current smoking is more strongly linked to pain intensity among veterans with HCV. Further investigations are needed to explore the impact of smoking status on pain and to promote smoking cessation and pain management in veterans with HCV

Proactive recruitment of cancer patients' social networks into a smoking cessation trial

This report describes the characteristics associated with successful enrollment of smokers in the social networks (i.e., family and close friends) of patients with lung cancer into a smoking cessation intervention