Access, engagement, and tobacco treatment by telephone quitlines among lesbian, gay, bisexual, and transgender adults

Tobacco smoking is the primary cause of early death and disability in U.S. adults, and the prevalence of tobacco use is disproportionate among socially disadvantaged populations, including people who identify as lesbian, gay, bisexual, or transgender (LGBT). Stigma stress associated with an LGBT identity is theorized to underlie this disparity, and may present barriers to tobacco use treatment. Evidence-based tobacco treatment includes telephonic cessation counseling by quitlines, however this mode of treatment has not been systematically evaluated for LGBT populations with regards to access, engagement, and treatment outcomes. In this study, access to quitlines was investigated as 1) differences in rates of quitline referrals between cisgender heterosexual (CH) and LGBT hospitalized patients, 2) willingness to accept a referral among patients attending an LGBT-tailored primary care clinic, and 3) calls to the quitline by LGBT identified adults during mass media campaigns. Quitline engagement in counseling calls and nicotine replacement, and 30-day self-reported cessation treatment outcomes seven months after intake was compared between CH and LGBT callers, using propensity score matching to estimate the average treatment effects. Nearly one-third of LGBT inpatients were referred to the quitline by a tobacco treatment specialist, a higher rate compared to CH but not statistically significant, and 40% of patients in the LGBT-tailored clinic would accept a quitline referral at the time of their visit. Mass media campaigns were effective at proportionally increasing quitline intakes with LGBT callers from the pre-campaign to the campaign duration over six campaigns. LGBT females were significantly less engaged in treatment than CH, and had a trend (p = .081) towards lower cessation rates. There were no differences in engagement or cessation outcomes between LGBT and CH males. The research conducted for this study was limited by convenience sampling methodology, social desirability bias, reliance on self-report measures of identity and cessation, as well as modeling outcomes with observational data. Implications for social work practice and tobacco control efforts are discussed within the context of these research findings. Future research should examine factors associated with successful treatment for LGBT quitline callers, with special emphasis on females

Study databases and search keywords (or final search strategy, if reported), N = 19, May 28–29, 2015.

<p>Study databases and search keywords (or final search strategy, if reported), N = 19, May 28–29, 2015.</p

Identifying Lesbian, Gay, Bisexual, and Transgender Search Terminology: A Systematic Review of Health Systematic Reviews

Research on the health of lesbian, gay, bisexual, and transgender (LGBT) populations canprovide important information to address existing health inequalities. Finding existingresearch in LGBT health can prove challenging due to the plethora of terminology used. Wesought to describe existing search strategies and to identify more comprehensive LGBTsearch terminology. We iteratively created a search string to identify systematic reviewsand meta-analyses about LGBT health and implemented it in Embase, PubMed/MEDLINE,and PsycINFO databases on May 28--29, 2015. We hand-searched the journal LGBTHealth. Inclusion criteria were: systematic reviews and meta-analyses that addressedLGBT health, used systematic searching, and used independent coders for inclusion. Thepublished search terminology in each record and search strings provided by authors onrequest were cross-referenced with our original search to identify additional terminology.Our search process identified 19 systematic reviews meeting inclusion criteria. The numberof search terms used to identify LGBT-related records ranged from 1 to 31. From theincluded studies, we identified 46 new search terms related to LGBT health. We removedfive search terms as inappropriate and added five search terms used in the field. The resulting search string included 82 terms. There is room to improve the quality of searching andreporting in LGBT health systematic reviews. Future work should attempt to enhance thepositive predictive value of LGBT health searches. Our findings can assist LGBT healthreviewers in capturing the diversity of LGBT terminology when searching

PRISMA Flow Diagram, May 28–29, 2015.

<p>PRISMA Flow Diagram, May 28–29, 2015.</p

Comparative effectiveness of post-discharge strategies for hospitalized smokers: study protocol for the Helping HAND 2 randomized controlled trial

Background: Smoking cessation interventions for hospitalized smokers are effective in promoting smoking cessation, but only if the tobacco dependence treatment continues after the patient leaves the hospital. Sustaining tobacco dependence treatment after hospital discharge is a challenge for health care systems. Our previous single-site randomized controlled trial demonstrated the effectiveness of an intervention that facilitated the delivery of comprehensive tobacco cessation treatment, including both medication and counseling, after hospital discharge. We subsequently streamlined the intervention model to increase its potential for dissemination. This new model is being tested in a larger multi-site trial with broader eligibility criteria in order to enroll a more representative sample of hospitalized smokers. This paper describes the trial design and contrasts it with the earlier study. Methods/Design A 2-arm, 3-site randomized controlled trial is testing the hypothesis that a multi-component Sustained Care intervention is more effective than Standard Care in helping hospitalized cigarette smokers stop smoking after hospital discharge. The trial enrolls adult daily cigarette smokers who are admitted to 1 of 3 participating hospitals in Massachusetts or Pennsylvania. Participants receive the same smoking cessation intervention in the hospital. They are randomly assigned to receive either Standard Care or Sustained Care after hospital discharge. Participants in the Sustained Care arm receive a free 3-month supply of FDA-approved smoking cessation medication and 5 interactive voice response calls that provide tailored motivational messages, medication refills, and access to a live tobacco treatment counselor. Participants in the Standard Care arm receive a smoking cessation medication recommendation and information about community resources. Outcomes are assessed at 1, 3, and 6 months after discharge. The primary outcome is biochemically-validated tobacco abstinence for the past 7 days at 6-month follow-up. Other outcome measures include self-reported tobacco abstinence measures, use of medication and counseling after discharge, hospital readmissions, and program cost-effectiveness. Discussion We adapted a proven intervention for hospitalized smokers to enhance its potential for dissemination and are testing it in a multi-site trial. Study enrollment data suggests that the trial achieved the goal of recruiting a broader sample of hospitalized smokers. Trial registration Comparative Effectiveness of Post-Discharge Strategies for Hospitalized Smokers (Helping HAND2) NCT01714323. Registered October 22, 2012

Impact of non- native tree species in Europe on soil properties and biodiversity: a review

In the context of global change, the integration of non-native tree (NNT) species into European forestry is increasingly being discussed. The ecological consequences of increasing use or spread of NNTs in European forests are highly uncertain, as the scientific evidence is either constraint to results from case studies with limited spatial extent, or concerns global assessments that lack focus on European NNTs. For either case, generalisations on European NNTs are challenging to draw. Here we compile data on the impacts of seven important NNTs (Acacia dealbata, Ailanthus altissima, Eucalyptus globulus, Prunus serotina, Pseudotsuga menziesii, Quercus rubra, Robinia pseudoacacia) on physical and chemical soil properties and diversity attributes in Europe, and summarise commonalities and differences. From a total of 103 publications considered, studies on diversity attributes were overall more frequent than studies on soil properties. The effects on soil properties varied greatly among tree species and depended on the respective soil property. Overall, increasing (45%) and decreasing (45%) impacts on soil occurred with similar frequency. In contrast, decreasing impacts on biodiversity were much more frequent (66%) than increasing ones (24%). Species phylogenetically distant from European tree species, such as Acacia dealbata, Eucalyptus globulus and Ailanthus altissima, showed the strongest decreasing impacts on biodiversity. Our results suggest that forest managers should be cautious in using NNTs, as a majority of NNT stands host fewer species when compared with native tree species or ecosystems, likely reflected in changes in biotic interactions and ecosystem functions. The high variability of impacts suggests that individual NNTs should be assessed separately, but NNTs that lack European relatives should be used with particular caution.ISSN:1619-003

Developing a framework of care for opioid medication misuse in community pharmacy

Background: Prescription opioid misuse is a major public health concern in the US. Few resources exist to support community pharmacists engaging patients who misuse or are at risk for misuse. Objectives: This report describes the results of the execution of the ADAPT-ITT model (a model for modifying evidence-based behavioral interventions to new populations and service settings) to guide the development of a behavioral health framework for opioid medication misuse in the community pharmacy setting. Methods: Pharmacy, addiction, intervention, and treatment experts were convened to attend a one-day meeting to review the empirical knowledgebase and discuss adapting the screening, brief intervention, and referral to treatment (SBIRT) protocol for addressing opioid medication misuse in community pharmacy. Qualitative data gathered from the meeting were analyzed by 2 independent coders in a 2-cycle process using objective coding schemes. Percentage of agreement and Cohen’s Kappa were calculated to assess coder agreement. Results: First-cycle coding identified 4 distinct themes, with coder percentage of agreement ranging from 93.5 to 99.6% and with Kappa values between 0.81 and 0.93. Second-cycle coding identified 10 sub-themes, with coder percentage of agreement ranging from 83 to 99.8% and with Kappa values between 0.58 and 0.93. Identified themes and sub-themes encompassed patient identification, intervention, prevention, and referral to treatment. Conclusions: Focus of screening efforts in the emerging model should capitalize on pharmacists’ knowledge of medication management. Screening likewise should be multidimensional in order to facilitate patient-centered interventions that activate additional disciplines able to interface with patients at risk or involved in medication misuse