Identifying Stress Variables Linking Socioeconomic Status and Smoking

Smoking is the leading cause of preventable death accounting for approximately 480,000 deaths every year (Jamal et al., 2015). Across the socioeconomic status gradient smoking prevalence differs greatly, with those of lower socioeconomic status smoking at much higher rates. Within the literature relationships have been identified between socioeconomic status, stress variables, and smoking. However, little research has explored the possibility of stress variables mediating the relationship between socioeconomic status and smoking. The goal of the current study was to identify stress variables linking socioeconomic status and smoking in order to identify variables to address in cessation programs for individuals across the socioeconomic status gradient. Stress variables examined as potential mediators between socioeconomic status and smoking included financial strain, discrimination, urban life stress, perceived stress, depression, and neighborhood perceptions. Participants (N = 238) were primarily female (67.6%) and African American (51.7%) adults from the Dallas metropolitan area. A majority of the sample reported being nonsmokers (n = 164). Participants who identified as being smokers at baseline (n = 74) reported smoking 9.96 (SD = 10.79) cigarettes per a day. Analyses revealed that financial strain and perceived neighborhood disorder were the only variables found to significantly mediate the relationship between socioeconomic status and cigarettes smoked per week. Additionally, financial strain was also found to significantly mediate the relationship between socioeconomic status and smoking status. Cessation programs targeting lower socioeconomic status groups should look to include some component to reduce financial strain and address perceived neighborhood disorder as these variables may act as barriers to successful cessation for this population

Readiness to Change and Smoking Expectancies Among Adult Male Substance Users Currently in Substance Use Treatment

The primary aims of the current study were to examine if smoking expectancies and readiness to quit smoking, important components in predicting smoking behavior and cessation, changed across time for adult smokers in substance use treatment. Participants (N = 51) were predominantly white (96.1%), adult, male smokers who were admitted to residential substance use treatment. Smoking outcome expectancies and readiness to change smoking were assessed among participants at treatment entry (n = 51), and subsequently at 30 days (n = 13), 60 days (n = 9), and 90 days (n = 3) from treatment entry. Ninety-day follow-up assessments were excluded from outcome analyses due to significant participant attrition. At baseline, the majority of participants were in the contemplation (40%) or preparation (action) (40%) stage of change for smoking cessation. Repeated measures analyses of variance (ANOVAs) revealed a significant decrease in health risk and negative affect reduction smoking expectancies across time points. Readiness to change smoking did not significantly differ across time points. Existing literature on smoking expectancies has shown that elevated health risk beliefs predict cessation treatment entry, whereas elevated expectations for negative affect reduction predict relapse after a cessation attempt. Findings in the current study suggest that manipulation of health risk expectancies at treatment entry may increase engagement in a subsequent cessation attempt. In addition, negative affect reduction expectancies may change with the acquisition of alternate skills to manage negative affect learned in substance use treatment. Although readiness to change smoking did not increase over time in substance use treatment, the majority of smokers at baseline were already in the contemplation and preparation stages for quitting smoking. Based on the current findings, the optimal time for smoking cessation intervention efforts may be between 30 to 60 days after entering substance use treatment

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

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