Predictors of Readiness to Quit Among a Diverse Sample of Sexual Minority Male Smokers

ABSTRACT Introduction: Readiness to quit smoking - a pattern of attitudes, intentions, and behaviors that reflect a likelihood of engaging in cessation activities—is a useful heuristic for understanding smoking disparities based on sexual orientation. This study examined demographic, tobacco-use patterns, psychosocial and cognitive factors associated with readiness to quit among gay and bisexual male smokers. Methods: A cross-sectional survey was conducted as part of a larger Tobacco Elimination and Control Collaboration (Q-TECC) initiative in the lesbian, gay, bisexual, and transgender (LGBT) community. Readiness to quit was measured by a composite score created from four variables (motivation to quit, importance of quitting, plan to quit, and confidence in quitting) (alpha=.87, M=3.42, SD=.96, range 1-5). Results: The sexual minority smokers in the sample (N=208; M=33 years) were racially/ethnically diverse. Latino men had significantly lower levels of readiness to quit compared to African American and White men. Hierarchical linear regression analyses were performed to explore the relative contributions of sociodemographic, tobacco-use patterns, psychosocial and cognitive factors on Readiness to Quit. In the final model, the following variables were associated with readiness to quit scores: Latino ethnicity, fewer quit attempts, positive expectancies for the beneficial effects of smoking, and lower perceived importance of smoking as an important LGBT health issue. None of the psychosocial factors were associated with readiness to quit. Discussion: Readiness to quit scores were largely predicted by modifiable attitudes, behaviors, and expectancies. Study findings have implications for improving outreach and awareness and for the development of effective treatment approaches

Racial/ethnic and geographic differences in access to a usual source of care that follows the patient-centered medical home model: Analyses from the Medical Expenditure Panel Survey data

This study examined racial and geographic differences in access to a usual source of care (USC) and it further explored these differences among individuals who had a USC that followed the patient-centered medical home (PCMH) model. Using cross-sectional data from the Household Component of the Medical Expenditure Panel Survey (2008-2013), our sample consisted of non-institutionalized US civilians ages 18-85 (n= 146,233; weighted n = 229,487,016). Our analysis included weighted descriptive statistics and weighted logistic regressions. Although 76% of the respondents had a USC, only 11% of them had a USC that followed the PCMH model. Among respondents who had a USC that followed the PCMH model, 80% were White, 13% Black, 5% Asian, and 12% were of Hispanic ethnicity. Across U.S. regions, 88% percent of those who had a USC that followed the PCMH model resided in metropolitan statistical areas (MSAs), 22% resided in the West, 26% in the Northeast, 25% in the Midwest, and 27% in the South. Results from logistic regression analyses indicated that race and ethnicity were not significant predictors of having a USC that followed the PCMH model. Northeastern U.S. residents (OR: 1.30; 95% CI:1.06-1.61) were more likely to have a USC that followed the PCMH model compared with southern residents. In conclusion, only a small percentage of respondents in our sample had a USC with the PCMH model. Further, race and ethnicity were not predictors of having a USC with the PCMH model

The genetic architecture of the human cerebral cortex

The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

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

A Qualitative Examination of Barriers and Motivators to Smoking Cessation among HIV positive African American MSM Smokers

Purpose: To identify barriers and motivators to smoking cessation among HIV-positive African American men-who-have-sex with men (MSM) who smoke. Procedures: A convenience sample of smokers was recruited for this study using a range of outreach approaches. Focus groups (N = 4) were conducted that examined: quit experiences, barriers to and motivators of cessation, cultural beliefs, and community norms. Established qualitative methods were used to conduct and analyze the focus groups. Main Findings: Participants (N = 31) reporting being diagnosed with HIV+ for M = 12 years. More than 60% reported a quit attempt in the past year. Knowledge was about effective smoking cessation treatments and the negative impact of smoking on the management of HIV was low. Barriers to smoking cessation included: low-self-efficacy, environmental, cultural, emotional, and provider factors. Motivators included: finances, health, appearance, and changing social norms. Conclusions: Study findings point to a number of barriers to and facilitators of smoking cessation in this population. Study results have implications for clinical practice, outreach and awareness campaigns, and future research

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

International audienc