Active clinical trials for "Tobacco Use Disorder"

The investigators aim to (1) examine the association between levels of progesterone (Prog), allopregnanolone (Allo), and the estradiol/progesterone (E2/P) ratios with smoking-related symptomatology during ad libitum smoking and (2) determine the association between Prog, Allo, and E2/P with the changes in smoking-related symptomatology and response to nicotine following overnight abstinence

Cigarette smoking is very common in current and former injection drug users and is known to cause chronic lung diseases. Quitting smoking is proven to improve the health of people addicted to cigarettes. . Little information exists regarding the perceptions and characteristics of drug users regarding quitting smoking. Additionally, most programs designed to help people quit smoking are not very successful. One reason these programs may not work well is because it is difficult to motivate people to quit smoking. New methods of motivating changes in behavior include small monetary payments for healthy behavior and reporting breathing tests with the concept of "lung age," which is the age of an average healthy person with similar breathing test results. For example, a health care provider can report results as "Although you are 50 years old, you have the lungs for a 70 year old". In this proposal, the investigators plan to first explore the beliefs and characteristics of current and former injection drug users and how they are related to quitting smoking. The investigators then plan to study whether the use of two new methods of motivation increases the chances that this group will stop smoking.

Emergency Departments (EDs) are a critical component of the U.S. healthcare system, treating over 119 million patients each year. While EDs have historically neglected tobacco control efforts, several recent studies have examined the feasibility and efficacy of implementing tobacco cessation in the ED. Work by our research team and others, has shown that tobacco treatment is both feasible and effective in the ED setting. Effective, evidence-based interventions for treating tobacco dependence have also been codified in the United States Public Health Service guidelines. Even brief interventions delivered by physicians and other healthcare providers can produce significant increases in cessation across diverse clinical settings (e.g., outpatient clinics, surgery units, EDs), and patient groups (cardiac, respiratory, general admissions). However, in clinical practice, delivery of tobacco interventions is inconsistent at best, particularly in non-primary care settings. This translational study uses an existing Emergency Department Information System (EDIS), to facilitate the identification of smokers and to enhance the provision of smoking cessation intervention materials and pharmacological adjuncts for patients receiving treatment in the ED. The EDIS tracks the geographic and chronologic progression of patients through the ED and contains triage and nursing notes, lab values, radiology reports and links to images, vital signs, embedded printable discharge instructions, and fax links to primary care provider (PCP) offices. Following recruitment of a baseline (care-as-usual) cohort (Step 1), the investigators will provide training to ED physicians and staff to improve the identification and treatment of smokers. Following Step 1, the investigators will make adaptations to the EDIS system that include smoking status tracking, tobacco treatment prompts and medication information panels for the emergency treating physician, and links to printable discharge instructions, quit-smoking medication information and referral to a pro-active phone follow-up counseling for enrolled smokers. A second cohort of participants (Step 2) will be enrolled after implementation is complete. Contemporaneous with Steps 1 and 2, participant cohorts will be recruited at a control site (UMass Medical) to control for potential effects of historical trends. This study represents a comprehensive systems-based translation of empirically supported tobacco treatment built into a widely used patient tracking platform (MedHost) maximizing the probability of developing a sustainable tobacco intervention that can be readily disseminated. Specific Aims A.1. To test the incremental efficacy of a modified Emergency Department Information System (EDIS) "MedHost", using a multiple-cohort design implemented in 2 steps. Two recruitment phases (baseline/care as usual and full implementation) will be used to assess the impact of EDIS enhancements on rates of identification and treatment of ED patients who smoke. The primary outcome is the difference in six-month abstinence between those recruited prior to program implementation (Baseline) versus those recruited when the program is fully implemented (Step 2). H1) Smokers enrolled during Step 2 at RIH will show significantly greater cessation at month 6 compared Step 1 and control site participants. A.2. To compare rates of smoker identification, physician intervention and follow up care for smoking cessation and use of quit-smoking medications among ED patients recruited before and after EDIS modification. H2) Compared to Step 1 and the control site, Step 2 will show significantly higher rates of smoker identification, physician intervention and follow-up for smoking, and use of quit-smoking medications. A.3. To investigate the effects of the EDIS enhancement on relevant behavioral and psychological constructs that may act as mediators of smoking behavior change ("Mechanisms of Action"), and the relationships of these potential mediators to smoking cessation (e.g., perceived risk, nicotine dependence; in Measures section). H3) Participants enrolled during Step 2 at RIH will show greater changes in posited mediational constructs than those enrolled in Step 1 and at the control site. A.4. To examine the incremental costs of implementation of the intervention and to conduct analyses of marginal cost effectiveness using cost-per-smoker-quit. (This aim is not hypothesis driven) Exploratory Aim: A.5. To examine ED physician and other health care providers (HCP) attitudes regarding the utility of the EDIS system for tobacco intervention. The investigators will conduct interviews with ED physicians and nurses to elicit their perceptions of the usefulness and helpfulness of the modified EDIS, and its effects on their perceived self-efficacy and motivation to provide tobacco intervention. The investigators will also solicit direct feedback on the modified platform and user interface.

Nicotine dependence is very common among Asian Americans; yet, research on understanding and treating nicotine dependence in this group is almost nonexistent. The proposed study is a first attempt to develop a smoking cessation program that is tailored to Korean-culture specific aspects. It is proposed that Korean Americans who receive a culturally tailored smoking cessation program will be more likely to have prolonged abstinence at 12-month follow-up than their counterparts who receive brief cessation counseling. Subjects in both arms receive nicotine patches for 8 weeks. Self-reported abstinence is validated with exhaled carbon monoxide and salivary cotinine tests.

The Smoking Termination Opportunity for inPatients, (STOP) project is designed to capture the opportunity that is provided by admission for acute smoking related illness, to assist patients through withdrawal by use of a combination of: the new medication Champix with best practice counselling initiated in an inpatient setting to achieve: sustained smoking abstinence reduced hospital bed and health service utilisation reduced inpatient smoking and craving prior to discharge

This study is designed to test the hypotheses that incentives can increase both participation in smoking cessation treatment and resulting cessation rates when they are offered to Medicaid BadgerCare Plus members.

A randomized control trial evaluating a novel smoking cessation intervention in individuals at a an inpatient clinic for clients with addiction and concurrent disorders. The intervention is based on cognitive bias modification, where participants are explicitly or implicitly trained to make avoidance movements by pushing a joystick in response to pictures of smoking, and as a result altering their cognitive biases towards smoking and tobacco dependence. Hypothesis: Participation in the experimental (tobacco-avoidance) condition will induce reduction of smoking, assessed as lower levels of carbon monoxide measured at baseline and 12 week follow-up.

This study compares two methods of teaching the 5As (Ask, Advise, Assess, Assist, Arrange) for tobacco dependence treatment to medical students: 1) traditional medical education (TE), and 2) multi-modal education (MME). The MME arm builds upon the traditional curriculum at the medical school by providing a web-based instructional program, a role play, preceptor training, and a booster session. The hypotheses are that MME will outperform TE on observed 5As counseling skills on the Objective Structured Clinical Exam (OSCE); and MME will outperform TE on self-reported 5As counseling skills.

The goal of this clinical research study is to learn how zileuton alone or the combination of zileuton and celecoxib may affect certain chemicals in the body that may be linked with a risk for smoking-related lung disease. These effects will be measured by a urine test

The goal of the proposed study is to validate an experimental paradigm to assess medication effects on smoking relapse following a brief (3-day) monitored period of smoking abstinence and a programmed cigarette lapse.