Smoking Cessation Research Articles

Author's Reply: Expanding the Scope: Reflections on Digital Smoking Cessation Strategies for Diverse Age Groups

Author's Reply: Expanding the Scope: Reflections on Digital Smoking Cessation Strategies for Diverse Age Groups

NICE proposes adding cytisine as treatment option for smoking cessation

NICE proposes adding cytisine as treatment option for smoking cessation

Smoking cessation and atherosclerotic cardiovascular events and mortality in chronic kidney disease.

Smoking cessation is recommended to reduce excess atherosclerotic cardiovascular disease (ASCVD) and mortality in patients with chronic kidney disease (CKD). However, this recommendation is largely based on observational studies on the general population Therefore, we aimed to evaluate the association of smoking dose and smoking cessation duration with ASCVD and mortality in patients with CKD. We compiled a comprehensive pooled dataset comprising 66 245 participants with CKD from the KNOW-CKD and the UK Biobank cohort. Additionally, we included 307 353 participants without CKD from the UK Biobank cohort. Participants were categorized according to smoking dose and duration of smoking cessation base on a questionnaire. The primary outcome was a composite of ASCVD events or all-cause mortality. Over a median follow-up period of 13.2 years, 14 671 (22.1%) participants reached the primary outcome. In the pooled CKD cohort, compared to never smokers, former and current smokers exhibited a 1.30- and 2.14-fold higher risk of the primary outcome, respectively. Among former smokers, the hazard ratios (HRs) (95% confidence intervals [CIs]) for smoking loads<20 and≥20 pack-years were 1.05 (1.00-1.10) and 2.14 (2.05-2.25), respectively. The increased risk of the primary outcome was attenuated by longer smoking cessation. The HRs (95% CIs) for smoking cessation of<10 years, 10-20 years, and≥20 years were 1.75 (1.65-1.86), 1.43 (1.34-1.52), and 1.11 (1.06-1.16), respectively, compared with never smokers. This association was also observed in individuals without CKD, but the risk was comparable between former smokers with smoking cessation≥20 years and non-smokers, suggesting that a longer cessation is required in patients with CKD to offset the smoking-related adverse effects. Among former smokers with CKD, the risk of ASCVD or mortality was substantially attenuated with less smoking load and a longer duration of smoking cessation.

Effectiveness of the Offer of the Smoke Free Smartphone App Compared With No Intervention for Smoking Cessation: Pragmatic Randomized Controlled Trial.

Digital technologies offer the potential for low-cost, scalable delivery of interventions to promote smoking cessation. We aimed to evaluate the effectiveness of the offer of Smoke Free-an evidence-informed, widely used app-for smoking cessation versus no support. In this 2-arm randomized controlled trial, 3143 motivated adult smokers were recruited online between August 2020 and April 2021 and randomized to receive an offer of the Smoke Free app plus follow-up (intervention arm) versus follow-up only (comparator arm). Both groups were shown a brief message at the end of the baseline questionnaire encouraging them to make a quit attempt. The primary outcome was self-reported 6-month continuous abstinence assessed 7 months after randomization. Secondary outcomes included quit attempts in the first month post randomization, 3-month continuous abstinence assessed at 4 months, and 6-month continuous abstinence at 7 months among those who made a quit attempt. The primary analysis was performed on an intention-to-treat (ITT) analysis basis. Sensitivity analyses included (1) restricting the intervention group to those who took up the offer of the app, (2) using complete cases, and (3) using multiple imputation. The effective follow-up rate for 7 months was 41.9%. The primary analysis showed no evidence of a benefit of the intervention on rates of 6-month continuous abstinence (intervention 6.8% vs comparator 7.0%; relative risk 0.97, 95% CI 0.75-1.26). Analyses of all secondary outcomes also showed no evidence of a benefit. Similar results were observed on complete cases and using multiple imputation. When the intervention group was restricted to those who took up the offer of the app (n=395, 25.3%), participants in the intervention group were 80% more likely to report 6-month continuous abstinence (12.7% vs 7.0%; relative risk 1.80, 95% CI 1.30-2.45). Equivalent subgroup analyses produced similar results on the secondary outcomes. These differences persisted after adjustment for key baseline characteristics. Among motivated smokers provided with very brief advice to quit, the offer of the Smoke Free app did not have a detectable benefit for cessation compared with follow-up only. However, the app increased quit rates when smokers randomized to receive the app downloaded it. ISRCTN ISRCTN85785540; https://www.isrctn.com/ISRCTN85785540. RR2-https://onlinelibrary.wiley.com/doi/full/10.1111/add.14652.

How should trial teams make decisions about the proportions and diversity of the ethnic groups in their trial?

The benefits of randomised trials are not shared equally, and people from ethnic minority groups are a key constituency under-served by clinical research and clinical care. The STRIDE project aimed to give trialists practical information about how to decide which ethnic groups should be in their trials, and at what proportion. We considered trials in six clinical areas: cancer, cardiovascular, diabetes, maternal health, mental health, and smoking cessation. We created a summary for each, including participants-intervention-comparators-outcomes, and data on disease prevalence by ethnicity. These were discussed with panels with clinical expertise, trial and methodology expertise, lived experience, funding, and experience of working with and on behalf of ethnic communities. For each trial, we asked panel members to decide which ethnic groups should have been involved and at what proportion. We discussed 23 trials with 40 individual panel members. Panels found our questions difficult to answer. The lack of publicly available data on prevalence by ethnicity was central to this. Where data were available, decision-making was easier but not simple. The discussions led to eight STRIDE recommendations. We recommend that discussions involve diverse teams and that discussions need time, with access to the best available data. In the absence of data or consensus, we recommend the adoption of 'default' minimum rates of inclusion, with oversampling considered. These discussions should inform site selection, and the practical challenges of recruitment and retention should not determine which groups are to be included. We also suggest five policy initiatives to support implementation of the recommendations. Broadly, these are (1) funders need to signal that ethnic diversity is expected, (2) trial teams need access to better data, (3) funders and others need to signal that ethnic diversity means better science, (4) more funding is needed for evaluation, and (5) Good Clinical Practice training should cover ethnic diversity. Agreeing targets for which ethnic groups to involve in a trial is essential but difficult. Our eight recommendations could help to make trials more ethnically diverse if followed, and we suggest five policy initiatives that would create a supportive environment for their implementation.

Contingency management for monosubstance use disorders: Systematic review and assessment of predicted versus obtained effects.

Contingency management (CM) is notably successful as a substance use disorder treatment and is most effective when targeting monosubstance use. Evidence suggests the effects of CM exceed predictions based on the value of the incentives delivered for monosubstance abstinence. In this systematic review, we examine common variations of CM interventions applied to a single substance to determine what factors may contribute to the larger effect. Our results show that CM produced moderate to large effect sizes when single drugs were targeted, with stable effects over time. We also found that interventions targeting cocaine abstinence overwhelmingly outperformed their predicted effect, whereas interventions for smoking cessation did not. Thus, incentives alone may not account for the success of CM, at least when applied to stimulant use disorder. We propose other potential sources of the effect including social reinforcement and the specific parameters of the reinforcement schedule.

Self-efficacy and health warnings as predictors of smoking cessation intent among Moroccan adolescents: Evidence from the Global Youth Tobacco Survey data

Self-efficacy and health warnings as predictors of smoking cessation intent among Moroccan adolescents: Evidence from the Global Youth Tobacco Survey data

Advantage of smoking cessation after coronary artery bypass grafting: a mortality study.

Advantage of smoking cessation after coronary artery bypass grafting: a mortality study.

Addressing tobacco screening and treatment among racially and ethnically minoritized parents in pediatric clinics: barriers and facilitators.

Household secondhand smoke (SHS) exposure remains a significant health issue for racially and ethnically minoritized children in the United States. Delivering parental tobacco treatment during pediatric primary care visits can reduce children's SHS exposure. This study examined current tobacco screening practices and health system stakeholder perceptions of facilitators and barriers to addressing tobacco use during pediatric visits among racially and ethnically minoritized parents. We conducted 25 semi-structured interviews with clinicians, staff, and health system leaders from 5 pediatric primary care clinics in Minneapolis-St. Paul, Minnesota. The study was informed by the Health Equity Implementation Framework. Interviews were analyzed using both directed content and thematic analysis. Participants identified multilevel facilitators and barriers to addressing parental tobacco use in minoritized families. Within the clinical encounter, barriers included linguistic and cultural barriers, health system navigational challenges, medical mistrust, low levels of clinician and staff knowledge, skills, and confidence, time constraints, and lack of alignment with external metrics. Facilitators centered on leveraging interpreters' cultural knowledge and the presence of culturally-congruent clinicians and staff to reduce medical mistrust and stigma, developing linguistically and culturally relevant resources, and integrating prompts and resources into the electronic health record. Participants described how lessons from previous system change mechanisms would facilitate this work. Addressing health system, training and resources, and linguistic and cultural barriers among clinicians and staff is essential to strengthen their capacity to address household SHS exposure among racially and ethnically minoritized populations as a component of pediatric preventive care. Clinicians and health system staff perceive unique barriers to identifying and addressing parental tobacco use among racially and ethnically minoritized parents during pediatric primary care visits. Solutions to expand tobacco treatment access to minoritized parents in pediatric settings must attend to clinician training needs on tobacco treatment, embedding clinical encounter resources and reminders that match the linguistic and cultural needs and preferences of their patient populations, and increasing access to high quality interpreting services and culturally-congruent staff.

Feasibility of recruiting young adults with low socioeconomic status for formative evaluation of a smoking cessation mobile intervention.

Participant recruitment is critical to the success of smoking cessation trials. However, recruitment feasibility studies for inclusion and exclusion criteria commonly used in smoking cessation research remain scarce. We assessed the feasibility of recruiting potential research volunteers (PRVs) under two sets of inclusion criteria to inform eligibility requirements for a smoking cessation mobile intervention trial. We invited PRVs nationwide to participate in qualitative evaluation of a smoking cessation mobile application. To be eligible under Criteria I, participants were aged 18-29 years, neither four-year college graduates nor enrollees, exclusive cigarette smokers, willing to quit within 30 days, and not using cessation aids. Criteria II expanded eligibility to those using cigarettes and non-combustible tobacco products (e.g. e-cigarettes) and willing to quit within 6 months. We calculated recruitment yields and associated costs. Of 10533 PRVs screened for eligibility, 48 were enrolled. Only 54 (0.5%) participants qualified under Criteria I and 164 (1.6%) under Criteria II. Age ineligibility was the top reason for exclusion (66.7%), whereas lifetime smoking, quit timeframe, and other tobacco product use contributed to ineligibility rates ranging from 46.5% to 65.3%. Enrolled participants were equally split by sex and roughly reflected the racial/ethnic composition of the United States. American Indians, who have the highest smoking prevalence, were <5% of enrolled participants. Recruitment costs averaged $106 per PRV. Eligibility requirements used in cessation trials were restrictive for recruitment efforts. Relaxing inclusion criteria will reflect current tobacco use patterns and facilitate the timely completion of trials within budgetary thresholds.

Effect of Electronic Cigarettes on the Change of Fagerstrom Test for Nicotine Dependence Scores during 1-Year Follow-up.

The use of e-cigarettes is increasing globally, particularly among young adults. Although several use them to quit smoking, their effects are controversial. The Fagerstrom Test for Nicotine Dependence (FTND) was used to assess nicotine dependence in the smoking cessation process. This study examined changes in FTND scores among young adults using different types of cigarettes over a 1-year period. Prospective cohort data were collected from cigarette users at higher education institutions in the lower northern region of Thailand to analyze changes in FTND scores over a 1-year period. E-cigarette users and combined users were compared with conventional cigarette users. A marginal structural model (MSM) with an inverse probability of weighting (IPW) was used to adjust for time-dependent and time-independent confounders. Of the 133 participants, 58 were e-cigarette users (43.6%), 33 were combined cigarette users (24.8%), and 42 were conventional cigarette users (31.6%). The results revealed that when both time-dependent and time-independent confounders were adjusted using MSM with IPW, e-cigarette users had a 0.20 decrease in the mean FTND score, and combined users had a 0.47 decrease in the mean FTND score compared to conventional cigarette users. However, the difference was not statistically significant. The use of e-cigarettes or combined cigarettes did not significantly affect nicotine dependence levels in young adults over a 1-year period. Consequently, e-cigarettes should not be recommended to reduce nicotine dependence among young adult cigarette users. Further studies are required to determine whether e-cigarettes affect smoking cessation rates.

Association of life's essential 8 with chronic obstructive pulmonary disease: a population-based analysis of NHANES 2007-2018.

Chronic obstructive pulmonary disease (COPD) is closely linked to cardiovascular diseases. We aimed to investigate the association between Life's Essential 8 (LE8), the newly established measurement to assess cardiovascular health (CVH), and COPD among U.S. general adults. This study extracted the National Health and Nutrition Examination Survey (2007-2018) data. Multivariate logistic regression models were used to examine the associations between LE8 and COPD. A restricted cubic spline regression model was used to explore the dose-response relationships between LE8 scores and COPD. In addition, subgroup and sensitivity analyses were performed to assess the robustness of our results. Our study included 19,774 participants representing 145.2million non-institutionalized U.S. population aged ≥ 20 years. The overall age-adjusted prevalence of COPD was 4.5%. After adjusting for the potential covariates, LE8 was inversely associated with COPD [adjusted odds ratio (AOR) = 0.169, 95% CI: 0.115, 0.249], exhibiting a nonlinear dose-response relationship (P for nonlinearity < 0.05). Similar trends in the associations of health behavior score (AOR = 0.300, 95% CI: 0.223, 0.404) and health factor score (AOR = 0.603, 95% CI: 0.426, 0.852) with COPD were also identified. Furthermore, higher LE8 metric scores of nicotine exposure and sleep health were associated with a lower prevalence of COPD. LE8 was inversely associated with spirometric/self-reported COPD in a nonlinear trend, primarily driven by the nicotine exposure metric of LE8. Adhering to LE8 guidelines, especially smoking cessation, to sustain optimal CVH levels may be beneficial to alleviate the burden of COPD.

Abstract 4138292: Smoking cessation is linked to regression of electrocardiographic left ventricular hypertrophy

Introduction/Background: Electrocardiographic left ventricular hypertrophy is a strong predictor of cardiovascular morbidity and mortality. Further, smoking cessation provides a range of health benefits; however, its association with left ventricular hypertrophy is unclear. Research Questions/Hypothesis: What impact does smoking cessation have on left ventricular hypertrophy regression? Goals/Aims: We investigated the association between smoking cessation and regression of left ventricular hypertrophy. Methods/Approach: We compared electrocardiographic left ventricular hypertrophy between baseline and 6 years after smoking cessation follow-up visits in 752 non-hypertensive subjects (695 males, 47.8±9.2 years), from available datasets of 234 596 health check-ups. Left ventricular hypertrophy on ECG was assessed using the Sokolow-Lyon voltage criteria: SV1+RV5 (mV), with left ventricular hypertrophy defined as &gt;3.5 mV. Results/Data: After 6 years of smoking cessation, body weight was found to increase (from 65.7±10.5 to 68.1±10.8 kg, p &lt;0.0001) and systolic blood pressure also increased (from 112.9±12.7 to 122.0±14.2 mmHg, p &lt;0.0001). Nevertheless, left ventricular hypertrophy on ECG regressed significantly (from 2.47 to 2.41 mV, p &lt;0.0001), and the proportion fulfilling the criteria for left ventricular hypertrophy also decreased from 8.4 to 6.5%. In addition, the antihypertensive drug prescription rate due to elevated blood pressure after 6 years was 13.7% (103/752). Therefore, the regression of left ventricular hypertrophy with or without antihypertensive drug use was assessed. The results showed that left ventricular hypertrophy regressed significantly both [2.68→2.45 mV ( p &lt;0.0001)] and [2.44→2.40 mV ( p =0.01)] in the groups administered (n=103) and not administered (n=649) antihypertensive drugs, respectively. Conclusions: Smoking cessation was found to be associated with regression of electrocardiographic left ventricular hypertrophy, despite being potentially associated with future weight gain, increased blood pressure, and with or without antihypertensive drugs. The results indicated that the health benefits of left ventricular hypertrophy regression from smoking cessation may outweigh the negative effects of weight gain and increased blood pressure from smoking cessation.

Specialty Tobacco Treatment Implementation in Oncology: A Qualitative Study.

In 2017, the National Cancer Institute (NCI) funded the Cancer Center Cessation Initiative (C3I) to implement and expand tobacco treatment programs in routine oncology care. Many C3I programs developed specialty care programs staffed by tobacco treatment specialists (TTSs) to deliver evidence-based treatment to adult patients who smoke. People involved in specialty tobacco treatment programs can help to identify implementation strategies and adaptations that may enhance tobacco treatment reach and effectiveness in cancer care and help more patients with cancer quit using tobacco. We conducted semistructured interviews with TTSs from 21 C3I-funded cancer centers and applied content analysis to interview transcripts from 37 TTSs and 17 respondents in other program roles. We used the Consolidated Framework for Implementation Research to code interview data. We identified final themes and implementation strategies and adaptations recommended by respondents on the basis of these codes. Respondents shared that implementation of specialty tobacco treatment programs in cancer care settings could be facilitated by training staff to provide patient connection to services, incorporating prescription of no- or low-cost cessation medications, hiring additional staff to deliver tobacco treatment, allocating space to the program, and automating electronic health record workflows. TTSs and others involved in specialty tobacco treatment in NCI-designated cancer centers identified ways to improve tobacco treatment access, use, and effectiveness by (1) adapting specialty tobacco treatment delivery to meet patient needs; (2) facilitating referrals and pharmacotherapy coordination; and (3) committing staffing, space, and support resources to tobacco treatment programs. Key program participants suggested that these approaches would help more oncology patients connect with evidence-based tobacco treatment and quit smoking.

Prevalence and characteristics of smokers interested in using virtual reality for encouraging smoking cessation: a representative population survey in Great Britain

Abstract Background Cigarette smoking is one of the leading causes of morbidity in the world. Virtual reality (VR) has been used to encourage and support quit attempts. However, interest in VR may differ according to sociodemographic characteristics. This study aimed to estimate the proportion and associated characteristics of smokers in Great Britain who were interested in using VR for smoking cessation. Methods Data were collected from 6,858 adults between February to April 2023, from the Smoking Toolkit Study—a monthly, nationally representative, cross-sectional survey of adults in Great Britain. Of these, 873 were smokers (unweighted). Prevalence of interest was assessed descriptively and associations between interest and sociodemographic and smoking characteristics were analysed with weighted logistic regression models. Results Of 905 (weighted) smokers, 34.6% (95% Confidence Interval (CI):31.0%-38.5%) were interested in using VR for smoking cessation. Smokers had greater odds of reporting interest in VR for smoking cessation who were: highly motivated to quit (Odds Ratio (OR):2.41, 95% CI:1.59–3.65), had made a quit attempt in the past year (OR:1.95, 95% CI:1.37–2.77), currently trying to cut down (OR:1.90, 95% CI:1.34–2.67) and interested in VR generally (OR:10.42, 95% CI:6.97–15.57). Those ≥ 65 years old (OR:0.29, 95% CI:0.15–0.57) and women (OR:0.69, 95% CI:0.49–0.97) were less likely to report interest. Conclusions The results of this study indicate that up to a third of adult smokers may be interested in using VR to support a quit attempt. However, the potential reach of a VR smoking cessation intervention may be lower in certain subgroups such as women, adults 65 years or older, and adults less motivated to quit. From a health equity perspective, it is recommended that non-digital but effective interventions should be made readily available for adults at risk of digital exclusion due to lack of interest. However, as VR grows in popularity and its technological potential becomes fully realised, future research could also focus on strategies to reduce digital exclusion and increase interest. For example, by involving these subgroups in co-design activities and using novel dissemination strategies.

E -cigarettes and kidney health: current knowledge and future perspectives.

Chronic conventional cigarette smoking has been closely linked to incident chronic kidney disease (CKD) in the general population. It is associated with the acceleration of pre-existing CKD and failure of kidney allograft function. Cessation of conventional cigarette smoking is effective in reducing the increased risk of smoking induced kidney damage. This narrative review summarizes current knowledge and future study perspectives of the impact of e-cigarettes (e-cigs) use on kidney health. The past decade has seen a dramatic increase in the use of electronic nicotine delivering systems, also called e-cigs. Compared to conventional cigarette smoking, little is known concerning the effects of e-cigs use on kidney health. A few cross-sectional studies suggest an association between vaping and kidney damage (albuminuria, reduction in estimated glomerular filtration rate) in adolescents and young adults. Furthermore, limited animal experiments indicate that e-cigs constituents/aerosols may lead to structural and functional kidney damage. The renal health effects of e-cigs remain largely uncertain and make it difficult to draw definitive conclusions about e-cigs use and kidney health. The relatively new popularity of e-cigs, the wide variability in device design and e-liquid formulations, and the lack of standardized methods to measure daily or life-long e-cigs exposure make it challenging to conduct comprehensive long-term studies. Nephrologists should actively address smoking habits in their patients and urge cessation of conventional cigarette smoking as well as e-cigs use to prevent CKD progression and improve overall health.

Association of Cigarette-E-Cigarette Transitions With Respiratory Symptom Resolution.

Adults increasingly use e-cigarettes for cigarette cessation because of the perceived reduced risk. While e-cigarette use is associated with reduced toxicant exposure compared with smoking, it is unclear whether transitioning from cigarettes to e-cigarettes is associated with resolution of respiratory symptoms. Data were obtained from the Population Assessment of Tobacco and Health (PATH) study waves 1-5. US adult participants were separated into observations with cigarette-e-cigarette exposure intervals determined from PATH waves 1-2, 2-3, and 3-4. Observations were included if the participant reported exclusively smoking at baseline and reported a baseline cough or wheeze. Mixed-effect Poisson models measured the association between cigarette-e-cigarette transitions over the two-wave exposure interval (from smoking to nonuse, exclusive e-cigarette use, continued smoking, or dual use) and the reported resolution of the participant's cough or wheeze. Among 5210 (3362 unique) observations, transitioning from cigarettes to e-cigarettes was associated with increased rates of wheeze resolution (incidence rate ratio [IRR] = 1.33; 95% confidence interval [CI] = 1.01 to 1.75) but not cough resolution (IRR = 1.18; 95% CI = 0.93 to 1.50) compared with persistent smoking. Cigarette to dual-use transitions were not associated with improvements in symptom resolution, and those who switched to dual use and maintained or increased their smoking intensity had 15% decreased rates of respiratory symptom resolution compared with persistent smoking. E-cigarette-assisted smoking cessation may increase rates of respiratory symptoms resolution among smokers who completely transition to e-cigarettes; however, there is risk for additional harm among those who initiate e-cigarette use without decreasing their smoking intensity. Government agencies are increasingly weighing the risks and benefits of e-cigarette-assisted cigarette cessation given the reduced harm associated with e-cigarette use. This study provides novel evidence that completely transitioning from cigarettes to e-cigarettes is associated with increased rates of resolution from self-reported wheeze symptoms. However, risk exists in e-cigarette-assisted cigarette cessation, as those who transitioned from exclusive cigarette smoking to dual use and did not reduce their cigarette smoking intensity had decreased rates of respiratory symptom resolution compared with persistent smokers.

Post-discharge tobacco abstinence in a Mumbai hospital after implementation of tobacco cessation counseling: A pragmatic evaluation of the LifeFirst program.

Hospitalization provides a key opportunity to address tobacco use. Few studies have examined cessation treatment in hospitals in low- and middle-income countries (LMIC). We aimed to measure tobacco abstinence among individuals discharged from a Mumbai hospital after the implementation of cessation counseling compared to abstinence among those discharged pre-implementation. Pre-post intervention study in the Prince Aly Khan Hospital, Mumbai pre- (11/2015-10/2016) and post-implementation (02/2018-02/2020) of LifeFirst counseling. LifeFirst is multi-session (up to six sessions) counseling extending from hospitalization up to six months post-discharge. Primary analyses compare self-reported 6-month continuous abstinence among hospitalized individuals post-implementation (intervention) with pre-implementation (comparator) using an intent-to-treat approach that includes all participants offered LifeFirst post-implementation in the intervention group. Secondary analyses compare those who received ≥ 1 LifeFirst session with the pre-implementation group. We enrolled n = 437 individuals pre-implementation (8.7% dual use, 57.7% smokeless tobacco, 33.6% smoking) and n = 561 post-implementation (8.6% dual use, 64.3% smokeless tobacco, 27.1% smoking). Post-implementation, 490 patients (87.3%) accepted ≥ 1 counseling session. Continuous abstinence 6-months post-discharge was higher post-implementation (post: 41.6% vs. pre: 20.0%; adjusted odds ratio [aOR]: 2.86, 95% confidence interval [CI] 1.94-4.21). Those who received LifeFirst had higher odds of continuous abstinence compared to pre-implementation (aOR: 2.95, 95% CI 1.98-4.40). Post-discharge abstinence was more common after implementation of a multi-session tobacco counseling program for hospitalized patients compared to abstinence among patients hospitalized before implementation. These findings represent observational evidence of a promising association between post-discharge abstinence and a hospital-based tobacco cessation program implemented within routine practice in an LMIC setting.

Abstract 4142792: VA Lipid Optimization Reimagined Quality Improvement Project (VALOR-QI) at the Dallas VA

The Dallas VA is one of the 50 VA sites participating in a national quality improvement initiative called VALOR-QI: VA Lipid Optimization Reimagined Quality Improvement Project. VALOR-QI is a collaborative project between the U.S. Department of Veterans Affairs (VA) and the American Heart Association (AHA) with the goal of positively impacting veterans’ cardiovascular (CV) health. As part of the program, VA sites work with an AHA QI Consultant to develop and deploy a local quality improvement plan to help overcome site specific barriers preventing veterans from achieving optimal cholesterol levels. We hypothesize that the QI strategies implemented will positively impact lipid levels and ultimately CV outcomes among high-risk patients. We aim to assess potential barriers to achieving LDL-C &lt;70 mg/dL and develop efficient ways to maintain LDL-C goal. Our approach to the VALOR-QI program at Dallas VA is by enrolling patients with established ASCVD and LDL-C &gt; 70 mg/dL from cardiology, vascular, diabetes, lipid, and independent PharmD clinics. These patients are followed by a health coach every 2- 6 months. Medical adherence is enforced by the health coach ensuring timely refills and reminders. Lifestyle modifications are encouraged via educational materials, referral to dieticians, recreation classes, and tobacco cessation. Patients are also encouraged to sign up for patient portal (my HealtheVet) to access electronic medical records and expedite communication with their healthcare team. The health coach provides individualized counseling regarding lipid lowering treatment and acts as liaison between patients and their providers. VALOR-QI was launched at Dallas VA in Jan 2023. As of May 17 th , 2024, an interim analysis showed that out of 132 veterans engaged, 49 (37.1%) achieved target LDL-C, 66 (50%) received educational material, 4 (3.03%) were referred to dieticians, 10 (7.58%) were referred to recreation programs, and 4 (17.4% of active smokers) were interested in quitting. In conclusion, our VALOR-QI strategy at Dallas VA showed encouraging results, but it is premature to make final conclusions. The support of a health coach showed improved medication adherence, health literacy, and lifestyle modification, thus achieving LDL-C target. Major barriers to achieving target LDL-C were health literacy about high cholesterol, challenges in navigating the health care system, and treatment inertia among patients and providers.

Abstract 4122507: Fetal Socioeconomic and Environmental Exposures Influence Fetal Brain Growth and Risk of Neonatal Brain Injury in Congenital Heart Disease

Introduction: Fetuses with CHD have smaller total brain volume (TBV) and are at risk for acquired brain white matter injury (WMI), both of which are linked to neurodevelopmental impairments. Social determinants of health (SDOH) and other fetal environmental factors have been linked to fetal brain health in other populations. Our aim was to test our hypothesis that these exposures influence fetal brain growth and postnatal WMI risk in severe CHD. Methods: Our prospective longitudinal cohort study enrolled fetuses with severe CHD to undergo fetal brain MRI and postnatal pre-operative brain MRI. Participants completed home environment surveys on individual SDOH and exposures. Community SDOH metrics were determined using Child Opportunity Index (COI) based on home address. An ‘at risk’ fetus composite was created if there was exposure to: personal/household smoking, welfare/food stamps, or poverty. TBV was calculated at both time points. Presence/degree of WMI was determined on postnatal MRI. Repeated measures analysis and logistic regression were performed to determine association between individual and community SDOH metrics with rate of TBV growth and risk of WMI. Results: 55 participants enrolled (54 fetal scans: mean GA 33.9 wks, 95%CI: 33.7,34.1; 47 neonatal scans: mean GA 39.3 wks 95%CI: 38.9,39.6). Fetal sex, smoking exposure, and several individual SDOH were associated with TBV growth. Adjusting for fetal sex and GA at scan, rate of TBV growth was slower with smoking exposure (coeff: -5.2, 95%CI: -10.3, -0.2, p= 0.04) and trended towards significance for those with welfare/food stamps or poverty. ‘At risk’ fetuses had slower rate of TBV growth than those without risk (coeff: -2.5, 95%CI: -5.0, -0.07, p= 0.04) (Figure 1). There were lower odds of pre-operative WMI with high COI compared to low after adjusting for GA at scan (OR= 0.16, 95%CI: 0.03, 0.9, p= 0.04). Conclusion: Smoking exposure and individual-level SDOH influence brain growth, while community COI is associated with risk of postnatal pre-op WMI in CHD. Our findings identify targets for intervention to optimize brain growth and outcomes in the CHD population, including smoking cessation programs, and nutritional and needs assessment during pregnancy.