Tobacco Cessation Efforts Research Articles

Veteran-nonveteran differences in alcohol and drug misuse by tobacco use status in Alabama SBIRT

ABSTRACTAlcohol and substance use can challenge military veterans who live in rural communities. In 2016, the screening, brief intervention, and referral to treatment in Alabama (AL-SBIRT) program was implemented in west Alabama. The primary aim of this study was to determine whether current tobacco use modified the relationship between veteran status and substance misuse. Self-reported wellness data was collected regarding substance, alcohol, or tobacco consumption. Risk levels for alcohol and drug use were measured using the United States Alcohol Use Disorders Identification Test (US-AUDIT) and the Drug Abuse Screening Test (DAST)-10. Substance and tobacco use were significantly and positively correlated. Veterans had a higher US-AUDIT and DAST score than nonveterans, and tobacco appeared to be an exacerbating factor. Effective evidence-based interventions are needed in rural settings. Technology based programs and motivational interviewing with trained clinicians may serve as beneficial and cost-effective interventions for tobacco use prevention and cessation efforts.

Federally qualified health center use of the Nebraska Tobacco Quitline.

INTRODUCTIONPromoting cessation services like quitlines is important to reduce tobacco-related morbidity and mortality. A critical need exists to improve clinical staff’s awareness of tobacco quitlines and reduce barriers in recommending and referring tobacco-using patients. The purpose was to obtain information on the use of the Nebraska Tobacco Quitline (NTQ) by Federally Qualified Health Center (FQHC) clinical staff at FQHC settings with tobacco-using patients. Specific aims were: 1) identify FQHC clinical staff and setting characteristics that influence current tobacco cessation assessment and interventions, and 2) identify barriers and facilitators that influence future use of NTQ by FQHC clinical staff and settings.METHODSThis study recruited participants from seven FQHC settings. All FQHC provider and non-provider clinical staff were recruited to complete a Clinical Staff Survey. The Medical Director, Associate Medical Director, or Nurse Manager at each FQHC was asked to provide setting information through the Setting Survey. Descriptive statistics were used to report percentages and qualitative data were analyzed using pattern coding.RESULTSThe main findings include insufficient awareness and insufficient perceived effectiveness of NTQ, non-providers reporting a limited role in tobacco cessation efforts beyond assessment of tobacco use, and the lack of supportive setting processes for intervention use.CONCLUSIONSTargeted efforts are needed to increase awareness and perceived effectiveness of NTQ, for role expansion for non-providers, and to add Electronic Health Record (EHR) prompts and e-referral capability to increase cessation interventions including NTQ referrals. Future research is suggested to better understand patient-specific barriers in using NTQ.

Characteristics of US adults attempting tobacco use cessation using e-cigarettes

BackgroundUse of e-cigarettes for tobacco cessation efforts is a growing trend in the United States. However, little is known about the factors that determine the use of e-cigarettes for this specific purpose. MethodsThis study examined current and former cigarette smokers that reported ever using e-cigarettes. Data were obtained from a 2018 Texas population health assessment survey (n = 569) and weighted to be representative to Texas. A multivariable logistic regression was used to assess the socio-demographic and behavioral correlates of using e-cigarettes for tobacco cessation. ResultsOverall, 41.3% of e-cigarette users reported using them for tobacco cessation. Among ever e-cigarette users, Non-Hispanic blacks (aOR: 0.21; 95% CI, 0.07–0.64), males (aOR: 0.40; 95% CI, 0.20–0.80), and individuals not confident in obtaining health information (aOR: 0.38; 95% CI, 0.15–0.96) were less likely to use e-cigarettes for tobacco use cessation. Conversely, among ever e-cigarette users, odds of using e-cigarettes for tobacco cessation were higher among those who were 35–44 years old (aOR: 3.68, 95% CI: 1.26–10.71), those who received advice to quit smoking from a healthcare professional (aOR: 2.77, 95% CI, 1.36–5.64), and those with more than 5 years since their last routine checkup (aOR: 3.91; 95% CI, 1.23–12.45). ConclusionFindings from this study suggest that both health behaviors and sociodemographic factors predict use of e-cigarettes for the purpose of tobacco cessation. Furthermore, the relationship between use of e-cigarettes as a cessation device and being advised to quit tobacco use by a healthcare professional calls for additional investigation.

Tobacco cessation practices among primary care physicians in northern Illinois.

e23054 Background: Tobacco cessation is an acknowledged key component of cancer survivorship programs, but significant barriers to program implementation exist. In a 2012 ASCO member survey, 86% of respondents agreed that tobacco cessation should be a routine part of clinical care. However, only 29% reported adequate training. A 2013 survey of physicians at NCI Cancer Centers also showed high levels of support for such programs, but only 1% of oncologists personally engaged themselves. This view is in line with ASCO guidelines that recommend cessation interventions by primary care (PCPs). There is a disconnect between the oncologist’s desire to provide high quality tobacco cessation support for cancer patients and the delegation and delivery of such support. The goal of our study is to evaluate current tobacco cessation practices of PCPs in a large integrated healthcare system. Methods: An electronic survey was sent to all PCPs (n = 165) of the NorthShore Medical Group (Northern Illinois) with questions about their views and practices regarding tobacco cessation. Results: 53 PCPs responded to the survey (response rate of 32%). 94% of respondents believe that PCPs are primarily responsible for addressing tobacco cessation with general patients. 89% believe that PCPs are also responsible for cancer patients, although 34% believe the responsibility should be shared with oncologists. 100% believe that tobacco use affects cancer outcomes in their patients, and 98% report sufficient training in providing cessation support. 90% always ask their patients about tobacco status at the initial visit; this drops to 21% at follow-up visits. For current smokers, 57% of PCPs recommend tobacco cessation all the time and 36% recommend services most of the time. Lack of patient willingness was the most frequently cited barrier to tobacco cessation efforts (74%), followed by lack of time (46%) and lack of resources (42%). Conclusions: PCPs view themselves as primarily responsible for addressing tobacco cessation with their patients but are limited by multiple factors. This primary care-based approach is endorsed by ASCO and other clinical guidelines. More financial and clinical support should be allocated for successful efforts against tobacco dependency.

Implementation of a low-dose computerized tomography (LDCT) lung cancer screening program (LCSP) across a large integrated health system.

1537 Background: The LDCT LCSP was launched as a critical component of our Cancer Program to support tobacco cessation efforts and increase early detection. Initially it was offered as a self-referral low cost screening. The program was expanded when the Affordable Care Act and Center for Medicare/Medicaid Services covered it as a preventative services benefit in January 2015. Methods: 9 LDCT LCSP locations were implemented between 2014-September 2016. Program data are submitted to the American College of Radiology Lung Cancer Data Registry since 2016. In 2017, a Best Practice Alert was created within our electronic health record (EHR) to alert the primary care clinician if his/her patient met criteria for a LDCT. Each of the sites managed their own programs up until September 2018 when a dedicated team (Team) of two nurses and one data support specialist was justified. The Team focus is to increase awareness of the LDCT LCSP and criteria for eligibility, improve tobacco history taking and pack year documentation in the EHR, increase smoking cessation counseling and referral, and facilitate presentation of all Lung RADS category 4 cases for review at one of our two Multidisciplinary Lung Cancer Case Conferences. Standardized management of key incidental findings was developed for coronary artery calcification, non-lung masses, thoracic aortic aneurysm, and critical pulmonary conditions. To date, we have not examined the impact of the LDCT LCSP on smoking cessation rates. All 9 program sites have been named a Screening Center of Excellence by the Lung Cancer Alliance. Results: In 2016, 1849 LDCT Screenings were performed, 4701 (154% increase) in 2017 and 7154 (52.5% increase) in 2018. Cancer Detection rates were 1.3% in 2016, 1.8% in 2017 and 1.3% for January-June 2018. Cancer registry data reports a 9% increase in Stage 0, 1, 2A and a 7.2% decrease in Stage IV at time of diagnosis from 2014-2017. Conclusions: The implementation of a LDCT LCSP has increased the percentage of patients diagnosed at an earlier stage of lung cancer. With standardized management of key incidental findings, we anticipate improvement in early detection and management of cardiac and pulmonary diseases.

Quality Improvement Initiative to Improve Tobacco Cessation Efforts in Radiation Oncology.

Although continued tobacco use in patients who are treated with radiation therapy is associated with inferior outcomes and increased treatment-related toxicity, multiple studies have shown that current tobacco cessation efforts in oncology are insufficient. A quality improvement (QI) initiative was developed with the goal of improving tobacco cessation efforts in radiation oncology. Using iterative plan-do-study-act cycles, barriers to tobacco cessation were identified and then addressed with a single-institutional QI initiative designed to improve physician assessment of patient readiness to quit tobacco by 50% or more. Residents assessed readiness to quit tobacco during new patient consultations and recorded this assessment in prespecified fields within the electronic health record. Feedback on assessment efforts was provided to our department via an automated search of the electronic health record. From December 2014 to February 2015, before the initiation of the QI initiative, 4% of patients were assessed for their readiness to quit tobacco. After implementing the initiative, 67% of patients were assessed for their readiness to quit. After instituting a QI initiative at our institution, significantly more patients were assessed for readiness to quit tobacco before treatment with radiation therapy. Ongoing efforts in our department are aimed at improving the efficacy of this intervention.

Tobacco screening and cessation efforts by dental providers: A quality measure evaluation.

The purpose of this study was to adapt, test, and evaluate the implementation of a primary care "Preventive care and Screening" meaningful use quality measure for tobacco use, in dental institutions. We determined the percentage of dental patients screened for tobacco use, and the percentage of tobacco users who received cessation counseling. We implemented the dental quality measure (DQM), in three dental schools and a large dental accountable care organization. An automated electronic health record (EHR) query identified patients 18 years and older who were screened for tobacco use one or more times within 24 months, and who received cessation counseling intervention if identified as a tobacco user. We evaluated EHR query performance with a manual review of a subsample of charts. Across all four sites, in the reporting calendar year of 2015, a total of 143,675 patients met the inclusion criteria for the study. Within 24 months, including 2014 and 2015 calendar years, percentages of tobacco screening ranged from 79.7 to 99.9 percent, while cessation intervention percentages varied from 1 to 81 percent among sites. By employing DQM research methodology, we identified intervention gaps in clinical practice. We demonstrated the successful implementation of a DQM to evaluate screening rates for tobacco use and cessation intervention. There is substantial variation in the cessation intervention rates across sites, and these results are a call for action for the dental profession to employ tobacco evidence-based cessation strategies to improve oral health and general health outcomes.

Tobacco prevalence and cessation efforts in soldiers deployed to Afghanistan

McDowell, David MPAS, PA-C; Carius, Brandon M. MPAS, PA-C; Jackson, Amy L. MPAS, PA-C; Lyons-White, Tracey MPAS, PA-C; Duran-Stanton, Amelia M. PhD, DSc, MPAS, PA-C Author Information

Tobacco use and its determinants in the 2015 Kenya WHO STEPS survey

BackgroundAccording to the World Health Organization (WHO), in 2015, over 1.1 billion people smoked tobacco, which represents around 15% of the global population. In Africa, around one in five adults smoke tobacco. The 2014 Kenya Global Adult Tobacco Survey reported that 2.5 million adults use tobacco products. The objective of our study was to describe patterns and determinants of tobacco use from the 2015 Kenya STEPS survey, including use of “smokeless” tobacco products and the more novel e-cigarettes.MethodsThe WHO STEPwise approach to surveillance (STEPS) was completed in Kenya between April and June 2015. Logistic regression analyses was used to assess factors affecting prevalence and frequency of tobacco use. Sociodemographic variables associated with tobacco use were considered: age, sex, level of education, wealth quintile, and residence. The relationship with alcohol as an intervening risk factor was also assessed. Our main outcomes of interest were current tobacco use, daily tobacco use and use of smokeless tobacco products.ResultsOf 4484 respondents, 605 (13.5%) reported being current tobacco users. Most active tobacco users were male (n = 507/605, 83.8%). Three out of four tobacco users (n = 468/605, 77.4%) reported being less than 50 years old, with the average start age being 21 (20.6, 95% CI 19.3–21.8) and the average quit age 27 (27.2, 95% CI 25.8–28.6). Most tobacco users had only ever attended up to primary school (n = 434/605, 71.7%). Men had nearly seven times higher odds of being tobacco users as compared to women (OR 7.63, 95% CI 5.63–10.33). Alcohol use had a positive effect on tobacco use. Finally, less than ten respondents reported having used e-cigarettes.ConclusionThe 2015 Kenya WHO STEPS provided primary data on the status of tobacco use in the country and other leading NCD risk factors, such as alcohol, and associated diseases. Our findings highlight key target populations for tobacco cessation efforts: young people, men, those with lower levels of education, and alcohol consumers. Further data is needed on the use of smokeless tobacco, and its impact on smoked tobacco products, as well as on the novel use of e-cigarettes.

Abstract 5278: Tobacco and areca nut use among Chuukese youth in Guam

Abstract Background: Little is known regarding the tobacco use of Micronesian population in Guam. According to the Youth Risk Behavior Survey (YRBS) 2013, Micronesian youth have a higher prevalence rate of current smokers (27.2% vs. 15.7% for U.S.) and current smokeless tobacco users (39.7% vs. 8.8% for US) compared to the U.S. They also have the highest rate among all ethnic groups in Guam. This study aims to investigate tobacco use and areca nut use, which may explain high lung and bronchus cancer incidence and mortality rates among Micronesians. The survey in this study focuses on Chuukese youth, the largest group among Micronesians in Guam. Methods: Respondent-driven sampling method (RDS) was used to recruit 364 Chuukese youth (ages 13-19) to complete the survey. YRBS question items that measured cigarette, cigar, and smokeless tobacco use were included in the survey. Measures for areca nut use were also included. Chi-square tests were performed by bivariate analysis. Only high school-level youth are included in the analysis. Results: A total of 237 Chuukese high school students completed the survey. Fourteen percent of the participants currently smoke cigarettes, 6.4% currently smoke cigars, and 23.7% currently use smokeless tobacco. In addition, smokeless tobacco remains highest regarding daily use (11%) within the past 30 days prior the survey. Although there is high use of smokeless tobacco among participants, there are significant associations between gender and cigarette and gender and cigar use only. Boys smoke cigarettes and cigar at higher rates than girls. Among the recruited participants, 32% are areca nut users with tobacco product as an ingredient. There is significantly high association between smokeless tobacco users and areca nut with tobacco users. The majority of cigarette smokers (82.4%) have tried to quit smoking. Fifty-six percent of the smokeless tobacco users have tried to quit as well. However, only 17% of the participants are aware of the Guam Youth Quitline. Conclusion: Results suggest the need to raise awareness among Chuukese youth on tobacco cessation programs on Guam, particularly the smoking cessation quitline. Tobacco cessation efforts should not focus on cigarette use only, but must also be expanded to include the use of smokeless tobacco products and chewing areca nut. Future studies should investigate the roles and implications of tobacco as an ingredient of areca nut chewing among Micronesian youth. Citation Format: Lilnabeth P. Somera, Brayan Simsiman, Grazyna Badowski, Hye-ryeon Lee, Kevin Cassel. Tobacco and areca nut use among Chuukese youth in Guam [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5278.

Leveraging technology to promote smoking cessation in urban and rural primary care medical offices

We examined the use of automated voice recognition (AVR) messages targeting smokers from primary care practices located in underserved urban and rural communities to promote smoking cessation. We partnered with urban and rural primary care medical offices (n = 7) interested in offering this service to patients. Current smokers, 18 years and older, who had completed an office visit within the previous 12 months, from these sites were used to create a smoker's registry. Smokers were recruited within an eight county region of western New York State between June 2012 and August 2013. Participants were contacted over six month intervals using the AVR system. Among 5812 smokers accrued 1899 (32%) were reached through the AVR system and 55% (n = 1049) continued to receive calls. Smokers with race other than white or African American were less likely to be reached (OR = 0.71, 0.57–0.90), while smokers ages 40 and over were more likely to be reached. Females (OR = 0.78, 0.65–0.95) and persons over age 40 years were less likely to opt out, while rural smokers were more likely to opt out (OR = 3.84, 3.01–4.90). Among those receiving AVR calls, 30% reported smoke free (self-reported abstinence over a 24 h period) at last contact; smokers from rural areas were more likely to report being smoke free (OR = 1.41, 1.01–1.97). An AVR-based smoking cessation intervention provided added value beyond typical tobacco cessation efforts available in these primary care offices. This intervention required no additional clinical staff time and served to satisfy a component of patient center medical home requirements for practices.

Tobacco-Free Policies and Tobacco Cessation Systems at Health Centers Serving Lesbian, Gay, Bisexual, and Transgender Clients.

LGBT populations have high rates of tobacco use. Health centers serving LGBT clients are an important source of care. The researchers aimed to assess the implementation of recommended systems-level tobacco cessation interventions at these health centers. Using systematic searching, directories, and expert review, we identified health centers serving LGBT clients that provide primary care. We conducted phone-based, semi-structured interviews with administrators (n = 11) between September 2016 and March 2017 regarding implementation of the Clinical Practice Guideline, Treating Tobacco Use and Dependence: 2008 Update (the Guideline). Two authors confirmed saturation and two authors conducted thematic coding. Eight themes were identified, including clear evidence of systems-level procedures for asking about, advising on, and assessing tobacco use. Interviewees viewed tobacco use as important given existing disparities. However, there was room for improvement in the following areas: (1) Education for staff on tobacco cessation was ad hoc and not formalized; (2) materials and resources for tobacco cessation available in the center varied widely and changed when a staff champion arrived or left; (3) no point person was assigned to coordinate tobacco cessation efforts; and, (4) assessment of tobacco use as a vital sign is not consistent-some centers met meaningful use quality metrics (e.g., once or more in the past 24 months) instead of the Guideline recommendation (every visit). Addressing tobacco use competes with addressing other health risk behaviors. Administrators at health centers serving LGBT clients viewed tobacco use as an important issue. However, there was room for improvement in implementation of systems recommended in the Guideline. Targeted outreach is warranted to improve standardization of implementation and promote cessation of tobacco use.

The relationship between past-month marijuana, cigarette, and cigar use among older adults in the United States.

INTRODUCTIONPrevious research indicates that marijuana use may be interrelated with combustible tobacco use among U.S. adolescents and young adults. However, little is known about this relationship during older adulthood. The purpose of this study was: 1) examine the prevalence of past-month marijuana, cigarette and cigar use, and 2) assess the associations between demographic and tobacco-use variables with past-month marijuana use, among a nationally representative sample of U.S. adults 50 years and older.METHODSData are from the public-use files of the 2013 National Survey on Drug Use and Health (NSDUH). The sample consisted of 6325 adults aged ≥50 years.RESULTSOverall, 2.98% (N=216) of the sample reported past-month marijuana use; higher prevalence was noted for those who were past-month users of cigarettes (15.62%, N=1162) and lower prevalence was noted for those who were past-month users of cigars (2.68%, N=176). After accounting for covariables, past-month cigarette use was the strongest predictor of past-month marijuana use (adjusted odds ratio [AOR]=5.19, 95% CI, 3.51-7.66). Additionally, past-month cigar use showed a positive association with past-month marijuana use (AOR=2.41, 95% CI, 1.23-4.72).CONCLUSIONSTobacco prevention, cessation, and control efforts that target older adults should be tailored effectively to address the use of marijuana and other combustible tobacco products.

Cost of Tobacco-related Cancer Hospitalizations in the U.S., 2014

Smoking has been causally linked to 12 tobacco-related cancers: oral cavity and pharynx, esophagus, stomach, colon and rectum, liver, pancreas, larynx, lung, cervix, bladder, kidney, and acute myeloid leukemia. Tobacco-related cancers-related morbidity and mortality have been well described, but little is known about the prevalence of tobacco-related cancer hospitalizations and associated costs. This study estimates the annual number of tobacco-related cancer hospitalizations and their associated direct medical costs in the U.S. This study examined data from the 2014 National Inpatient Sample, the largest publicly available all-payer inpatient care database in the U.S. The authors calculated number of hospitalizations, total costs, length of stay, and cost per stay for tobacco-related cancer hospitalizations and cancer hospitalizations not related to tobacco. In 2014, there were an estimated 461,295 annual tobacco-related cancer hospitalizations at a cost of $8.2 billion in the U.S. Tobacco-related cancers accounted for 45% of total cancer hospitalizations and cancer hospitalization costs. Compared with cancer hospitalizations not related to tobacco, tobacco-related cancer hospitalizations had a longer mean length of stay (6.8 vs 5.7 days). The burden of tobacco-related cancer hospitalizations is substantial in the U.S. These findings highlight the importance of tobacco prevention and cessation efforts to decrease the burden of tobacco-related cancers in the U.S.

Designing and validation of text messages for m-Health intervention for tobacco cessation and management.

Tobacco is a growing epidemic and tobacco-related death results in health consequences and lost economic opportunities. Tobacco cessation efforts mandate the use of multiple strategies to bring about behaviour change. To develop and validate health promotive text messages using transtheoretical model and prospect theory for behaviour change. The present observational study was conducted in a tertiary care hospital, Delhi among patients reporting at Tobacco Cessation Centre (TCC). The study was divided into two phases: first involved development of text messages in local language (Hindi) using a sound theoretical basis (TTM and prospect theory) and second phase dealt with validation of the developed text messages by patients and experts in the field of tobacco cessation. Descriptive statistics was obtained using the SPSS version 17. The sample comprised 20 males and 6 females. Average appeal score ranged from 6.1 to 9.6 (54 messages). Forty two messages out of a total of 54 messages were found to be appropriate after validation by the experts. Mean words of the final messages (42 messages) was 24.5 ± 1.3. Two hundred ninety one (90%) out of a total of 324 questionnaires showed adequate understanding of message as assessed by the reviewers. The current effort developed and validated health promotive text messages package to aid in tobacco cessation. The preventive text messages were grounded in evidence and sound theoretical basis and followed a standard validating procedure leading to satisfactory understanding and appeal in all domains.

Sexual Orientation Discrimination and Tobacco Use Disparities in the United States.

Differences in tobacco/nicotine use by sexual orientation are well documented. Development of interventions requires attention to the etiology of these differences. This study examined associations among sexual orientation discrimination, cigarette smoking, any tobacco/nicotine use, and DSM-5 tobacco use disorder (TUD) in the United States. We used data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions based on in-person interviews with a nationally representative sample of noninstitutionalized US adults. Approximately 8.3% of the target population was estimated to have same-sex sexual attraction, 3.1% had at least one same-sex sexual partner in the past-year, and 2.8% self-identified as lesbian, gay, or bisexual. Sexual attraction, sexual behavior, and sexual identity were significantly associated with cigarette smoking, any tobacco/nicotine use, and DSM-5 TUD. Risk of all tobacco/nicotine outcomes was most pronounced for bisexual adults across all three sexual orientation dimensions. Approximately half of sexual minorities who identified as lesbian or gay and one-fourth of those who identified as bisexual reported past-year sexual orientation discrimination. Sexual minorities who experienced high levels of past-year sexual orientation discrimination had significantly greater probability of past-year cigarette smoking, any tobacco/nicotine use, and TUD relative to sexual minorities who experienced lower levels of sexual orientation discrimination or no discrimination. Sexual minorities, especially bisexual adults, are at heightened risk of cigarette smoking, any tobacco/nicotine use, and DSM-5 TUD across all three major sexual orientation dimensions. Tobacco prevention and cessation efforts should target bisexual adults and consider the role that sexual orientation discrimination plays in cigarette smoking and treatment of TUD. Differences in tobacco/nicotine use by sexual orientation are well documented, but little is known about differences across all three sexual orientation dimensions (attraction, behavior, and identity) or the origins of these differences. This study is the first to show that differences in tobacco/nicotine use across the three sexual orientation dimensions for respondents who were exclusively heterosexually-oriented were minimal, but varied more substantially among sexual minority women and men across the three sexual orientation dimensions. Sexual minorities who experienced high levels of past-year sexual orientation discrimination had significantly greater probability of cigarette smoking, any tobacco/nicotine use and DSM-5 tobacco use disorder.

Ways that psychologists can contribute to tobacco cessation efforts in integrated primary care settings.

Ways that psychologists can contribute to tobacco cessation efforts in integrated primary care settings.

Abstract 3265: Characterization of epithelial oral dysplasia in non-smokers: working towards precision medicine

Abstract Objectives: Although tobacco usage is still one of the strongest risk factors associated with oral cancer risk, there is a subset of non-smokers who develop oral cancer. Tobacco cessation efforts have resulted in a drop in oral cancer rates associated with this habit, leading to a growing interest in the increased proportion of cases occurring among non-smokers (NS). Lesions with oral epithelial dysplasia (OED) are at risk of progressing to oral cancer. Not only is the natural history of OED in NS poorly understood, but the path to interception of disease in NS is poorly defined. There is a gap in the knowledge surrounding the clinicopathological and genetic characterization, and the risk of progression in this growing category. This information is critical to the evolution of precision medicine in this subgroup. The aim of this study was to: 1) Describe the molecular and clinicopathological features of OED in NS as compared to smokers in longitudinal follow-up; and 2) To compare progression rates and time to progression in NS and smokers with OED. Methods: The study focused on cases with histologically confirmed mild or moderate OED in follow-up in the Oral Cancer Prediction Longitudinal Study. Clinicopathological data, including lesion site, size, texture, colour, consistency, border characteristics, fluorescence visualization (FV), and toluidine blue (TB) retention, were collected in addition to detailed smoking history. A genomic based marker test (gMART) which uses loss of heterozygosity (LOH) at key chromosomal loci to stratify lesions to progression risk, was performed on baseline biopsies. Progression was considered to be advancement to severe dysplasia, carcinoma in situ, or squamous cell carcinoma. Results: Out of 231 OED, 30% were NS related, based on self-reported smoking status. Although there were more smokers with OED than NS, a significantly higher proportion of the OED underwent malignant transformation in NS (P=.048). Although not significant, time to outcome was also faster in this group. Most clinical features were equally predictive except for lesion site. Ever smokers (ES) were more likely to have OED at the floor of mouth while OED was more likely to occur at the tongue or gingiva (P<.001) in NS. LOH risk patterns were strongly associated with progression (moderate risk = OR 4.84; high risk = OR 28.1; P=.001) and equally sensitive in both NS and ES subgroups. Conclusions: These findings support the premise that progressive lesions in NS and ES have some similar genetic underpinnings, and emphasize the need for clinicians to consider the molecular genomic profiles in the triage of OED. LOH markers can sort high-risk lesions, despite risk habits, and should be an important consideration in the treatment of OED. This marker is of particular use in the targeting of candidates for chemoprevention. Citation Format: Leigha D. Rock, Miriam P. Rosin, Lewei Zhang, Batoul Shariati, Denise M. Laronde. Characterization of epithelial oral dysplasia in non-smokers: working towards precision medicine [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3265. doi:10.1158/1538-7445.AM2017-3265

Development and Evaluation of an iPad Application to Promote Knowledge of Tobacco Use and Cessation by Pregnant Women

We describe the development and evaluation of an iPad application to promote knowledge of tobacco risk and cessation resources for pregnant women. Pregnant women completed a survey on tobacco use in pregnancy, and clinicians reviewed their tobacco cessation practices and resources. The women reported that content was easy to understand (98%) and helped them understand tobacco risks (94%). Tobacco users reported that the information helped them want to quit smoking (75%) and provided ideas on how to quit (58%). Clinicians reported themes that reflected ease of use, support of pregnant women, and use of electronic resources. We conclude that iPad applications and other electronic health education delivery methods are useful tools that can augment coordinated and consistent tobacco cessation efforts in clinical settings.

Nicotine Acutely Enhances Reinforcement from Non-Drug Rewards in Humans.

Preclinical research documents that, aside from the primary and secondary reinforcing effects of nicotine intake itself, nicotine also acutely enhances the reinforcing efficacy of non-drug reinforcers (“rewards”). Study of these effects in humans has largely been overlooked, but very recent findings suggest they may have clinical implications for more fully understanding the persistence of tobacco dependence. This overview first outlines the topic and notes some recent human studies indirectly addressing nicotine effects on related responses (e.g., subjective ratings), explaining why those findings do not directly confirm enhancement of behavioral reinforcement per se due to nicotine. Then, the methodology used in the subsequently presented studies is described, demonstrating how those studies specifically did demonstrate enhancement of reinforced responding for non-drug rewards. The main section focuses on the limited controlled research to date directly assessing nicotine’s acute reinforcement-enhancing effects in humans, particularly as it relates to reinforced behavioral responding for non-drug rewards in non-human animal models. After detailing those few existing human studies, we address potential consequences of these effects for dependence and tobacco cessation efforts and then suggest directions for future research. This research indicates that nicotine per se increases responding in humans that is reinforced by some rewards (auditory stimuli via music, visual stimuli via video), but perhaps not by others (e.g., money). These reinforcement-enhancing effects in smokers are not due to dependence or withdrawal relief and can be restored by a small amount of nicotine (similar to a smoking lapse), including from e-cigarettes, a non-tobacco nicotine product. Future clinical research should examine factors determining which types of rewards are (or are not) enhanced by nicotine, consequences of the loss of these nicotine effects after quitting smoking, potential individual differences in these effects, and the possibility that nicotine via nicotine replacement therapy and non-nicotine quit medications may attenuate loss of these effects upon quitting. Further study with humans of nicotine’s reinforcement-enhancing effects may provide a more complete understanding of smoking persistence and added mechanisms of cessation medication efficacy.