Elsevier

Addictive Behaviors

Volume 67, April 2017, Pages 92-99
Addictive Behaviors

A pilot trial of In vivo NRT sampling to increase medication adherence in community corrections smokers

https://doi.org/10.1016/j.addbeh.2016.12.011Get rights and content

Highlights

  • Novel behavioral intervention designed to improve smoking cessation NRT adherence.

  • In vivo intervention group evinced greater patch use and gum use.

  • Intervention group reported decreased withdrawal and craving severity.

  • In vivo NRT sampling may increase NRT adherence relative to standard counseling.

Abstract

Background

Individuals in the criminal justice system demonstrate high rates of cigarette use (70–80%) and low adherence to smoking cessation medication. Educational approaches have not been shown to promote adherence or cessation, though medication sampling has boosted both use and cessation. The objective of the present study was to determine whether In vivo nicotine replacement therapy (NRT) sampling approach increases NRT adherence among criminal justice smokers during a subsequent quit attempt.

Methods

We conducted a pilot study with 43 community corrections smokers randomized to a 4-session (one 30-min session per week) precessation intervention of either In vivo NRT sampling (Session 1: patch; Session 2: gum; Session 3: combination NRT (cNRT); Session 4: review) vs. 4 time-matched sessions of standard smoking cessation with cNRT started after Session 1. Both groups received an additional 8 weeks of cNRT following the four intervention sessions.

Results

During the in vivo administration of NRT, total withdrawal and craving severity significantly decreased from pre- to post-session compared to Control participants. In vivo participants evinced greater patch use at Session 4 and greater gum use through Week 8 relative to Controls.

Discussion

In vivo NRT sampling may increase NRT adherence relative to standard counseling sessions among criminal justice smokers. A larger trial of this novel intervention appears to be warranted.

Introduction

Cigarette smoking prevalence rates within the U.S. have declined from 45% in the 1960s to about 18.1% of the population identified as current smokers over the past few years (CDC, 2014). However, smoking prevalence remains much higher in criminal justice populations (70–80%) (Cropsey et al., 2010, Cropsey et al., 2008). Nearly 12.3% of all current smokers are involved in the criminal justice system (Carson and Sabol, 2012, Cropsey et al., 2010). Few interventions have been tested with this population despite the fact that these smokers have high rates of comorbid mental and medical problems that are directly impacted by smoking (Carson and Sabol, 2012, Covey et al., 2007, U.S. Department of Health and Human Services, 1998). The few cessation trials that have been conducted demonstrate smoking abstinence rates of about 12% at one year follow-up (Cropsey et al., 2015, Cropsey et al., 2008). Adherence to medication in these studies was low, with less than half of participants taking the medications or using the NRT to optimal benefit (Cropsey et al., 2008, Cropsey et al., 2015).

Most people attempt to quit smoking without use of any medication (CDC, 2011), and among those who use, 69% prematurely quit medication use (Balmford, Borland, Hammond, & Cummings, 2011). Adherence to cessation medication is particularly problematic among individuals from disadvantaged populations, which predominate the criminal justice system (Balmford et al., 2011, Ferguson et al., 2011, Shiffman et al., 2008). African American smokers report less lifetime use of smoking cessation medications, and report more concerns about addiction potential, efficacy, and interactions with other medications relative to White, non-Hispanic smokers (Carpenter et al., 2011, Ryan et al., 2011, Shiffman et al., 2008, Shiffman et al., 2008). Negative perceptions of the healthcare system, low belief in the efficacy of medication, difficulty accessing services, and cost collectively undermine best practice medication use (Cutler and Everett, 2010, Kiortsis et al., 2000, Pieh-Holder et al., 2012, Roebuck et al., 2011, Sewell et al., 2012). Interventions to improve adherence in these populations have been identified as the single best means to address health disparities (Simeonova, 2013). In fact, adherence to smoking cessation pharmacotherapies more than triples the rate of abstinence (Cropsey et al., 2015, Shiffman et al., 2008, Raupach et al., 2014), highlighting the critical importance of developing interventions to increase medication adherence.

The majority of interventions designed to increase medication adherence have been psychoeducational and demonstrate small effects with little resultant behavioral change (DeFulio and Silverman, 2012, Demonceau et al., 2013, Halpern et al., 2013, McDonald et al., 2002, Van Camp et al., 2013, Viswanathan et al., 2012a, Viswanathan et al., 2012b). Similarly, medication adherence interventions in non-forensic samples that provide psychoeducation to increase adherence have been shown to increase attitudes and intentions to use NRT, but do not result in behavioral changes such as cessation (Ferguson et al., 2011, Juliano and Brandon, 2004, Mooney et al., 2006). Experiential sampling of NRT can improve perceptions of NRT over psychoeducation alone, but prior tests of this approach have not investigated effects on medication adherence and subsequent cessation (Schneider et al., 2006, Schneider et al., 2008). However, experiential interventions such as nicotine sampling with practice quit attempts (PQA) have resulted in changes in behavioral outcomes such as use of NRT, quit attempts, and cessation (Carpenter et al., 2011, Jardin et al., 2014). Nicotine sampling interventions provide an opportunity for smokers to try cessation medications for an abbreviated period (1–2 weeks), to learn more about the quit process, but with no pressure for immediate abstinence (Carpenter et al., 2011, Jardin et al., 2014). One limitation of this approach is that it still relies on the individual to use the NRT on their own with no assurance that they actually ever sample it. Additionally, if the individual experiences any unpleasant side effects, they may discontinue medication after only brief use. Thus, a more regimented, prescribed sampling experience could yield a stronger response.

The primary aim of this study was to pilot test a novel, experiential precessation treatment approach designed to increase NRT adherence during a subsequent quit attempt among smokers under community corrections supervision (e.g., probation, parole, etc.), who represent a disenfranchised group of smokers with poor medication adherence and low cessation outcomes. A secondary aim of this study was to examine smoking reduction and abstinence to determine potential effects of the intervention on smoking cessation behavior. Treatment involved NRT use under supervised, instructed conditions, and discussion surrounding NRT-related expectancies, negative side effects, and positive outcomes (e.g., relief from withdrawal and craving). Between sessions, experimental intervention participants were dispensed a week of medication to use for PQAs and to acclimate to the medication. It was hypothesized that this experiential approach coupled with PQAs would yield superior rates of NRT adherence and smoking cessation relative to standard behavioral therapy with combination NRT. It is important to note that the Control group received the same level of evidence-based medications, but did not undergo the structured, guided in vivo sampling experience.

Section snippets

Participants

Participants responded to flyers advertising the study at the community corrections office in Birmingham, Alabama. One hundred and seven participants were screened on the phone for inclusion and 47 smokers were scheduled for in-person screening. This study received approval from the University of Alabama at Birmingham Institutional Review Board and all participants provided written, informed consent prior to study procedures (see CONSORT diagram Fig. 1). Inclusion criteria included current

Demographics

The groups were largely comparable on most demographic and smoking characteristics. In vivo participants had significantly less education relative to Control participants. African American smokers were overrepresented in the In vivo group relative to the Control condition, although this difference only approached significance (p < 0.06). No differences between the two groups were found on prior quit attempts (p = 0.78). No other significant differences between the groups were noted. Race and

Discussion

This pilot trial of In vivo NRT sampling demonstrated initial feasibility and acceptability as evidenced by good retention through the intervention phase. The ability to administer NRT in-session with strong subjective improvements (craving, withdrawal) confirms the feasibility of providing an in-session experience with NRT that could be administered and detected in a relatively brief intervention. The In vivo sampling experience easily lends itself to widespread dissemination. The intervention

Funding information

This study was funded by the UAB Department of Psychiatry funds.

Conflict of information

All authors declare that they have no conflicts of interest.

Contributors

Peter S. Hendricks, Ph.D., Samantha Schiavon, M.A., Aaron Sellers, Morgan Froelich, Richard C. Shelton, M.D., Matthew J. Carpenter, Ph.D.

Acknowledgements

None.

References (56)

  • J. Balmford et al.

    Adherence to and reasons for premature discontinuation from stop-smoking medications: Data from the ITC Four-Country Survey

    Nicotine & Tobacco Research

    (2011)
  • T. Boardman et al.

    Self-efficacy and motivation to quit during participation in a smoking cessation program

    Journal of Behavioral Medicine

    (2005)
  • K. Cahill et al.

    Pharmacological interventions for smoking cessation: An overview and network meta-analysis

    Cochrane Database of Systematic Reviews

    (2013)
  • M.J. Carpenter et al.

    Nicotine therapy sampling to induce quit attempts among smokers unmotivated to quit: A randomized clinical trial

    JAMA Internal Medicine

    (2011)
  • E.A. Carson et al.

    Prisoners in 2011

    (December, 2012)
  • Centers for Disease Control and Prevention

    Quitting smoking among adults–United States, 2001–2010

    MMWR. Morbidity and Mortality Weekly Report

    (2011)
  • Centers for Disease Control and Prevention

    Current cigarette smoking among adults—United States, 2005–2012

    Morbidity and Mortality Weekly Report

    (2014)
  • N.L. Cooney et al.

    Smoking cessation during alcohol treatment: A randomized trial of combination nicotine patch plus nicotine gum

    Addiction

    (2009)
  • L.S. Cox et al.

    Evaluation of the brief questionnaire of smoking urges (QSU-brief) in laboratory and clinical settings

    Nicotine & Tobacco Research

    (2001)
  • L.S. Covey et al.

    Smokers' response to combination bupropion, nicotine patch, and counseling treatment by race/ethnicity

    Ethnicity & Disease

    (2007)
  • K.L. Cropsey et al.

    Varenicline for smoking reduction prior to cessation

    JAMA

    (2015)
  • K.L. Cropsey et al.

    Smoking cessation intervention for female prisoners: Addressing an urgent public health need

    American Journal of Public Health

    (2008)
  • K.L. Cropsey et al.

    Smoking characteristics of community corrections clients

    Nicotine & Tobacco Research

    (2010)
  • K.L. Cropsey et al.

    How low should you go? Determining the optimal cutoff for exhaled carbon monoxide to confirm smoking abstinence when using cotinine as reference

    Nicotine & Tobacco Research

    (2014)
  • D.M. Cutler et al.

    Thinking outside the pillbox—Medication adherence as a priority for health care reform

    New England Journal of Medicine

    (2010)
  • J. Demonceau et al.

    Identification and assessment of adherence-enhancing interventions in studies assessing medication adherence through electronically compiled drug dosing histories: A systematic literature review and meta-analysis

    Drugs

    (2013)
  • J.F. Etter et al.

    Attitudes toward nicotine replacement therapy in smokers and ex-smokers in the general public

    Clinical Pharmacology and Therapeutics

    (2001)
  • S.G. Ferguson et al.

    Nicotine replacement therapies: Patient safety and persistence

    Patient Related Outcome Measures

    (2011)
  • Cited by (11)

    View all citing articles on Scopus
    View full text