Tobacco use is causally associated with the risk of developing multiple health conditions, including over a dozen types of cancer, and is responsible for 30% of cancer deaths in the U [...]

Because tobacco use remains one of the leading causes of disease, disability, and mortality, tobacco treatment programs should be integrated into medical systems such as hospitals and outpatient centers. Medical providers have a unique, high-impact opportunity to initiate smoking cessation treatment with patients. However, there are several barriers that may hinder the development and implementation of these programs. The purpose of this review was to address such barriers by illustrating several examples of successful tobacco treatment programs in US health-care systems that were contributed by the authors. This includes describing treatment models, billing procedures, and implementation considerations. Using an illustrative review of vignettes from existing programs, various models are outlined, emphasizing commonalities and unique features, strengths and limitations, resources necessary, and other relevant considerations. In addition, clinical research and dissemination trials from each program are described to provide evidence of feasibility and efficacy from these programs. This overview of example treatment models designed for hospitals and outpatient centers provides guidelines for any emerging tobacco cessation services within these contexts. For existing treatment programs, this review provides additional insight and ideas about improving these programs within their respective medical systems.

Abstract Quitting smoking after a cancer diagnosis leads to better outcomes for cancer patients, including lower risk for a second primary cancer and increased survival. Yet few cancer patients receive smoking cessation services during their oncology health care visits, and disparities in the receipt of such smoking cessation services exist. As part of the Cancer Moonshot, the National Cancer Institute (NCI) has dedicated funding to expand and enhance smoking cessation services at NCI-Designated Cancer Centers for all patients who smoke. We report on the baseline characteristics of tobacco treatment programs (TTPs) at the 22 Cancer Centers initially funded through the Cancer Center Cessation Initiative (C3I), for six months before funding was awarded. Characteristics measured included consistency of smoking status documentation in electronic health records (EHR), types of cessation services offered, and referral methods used. TTP reach (the percentage of smokers who engaged in any type of TTP) was calculated overall and by patient demographics for Centers providing aggregate patient data (n=11). Data were collected in 2018. Among the 22 funded Centers, 40.9% consistently documented smoking status using the EHR. At least one type of cessation service was offered at 77.3% of Centers. Quitline referral was the most frequently cited service (50%), followed by in-person TTPs (45.5%). One Center offered text and web-based programs. Only 31.8% of centers used the EHR to refer patients to TTPs; among those, one used an opt-out referral method. TTP reach on average was 22.2%, but varied by Center, ranging from 0.5% to 79.7%. About 27% of Black, 21% of White, 20.3% of Hispanic and 12.2% of Asian patients who smoked received cessation services. Less than 8% of patients aged 18-24 received cessation services compared with those aged 25-44 (18.3%), 45-64 (24.7%) and 65+ (21.9%). A slightly higher percentage of female patients (23%) received cessation services compared with males (21.7%). The majority of C3I funded Cancer Centers offered some type of TTP in the prefunding period. However, on average only 22% of smokers were reached by a TTP, and reach varied by race, age, and gender of smokers. The Cancer Center Cessation Initiative provides an opportunity for Cancer Centers to improve the reach and effectiveness of smoking cessation services for cancer patients who smoke, and reduce disparities in the receipt of cessation services by providing financial and technical support for Centers to build and implement comprehensive evidence-based smoking cessation programs. Citation Format: Heather D'Angelo, Betsy Rolland, Rob Adsit, Glen Morgan, Marika Rosenblum, Michael C. Fiore. The National Cancer Institute Cancer Center Cessation Initiative (C3I): Examining the baseline characteristics and reach of tobacco treatment programs within NCI-Designated Cancer Centers in the C3I [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A001.

Quitting smoking leads to improved outcomes for patients with cancer, yet too few patients receive cessation services during their oncology healthcare visits. The National Cancer Institute (NCI) dedicated Cancer Moonshot funding for NCI-Designated Cancer Centers to develop a population-based approach to reach all patients who smoke with tobacco treatment services. As a result, the Cancer Center Cessation Initiative (C3I) offers an unparalleled opportunity to identify effective implementation strategies and barriers to delivering tobacco treatment services across multiple clinical oncology settings. Over one year after receiving funding, the first cohort of C3I funded Centers demonstrated progress in hiring tobacco treatment specialists, adding new tobacco treatment programs, and integrating EHR-based tobacco treatment referrals. However, tobacco treatment program reach remains low in some settings, even using a broad definition of patient engagement. Centers identified implementation challenges related to staff training needs, devising new clinical workflows, and engagement of IT leadership. Understanding implementation challenges may help other clinical oncology settings effectively implement tobacco treatment programs, leading to improved cancer outcomes by helping patients quit smoking.

Despite recommendations that all patients with cancer be offered effective treatment to help them quit smoking, such treatment is often neglected. The Cancer Moonshot initiative aims to jump-start smoking-cessation treatment at cancer centers.

Quitting smoking after a cancer diagnosis leads to better outcomes for cancer patients, including lower risk for a second primary cancer and increased survival. However, few cancer patients receive smoking cessation services during their oncology healthcare visits, and disparities in the receipt of such smoking cessation services exist. As part of the Cancer Moonshot, the National Cancer Institute (NCI) has dedicated funding to expand and enhance smoking cessation services at NCI-Designated Cancer Centers for all patients who smoke. We report on characteristics of tobacco treatment programs (TTPs) at the 22 Cancer Centers funded through the Cancer Center Cessation Initiative (C3I) for 6 months before funding was awarded ("pre-funding period"), and for 6 months during the first year of funding. We will also report on the second half of the first year of funding. Characteristics measured included referral methods to cessation services (e.g. referrals via electronic health records (EHR)), and types of cessation services offered. TTP reach (the percentage of smokers who engaged in any type of TTP) was calculated overall and by patient demographics for Centers providing aggregate patient data (n=13). Data were collected in 2018. Between the pre-funding period and first year of funding, the number of C3I funded Centers offering in-person smoking cessation counseling increased from 10 to 15 (45.5% to 68.2%). EHR referrals to tobacco treatment programs increased from 31.8% of Centers to 68.2%. Four Centers (18.2%) offered text and web based cessation programs in the first funding year compared with only 1 Center (4.5%) in the pre-funding period. During the first funding period, TTP reach on average was 20.2%, but varied by Center, ranging from 0.5% to 86.5%. During the first funding period, 16.4% of Black, 15.8% of White, 11.8% of Hispanic, 10.6% of Asian, and 6.2% of American Indian/Alaska Native smokers received smoking cessation services. About 13% of smokers aged 18-24 received cessation services, compared with those aged 25-44 (17.7%), 45-64 (22.9%) and 65+ (18.7%). The majority of C3I funded Cancer Centers offered some type of TTP; however, on average only 20% of smokers were reached by a TTP. Further, TTP reach varies by race, ethnicity, and age. The C3I provides an opportunity to improve the reach and effectiveness of smoking cessation services for cancer patients who smoke, and reduce disparities in the receipt of cessation services by providing financial and technical support for Centers to build and implement comprehensive evidence-based smoking cessation programs.Citation Format: Heather D'Angelo, Betsy Rolland, Rob Adsit, Michael Fiore, Marika Rosenblum, Glen Morgan. The NCI Cancer Center Cessation Initiative (C3I): Characteristics and reach of tobacco treatment programs among NCI-designated cancer centers in the C3I [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 2433.

Adolescence is a time of dramatic changes in brain structure and function, and the adolescent brain is highly susceptible to being altered by experiences like substance use. However, there is much we have yet to learn about how these experiences influence brain development, how they promote or interfere with later health outcomes, or even what healthy brain development looks like. A large longitudinal study beginning in early adolescence could help us understand the normal variability in adolescent brain and cognitive development and tease apart the many factors that influence it. Recent advances in neuroimaging, informatics, and genetics technologies have made it feasible to conduct a study of sufficient size and scope to answer many outstanding questions. At the same time, several Institutes across the NIH recognized the value of collaborating in such a project because of its ability to address the role of biological, environmental, and behavioral factors like gender, pubertal hormones, sports participation, and social/economic disparities on brain development as well as their association with the emergence and progression of substance use and mental illness including suicide risk. Thus, the Adolescent Brain Cognitive Development study was created to answer the most pressing public health questions of our day.

Importance and objective. We estimate how often adult smokers are advised to quit using a nationally representative sample of adults in the United States.Design and participants. Data are from the 2012-2013 household component of the United States (US) Medical Expenditures Panel Survey (MEPS).Main outcome measure. Current smoking and advice to quit offered by providers.Results. Smoking was reported by 18.26% (CI 17.13%-19.38%) of 2012 MEPS respondents. Less than half of adult smokers (47.24%, CI 44.30%-50.19%) were advised to quit by their physicians although 17.57% (CI 15.37%-19.76%) had not seen a doctor in the last 12 months. Advice to quit was given significantly less often to respondents classified as: aged 18-44 (40.29%), men (40.20%), less educated (42.26%), lower family income (43.51%), Hispanic (33.82%), never married (39.55%), and living outside the northeast. Smoking status at year 2 for patients who had received advice to quit was similar (85.13%: SE 1.62%) to those who had seen a physician but were not advised to quit (81.95%: SE 2.05%). Advice to quit smoking was less common than the use of common medical screening tests.Conclusions and relevance. Smoking cessation advice is given to less than half of current cigarette smokers and it is least likely to be given to themost vulnerable populations. Efforts to reduce smoking are deployed less often than other preventive practices. The rate of advice to quit has not changed over the last decade. Health care providers are missing an important opportunity to affect health behaviors and outcomes. Published by Elsevier Inc.

The cancer burden attributable to modifiable behavioral risks is substantial, accounting for more than two-thirds of all cancer deaths in the United States. Promoting cancer prevention clinically by addressing tobacco use, obesity, physical inactivity, and other behaviors represents an important but largely untapped opportunity in medicine. Achieving this objective may be accelerated by strategically leveraging information technology (IT)-supported protocols, embodied by electronic health record systems, web-assisted interventions, and mobile and smartphone applications. Smoking cessation, as a key preventable cancer target for which IT modalities have already been successfully applied, will serve as an exemplar. This chapter will review behavioral risk factors for cancer and IT for cancer prevention, and discuss the intersection of technology with the patient, provider, and health care systems.

Increasingly, experts and interested laypeople are turning to the explosion of online data to form and explore hypotheses about relationships between public health intervention strategies and their possible impacts. We have engaged in a multi-year collaboration to use and design semantic techniques and tools to support the current and next generation of these explorations. We introduce a tool, qb.js, to enable access to multidimensional statistical data in ways that allow non-specialists to explore and create specific visualizations of that data. We focus on explorations of health data - in particular aimed at helping to support the formation and analysis of hypotheses about public health intervention strategies and their correlation with health-related behavior changes. We used qb.js to formulate and explore the hypothesis that youth tobacco access laws have consistent, measurable impacts on the rate of change in cigarette smoking among high school students over time. While focused in this instance on one particular intervention strategy (i.e., limiting youth access to tobacco), this analytics platform may be used for a wide range of correlational analyses. To address this hypothesis, we converted population science data on tobacco-related policy and behavior from ImpacTeen to a Resource Description framework (RDF) representation that was annotated with the RDF Data Cube vocabulary. A Semantic Data Dictionary enabled mapping between the original datasets and the RDF representation. This allowed for the creation and publication of data visualizations using qb.js. The RDF Data Cube representation made it possible to discover a significant downward effect from the introduction of nine youth tobacco access laws on the rate of change in smoking prevalence among high school-aged youth.

BackgroundLarge cross-disciplinary scientific teams are becoming increasingly prominent in the conduct of research.PurposeThis paper reports on a quasi-experimental longitudinal study conducted to compare bibliometric indicators of scientific collaboration, productivity, and impact of center-based transdisciplinary team science initiatives and traditional investigator-initiated grants in the same field.MethodsAll grants began between 1994 and 2004 and up to 10 years of publication data were collected for each grant. Publication information was compiled and analyzed during the spring and summer of 2010.ResultsFollowing an initial lag period, the transdisciplinary research center grants had higher overall publication rates than the investigator-initiated R01 (NIH Research Project Grant Program) grants. There were relatively uniform publication rates across the research center grants compared to dramatically dispersed publication rates among the R01 grants. On average, publications produced by the research center grants had greater numbers of coauthors but similar journal impact factors compared with publications produced by the R01 grants.ConclusionsThe lag in productivity among the transdisciplinary center grants was offset by their overall higher publication rates and average number of coauthors per publication, relative to investigator-initiated grants, over the 10-year comparison period. The findings suggest that transdisciplinary center grants create benefits for both scientific productivity and collaboration. Large cross-disciplinary scientific teams are becoming increasingly prominent in the conduct of research. This paper reports on a quasi-experimental longitudinal study conducted to compare bibliometric indicators of scientific collaboration, productivity, and impact of center-based transdisciplinary team science initiatives and traditional investigator-initiated grants in the same field. All grants began between 1994 and 2004 and up to 10 years of publication data were collected for each grant. Publication information was compiled and analyzed during the spring and summer of 2010. Following an initial lag period, the transdisciplinary research center grants had higher overall publication rates than the investigator-initiated R01 (NIH Research Project Grant Program) grants. There were relatively uniform publication rates across the research center grants compared to dramatically dispersed publication rates among the R01 grants. On average, publications produced by the research center grants had greater numbers of coauthors but similar journal impact factors compared with publications produced by the R01 grants. The lag in productivity among the transdisciplinary center grants was offset by their overall higher publication rates and average number of coauthors per publication, relative to investigator-initiated grants, over the 10-year comparison period. The findings suggest that transdisciplinary center grants create benefits for both scientific productivity and collaboration.

Background: Large cross-disciplinary scientific teams are becoming increasingly prominent in the conduct of research.Purpose: This paper reports on a quasi-experimental longitudinal study conducted to compare bibliometric indicators of scientific collaboration, productivity, and impact of center-based transdisciplinary team science initiatives and traditional investigator-initiated grants in the same field.Methods: All grants began between 1994 and 2004 and up to 10 years of publication data were collected for each grant. Publication information was compiled and analyzed during the spring and summer of 2010.Results: Following an initial lag period, the transdisciplinary research center grants had higher overall publication rates than the investigator-initiated R01 (NIH Research Project Grant Program) grants. There were relatively uniform publication rates across the research center grants compared to dramatically dispersed publication rates among the R01 grants. On average, publications produced by the research center grants had greater numbers of coauthors but similar journal impact factors compared with publications produced by the R01 grants.Conclusions: The lag in productivity among the transdisciplinary center grants was offset by their overall higher publication rates and average number of coauthors per publication, relative to investigator-initiated grants, over the 10-year comparison period. The findings suggest that transdisciplinary center grants create benefits for both scientific productivity and collaboration. (Am J Prev Med 2012; 42(2): 157-163) Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine

Background: The Consortium of Hospitals Advancing Research on Tobacco (CHART) is a network of six projects and a research coordinating unit funded by the National Heart, Lung, and Blood Institute, the National Cancer Institute, the National Institute on Drug Abuse, and the National Institutes of Health (NIH) Office of Behavioral and Social Science Research. The CHART projects will assess the effectiveness and cost-effectiveness of smoking cessation interventions initiated during hospitalization and continued post-discharge.Methods/design: Along with a seventh project funded previously under the NIH Challenge grants, the CHART projects will assess smoking cessation strategies delivered to approximately 10,000 hospitalized smokers across a geographically diverse group of nearly 20 private, public, academic, and community hospitals. The CHART research coordinating unit at Kaiser Permanente Center for Health Research provides organizational and data coordination support, facilitating the development of common measures for combining data from multiple CHART projects.Discussion: The targeted enrollment in CHART, if achieved, will represent the largest, most diverse pooled dataset of hospitalized smokers receiving smoking cessation assistance, and is designed to contribute to the dissemination and implementation of smoking cessation interventions provided by hospital systems.

The complexity of social and public health challenges has led to burgeoning interest and investments in cross-disciplinary team-based research, and particularly in transdisciplinary (TD) team-based research. TD research aims to integrate and ultimately extend beyond discipline-specific concepts, approaches, and methods to accelerate innovations and progress toward solving complex real-world problems. While TD research offers the promise of novel, wide-reaching, and important discoveries, it also introduces unique challenges. In particular, today's investigators are generally trained in unidisciplinary approaches and may have little training in, or exposure to, the scientific skills and team processes necessary to collaborate successfully in teams of colleagues from widely disparate disciplines and fields. Yet these skills are essential to maximize the efficiency and effectiveness of TD team-based research. In the current article, we propose a model of TD team-based research that includes four relatively distinct phases: development, conceptualization, implementation, and translation. Drawing on the science of team science field, as well as the findings from previous research on group dynamics and organizational behavior, we identify key scientific goals and team processes that occur in each phase and across multiple phases. We then provide real-world exemplars for each phase that highlight strategies for successfully meeting the goals and engaging in the team processes that are hallmarks of that phase. We conclude by discussing the relevance of the model for TD team-based research initiatives, funding to support these initiatives, and future empirical research that aims to better understand the processes and outcomes of TD team-based research.

We describe an approach to developing next generation health information portals. This prototype portal was developed to address two complementary goals (1) design and create a site where people can explore potential relationships between selected health-related behaviors, policies, and demographic data (2) explore semantic web technologies and linked data as enabling technologies for next generation health informatics portals. Our multidisciplinary team includes population and behavioral scientists, social network scientists, statisticians, and computer scientists focused on creating innovative proof of concept applications that integrate complex health data in understandable and usable ways. Our semantic-web based framework allowed us to design exemplar community health portal applications, with an initial focus on tobacco-related health data such as smoking prevalence and tobacco policies (taxation and smoking bans). We describe our approach, two semantically-enabled tobacco-related applications, and discuss how this approach can be used in a broad spectrum of community health applications.

The National Cancer Institute cancer centers possess the credibility to help smokers quit. With the greater life expectancies forecast for patients with cancer, addressing smoking at cancer centers has taken on greater importance.

INTRODUCTION:Concomitant use of two forms of tobacco is an increasing public health concern, yet there is little consensus regarding a consistent definition of so-called "dual use." We defined dual use as cigarette and smokeless tobacco (ST) consumption with either product used daily or nondaily.METHODS:We analyzed a cohort of 36,013 Air Force recruits. We categorized dual tobacco use across 2 dimensions, type of tobacco products (cigarettes, ST, or others), and the frequency of use (daily vs. nondaily). We determined how varying the definition impacted the prevalence estimates and evaluated the prevalence estimate based on our recommended definition of dual use. Multivariate logistic regression analysis was used to evaluate the risk profile of dual users of ST and cigarettes versus mono users of ST and mono users of cigarettes.RESULTS:Varying definitions of dual use vary prevalence estimates 50-fold (0.5%-25.3%). Including only ST and cigarettes narrows the prevalence estimate to less than 4-fold (2.0%-9.7%). Dual users are more likely to be young Caucasian males, with lower education, and from families with relatively higher incomes. Compared with mono users, dual users of cigarettes and ST have a distinct pattern of risk profiles.CONCLUSIONS:Depending on the definition of dual use, markedly different prevalence and risk profiles are observed. Dual users of ST and cigarettes are a unique group of tobacco users. We propose a common definition of dual use to advance our understanding of this unique group.