Miriam Hospital Leads in Smoking Research
Friday, November 11, 2011
Physicians and researchers at The Miriam Hospital are leading a number of groundbreaking studies that hold great promise in the treatment, prevention and cessation of smoking and may also shed some light on the physical effects of tobacco use. With the Great American Smokeout on the horizon on November 17, here's a timely look.
Treatment: Helping emergency room patients kick the habit
The National Cancer Institute recently awarded a $2.6 million grant to Beth Bock, Ph.D., from The Miriam Hospital’s Centers for Behavioral and Preventive Medicine, to develop a system-based tracking and treatment program for emergency patients who smoke. The goal is to integrate a tobacco cessation intervention into existing electronic medical tracking software, making it easier for emergency department staff to provide counseling and information to smokers and help them to quit.
Emergency departments across the U.S. receive more than 119 million visits annually, making them an ideal setting to identify smokers and initiate treatment – particularly for underserved populations who rely on emergency rooms for primary care and also are more likely to smoke. However, clinical delivery of smoking interventions has been inconsistent nationwide.
As part of this initiative, Bock, along with fellow principal investigator Bruce Becker, M.D., M.P.H. of Rhode Island Hospital, and their team will adapt an existing Emergency Department Information System (EDIS) to assist with the identification of smokers, prompt physician intervention, enhance the provision of smoking cessation intervention materials as discharge instructions, facilitate quit-smoking medication prescription and advice, and connect the patient to follow up care through their primary care provider and a pro-active telephone quit line. Researchers will also work with emergency department nurses and physicians to make and implement their feedback and changes to the system
Once the EDIS is fully implemented, the research team will measure both the impact and cost-effectiveness of the system in a group of smoking patients, which they’ll compare to a similar group of patients who did not receive the intervention. “Because this is a comprehensive, systems-based approach to patient care for tobacco cessation, it holds important implications not only for the emergency department setting but for other inpatient and outpatient settings as well,” she says. “This intervention has the potential to reach millions of smokers each year.”
Research: Link between cigarette smoking and Hodgkin’s lymphoma
A recent report by Miriam Hospital researchers published in the Journal of Clinical Oncology found that smoking seems to increase the odds of developing Hodgkin’s lymphoma in current smokers and that the risk was higher in men and older individuals and increased with higher intensity and longer duration of smoking. The study is the first to clearly demonstrate this relationship.
Hodgkin’s lymphoma represents approximately 10 to 15 percent of lymphoma cases in the United States. It commonly affects young adults and while it is curable, treatment is often associated with debilitating short- and long-term adverse effects, such as secondary cancers and infertility.
Based on a literature review of 17 previously published studies, individuals who smoked had a 39 percent higher risk of developing Hodgkin’s lymphoma compared to those who have never smoked. Men who currently smoke had a 78 percent increased risk of Hodgkin’s lymphoma, while older patients (those older than 30 to 40 years) had a 76 percent increased risk. While there was no apparent increased risk of lymphoma in individuals who smoked fewer than 10 cigarettes per day, the risk jumped to 51 percent in those who smoked more than 20 cigarettes per day.
“It appears we can now add Hodgkin’s lymphoma to the list of the many diseases and conditions that are linked to cigarette smoking,” says lead author Jorge J. Castillo, M.D., a hematologist/oncologist with The Leonard and Adele R. Decof Family Comprehensive Cancer Center at The Miriam Hospital. “Our findings suggest that quitting smoking can significantly reduce the risk of developing this disease.”
Tailored smoking cessation interventions needed for smokers with physical disabilities
People with physical disabilities, including mobility impairments, smoke at a higher rate than the general population, yet very few smoking cessation studies have targeted this group of smokers. Now, a new study by The Miriam Hospital’s Centers for Behavioral and Preventive Medicine, published online by the journal Health Psychology, suggests that helping smokers with physical disabilities lead more active and fulfilling lives may improve their readiness to quit smoking.
Mobility impairments can restrict one’s ability to participate in many valued activities, such as work, shopping, sports or visiting family. “Our study revealed that smokers who engaged in more valued life activities and found satisfactory replacements for activities restricted by their lack of mobility were more ready to quit smoking,” said lead author Andrew Busch, Ph.D.
In the study, Busch and senior author Belinda Borrelli, Ph.D. interviewed 47 smokers with chronic mobility impairments who rely on mobility aids, such as a wheelchair or cane. They found that 74 percent of participants who were preparing to quit smoking had found a satisfactory replacement for the most important activity that they had to give up due to their mobility impairment. The rates of satisfactory replacements were significantly lower for smokers who were merely contemplating quitting or not seriously considering quitting at the time of the interview.
In addition, participants who were engaged in more activities that they found pleasurable or meaningful or that brought them a sense of accomplishment – including volunteering, art or outings with family – were more likely to feel confident that they would be able to successfully quit.
“Counseling treatments that help smokers with physical disabilities reengage with valued life activities may be particularly useful for increasing smoking cessation,” said Borrelli, director of the Program in Nicotine and Tobacco at The Miriam Hospital’s Centers for Behavioral and Preventive Medicine and developer of the study. The study was funded by a grant to Borrelli from The National Cancer Institute (R01 CA137616).
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