Smoke Screen Smoking Cessation as an Entrée for Managing Risky Drinking and Drug Use in Health Care Settings

1. Smoke Screen Smoking Cessation as an Entrée for Managing Risky Drinking and Drug Use in Health Care Settings medicineworld.org

2. Horse called “SBIRT FOR HEALTHY LIFESTYLES” Trojan GPs Greek drug researchers hidden in Trojan Horse

3. Rationale for Multiple Risk Factor Behavior Change • Smoking is very common in heavy drinkers and drug users, thereby creating economies of scale in detection and intervention. • Smoking cessation has gained wide acceptance in primary care. Brief intervention packages are similar, making it efficient to train health care providers to target related health risk behaviors at the same time. • Smoking, drinking and drug use provide reciprocal cues, making it difficult to change one behavior without modifying the others.

4. Vital Signs Project • To evaluate the efficacy of brief interventions for smokers and risky drinkers when delivered separately and in combination • To study the feasibility of implementing combined alcohol/tobacco screening and brief interventions in community dental settings

5. Vital Signs Staff • Thomas Babor, PhD, MPH (PI) • Cheryl Oncken, MD, MPH (Co-PI) • Howard Bailit, DMD, PhD (Donaghue Liaison) • Steven Lepowsky, DDS (Director, AEGD) • Bonnie McRee, MPH (Investigator) • Janice Vendetti, MPH (Project Director) • Donna Damon, MPH-ABD (Dental Clinic Liaison) • Robin Odell (Health Educator)

6. Rationale for Including SBI in Dental Care • Over 40% of 18-44 yr. olds & 49% of 45-64 yr. olds see a dentist at least once a year. • Although it is well known that smoking and alcohol play a significant role in the etiology of oral cancer • Dental patients are not aware of this association. • Dentists do not routinely inquire about health habits associated with oral cancer nor do they provide brief health education advice.

7. Vital Signs Study Design Screening 3 Month Follow-up Session

8. Screening • Patient completes a Healthy Lifestyles Screening Survey in the Dental Clinic waiting area: • Demographic information & general health questions • Fagerstrom Test for Nicotine Dependence (FTND) • Alcohol Use Disorders Identification Test (AUDIT) • Score of 7 or less = low-risk drinker • Score between 8-19 = at-risk or risky drinker • Score over 19 = likely alcohol dependent

9. Conducting the Brief Intervention • Health Educator conducts the brief intervention in the waiting area of the Dental Clinic. • Provides personalized feedback to the patient • Determines the patient’s willingness to set a date to quit smoking or cut down on their drinking • Arranges for NRT distribution and distribute educational materials • Health Educator provides the resident with information obtained during the intervention. • Resident reinforces the brief intervention

10. Screening Prevalence Rates(n=6,687 screened)

11. Randomized 280 Risky Drinking Smokers (79% follow-up rate) • 56 received smoking only brief intervention • 54 received drinking only brief intervention • 60 received combined smoking and drinking brief interventions • 51 received no intervention (wait-list control group)

12. Demographic Characteristics of Follow-up Sample (n=221)

13. Substance Use Characteristics of Follow-up Sample (n=221)

14. Primary Outcome Measures at 3- Post Randomization • Reduction in the number of cigarettes per day • Reduction in the number of standard alcohol drinks per week • Smoking abstinence • Drinking within AUDIT non-hazardous score limits

15. Preliminary Outcomes:Non-verified Smoking Abstinence Rates

16. % Non-hazardous drinking at 3-month follow-up (AUDIT negative)

17. 3-Month Follow-up Average Number of Cigarettes Smoked Per Day

18. 3-Month Follow-up Average Number of Drinks Per Week

19. Summary • There are high prevalence rates of smoking and risky drinking in our dental clinic. • Preliminary results are promising in suggesting that individuals who are smokers and risky drinkers tend to reduce both risk behaviors simultaneously when one or both are the subject of an office-based brief intervention. • It is unclear whether there is an additional benefit to be gleaned from the combined interventions. • A smoking intervention is effective for both (smoking and drinking) behaviors whereas a drinking intervention is less effective for smoking than a smoking intervention.

20. Double Trouble: Investigating Behavioral Interventions for Smoking & Marihuana Use

22. Smoke Screen Study PHASE I Screen patients Study Ineligible: Tobacco+ / MJ- Study Eligible (N=350): Tobacco+ / MJ+ Conduct 2-week tobacco booster call. Conduct 4-week tobacco booster call. PHASE II

23. Smoke Screen Study PHASE II Phase II Enrollment & Phase I Follow-up Assessment Control Group (N=43) BI Group (N=129) BI+MET Group (N=129) MET-based Session MET-based Session 2-Month Phase II Follow-up 4-Month Phase II Telephone Follow-up 6-Month Phase II Follow-up

24. Findings/Conclusions • No differences were found in self-reported marihuana use between control and intervention groups • After smoking cessation a sequential intervention for marihuana use does not add significantly to multiple risk behavior change.

25. Whither Multiple Risk Factor Behavior Change Research? • Simultaneous vs sequential interventions • Theory testing research (Stage of Change, Planned Behavior, etc.) • Target behavior combinations (diet, exercise, alcohol, drugs, smoking, etc.) • Intensity and duration of interventions • Feasibility issues

26. 6-Month Follow-up Average Number of Cigarettes Smoked Per Day

27. Preliminary Outcomes: 6-Month Follow-up Average Number of Drinks Per Week (n=167)