A preliminary randomized trial of reinforcement contingencies to improve compliance with ecological momentary assessment.

Ecological Momentary Assessment (EMA) methods are increasingly used by translational scientists to study real-world behavior and experience. The ability to draw meaningful conclusions from EMA research depends upon participant compliance with assessment completion. Most EMA studies provide financial compensation for compliance, but little empirical evidence addresses the impact of reinforcement parameters on the level of compliance.

Factors Influencing Patient Receptivity to Brief Alcohol Interventions in Primary Care: An Application of Conjoint Analysis.

: Brief alcohol interventions (BAIs) are an evidence-based practice for addressing hazardous alcohol use in primary care settings. However, numerous barriers to implementation of BAIs in routine practice have been identified, including concerns about patient receptivity to BAIs. Despite this being a commonly identified barrier to BAI implementation, little BAI implementation research has focused on patient receptivity.

Brief conjoint visits between an embedded behavioral health provider and primary care team member: When are they used and what are the barriers and facilitators?

Introduction: Conjoint visits utilize the expertise of primary care providers (PCPs) and behavioral health providers (BHPs) to address complex comorbidities in patients. The objectives were to describe the use and features of conjoint visits and identify barriers and facilitators as described by BHPs in integrated settings.

Method: Three hundred and forty-five BHPs who worked in integrated primary care, a majority identifying as female and white, completed an online survey between October 2018 and July 2019.

Evaluating Declines in Compliance With Ecological Momentary Assessment in Longitudinal Health Behavior Research: Analyses From a Clinical Trial.

Background: Ecological momentary assessment (EMA) is increasingly used to evaluate behavioral health processes over extended time periods. The validity of EMA for providing representative, real-world data with high temporal precision is threatened to the extent that EMA compliance drops over time.

Objective: This research builds on prior short-term studies by evaluating the time course of EMA compliance over 9 weeks and examines predictors of weekly compliance rates among cigarette-using adults.

Prevalence and predictors of team-based care activities between primary care providers and embedded behavioral health providers: a national survey.

Primary care (PC) settings increasingly use team-based care activities with embedded behavioral health providers (BHPs) to enhance patient care via group medical visits, conjoint appointments, team huddles, and warm handoffs. Aim 1 was to describe the variation of team-based care activities within integrated PC clinics. Aim 2 was to explore whether factors associated with the BHP (e.

Virtual integrated primary care teams: Recommendations for team-based care.

Introduction: Integrated primary care teams are increasingly relying upon virtual care, including both telehealth and team members who are teleworking, due to the COVID-19 pandemic. This shift to virtual care can present challenges for the coordination and provision of team-based care in primary care. The current report uses extant literature on teams to provide recommendations to support integrated primary care teams, including behavioral health providers, in adapting to and sustaining virtual team-based care.

Practical Opportunities for Biopsychosocial Education Through Strategic Interprofessional Experiences in Integrated Primary Care.

Even with the expansion of primary care teams to include behavioral health and other providers from a range of disciplines, providers are regularly challenged to deliver care that adequately addresses the complex array of biopsychosocial factors underlying the patient's presenting concern. The limits of expertise, the ever-changing shifts in evidence-based practices, and the difficulties of interprofessional teamwork contribute to the challenge. In this article, we discuss the opportunity to leverage the interprofessional team-based care activities within integrated primary care settings as interactive educational opportunities to build competencies in biopsychosocial care among primary care team members.

Barriers and Pathways to Changing Smoking and Risky Drinking in Primary Care Patients With Chronic Conditions Who Failed to Respond to Brief Advice.

Many individuals who smoke tobacco or consume alcohol at hazardous levels have chronic conditions that are caused or exacerbated by these behaviors. The objective of this survey study was to obtain data on the health care concerns, barriers, and readiness to change indicators of smokers/risky drinkers with related health conditions who have not responded to standard primary care interventions. 167 participants (120 who reported current smoking or risky drinking or both) completed a 1-time mailed survey in 2017/2018.

The use and impact of self-monitoring on substance use outcomes: A descriptive systematic review.

Self-Monitoring (SM), the act of observing ones' own behavior, has been used in substance use treatment because SM may bring conscious awareness to automatized substance use behaviors. Empirical findings regarding SM's effectiveness are mixed. The aim of this study was to synthesize the literature for the efficacy of SM on substance use.

The impact of three weeks of pre-quit varenicline on reinforcing value and craving for cigarettes in a laboratory choice procedure.

Rationale: Varenicline, a partial nicotinic agonist, is theorized to attenuate pre-quit smoking reinforcement and post-quit withdrawal and craving. However, the mechanisms of action have not been fully characterized, as most studies employ only retrospective self-report measures, hypothetical indices of reinforcing value, and/or nontreatment-seeking samples.

Objectives: The current research examined the impact of pre-quit varenicline (vs.

Barriers to and Facilitators of Delivering Brief Tobacco and Alcohol Interventions in Integrated Primary Care Settings.

Objective: Tobacco and excessive alcohol use are 2 of the top 3 preventable causes of death in the United States, yet most patients using these substances do not pursue treatment. Most patients do visit their primary care provider (PCP) annually, but PCPs report that they are not very effective in addressing behavior change with patients. Brief interventions for alcohol and tobacco use are effective and can be delivered by behavioral health providers (BHPs) embedded in the primary care setting.

Assessment of the Choice Behavior Under Cued Conditions (CBUCC) paradigm as a measure of motivation to smoke under laboratory conditions.

Background And Aims: The Choice Behavior under Cued Conditions (CBUCC) task uses three indices of tobacco use (consumption, money spent to access a cigarette and latency to reach for a cigarette) to assess motivation to smoke under laboratory conditions. Initial research with this procedure has shown that it can evince cue-specific craving and differential responding for smoking versus a neutral cue. This study aimed to replicate these findings and assess the interaction of cue-specific craving and behavior with abstinence prior to testing.

Characteristics and clinical treatment of tobacco smokers enrolled in a VA substance use disorders clinic.

Individuals with a substance use disorder (SUD) diagnosis are more than twice as likely to smoke cigarettes as the general population. Emerging research has suggested that treating a substance use disorder simultaneously with tobacco use leads to a higher rate of treatment success for both substances. Despite this, substance use treatment protocols tend not to focus on tobacco use; in fact, traditional substance use treatments often discourage patients from attempting to quit smoking.

Electronic Medical Record Documentation of Driving Safety for Veterans with Diagnosed Dementia.

Objectives: Many older adults continue to drive following dementia diagnosis, with medical providers increasingly likely to be involved in addressing such safety concerns. This study examined electronic medical record (EMR) documentation of driving safety for veterans with dementia (N = 118) seen in Veterans Affairs primary care and interdisciplinary geriatrics clinics in one geographic region over a 10-year period.

Methods: Qualitative directed content analysis of retrospective EMR data.

Craving and tobacco use: Development of the choice behavior under cued conditions (CBUCC) procedure.

Many addiction theories propose that craving modulates smoking. Research on this relationship has yielded mixed results, which might be explained, in part, by a consideration of the various behaviors representing tobacco use. Tobacco use can be divided into seeking (attempts to access cigarettes) and consumption (ingestion of tobacco).

Selection criteria limit generalizability of smoking pharmacotherapy studies differentially across clinical trials and laboratory studies: A systematic review on varenicline.

Background: The selection criteria used in clinical trials for smoking cessation and in laboratory studies that seek to understand mechanisms responsible for treatment outcomes may limit their generalizability to one another and to the general population.

Methods: We reviewed studies on varenicline versus placebo and compared eligibility criteria and participant characteristics of clinical trials (N=23) and laboratory studies (N=22) across study type and to nationally representative survey data on adult, daily USA smokers (2014 National Health Interview Survey; 2014 National Survey on Drug Use and Health).

Results: Relative to laboratory studies, clinical trials more commonly reported excluding smokers who were unmotivated to quit and for specific medical conditions (e.

Measurement of Common Mental Health Conditions in VHA Co-located, Collaborative Care.

The VA has integrated psychologists and other licensed mental health providers, known collectively as co-located collaborative care (CCC) providers, into patients' primary care medical homes to improve mental health services for veterans. However, it is unclear if CCC providers are routinely using mental health measures as part of evidence-based, coordinated care. This study aimed to determine the prevalence and predictors of CCC provider utilization of brief, validated measures.

A comparative evaluation of self-report and biological measures of cigarette use in nondaily smokers.

A large subset of individuals who smoke cigarettes do not smoke regularly, but the assessments used to collect data on cigarette consumption in nondaily smokers have not been rigorously evaluated. The current study examined several self-report and biomarker approaches to the assessment of cigarette use in a sample of nondaily smokers (n = 176). Participants were randomly assigned to a daily monitoring condition (n = 89), requiring a daily report of the number of cigarettes smoked in the previous 24 hours, or a no monitoring condition (n = 87).

The Reliability and Stability of Puff Topography Variables in Non-Daily Smokers Assessed in the Laboratory.

Introduction: Puff topography variables, often measured using the Clinical Research Support System device, have traditionally been studied in regular, daily smokers and have been shown to be highly stable. However, more recent research has focused on non-daily smokers as a population of interest. As such, the aim of this article was to examine puff topography stability (cross-cigarette agreement over time) and reliability (within-cigarette consistency) in non-daily smokers across six laboratory sessions.

Outpatient health care utilization in a sample of cognitively impaired veterans receiving care in VHA geriatric evaluation and management clinics.

Within the Veterans Health Administration (VHA), Geriatric Evaluation And Management (GEM) clinics are designed specifically to address the needs of older veterans with complex age-related concerns, including dementia and comorbid medical and mental health conditions. Previous literature describes aging veterans as having greater health care needs compared with age-matched nonveteran samples, and multimorbidity is of particular concern in this population. Using data extracted from electronic medical records (EMRs), the present study describes the demographic characteristics, mental health diagnoses, and health care utilization of a sample of 476 VHA GEM patients with diagnosed cognitive impairment or dementia seen in clinics across Upstate New York.

The relationship between craving and tobacco use behavior in laboratory studies: a meta-analysis.

Published laboratory studies from the last 50 years that included measures of craving and tobacco-consumption or tobacco-seeking measures were included in a meta-analysis in order to assess the relationship between craving and tobacco use. Seeking measures were further subdivided into those that reflected control by nonautomatic and automatic cognitive processes. Of 2,498 articles identified by the initial literature review, 204 analyses from 50 studies were deemed eligible.

The magnitude and reliability of cue-specific craving in nondependent smokers.

Background: Cue-reactivity is a robust phenomenon in regular cigarette smokers (Carter and Tiffany, 1999), but it has not been widely investigated in nondependent smokers. Further, most research on cue-specific craving assesses response to cues in a single experimental session. As such, investigations of cue-specific craving have primarily measured state-like but not trait-like responses to smoking stimuli.

Diagnostic utility of craving in predicting nicotine dependence: impact of craving content and item stability.

Introduction: Craving is useful in the diagnosis of drug dependence, but it is unclear how various items used to assess craving might influence the diagnostic performance of craving measures. This study determined the diagnostic performance of individual items and item subgroups of the 32-item Questionnaire on Smoking Urges (QSU) as a function of item wording, level of craving intensity, and item stability.

Methods: Nondaily and daily smokers (n = 222) completed the QSU on 6 separate occasions, and item responses were averaged across the administrations.

A systematic review of the relationships between craving and smoking cessation.

Introduction: Craving is often portrayed as a defining feature of addiction, but the role of craving in the addictive process is controversial. Particularly contentious is the extent to which drug craving predicts subsequent relapse.

Methods: This review synthesizes findings from 62 smoking cessation studies published through December 2011.

Impact of varenicline on cue-specific craving assessed in the natural environment among treatment-seeking smokers.

Rationale: Varenicline is believed to work, in part, by reducing craving responses to smoking cues and by reducing general levels of craving; however, these hypotheses have never been evaluated with craving assessed in the natural environments of treatment-seeking smokers.

Objectives: Ecological momentary assessment procedures were used to assess the impact of varenicline on cue-specific and general craving in treatment-seeking smokers prior to quitting.

Methods: For 5 weeks prior to quitting, 60 smokers carried personal digital assistants that assessed their response to smoking or neutral cues.