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Tobacco Use and Quit Attempts Among Methadone Maintenance Clients

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Tobacco Use and Quit Attempts Among Methadone Maintenance Clients 34. Tabachnick BG, Fidell LS. Using Multivariate Sta- critical review. Am J Public Health. 1987;77: 38. Zastowny TR, Adams EH, Black GS, Lawton tistics. 3rd ed. NewYork,NY: HarperCollins; 1996. 153–160. KB, Wilder AL. Sociodemographic and attitu- 35. Cohen J, Cohen P. Applied Multiple Regression/ 37. McDivitt JA, Zimick S, Hornick RC. Explaining dinal correlates of alcohol and other drug use Correlation Analysis for the Behavioral Sciences. the impact of a communication campaign to among children and adolescents: analysis of a Hillsdale, NJ: Lawrence Erlbaum; 1983. change vaccination knowledge and coverage in large-scale attitude tracking study. J Psychoac- 36. Flay BR. Mass media and smoking cessation: a the Philippines. Health Commun. 1997;9:95–118. tive Drugs. 1993;25:224–237. Tobacco Use and Quit Attempts Among Methadone Maintenance Clients ABSTRACT Kimber Paschall Richter, PhD, MPH, Cheryl A. Gibson, PhD, Jasjit S. Ahluwalia, MD, MPH, MS, and Kristin H. Schmelzle, MA Objectives. This study examined to- Tobacco-related illness is a major cause of Measures bacco use prevalence, types of tobacco death for people who have undergone treat- used, interest in quitting, and prior quit ment for alcohol or illicit drug use.1,2 Smok- The self-administered 12-item question- attempts among persons in methadone ing rates appear to be very high among patients naire was designed to place minimal burden maintenance treatment. in methadone maintenance treatment, the treat- on clients and staff. The survey took 3 to 5 Methods. Counselors collected sur- ment of choice for many people with opiate minutes to complete and was anonymous. De- veys from 84% (550 of 655) of all clients addiction. Although no representative data are mographic questions included age, sex, high- in a 4-county metropolitan area. available, several surveys have reported preva- est grade or level of schooling, racial/ethnic Results. Most clients (77%) smoked lence rates of 85% to 98%.3–5 background, and age at which participants first cigarettes. Of the 59 former tobacco users, Approximately a quarter of a million peo- entered methadone treatment. Number of years only 6 reported using a cessation phar- ple in the United States and Europe are enrolled in methadone treatment was calculated by sub- macotherapy to quit.Three quarters of the in methadone maintenance treatment.6 Metha- tracting age at which participants first entered current smokers had attempted to quit at done is one of the most carefully controlled, methadone treatment from current age. This least once, with an average of 5 attempts. monitored, and evaluated pharmacologic treat- figure was an approximation of current smok- Most smokers (80%) were “somewhat” ments in the history of medicine.7 It reduces ers’exposure to methadone treatment, because or “very” interested in quitting. heroin use, opiate-related deaths, criminality, some clients probably cycled in and out of Conclusions. The quit ratio among and rates of HIV infection6 and is associated treatment. methadone maintenance treatment cli- with increased employment and increased use Seven questions about tobacco use were ents was 12%, compared with 50% na- of health and social services.8 However, in na- adapted from the Behavioral Risk Factor Sur- tionwide. To reduce morbidity and mor- tional evaluations of methadone maintenance veillance System, theYouth Risk Behavior Sur- tality, cessation interventions must be treatment,9–11 little to no mention is made of vey, and the Mayo Nicotine Dependence Cen- developed and disseminated. (Am J Pub- monitoring or treating cigarette use among pa- ter Questionnaire.12–14 In general, reliability of lic Health. 2001;91:296–299) tients, even though smoking is associated with tobacco questions from these survey instru- chronic illness and premature death among per- ments is high.15,16 The proportion of tobacco sons with a history of opiate dependence.1 users who had successfully quit (quit ratio) was This study was conducted to establish calculated by dividing the number of former the prevalence of cigarette smoking, and tobacco users by the number of current and for- interest in quitting, among methadone cli- mer tobacco users and then multiplying by 100. ents in a 4-county metropolitan area. Current cigarette smokers were asked to report the age at which they started smoking Methods Kimber Paschall Richter, Jasjit S. Ahluwalia, and Kristin Schmelzle are with the Department of Pre- Subjects ventive Medicine, University of Kansas School of Medicine, Kansas City, and the Kansas Cancer In- Surveys were distributed to clients of stitute. Cheryl A. Gibson and Jasjit S. Ahluwalia are methadone maintenance clinics serving 4 urban with the Department of Internal Medicine, Univer- and suburban counties that span Greater Kansas sity of Kansas School of Medicine. City. Two of the 5 clinics were public programs, Requests for reprints should be sent to Kimber Paschall Richter, PhD, MPH, Department of Pre- 2 were private and for profit, and 1 was pri- ventive Medicine, University of Kansas Medical Cen- vate and not for profit. Eighty-four percent ter, 3901 Rainbow Blvd, Kansas City, KS 66160- (550 of 655) of all clients served by the clinics 7313 (e-mail: [email protected]). completed and returned surveys. This brief was accepted April 13, 2000. 296 American Journal of Public Health February 2001, Vol. 91, No. 2 regularly, the number of cigarettes smoked per power to examine differences in smoking be- former tobacco users, and 11% reported never day, the number of times a quit attempt was haviors between racial/ethnic minority and using any form of tobacco (data not shown). No made that lasted at least 24 hours, their longest White persons. Confidence intervals and hy- significant differences were found between quit attempt, their level of interest in quitting, pothesis tests were constructed with Minitab Whites and people of color regarding propor- and whether they would be interested in at- (Minitab, Inc, State College, Pa) to examine tions of people who currently used tobacco. tending a smoking cessation program offered sex and racial/ethnic differences in tobacco When we analyzed the proportion of smokers through methadone treatment. The number of use. Inferential statistics included χ2 analyses within sex, a higher proportion of women years of smoking was derived by subtracting and t tests. (84%) than men (75%) were current tobacco age at which cigarettes were smoked regularly users (χ2 =5.944, P=.015) (data not shown). from current age. This figure was an approxi- The quit ratio was 12%. Most former to- mation of current smokers’ exposure to to- Results bacco users had quit on their own, without any bacco, because some may have been abstinent aid. Only 6 of the 59 former tobacco users re- for a short or long time. Sample Characteristics ported using any pharmacotherapy to quit smoking: 4 with nicotine patches and 2 with Procedure The majority of participants (52%) were nicotine gum. The quit ratio differed by race/ aged 40 to 49 years (Table 1). The age range ethnicity; 20% of the people of color but only Clinic counselors distributed surveys to was 18 to 86 years. Sixty-three percent of the 10% of the Whites had successfully quit (χ2 = their clients during their routine visits. Clients sample was male. Most respondents (81%) were 7.438, P=.006). returned surveys either to a counselor or to a White. Forty-two percent had some post–high box at the methadone dispensing window. school education.The number of years in meth- Cigarette Use Counselors avoided surveying the same client adone maintenance varied considerably among more than once. participants, with treatment spans of less than The cigarette smoking prevalence rate was 1 year to 37 years.The population was not dis- 77% (Table 2). Most (98%) current tobacco Statistical Analysis tributed homogeneously among clinics; women users smoked cigarettes (data not shown). Only were significantly more likely than men to use 12% of the tobacco users used other tobacco Descriptive statistics were calculated with public clinics (χ2 =10.966, P<.001), and peo- products. Cigarette smokers reported smoking SAS.17 Frequencies and percentages were cal- ple of color were more likely thanWhites to at- an average of 20 (SD=12) cigarettes per day. culated for all categorical variables. Means, tend public clinics (χ2 =32.254, P<.001). No significant differences between males and medians, SDs, and ranges were computed for females were found in number of cigarettes continuous variables. Age was grouped into 5 Tobacco Use smoked. However, people of color smoked categories. We used 5 racial/ethnic categories fewer cigarettes per day than did Whites (av- but in analyses combined these into 2 groups— Among all 550 respondents, 78% cur- erage of 17 and 24, respectively; t=5.72, White and people of color—to maximize rently used some form of tobacco, 11% were P<.001). TABLE 1—Profile of Participants Total Sample Current Tobacco Users Nonusers (N=550)a (n=430)c (n=118) Sociodemographic Characteristicsb No. % No. % No. % Sex Male 346 63 259 60 85 73 Female 202 37 170 40 32 27 Age, y 18–29 27 5 21 5 6 5 30–39 136 25 109 26 27 23 40–49 286 52 222 52 63 54 50–59 84 15 65 15 18 15 ≥60 12 2 9 2 3 3 Racial/ethnic background White 443 81 355 83 88 76 African American 76 14 52 12 22 19 Other 25 5 19 4 6 5 Educational background High school or less 316 58 256 60 60 52 Post–high school 229 42 171 40 56 48 Years in methadone treatmentd 10 0–37 10 0–37 10 0–33 Methadone program type Public 265 48 208 48 56 47 Private 285 52 222 52 62 53 aSubsample sizes for survey items differed slightly owing to nonresponse.
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