Browsing by Author "Horn, Kimberly"

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    Behavioural intentions in response to a potential menthol cigarette sales ban: a survey examining smokers in Washington, DC public housing
    Dearfield, Craig T.; Horn, Kimberly; Crandell, Ian; Bernat, Debra H. (Bmj Publishing Group, 2022-07)
    Objectives Local, national and international policies are being proposed to ban the sale of menthol-flavoured tobacco products. With more bans being implemented, it is increasingly important to understand reactions to these bans among smokers of low socioeconomic status. This study examined public housing residents' behavioural intentions if menthol-flavoured cigarettes were no longer sold. Setting 15 District of Columbia Housing Authority properties between March 2019 and March 2021. Participants 221 District of Columbia Housing Authority residents ages 18-80 years who reported smoking menthol cigarettes (83.3% African-American/black). Primary and secondary outcomes Cigarette quitting and switching intentions due to a hypothetical menthol-flavoured cigarette sales ban. Results Nearly one-half (48.0%) of residents said they intended to quit cigarette use if menthol-flavoured products were no longer sold, while 27.2% were unsure if they would quit, and 24.9% reported they would not quit. Older residents (OR 0.94 per year, 95% CI 0.91 to 0.97), senior/disabled building versus family building residents (OR 0.50, 95% CI 0.25 to 0.97), those who smoked within 30 min of waking (OR 0.48, 95% CI 0.23 to 0.98) and daily smokers (OR 0.42, 95% CI 0.21 to 0.84) had lower odds of reporting quit intentions associated with a menthol ban. Of those not intending to quit, 40.7% reported they would switch to non-menthol cigarettes, 20.4% to another non-menthol product, 13.0% to menthol e-cigarettes and 20.4% to another menthol product. Conclusions Results suggest banning the sale of menthol-flavoured products has the potential to impact cigarette smoking cessation. Nearly three-quarters of smokers in public housing indicated a possibility of quitting smoking because of a menthol cigarette ban. Bans that include all flavours in all tobacco products may be most effective for facilitating overall tobacco cessation.
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    Comparison between Gradual Reduced Nicotine Content and Usual Nicotine Content Groups on Subjective Cigarette Ratings in a Randomized Double-Blind Trial
    Lin, Wenxue; Krebs, Nicolle M.; Zhu, Junjia; Foulds, Jonathan; Horn, Kimberly; Muscat, Joshua E. (MDPI, 2020-09-26)
    In 2018, the United States Food and Drug Administration (FDA) issued an advanced notice of proposed rulemaking to reduce nicotine in tobacco products to produce a minimally addictive or nonaddictive effect, but there was a research gap in the subjective responses of reduced-nicotine-content cigarettes. We compared the responses of the modified cigarette evaluation questionnaire (mCEQ) and cigarette-liking scale (CLS) between the gradually reduced nicotine content (RNC) group and the usual nicotine content (UNC) group. Linear mixed-effects models for repeated measures were used to analyze and compare the change over time for the mCEQ and CLS across the two treatment groups (RNC and UNC). We found that the change over time for the mCEQ and CLS was significant between the RNC and the UNC treatment groups at the beginning of visit 6 with 1.4 mg nicotine/cigarette. At visits 8 and 9, the RNC group reported significantly lower satisfaction scores compared to UNC. Subscale analysis showed that smoking satisfaction decreased in RNC while other measures, such as cigarette enjoyment, did not change. Understanding the impact of nicotine reduction on cigarette subjective responses through evaluation and liking scales would provide valuable information to the FDA on nicotine reduction policies for cigarettes.
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    Developing medical simulations for opioid overdose response training: A qualitative analysis of narratives from responders to overdoses
    Edwards, G. Franklin; Mierisch, Cassandra; Mutcheson, Brock; Coleman, Keel; Horn, Kimberly; Parker, Sarah Henrickson (PLOS, 2024-03-28)
    Medical simulation offers a controlled environment for studying challenging clinical care situations that are difficult to observe directly. Overdose education and naloxone distribution (OEND) programs aim to train potential rescuers in responding to opioid overdoses, but assessing rescuer performance in real-life situations before emergency medical services arrive is exceedingly complex. There is an opportunity to incorporate individuals with firsthand experience in treating out-of-hospital overdoses into the development of simulation scenarios. Realistic overdose simulations could provide OEND programs with valuable tools to effectively teach hands-on skills and support context-sensitive training regimens. In this research, semi-structured interviews were conducted with 17 individuals experienced in responding to opioid overdoses including emergency department physicians, first responders, OEND program instructors, and peer recovery specialists. Two coders conducted qualitative content analysis using open and axial thematic coding to identify nuances associated with illicit and prescription opioid overdoses. The results are presented as narrative findings complemented by summaries of the frequency of themes across the interviews. Over 20 hours of audio recording were transcribed verbatim and then coded. During the open and axial thematic coding process several primary themes, along with subthemes, were identified, highlighting the distinctions between illicit and prescription opioid overdoses. Distinct contextual details, such as locations, clinical presentations, the environment surrounding the patient, and bystanders’ behavior, were used to create four example simulations of outof- hospital overdoses. The narrative findings in this qualitative study offer context-sensitive information for developing out-of-hospital overdose scenarios applicable to simulation training. These insights can serve as a valuable resource, aiding instructors and researchers in systematically creating evidence-based scenarios for both training and research purposes.
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    Evaluating Rescuer Performance in Response to Opioid Overdose in a Community Setting: Evidence for Medically Appropriate Process Measures
    Edwards, G. Franklin III; Mierisch, Cassandra; Strauss, Allison; Mutcheson, Brock; Coleman, Keel; Horn, Kimberly; Parker, Sarah H. (Elsevier, 2023-02)
    Overdose education and naloxone distribution (OEND) programs are widely accepted to reduce opioid overdose deaths. However, there is currently no validated instrument to evaluate the skills of learners completing these programs. Such an instrument could provide feedback to OEND instructors and allow researchers to compare different educational curricula. The aim of this study was to identify medically appropriate process measures with which to populate a simulation-based evaluation tool. Researchers conducted interviews with 17 content experts, including healthcare providers and OEND instructors from south-central Appalachia, to collect detailed descriptions of the skills taught in OEND programs. Researchers used three cycles of open coding, thematic analysis, and consulted currently available medical guidelines to identify thematic occurrences in qualitative data. There was consensus among content experts that the appropriate nature and sequence of potentially lifesaving actions during an opioid overdose is dependent on clinical presentation. Isolated respiratory depression requires a distinct response compared to opioid-associated cardiac arrest. To accommodate these different clinical presentations, raters populated an evaluation instrument with the detailed descriptions of overdose response skills, such as naloxone administration, rescue breathing, and chest compressions. Detailed descriptions of skills are essential to the development of an accurate and reliable scoring instrument. Furthermore, evaluation instruments, such as the one developed from this study, require a comprehensive validity argument. In future work, the authors will integrate the evaluation instrument in high-fidelity simulations, which are safe and controlled environments to study trainees’ application of hands-on skills, and conduct formative assessments.
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    Implementation of the Department of Housing and Urban Development’s Smoke-Free Rule: A Socio-Ecological Qualitative Assessment of Administrator and Resident Perceptions
    Horn, Kimberly; Johnson, Sallie B.; Rincón-Gallardo Patiño, Sofía; Krost, Kevin; Gray, Tiffany; Dearfield, Craig; Du, Chenguang; Bernat, Debra (MDPI, 2021-08-24)
    In July 2018, the United States Department of Housing and Urban Development (HUD) implemented a mandatory smoke-free rule in public housing. This study assessed administrator and resident perceptions of rule implementation during its initial year in the District of Columbia Housing Authority (DCHA). Assessment included nine focus groups (n = 69) with residents and in-depth interviews with administrators (n = 7) and residents (n = 26) from 14 DCHA communities (family = 7 and senior/disabled = 7). Semi-structured discussion guides based on the multi-level socio-ecological framework captured dialogue that was recorded, transcribed verbatim, and coded inductively. Emerging major themes for each socio-ecological framework level included: (1) Individual: the rule was supported due to perceived health benefits, with stronger support among non-smokers; (2) Interpersonal: limiting secondhand smoke exposure was perceived as a positive for vulnerable residents; (3) Organizational: communication, signage, and cessation support was perceived as a need; (4) Community: residents perceived mobility, disability, weather, and safety-related issues as barriers; and (5) Public Policy: lease amendments were perceived as enablers of rule implementation but expressed confusion about violations and enforcement. A majority of administrators and residents reported favorable implications of the mandated HUD rule. The novel application of a socio-ecological framework, however, detected implementation nuances that required improvements on multiple levels, including more signage, cessation support, clarification of enforcement roles, and addressing safety concerns.
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    Is peer support a tipping point for the opioid use disorder crisis in Appalachia? Research holds the answer
    Horn, Kimberly; Mathis, Stephanie M.; Nagle, Lara; Hagaman, Angela; Dunkenberger, Mary B.; Pack, Robert (2024-06-25)
    Background: The present commentary highlights the pressing need for systematic research to assess the implementation and effectiveness of medications for opioid use disorder, used in conjunction with peer recovery support services, to improve treatment outcomes for individuals with opioid use disorder in Central Appalachia. This region, encompassing West Virginia, Eastern Kentucky, Southwest Virginia, East Tennessee, and Western North Carolina, has long grappled with a disproportionate burden of the opioid crisis. Due to a complex interplay of cultural, socioeconomic, medical, and geographic factors, individuals in Central Appalachia face challenges in maintaining treatment and recovery efforts, leading to lower success rates. Approach: To address the issue, we apply an exploratory approach, looking at the intersection of unique regional factors with the utilization of medications for opioid use disorder, in conjunction with peer recovery support services. This combined treatment strategy shows promise in addressing crucial needs in opioid use disorder treatment and enhancing the recovery journey. However, there are significant evidence gaps that need to be addressed to validate the expected value of incorporating peer support into this treatment strategy. Conclusion: We identify nine obstacles and offer recommendations to address the gaps and advance peer recovery support services research. These recommendations include the establishment of specific partnerships and infrastructure for community-engaged, peer recovery support research; improved allocation of funding and resources to implement evidence-based practices such as peer support and medication-assisted treatment; developing a more precise definition of peer roles and their integration across the treatment and recovery spectrum; and proactive efforts to combat stigma through outreach and education.
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    Resident Support for the Federally Mandated Smoke-Free Rule in Public Housing: 2018-2022
    Dearfield, Craig T.; Ulfers, Margaret; Horn, Kimberly; Bernat, Debra H. (MDPI, 2024-01-17)
    This study examines support for the Department of Housing and Urban Development’s (HUD) mandatory smoke-free rule up to four years post-rule among smokers and non-smokers. A repeated cross-sectional design was used where District of Columbia public housing residents aged 18+ (n = 529) completed surveys during three time points: July 2018 (pre-rule), November 2018–March 2020 (post-rule), and September 2020–December 2022 (post-rule + COVID-19). Full support for the rule was indicated by agreeing that smoking should not be allowed in all indoor locations and within 25 feet of buildings. Descriptive statistics showed significant differences in support across time for smokers (5.3%, 30.7%, and 22.5%, respectively) and similar support across time for nonsmokers (48.2%, 52.2%, and 40.0%, respectively). In unstratified regression analysis, pre-rule support was lower than when the rule was in effect (aOR = 0.47, 95% CI = 0.25, 0.90), and tobacco users were less likely to support the rule (aOR = 0.34, 95% CI = 0.23, 0.50). Stratified logistic regression results showed that pre-rule support was lower among smokers compared to post-rule support (aOR = 0.14, 95% CI = 0.03, 0.59); support among nonsmokers did not vary by time. Findings overall indicate low support for the smoke-free rule up to 4 years post-implementation. Engaging residents with the rule and promoting health and well-being may further enhance policy effectiveness and acceptance.
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    Smoking cessation intentions and attempts one year after the federally mandated smoke-free housing rule
    Horn, Kimberly; Dearfield, Craig T.; Johnson, Sallie Beth; Krost, Kevin; Patino, Sofia Rincon Gallardo; Gray, Tiffany; Crandell, Ian; Bernat, Debra H. (Elsevier, 2021-12)
    The present study examines public housing residents' smoking cessation intentions, expectancies, and attempts one year after implementation of the Department of Housing and Urban Development's mandatory smoke-free rule in public housing. The sample includes 233 cigarette smokers, ages 18-80, who reside in the District of Columbia Housing Authority. Data collection occurred between March and August 2019. Descriptive statistics, chi-square, and Wilcoxon two-sample test analyses assessed smoking cessation intentions, expectancies, and attempts across resident demographics and characteristics. Findings showed 17.2% of residents reported not thinking about quitting, 39.1% reported thinking about quitting, and 48.6% reported thinking about quitting specifically because of the rule. Residents ages 60-80 were more likely to consider quitting because of the rule, compared to residents ages 18-59. Of those thinking of quitting, 58.6% were sure they could quit if they tried. Those thinking of quitting due to the rule (62.0%) were more likely to have made at least one quit attempt in the past 3 months than those i not attributinging thinking of quitting to the rule. Res Residents trying to quit reported an average of 2.7 attempts in the last 3 months;; most perceived evidence-based cessation supports as not helpful. A A majority reported thinking about quitting and attempting to quit but continuing to smoke, indicating a significant gap between intent to quit and successfully quitting. Results suggest that the rule positively influenced smoking behaviors. However, additional interventions are needed to assist public housing residents with successfully quitting smoking.
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    Tapping into community expertise: stakeholder engagement in the design process
    Morshedzadeh, Elham; Dunkenberger, Mary Beth; Nagle, Lara; Ghasemi, Shiva; York, Laura; Horn, Kimberly (Taylor & Francis, 2022-10)
    The Connection to Care (C2C) project, a transdisciplinary work-in-progress, employs community-engaged participatory research and design methods at the nexus of policy adaptation and product innovations. C2C aims to advance practices that identify and leverage the critical junctures at which people with substance use disorder (SUD) seek lifesaving services and treatment, utilizing stakeholder input in all stages of design and development. Beginning in the Fall of 2018, members of our research team engaged with those at the forefront of the addiction crisis, including first responders, harm reduction and peer specialists, treatment providers, and individuals in recovery and in active substance use in a community greatly impacted by SUD. Through this engagement, the concept for programs and products representing a connection to care emerged, including the design of a backpack to meet the needs of individuals with SUD and those experiencing homelessness. From 2020 to 2022, more than 1,200 backpacks with lifesaving and self-care supplies have been distributed in local communities, as one component of the overall C2C initiative. The backpack is a recognized symbol of the program and has served as an impetus for further program and policy explorations, including as a lens to better understand the role of ongoing stigma. Though addiction science has evolved significantly in the wake of the opioid epidemic, artifacts of policies and practices that criminalize and stigmatize SUD remain as key challenges. This paper explains the steps that C2C has taken to address these challenges, and to empower a community that cares.
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    Tobacco use among Appalachian adolescents: An urgent need for virtual scale out of effective interventions
    Horn, Kimberly; Schoenberg, Nancy; Rose, Shyanika; Romm, Katelyn; Berg, Carla (European Publishing, 2022-11)
    Tobacco use, typically initiated during adolescence, can escalate into young adulthood, even among experimenting or intermittent users. Despite declines in cigarette smoking among US adolescents, use of other tobacco products and poly-tobacco are on the rise among Appalachian adolescents. Unfortunately, Appalachian adolescent tobacco users also are less likely to receive effective tobacco interventions due to various barriers: a) accessibility (e.g. service and provider shortages, affordability, and transportation; b) acceptability (e.g. issues of privacy and stigma); and c) cultural relevance. The present review provides critical considerations synthesized from an extensive body of literature on the suitability of virtual tobacco interventions, the need for well-timed interventions that address complex tobacco use, and the rationale for leveraging and scaling evidence-based interventions inform novel interventions for Appalachian adolescent tobacco users. Borrowing strength from existing in-person evidence-based adolescent tobacco interventions and state-of-the-art virtual health services, a well-planned virtual scale out of tobacco interventions holds potential to minimize barriers unique to Appalachia.