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The objective of this study is to explore how HIV care affects health-related quality of life (HRQoL) among older people in Uganda.We enrolled older-aged (≥49 years) people with HIV receiving HIV care and treatment, along with age- and sex-similar people without HIV. We measured health-related quality of life using the EQ-5D-3L scale.People with HIV (Older people with HIV receiving care and treatment reported higher health-related quality of life than people without HIV in Uganda. Access to primary care through HIV programs and/or social network mobilization may explain this difference, but further research is needed to elucidate the mechanisms.

BACKGROUND Nondaily smoking is a wide-spread, increasingly prevalent pattern of smoking that is particularly prevalent in ethnic minority and vulnerable populations such as persons with mental health and substance use challenges. To date, no effective treatment approach for this type of smokers has been identified. OBJECTIVE To use a randomized controlled trial to evaluate proof-of-concept markers of the Smiling instead of Smoking (SiS) app, a smoking cessation smartphone app designed specifically for nondaily smokers. This app was iteratively developed and is now in its 3rd Version. Prior studies have demonstrated acceptability and feasibility when participants were onboarded in person (Study 1) and remotely (Study 2), and showed within-person changes in line with hypothesized mechanisms of change. This is the first randomized test of this app. METHODS A total of 225 adult nondaily smokers will be asked to undertake a quit attempt while using their smoking cessation support materials for a period of seven weeks, one week prior to and six weeks following their chosen quit date. Participants will be randomized to use one of the three following materials: the SiS smartphone app vs. the National Cancer Institute (NCI)’s smartphone app QuitGuide (QG) vs. the NCI’s smoking cessation brochure “Clearing the Air” (CtA). All participants will participate in a 15-minute scripted onboarding phone-call, during which study staff will introduce participants to their support materials. Survey links will be sent for 2, 6, 12, and 24-week follow-ups, anchored on the participants’ initially chosen quit date. The primary outcome is self-efficacy to remain abstinent from smoking at treatment end, as measured by the Smoking Self-Efficacy Questionnaire. Secondary outcomes cover several domains relevant to treatment development and implementation: treatment acceptability (e.g., satisfaction with smoking cessation support, as measured by the Client Satisfaction Scale; app usability, as measured by the System Usability Scale), treatment feasibility (e.g., as measured by the number of days participants used the SiS/QG app during the prescribed treatment period, the extent to which they used smoking cessation strategies), and, in an exploratory way, treatment efficacy as assessed by self-reported 30-day point prevalence abstinence. RESULTS Recruitment began in January 2021 and will continue until July 2022. The final 24-week follow-up is expected to be completed in January 2023. The trial is funded by the American Cancer Society. CONCLUSIONS This study is designed to test if the SiS app warrants testing in a large-scale randomized controlled trial to test its effectiveness in supporting smoking cessation for nondaily smokers. The design of this study also enables insights into issues pertinent to smoking cessation smartphone app treatment development and implementation by measuring, in a randomized design, markers of treatment satisfaction, engagement with the technology and content of the treatment, and adherence to the treatment plan. CLINICALTRIAL NCT04672239

Our objective was to evaluate the feasibility and acceptability, and preliminary efficacy of a modified comprehensive behavioral intervention for tics (MCBIT) therapy for youth with chronic tic disorders (CTDs), co-occurring attention-deficit hyperactivity disorder (ADHD), and associated psychosocial impairment. Seventeen youth ages 10-17 with CTD and co-occurring ADHD were randomly assigned to the MCBIT group (n = 9) or to a control group where they received traditional comprehensive behavioral intervention for tics (CBIT) therapy (n = 8). Both groups received ten 55-minute weekly treatment sessions, and two 55-minute biweekly relapse prevention sessions. Sixteen of the 17 participants completed the study, and acceptability ratings in both treatment groups were high with no significant differences in expectation of improvement. The MCBIT and CBIT groups in combination showed significant improvement in tic severity, ADHD symptom severity, and tic-related impairment. Group differences were not significant. The results indicate that MCBIT treatment is feasible and acceptable for youth with CTD and ADHD, and is similarly well tolerated relative to traditional CBIT. Results were not sufficiently superior to recommend MCBIT over CBIT for this population. However, given the demonstrated benefit of behavioral treatments that target co-occurring conditions concurrently, continuing to examine novel behavioral approaches that can target tics and related conditions simultaneously and successfully is recommended.

BACKGROUND The population of nondaily smokers is large (ie, 24.3% of adult smokers) and increasing (ie, 27% increase over the past decade). The cancer risk of nondaily smoking is substantial (40%-50% of that seen in daily smokers). Existing treatments are ill-suited for nondaily smoking, because the treatments are based on nicotine dependence, and traditional treatments and treatment modalities (eg, in-person counseling, medication) do not appeal to non-dependent nondaily smokers. OBJECTIVE We sought to develop a smartphone app that acts as a behavioral, in-the-pocket coach and uses positive psychology exercises to enhance quitting success. METHODS Nondaily smokers (n=30) used Version 1 of the “Smiling Instead of Smoking” (SiS) app while undergoing a quit attempt (1 week pre-, 2 weeks post-quit). The app assigned daily positive psychology exercises, provided smoking cessation tools (ie, scheduling quit day, logging personal reasons for quitting, planning for challenging times, enlisting social support), and made information about smoking cessation available (ie, benefits of quitting, strategies for cravings). Participants answered surveys at baseline and 2, 6, and 12 weeks post-quit and participated in structured user feedback sessions 2 weeks after their chosen quit day. RESULTS During the 3 weeks of ‘prescribed’ use, 50% of participants completed every daily positive psychology exercise, and the remaining 50% completed on average 85% of the daily exercises. Use of the user-initiated tools was limited: 20% did not use the “Challenging Times” tool at all; those who did only used it twice (median); 27% used the “Social Support” tool on multiple days. Self-reported smoking abstinence rates were 43.3% (7-day abstinence) 2 weeks post-quit, and 40.0% and 43.3% (30-day abstinence) at 6 and 12 weeks post-quit, respectively. Most participants (90%) felt the app helped them during their quit attempt, especially in terms of staying on track, giving them confidence, and reinforcing the idea that quitting was worthwhile. Usefulness ratings were particularly high for functionality that allowed participants to (re-)schedule their quit day and log their personal reasons for quitting smoking. In line with putative mechanisms underlying smoking cessation, compared to baseline, participants reported a lower urge to smoke (F(1,29)=20.55, P CONCLUSIONS A positive psychology approach to support smoking cessation resonated well with nondaily smokers. App usage of these exercises was high over a 3-week period, suggesting that this treatment approach is sustainable during the critical phase of smoking cessation. Abstinence rates were substantially higher than natural quit rates in this population, and thus offer some promise, which will need to be evaluated in a randomized trial.