Theodore Fetterling

Background: Smoking is the leading risk factor for postoperative complications and is associated with longer hospital stays, reoperations, and 30-day mortality. Smoking rates among patients undergoing major elective surgery are high (22.3%‐43.0%). It is urgent to identify efficacious, strategically timed smoking cessation interventions for patients undergoing surgery. Objective: The goal of this pilot randomized controlled trial is to design and test the feasibility of the first mobile contingency management (mCM) smoking-cessation intervention for military veterans undergoing major elective surgery and to evaluate the effectiveness of mCM compared to treatment as usual (TAU) as exploratory analysis. Methods: We will adapt and adjust a contingency management protocol for delivery over 5 weeks using mobile carbon monoxide monitoring in the perioperative period. We will then test its feasibility and effectiveness in veteran smokers undergoing major elective surgery (n=36). Participants will be randomized to receive mCM or TAU. Both groups will receive pharmacotherapy. The feasibility of mCM will be assessed by (1) recruitment rate, (2) level of engagement, and (3) retention. We will also compare mCM with TAU on smoking cessation outcomes (quit attempts, cigarettes per day, and nicotine dependence severity) over 5 weeks to examine effectiveness. Results: This pilot trial has been funded since July 2024, and a 1-year no-cost extension has been granted through June 2027. The recruitment and data collection started in December 2025. The first participant consented on December 12, 2026. As of May 2026, 18 participants have been enrolled and randomized in this pilot trial. Enrollment of the last participant is expected to be in March 2027 to reach a target of 36 enrolled participants, and the data collection is expected to be completed by April 2027. There will be no interim data analysis, but preliminary analysis is expected to be completed by August 2027, and all data analyses will be completed by the end of 2027. Conclusions: Novel interventions to support smoking cessation may reduce morbidity, mortality, and health care costs for patients undergoing major surgery. mCM has a high potential to implement widely to improve surgical outcomes.

Objective: Motivational Interviewing may be an ideal communication style to use in conjunction with Collaborative Care to address opioid risk, as it can facilitate the discussion of alternative pain care strategies (APCSs) that are pharmacological (APCS-P; e.g., the use of non-opioid pain relievers) or non-pharmacological (APCS-NP; e.g., yoga). This study developed and piloted a coding system (MI Skills Code–APCS) for these discussions. Method: Sessions (n = 119) from a completed randomized controlled trial comparing Collaborative Care Motivational Interviewing (CCMI) or Attention Control Psychoeducation (ACP) delivered by care managers over 12 weeks to veterans with chronic pain and high-risk opioid use enrolled in VA primary care (N = 44). Results: Coders were able to reliably code the client utterances related to APCSs in the sessions (ICCs = 0.58–0.81). The APCS-P and APCS-NP codes were positively correlated with each other. There were two significant relationships between the MISC-APCS codes (motivational states) and the pain interference and endorsement of non-pharmacological pain care goals at 20-week follow-up. Conclusions: The MISC-APCS has promise as a coding system that can reliably record client utterances regarding different types of pain care strategies. These utterances may be associated with post-treatment reports of pain and efforts to reduce opioid risk. The rapid development of artificial intelligence applications to healthcare can utilize this coding system to assist with the assessment and treatment of chronic pain.

Background: As cannabis use in the U.S. has continued to rise among young adults, research is necessary to understand the reinforcing aspects of use. While there are several established demographic indicators of young adult cannabis use, including age, male sex, and sexual orientation, no studies have examined relations between these indicators and facets of cannabis-related positive consequences (i.e., social, mood, cognitive, and sexual enhancement). Objectives: The present study examined associations between age, sex, and sexual orientation with facets of cannabis-related positive consequences. College students (N = 615; age M = 19.98, SD = 1.97; 68.3% female; 27.5% sexual minority) completed self-report questionnaires of demographics, cannabis use frequency, and positive and negative consequences of use. Using exploratory path analysis, we examined associations between common indicators of cannabis use (i.e., age, sex, sexual orientation) and positive consequence facets (i.e., social, mood, cognitive, and sexual enhancement), controlling for cannabis use frequency and negative consequences. We tested models for frequency (i.e., how often) and valence (i.e., how strongly) of positive consequences. Results: Sexual minority orientation was significantly positively associated with several facets of positive consequence frequency and valence, while age was significantly negatively associated with social enhancement consequences. Sex was not associated with positive consequences. Exploratory sensitivity analyses noted similar associations between bisexual/pansexual identity and positive consequence frequency and valence. Conclusions/Importance: The observed associations may help explain use disparities between sexual minorities and their heterosexual peers. Future research is needed to elucidate the role of positive consequences in cannabis use initiation and escalation, which may inform individual tailoring of cannabis prevention and intervention efforts.