Christine Elizabeth Sheffer

• PhD
• Professor (Full) at Roswell Park Comprehensive Cancer Center

Introduction: To eliminate tobacco-related disparities, tobacco control research would benefit from a paradigm shift. Intersectionality, a framework pioneered by Kimberlé Crenshaw in late 1980s, has the potential to improve our understanding of why and how certain social groups are disproportionately harmed by commercial tobacco use, and improve o...

Introduction: Many individuals with lung cancer report experiencing stigma associated with their diagnosis. The objective of this study was to explore how different factors, including smoking status, lung cancer concern, and thoughts on smoking behaviors, were associated with increased stigmatizing attitudes towards people with lung cancer. Metho...

Introduction: Cannabis use is increasing among cigarette smokers in the United States (US). Prior studies suggest that cannabis use may be a barrier to smoking cessation. Yet, the extent to which this is the case among adults seeking to quit tobacco use remains unclear. Tobacco quitlines are the most common provider of no-cost treatment for adults...

Patients with autism spectrum disorder (ASD) display distinctive neurophysiological characteristics associated with significant cognitive, emotional, and behavioral symptoms. Transcranial direct current stimulation (tDCS) applied to the frontal or temporoparietal lobes has demonstrated potential to reduce the severity of ASD-related symptoms. Recen...

Relapse to smoking continues to be among the most urgent global health concerns. Novel, accessible, and minimally invasive treatments to aid in smoking cessation are likely to improve the reach and efficacy of smoking cessation treatment. Encouraging prospection by decreasing delay discounting (DD) is a new therapeutic target in the treatment of sm...

African Americans are more likely to die from tobacco-related diseases and less likely to quit smoking than their white counterparts. Evidence of greater prevalence of posttraumatic stress disorder (PTSD) among African Americans underscores the importance of studying the effects of traumatic event exposure on tobacco dependence treatment outcomes i...

Maintaining adequate amounts of physical activity is a critical component of survivorship care for women with breast cancer. Increased physical activity is associated with increases in well-being, quality of life, and longevity, but women with cancer face unique, cancer-related factors that might affect physical activity. Consistent with the Compet...

Despite remarkable progress, tobacco control efforts are not equitably distributed, and tobacco-related disparities continue to contribute to significant health disparities. Our premise in this commentary is that Intersectionality can serve as a productive analytical framework for examining tobacco-related disparities across and within multiple mar...

Background: Tobacco use remains one of the world's greatest preventable causes of death and disease. While most smokers want to quit, few are successful, highlighting a need for novel therapeutic approaches to support cessation efforts. Lower delay discounting (DD) rates are associated with increased smoking cessation success. Future thinking prim...

Tobacco use is projected to kill 1 billion people in the 21st century. Tobacco Use Disorder (TUD) is one of the most common substance use disorders in the world. Evidence-based treatment of TUD is effective, but treatment accessibility remains very low. A dearth of specially trained clinicians is a significant barrier to treatment accessibility, ev...

Black cigarette smokers experience higher craving, lower cessation rates, and increased health complications from tobacco use than Whites. We examined psychophysiological and behavioral differences in attentional bias to smoking cues between Black and White smokers. Thirty-one participants (Blacks, n = 20; MAge = 45 and Whites, n = 11, MAge = 47.64...

Despite the importance of smoking cessation to cancer care treatment, historically, few cancer centers have provided treatment for tobacco dependence. To address this gap, the National Cancer Institute (NCI) launched the Cancer Center Cessation Initiative (C3i). As part of this effort, this study examined implementation outcomes in a cohort of canc...

Introduction Recent evidence suggests that quitline text messaging is an effective treatment for smoking cessation, but little is known about the relative effectiveness of the message content. Aims A pilot study of the effects of gain-framed (GF; focused on the benefits of quitting) versus loss-framed (LF; focused on the costs of continued smoking...

Background: Despite the considerable success of comprehensive tobacco control efforts, tobacco use remains one of the greatest preventable causes of death and disease today. Over half of all smokers in the US make quit attempts every year, but over 90% relapse within 12 months, choosing the immediate reinforcement of smoking over the long-term ben...

Aims: Most cigarette smokers want to quit smoking and more than half make an attempt every year, but less than 10% remain abstinent for at least 6 months. Evidence-based tobacco use treatment improves the likelihood of quitting, but more than two-thirds of individuals relapse when provided even the most robust treatments. Identifying for whom trea...

Smoking cigarettes is a leading global cause of preventable death and disease. Men historically smoke more than women, but the prevalence of smoking among women in low and middle-income countries is increasing at an alarming rate. Understanding the factors that influence smoking initiation among women and girls is needed to address the growing epid...

Objectives: Head and neck cancer (HNC) constitutes a substantial portion of the cancer burden worldwide, with over 550,000 new cases and over 300,000 deaths annually, with disproportionately high mortality rates in the developing countries. The large majority of HNCs are caused by tobacco use, and synergistic effects of tobacco and alcohol use. Usi...

There is growing interest in non-invasive brain stimulation as a novel treatment option for substance use disorders (SUDs). Recent momentum stems from a foundation of preclinical neuroscience research demonstrating causal and associative links between neural circuit activity and drug consuming behavior, as well as recent FDA-approval of non-invasiv...

Objective: Delay discounting, the propensity to devalue delayed rewards, has robust predictive validity for multiple health behaviors and is a new therapeutic target for health behavior change. Priming can influence behaviors in a predictable manner. We aimed to use the Future Thinking Priming task, administered remotely, to reliably decrease dela...

Background: African American smokers suffer disproportionately from tobacco-related disease caused, in part, by lower rates of smoking cessation. We examined whether smoke-free home policies and delay discounting were differentially associated with cigarettes smoked per day (CPD) and nicotine dependence (ND) among African Americans and Whites. Me...

Addiction is correlated with the dysfunction of definite neural circuitry involving deep as well as superficial brain regions. Among the deep structures are the midbrain ventral tegmental area (VTA) and the nucleus accumbens of the ventral striatum, connected to each other by means of dopaminergic fibers. This pathway is the neural correlate of nor...

Background: Delay discounting rate shows robust predictive validity for tobacco use behaviors and is a new therapeutic target in the treatment of tobacco use. Identifying factors that influence relations between delay discounting and the choice to smoke cigarettes is key to the development of effective interventions that target delay discounting t...

Intensive tobacco treatment programs offer many advantages relative to other treatment options, particularly for more complex patients, e.g., highly nicotine dependent, or those with medical and psychiatric symptoms and disorders. Efforts to better understand those who choose to enroll in these programs, particularly regarding the characteristics t...

Background: Daily cannabis use is increasing in the United States (US). Yet, it is not known whether daily cannabis use is disproportionately common, or whether it has increased differentially over time, by mental health status. This study estimated the prevalence of daily cannabis use among adults in the US with and without past-month serious psy...

Socioeconomic disparities in treatment failure rates for evidence-based tobacco dependence treatment are well-established. Adapted cognitive behavioral treatments are extensively tailored to meet the needs of lower socioeconomic status (SES) smokers and dramatically improve early treatment success, but there is little understanding of why treatment...

Background The identification of new therapeutic targets to improve health behaviors among cancer survivors (CS) is likely to improve cancer treatment outcomes. Delay discounting (DD) rate is the degree to which one devalues rewards as a function of time to receipt. Lower DD rates (ie, prioritizing long‐term over immediate rewards) are associated w...

p class="Pa7">In the United States, tobacco use is a lead­ing contributor to inequities in cancer health among individuals for many ethnic, racial, sexual minority, and other minority groups as well as individuals in lower socioeconom­ic groups and other underserved popula­tions. Despite remarkable decreases in tobacco use prevalence rates in the U...

Many smokers attempt to quit every year, but 90% relapse within 12 months. Converging evidence suggests relapse is associated with insufficient activation of the prefrontal cortex. Delay discounting rate reflects relative activity in brain regions associated with relapse. High-frequency repetitive transcranial magnetic stimulation (rTMS) of the lef...

Introduction: Evidence-based treatments for tobacco dependence are significantly less effective for smokers of lower socioeconomic status which contributes to socioeconomic disparities in smoking prevalence rates and health. We aimed to reduce the socioeconomic gradient in treatment outcomes by systematically adapting evidence-based, cognitive-beh...

: The presence of structured addiction research training programs helps to ensure that the scientific workforce includes well-trained, diverse scientists necessary to reduce the negative impact of alcohol, drug, and tobacco use disorders. Although the field has made significant progress in the development of standards for clinical training in addic...

Data from treatment studies tends to show women are less likely to quit smoking than men, but these findings have been disputed, typically based on contradictory evidence from epidemiological investigations.The purpose of this review was to shed light on this conflict.We conducted a qualitative review in January 2016 to examine sources of variation...

Steep discounting of delayed rewards is linked with a variety of unhealthy behaviors that contribute to the major causes of preventable death and disease. Growing evidence suggests that decreases in delay discounting contribute to healthier preferences. This study sought to provide preliminary evidence for the viability of developing a brief primin...

Randomized double-blind sham control study evaluating the feasibility of high frequency Transcranial Magnetic Stimulation of the dorsolateral prefrontal cortex in the treatment of tobacco dependence.

With smoking prevalence rates estimated to be 4 to 5 times greater than the national mean, those in recovery from substance use disorders (SUDs) are at significant risk for tobacco-related death and disease.1,2 The reasons for this disparity are likely to be multi-faceted and remain unclear. This study explored relationships between length of recov...

Abstract: The US smoking prevalence is remarkably disparate and free treatment for tobacco dependence provided through quitlines reaches just 1-2% of smokers. We examined barriers to use of the quitline in the Arkansas Mississippi delta region an historically underserved region. We used community-based participatory methods to prioritize findings f...

Delay discounting is a behavioral economic index of impulsivity that reflects a person's relative preference for small immediate rewards versus larger delayed rewards. Elevated delay discounting is robustly linked to addictive disorders and has been increasingly investigated as a viable endophenotype for genetic influences on addiction. The aim of...

Introduction: Tobacco use is the leading cause of preventable death and disease and contributes significantly to socioeconomic health disparities. The prevalence of smoking among individuals of lower socioeconomic status (SES) in the US, many of whom are African American (AA), is three to four times greater than the prevalence of smoking among indi...

Each year, tobacco use causes over 6 million deaths and is responsible for hundreds of billions of dollars in health care and economic costs in the world (WHO, 2011). If current trends continue, tobacco is expected to kill over 1 billion people in the 21 st century, making it one of the single greatest causes of preventable death and disease in his...

BACKGROUND Given that continued smoking after a cancer diagnosis increases the risk of adverse health outcomes, patients with cancer are strongly advised to quit. Despite a current lack of evidence regarding their safety and effectiveness as a cessation tool, electronic cigarettes (E-cigarettes) are becoming increasingly popular. To guide oncologis...

OBJECTIVES: We examined socioeconomic disparities in tobacco dependence treatment outcomes from a free, proactive telephone counseling quitline. METHODS: We delivered cognitive-behavioral treatment and nicotine patches to 6626 smokers and examined socioeconomic differences in demographic, clinical, environmental, and treatment use factors. We used...

Introduction: Illicit drug use and nicotine dependence (ND) frequently co-occur. Yet, to date very few studies have examined the role of alcohol and illicit drug use in ND persistence. The objectives of this study were to investigate the relationships between specific classes of drug use, abuse, and dependence and the persistence of ND over time a...

The need for aggressive efforts to help tobacco users quit remains a healthcare priority. Brief interventions delivered in the healthcare environment continue to be a valuable component of a comprehensive tobacco control policy. Unfortunately, such treatments are offered less often than desired, and quality is variable. Previous research has demons...

Abstract Aims: To investigate the relation between smoking relapse and depression and specific anxiety disorders (generalized anxiety disorder [GAD] and panic attacks) among smokers in the U.S. who have quit over a 10-year period. Design,Setting,Participants: Data were drawn from the Midlife Development in the United States (MIDUS) Survey Waves I&...

Repetitive transcranial magnetic stimulation (rTMS) is a new frontier in the examination of addictive behaviors and perhaps the development of new interventions. This study examined differences in recruitment, eligibility, and retention among smokers and nonsmokers in an rTMS study. We modeled participant eligibility and study completion among elig...

Objectives: We compared participant characteristics and abstinence outcomes of smokers who chose in-person or telephone tobacco dependence treatment. Methods: We provided the same treatment content to 7267 smokers in Arkansas between 2005 and 2008 who self-selected treatment modality; examined demographic, clinical, environmental, and treatment...

A valid sham control is important for determining the efficacy and effectiveness of repetitive transcranial magnetic stimulation (rTMS) as an experimental and clinical tool. Given the manner in which rTMS is applied, separately or in combination with self-regulatory approaches, and its intended impact on brain states, a valid sham control of this t...

Cigarette smokers and substance users discount the value of delayed outcomes more steeply than non-users. Higher discounting rates are associated with relapse and poorer treatment outcomes. The left dorsolateral prefontal cortex (DLPFC) exerts an inhibitory influence on impulsive or seductive choices. Greater activity in the prefrontal cortex is as...

Background: RNs and APNs have an extensive reach into the smoking population and can apply evidence-based treatments to facilitate tobacco cessation. Training in implementing the 2008 Clinical Practice Guideline for Treating Tobacco Use and Dependence is seldom offered, and little is known about the long-term effects of brief training on behaviors...

Tobacco use disproportionately affects lower socioeconomic status (SES) groups. Current explanations as to why lower SES groups respond less robustly to tobacco control efforts and tobacco dependence treatment do not fully account for this disparity. The identification of factors that predict relapse in this population might help to clarify these d...

We examined socioeconomic disparities in a community-based tobacco dependence treatment program. We provided cognitive-behavioral treatment and nicotine patches to 2739 smokers. We examined treatment use, clinical and environmental, and treatment outcome differences by socioeconomic status (SES). We used logistic regressions to model end-of-treatme...

Overview Introduction Development of a sham stimulation technique for humans PET-guided TMS studies of tinnitus perception TMS investigations of decision-making in tobacco addiction TMS investigations in rodents Conclusion References

Tobacco use greatly contributes to overall socioeconomic health disparities, and physicians are a major source of information about effective methods for tobacco cessation. This study examined the tobacco intervention practices of primary care physicians in Arkansas who treat a high proportion of lower socioeconomic status patients. More than 70% o...

To examine the feasibility of a fax referral program to increase enrollment in tobacco dependence treatment in emergency department (ED) patients. The control group received quit advice and printed information; the intervention group also received a faxed referral that generated telephone contacts. Treatment enrollment was higher in the interventio...

We sought to gain an empirical and practical understanding of the barriers experienced by residents of the Mississippi River Delta in Arkansas to using the free, proactive telephone counseling (quitline) for tobacco dependence. Barriers included a lack of appropriate telephone service, lack of knowledge about the quitline, and lack of trust in the...

Weight concern is a common and significant barrier to abstinence for many smokers. This quasi-experimental pilot study used multivariate logistic regression to examine the effects of offering a weight management treatment program on tobacco dependence treatment outcomes. Age, gender, ethnicity, educational level, nicotine dependence level, body mas...

Understanding the utilization of evidence-based telephone counseling (quitlines) for tobacco use for lower socioeconomic (SES) groups is important given higher prevalence of tobacco use in lower SES groups and the recent CDC recommendations promoting quitlines. All 50 states provide a quitline with the assumption that the quitline is particularly a...

This paper is a report of a study conducted to examine the effects of a brief training in the treatment of tobacco use and dependence on the tobacco use intervention-related knowledge and attitudes of nurses.   Nurses are the largest group of healthcare providers and they have an extended reach into the population of tobacco users. Thus, increasing...

The purpose of this study was to examine the effectiveness of adding the Forever Free relapse prevention materials to telephone counseling provided by the Arkansas quitline. Results suggest that the addition of Forever Free materials to telephone counseling does not improve quit rates for those participants who receive at least one session of couns...

The aim of this study was to describe the rates of enrollment in tobacco dependence treatment among smoking adults who accepted a fax referral from health care providers at a children's hospital, and to examine smoker characteristics associated with enrollment. Secondary analysis of the state-sponsored fax referral and treatment program data on all...

Health care providers have an extended reach into the population of tobacco users. Increasing the number and variety of health care providers that deliver the evidence-based, brief interventions for tobacco use prescribed by the Public Health Service Clinical Practice Guideline is likely to result in more tobacco users exposed to evidence-based tre...

Purpose Outcomes from a statewide program that delivered evidence-based, intensive treatment for tobacco dependence to a rural population of lower socioeconomic status (SES) were evaluated. Factors that predicted success and measurement considerations were examined. Design and Analyses Data were collected at intake, at all treatment sessions, and...

Although medical facilities restrict smoking inside, many people continue to smoke outside, creating problems with second-hand smoke, litter, fire risks, and negative role modeling. In 2005, Arkansas passed legislation prohibiting smoking on medical facility campuses. Hospital administrators (N=113) were surveyed pre- and post-implementation. Admin...

Oral and maxillofacial surgeons (OMS) treat oral disease attributable to and/or complicated by tobacco use and have unique opportunities to treat patients with tobacco dependence. This study assessed the tobacco-use-related knowledge, attitudes and intervention behaviors of OMS in the United States. The authors mailed a 38-item survey to members of...

Tobacco cessation Quitlines have become an integral part of the nation's tobacco cessation efforts. In Arkansas the SOSQuitline began providing treatment on August 11, 2005. The SOSQuitline was expected to handle approximately 2400 callers in the first year. The SOSQuitline actually served 5619 unique callers seeking treatment or information in the...

Intensive, evidence-based treatment for tobacco dependence has been historically available only in academic medical centers in metropolitan areas. Implementation in rural areas faces a number of barriers including attracting enough patients to be cost-effective, attracting and supervising qualified personnel, and adherence to rigorous evaluation me...

Relative to other regions in the USA, Mississippi has a high prevalence of tobacco use and tobacco-related disease. This study assessed the tobacco-related knowledge, attitudes and intervention behaviours of family doctors, dentists and nurse practitioners in the state of Mississippi. The Provider Attitude Survey, an 85-item measure of tobacco-rela...

Participation in tobacco cessation programs can help reduce the prevalence of tobacco use. Treatment for tobacco dependence is available to all Arkansans free of charge. Referral to treatment can be made through a highly utilized fax-back referral program. Although Arkansas treatment and referral programs have experienced tremendous growth, partici...

Intensive, evidence-based treatment for tobacco dependence has been historically available only in academic medical centers in metropolitan areas. Implementation in rural areas faces a number of barriers including attracting enough patients to be cost-effective, attracting and supervising qualified personnel, and adherence to rigorous evaluation me...

The literature supporting tobacco free workplaces is clear: Employee smoking decreases worker productivity and increases worker absenteeism and employer costs. Policies that discourage smoking at work reduce the number of employees who smoke and the number of cigarettes smoked by employees who continue to smoke. The Arkansas Smoke-free Workplace As...

Tobacco use is the leading cause of preventable death and disease in the U.S. with cessation causing major health benefits. Healthcare providers are vital to the delivery of tobacco cessation services. The evidence-based Public Health Service (PHS) Clinical Practice Guideline for the Treatment of Tobacco Use and Dependence (Fiore, 2000) provides re...

Tobacco use is the leading cause of preventable death and disease in the U.S. Cessation provides major health benefits. The healthcare system is vital to the delivery of tobacco cessation services. The Public Health Service Clinical Practice Guideline for the Treatment of Tobacco Use and Dependence (Fiore, 2000) provides recommendations for treatme...

To examine the taxonomic categories derived from a reorganization of the popular and useful Multidimensional Pain Inventory (MPI)/Multiaxial Assessment of Pain (MAP) system. Cluster-analytic procedures were utilized to analyze data from 976 pain patients who presented for treatment at a pain clinic. Ward's method was utilized followed by seeded and...

During this meeting, the participants developed a strategic set of recommendations for ASPH to continue to advance the study of tobacco control in public health through research and education/training programs. The meeting focused on sustaining and further developing tobacco-related research and education/ training programs. All four issues were ad...

Tobacco use is the single most costly health risk behavior today. Although Arkansas has seen a significant decrease in smoking prevalence (28.5% in 1997 to 25.2% in 2000), low-socioeconomic (SES) populations in Arkansas continue to use tobacco at a high rate and suffer disproportionately from tobacco-related diseases. In 1998, nearly 14% of all Med...

This study examined ethnic differences in the use of pain descriptors, comparing standardized pain assessment data from African American and European American patients with heterogeneous chronic pain syndromes. The measure was the Short-Form McGill Pain Questionnaire (SF–MPQ) including the embedded Visual Analog Scale (VAS). Exploratory factor anal...

Despite wide distribution of an evidence-based clinical practice guideline, the provision of treatment for tobacco use has been weak. The primary care setting is an ideal environment in which to implement the tobacco clinical practice guideline. It has been suggested that implementation of the guideline may be enhanced by adapting guideline recomme...

Sex differences in 351 patients with chronic low back pain were examined. Biological, psychological, and psychosocial factors were considered. Sex differences in adaptive functioning were consistent with traditional gender roles. Significant interactions were found for sex and employment status, and sex and marital status. Retired women reported mo...

The effects of self-presentation demands were evaluated through conversational probe (CP) role-play tasks. Participants (N=29) were required to manage their self-presentations (i.e., the impression they made, in each of two conditions). During high impression management (IM) demand, participants were evaluated on their performance. During Low IM de...

Johnson Achievement Test-Revised Edition. Data was collected from 94 children referred to the Arbor Neuropsychological Assessment Clinics. All children were school-aged, and were referred for learning or behavioral difficulties. The results indicate that the WISC-III explained 32% of the variability, whereas the WRAML explained 44% of the variabili...