Community-based navigators for tobacco cessation treatment: a proof-of-concept pilot study among low-income smokers

Arnold H Levinson, Patricia Valverde, Kathleen Garrett, Michele Kimminau, Emily K Burns, Karen Albright, Debra Flynn, Arnold H Levinson, Patricia Valverde, Kathleen Garrett, Michele Kimminau, Emily K Burns, Karen Albright, Debra Flynn

Abstract

Background: A majority of continuing smokers in the United States are socioeconomically disadvantaged (SED) adults, who are less likely than others to achieve and maintain abstinence despite comparable quit-attempt rates. A national research initiative seeks effective new strategies for increasing successful smoking cessation outcomes among SED populations. There is evidence that chronic and acute stressors may interfere with SED smokers who try to quit on their own. Patient navigators have been effectively used to improve adherence to chronic disease treatment. We designed and have pilot-tested an innovative, non-clinical community-based intervention--smoking cessation treatment navigators--to determine feasibility (acceptance, adherence, and uncontrolled results) for evaluation by randomized controlled trial (RCT).

Methods: The intervention was developed for smokers among parents and other household members of inner city pre-school for low-income children. Smoking cessation treatment navigators were trained and deployed to help participants choose and adhere to evidence-based cessation treatment (EBCT). Navigators provided empathy, resource-linking, problem-solving, and motivational reinforcement. Measures included rates of study follow-up completion, EBCT utilization, navigation participation, perceived intervention quality, 7-day point abstinence and longest abstinence at three months. Both complete-case and intent-to-treat analyses were performed.

Results: Eighty-five percent of study participants (n = 40) completed final data collection. More than half (53%) enrolled in a telephone quitline and nearly three-fourths (71%) initiated nicotine replacement therapy. Participants completed a mean 3.4 navigation sessions (mean 30 min duration) and gave the intervention very high quality and satisfaction ratings. Self-reported abstinence was comparable to rates for evidence-based cessation strategies (21% among study completers, 18% using intent-to-treat analysis; median 21 days abstinent among relapsers).

Conclusions: The pilot results suggest that smoking cessation treatment navigators are feasible to study in community settings and are well-accepted for increasing use of EBCT among low-income smokers. Randomized controlled trial for efficacy is warranted.

Figures

Fig. 1
Fig. 1
How exiting participants (n = 23) rated their guides on prompted attributes and behaviors

References

    1. CDC Cigarette smoking among adults – United States, 2006. Morb Mort Wkly Rept MMWR. 2007;56:1157–61.
    1. CDC Cigarette smoking among adults and trends in smoking cessation: United States, 2008. Morb Mort Wkly Rept MMWR. 2009;58:1227–32.
    1. Lee DJ, Fleming LE, Arheart KL, LeBlanc WG, Caban AJ, Chung-Bridges K, et al. Smoking rate trends in U.S. occupational groups: The 1987 to 2004 National Health Interview Survey. J Occ Environ Med. 2007;49(1):75–81. doi: 10.1097/JOM.0b013e31802ec68c.
    1. Barbeau EM, Krieger N, Soobader MJ. Working class matters: Socioeconomic disadvantage, race/ethnicity, gender, and smoking in NHIS 2000. Am J Public Health. 2004;94:269–78. doi: 10.2105/AJPH.94.2.269.
    1. Jefferis B, Graham H, Manor O, Power C. Cigarette consumption and socio-economic circumstances in adolescence as predictors of adult smoking. Addiction. 2003;98(12):1765–72. doi: 10.1111/j.1360-0443.2003.00552.x.
    1. Webb MS, Carey MP. Tobacco smoking among low-income Black women: Demographic and psychosocial correlates in a community sample. Nicot Tob Res. 2008;10(1):219–29. doi: 10.1080/14622200701767845.
    1. Flint AJ, Novotny TE. Poverty status and cigarette smoking prevalence and cessation in the United States, 1983-1993: the independent risk of being poor. Tob Control. 1997;6(1):14–8. doi: 10.1136/tc.6.1.14.
    1. Pierce JP, Fiore MC, Novotny TE, Hatziandreu EJ, Davis RM. Trends in cigarette smoking in the United States: Educational differences are increasing. JAMA. 1989;261:51–60.
    1. Agrawal A, Sartor C, Pergadia ML, Huizink AC, Lynskey MT. Correlates of smoking cessation in a nationally representative sample of U.S. adults. Addict Beh. 2008;33(9):1223–6. doi: 10.1016/j.addbeh.2008.04.003.
    1. Siahpush M, Heller G, Singh G. Lower levels of occupation, income and education are strongly associated with a longer smoking duration: Multivariate results from the 2001 Australian National Drug Strategy Survey. Public Health. 2005;119(12):1105–10. doi: 10.1016/j.puhe.2005.03.004.
    1. Burns EK, Levinson AH, Lezotte D, Prochazka AV. Differences in smoking duration between Latinos and Anglos. Nicot Tob Res. 2007;9(7):731–7. doi: 10.1080/14622200701397882.
    1. Kotz D, West R. Explaining the social gradient in smoking cessation: It’s not in the trying, but in the succeeding. Tob Control. 2009;18:43–6. doi: 10.1136/tc.2008.025981.
    1. Reid JL, Hammond D, Boudreau C, Fong GT, Siahpush M. Socioeconomic disparities in quit intentions, quit attempts, and smoking abstinence among smokers in four western countries: findings from the International Tobacco Control Four Country Survey. Nicot Tob Res. 2010;12(suppl):S20–33. doi: 10.1093/ntr/ntq051.
    1. Liu F. Quit attempts and intention to quit cigarette smoking among Medicaid recipients in the USA. Public Health. 2010;124(10):553–8. doi: 10.1016/j.puhe.2010.05.015.
    1. Caleyachetty A, Lewis S, McNeill A, Leonardi-Bee J. Struggling to make ends meet: exploring pathways to understand why smokers in financial difficulties are less likely to quit successfully. Eur J Public Health. 2012;22(Suppl 1):41–8. doi: 10.1093/eurpub/ckr199.
    1. Carlini BH, McDaniel AM, Weaver MT, Kauffman RM, Cerutti B, Stratton RM, et al. Reaching out, inviting back: using Interactive voice response (IVR) technology to recycle relapsed smokers back to Quitline treatment--a randomized controlled trial. BMC Public Health. 2012;12:507. doi: 10.1186/1471-2458-12-507.
    1. Partos TR, Borland R, Siahpush M. Socio-economic disadvantage at the area level poses few direct barriers to smoking cessation for Australian smokers: findings from the International Tobacco Control Australian cohort survey. Drug Alcohol Rev. 2012;31(5):653–63. doi: 10.1111/j.1465-3362.2012.00427.x.
    1. Rafful C, Garcia-Rodriguez O, Wang S, Secades-Villa R, Martinez-Ortega JM, Blanco C. Predictors of quit attempts and successful quit attempts in a nationally representative sample of smokers. Addict Behav. 2013;38(4):1920–3. doi: 10.1016/j.addbeh.2012.12.019.
    1. Solberg LI, Asche SE, Boyle R, McCarty MC, Thoele MJ. Smoking and cessation behaviors among young adults of various educational backgrounds. Am J Public Health. 2007;97(8):1421–6. doi: 10.2105/AJPH.2006.098491.
    1. Gilman SE, Abrams DB, Buka SL. Socioeconomic status over the life course and stages of cigarette use: initiation, regular use, and cessation. J Epidemiol Community Health. 2003;57(10):802–8. doi: 10.1136/jech.57.10.802.
    1. Levy DT, Romano E, Mumford E. The relationship of smoking cessation to sociodemographic characteristics, smoking intensity, and tobacco control policies. Nicot Tob Res. 2005;7(3):387–96. doi: 10.1080/14622200500125443.
    1. Levinson A, Perez-Stable E, Espinoza P, Flores E, Byers T. Latinos report less use of pharmaceutical aids when trying to quit smoking. Am J Prev Med. 2004;26:105–11. doi: 10.1016/j.amepre.2003.10.012.
    1. Foulds J, Gandhi KK, Steinberg MB, Richardson DL, Williams JM, Burke MV, et al. Factors associated with quitting smoking at a tobacco dependence treatment clinic. Am J Health Beh. 2006;30(4):400–12. doi: 10.5993/AJHB.30.4.6.
    1. Shiffman S, Brockwell SE, Pillitteri JL, Gitchell JG. Individual differences in adoption of treatment for smoking cessation: Demographic and smoking history characteristics. Drug Alcoh Dep. 2008;93:121–31. doi: 10.1016/j.drugalcdep.2007.09.005.
    1. Cokkinides VE, Halpern MT, Barbeau EM, Ward E, Thun MJ. Racial and ethnic disparities in smoking-cessation interventions: Analysis of the 2005 National Health Interview Survey. Am J Prev Med. 2008;34(5):404–12. doi: 10.1016/j.amepre.2008.02.003.
    1. Burns EK, Deaton EA, Levinson AH. Rates and reasons: Disparities in low intentions to use a state smoking cessation quitline. Am J Health Promo. 2011;25(5S):S59–65. doi: 10.4278/ajhp.100611-QUAN-183.
    1. Hiscock R, Bauld L, Amos A, Fidler JA, Munafò M. Socioeconomic status and smoking: a review. Ann NY Acad Sci. 2012;1248(1):107–23. doi: 10.1111/j.1749-6632.2011.06202.x.
    1. Businelle MS, Kendzor DE, Reitzel LR, Costello TJ, Cofta-Woerpel L, Li Y, et al. Mechanisms linking socioeconomic status to smoking cessation: a structural equation modeling approach. Health Psychol. 2010;29(3):262–73. doi: 10.1037/a0019285.
    1. Kendzor DE, Businelle MS, Costello TJ, Castro Y, Reitzel LR, Cofta-Woerpel LM, et al. Financial strain and smoking cessation among racially/ethnically diverse smokers. Am J Public Health. 2010;100(4):702–6. doi: 10.2105/AJPH.2009.172676.
    1. National Cancer Institute: Improving Effectiveness of Smoking Cessation Interventions and Programs in Low Income Adult Populations. RFA CA-08-023. 2008. Accessible at .
    1. Harburg E, Erfurt JC, Chape C, Hauenstein LS, Schull WJ, Schork MA. Socioecological stressor areas and black-white blood pressure. Detroit J Chronic Dis. 1973;26(9):595–611. doi: 10.1016/0021-9681(73)90064-7.
    1. Dohrenwend BP. Social status and stressful life events. J Person Soc Psychol. 1973;28:225–35. doi: 10.1037/h0035718.
    1. Aneshensel CS. Social stress: theory and research. Ann Rev Sociol. 1992;18:15–38. doi: 10.1146/annurev.so.18.080192.000311.
    1. Mulder BC, de Bruin M, Schreurs, van Ameijden EJ, van Woerkum CM. Stressors and resources mediate the association of socioeconomic position with health behaviours. BMC Public Health. 2011;11(1):798–807. doi: 10.1186/1471-2458-11-798.
    1. Mezuk B, Rafferty JA, Kershaw KN, Hudson D, Abdou CM, Lee H, et al. Reconsidering the role of social disadvantage in physical and mental health: stressful life events, health behaviors, race, and depression. Am J Epidemiol. 2010;172:1238–49. doi: 10.1093/aje/kwq283.
    1. Jackson JS, Knight KM. Race and self-regulatory health behaviors: the role of the stress response and the HPA axis in physical and mental health disparities. In: Schaie KW, Cartensen L, editors. Social Structures, Aging, and Self Regulation in the Elderly. New York, NY: Springer; 2006.
    1. Fischer SM, Sauaia A, Kutner JS. Patient navigation: A culturally competent strategy to address disparities in palliative care. J Palliative Med. 2007;10(5):1023–8. doi: 10.1089/jpm.2007.0070.
    1. Wells KJ, Battaglia TA, Dudley DJ, Garcia R, Greene A, Calhoun E, et al. Patient navigation research program: patient navigation: state of the art or is it science? Cancer. 2008;113(8):1999–2010. doi: 10.1002/cncr.23815.
    1. American Cancer Society A summary of the American Cancer Society report to the nation: cancer in the poor. CA Cancer J Clin. 1989;39:263–526. doi: 10.3322/canjclin.39.5.263.
    1. Dohan D, Schrag D. Using navigators to improve care of underserved patients: current practices and approaches. Cancer. 2005;104(4):848–55. doi: 10.1002/cncr.21214.
    1. Retkin R, Antoniadis D, Pepitone DF, Duval D. Legal services: a necessary component of patient navigation. Semin Oncol Nurs. 2013;29(2):149–55. doi: 10.1016/j.soncn.2013.02.010.
    1. Paskett ED, Harrop JP, Wells KJ. Patient navigation: an update on the state of the science. CA Cancer J Clin. 2011;61(4):237–49. doi: 10.3322/caac.20111.
    1. Paskett ED, Katz ML, Post DM, Pennell ML, Young GS, Seiber EE, et al. The Ohio Patient Navigation Research Program: does the American Cancer Society patient navigation model improve time to resolution in patients with abnormal screening tests? Cancer Epidemiol Biomarkers Prev. 2012;21(10):1620–8. doi: 10.1158/1055-9965.EPI-12-0523.
    1. Battaglia TA, Bak SM, Heeren T, Chen CA, Kalish R, Tringale S, et al. Boston patient navigation research program: the impact of navigation on time to diagnostic resolution after abnormal cancer screening. Cancer Epidemiol Biomarkers Prev. 2012;21(10):1645–54. doi: 10.1158/1055-9965.EPI-12-0532.
    1. Hoffman HJ, LaVerda NL, Young HA, Levine PH, Alexander LM, Brem R, et al. Patient navigation significantly reduces delays in breast cancer diagnosis in the District of Columbia. Cancer Epidemiol Biomarkers Prev. 2012;21(10):1655–63. doi: 10.1158/1055-9965.EPI-12-0479.
    1. Markossian TW, Darnell JS, Calhoun EA. Follow-up and timeliness after an abnormal cancer screening among underserved, urban women in a patient navigation program. Cancer Epidemiol Biomarkers Prev. 2012;21(10):1691–700. doi: 10.1158/1055-9965.EPI-12-0535.
    1. Raich PC, Whitley EM, Thorland W, Valverde P. Fairclough D; Denver Patient Navigation Research Program: Patient navigation improves cancer diagnostic resolution: an individually randomized clinical trial in an underserved population. Cancer Epidemiol Biomarkers Prev. 2012;21(10):1629–38. doi: 10.1158/1055-9965.EPI-12-0513.
    1. Dudley DJ, Drake J, Quinlan J, Holden A, Saegert P, Karnad A, et al. Beneficial effects of a combined navigator/promotora approach for Hispanic women diagnosed with breast abnormalities. Cancer Epidemiol Biomarkers Prev. 2012;21(10):1639–44. doi: 10.1158/1055-9965.EPI-12-0538.
    1. Fiscella K, Whitley E, Hendren S, Raich P, Humiston S, Winters P, et al. Patient navigation for breast and colorectal cancer treatment: a randomized trial. Cancer Epidemiol Biomarkers Prev. 2012;21(10):1673–81. doi: 10.1158/1055-9965.EPI-12-0506.
    1. Egan M, Anderson S, McTaggart J. Community navigation for stroke survivors and their care partners: description and evaluation. Top Stroke Rehabil. 2010;17(3):183–90. doi: 10.1310/tsr1703-183.
    1. Esperat MC, Flores D, McMurry L, Feng D, Song H, Billings L, et al. Transformacion Para Salud: A patient navigation model for chronic disease self-management. Online J Issues Nurs. 2012;17(2):2.
    1. Wang X, Fang C, Tan Y, Liu A, Ma GX. Evidence-based intervention to reduce access barriers to cervical cancer screening among underserved Chinese American women. J Womens Health (Larchmt) 2010;19(3):463–9. doi: 10.1089/jwh.2009.1422.
    1. Domingo JB, Davis EL, Allison AL, Braun KL. Cancer patient navigation case studies in Hawai’i: the complimentary role of clinical and community navigators. Hawaii Med J. 2011;70(12):257–61.
    1. Nguyen TU, Tran JH, Kagawa-Singer M, Foo MA. A qualitative assessment of community-based breast health navigation services for Southeast Asian women in Southern California: recommendations for developing a navigator training curriculum. Am J Public Health. 2011;101(1):87–93. doi: 10.2105/AJPH.2009.176743.
    1. Krebs LU, Burhansstipanov L, Watanabe-Galloway S, Pingatore NL, Petereit DG, Isham D. Navigation as an intervention to eliminate disparities in American Indian communities. Semin Oncol Nurs. 2013;29(2):118–27. doi: 10.1016/j.soncn.2013.02.007.
    1. Nezami E, Sussman S, Pentz MA. Motivation in tobacco use cessation research. Subst Use Misuse. 2003;38(1):25–50. doi: 10.1081/JA-120016564.
    1. Vidrine JI, Reitzel LR, Figueroa PY, Velasquez MM, Mazas CA, Cinciripini PM, Wetter DW: Motivation and problem solving (MAPS): Motivationally based skills training for treating substance use. Cogn Beh Pract 2013; 20(4):501-16.
    1. Miller M. Addictive behavior and the theory of psychological reversals. Addict Beh. 1985;10:177–80. doi: 10.1016/0306-4603(85)90024-3.
    1. Miller WR, Rollnick S. Motivational interviewing: Preparing people to change addictive behavior. New York: Guilford Press; 1991.
    1. Burke BL, Arkowitz H, Menchola M. The efficacy of motivational interviewing: a meta-analysis of controlled clinical trials. J Consult Clin Psychol. 2003;71(5):843–61. doi: 10.1037/0022-006X.71.5.843.
    1. Fiore MC, Jaén CR, Baker TB. Clinical Practice Guideline Treating Tobacco Use and Dependence 2008 Update Panel: A clinical practice guideline for treating tobacco use and dependence: 2008 update. Am J Prev Med. 2008;35(2):158–76. doi: 10.1016/j.amepre.2008.04.009.
    1. Lai DTC, Cahill K, Qin Y, Tang J-L: Motivational interviewing for smoking cessation. Cochrane Database of Systematic Reviews 2015 Mar 2;3:CD006936. doi:10.1002/14651858.CD006936.pub3.
    1. Lundahl BW, Kunz C, Brownell C, Tollefson D, Burke BL. A meta-analysis of motivational interviewing: Twenty-five years of empirical studies. Res Soc Work Pract. 2010;20(2):137–60. doi: 10.1177/1049731509347850.
    1. Cox LA, Nollen NL, Mayo MS, Choi WS, Faseru B, Benowitz NL, et al. Bupropion for smoking cessation in African American light smokers: a randomized controlled trial. J Natl Cancer Inst. 2012;104:290–8. doi: 10.1093/jnci/djr513.
    1. Emmons KM, Hammond SK, Fava JL, Velicer WF, Evans JL, Monroe AD. A randomized trial to reduce passive smoke exposure in low-income households with young children. Pediatrics. 2001;108:18–24. doi: 10.1542/peds.108.1.18.
    1. Lawrence D, Graber JE, Mills SL, Meissner HI, Warnecke R. Smoking cessation interventions in US racial/ethnic minority populations: an assessment of the literature. Prev Med. 2003;36:204–16. doi: 10.1016/S0091-7435(02)00023-3.
    1. Parsons T. Essays in Sociological Theory. Simon and Schuster: New York, NY; 2010.
    1. O’Malley AS, Sheppard VB, Schwartz M, Mandelblatt J. The role of trust in use of preventive services among low-income African-American women. Prev Med. 2004;38(6):777–85. doi: 10.1016/j.ypmed.2004.01.018.
    1. Born W, Engelman K, Greiner KA, Bhattacharya SB, Hall S, Hou Q, Ahluwalia JS: Colorectal cancer screening, perceived discrimination, and low-income and trust in doctors: a survey of minority patients. BMC Public Health 2009, 9:363. .
    1. Franzini, L: Self-rated health and trust in low-income Mexican-origin individuals in Texas. Soc Sci Med 2008, 67(12):1959-69.
    1. Becker G, Newsom E. Socioeconomic status and dissatisfaction with health care among chronically Ill African Americans. Am J Public Health. 2003;93(5):742–8. doi: 10.2105/AJPH.93.5.742.
    1. Armstrong K, Ravenell KL, McMurphy S, Putt M. Racial/ethnic differences in physician distrust in the United States. Am J Public Health. 2007;97(7):1283–9. doi: 10.2105/AJPH.2005.080762.
    1. Corbie-Smith G, Thomas SB, St George DM. Distrust, race, and research. Arch Intern Med. 2002;162:2458–63. doi: 10.1001/archinte.162.21.2458.
    1. Schnittker J. Social distance in the clinical encounter: Interactional and sociodemographic foundations for mistrust in physicians. Soc Psychol Q. 2004;67(3):217–35. doi: 10.1177/019027250406700301.
    1. Hunt KA, Gaba A, Lavizzo-Mourey R. Racial and ethnic disparities and perceptions of health care: Does health plan type matter? Health Serv Res. 2005;40(2):551–76. doi: 10.1111/j.1475-6773.2005.0z373.x.
    1. Naar-King S, Outlaw A, Green-Jones M, Wright K, Parsons, JT: Motivational interviewing by peer outreach workers: a pilot randomized clinical trial to retain adolescents and young adults in HIV care. AIDS Care 2009, 21(7):868-873.
    1. Department of Health and Human Services, Administration for Children & Families. About the Office of Head Start. []
    1. Wortley PM, Husten CG, Trosclair A, Chrismon J, Pederson LL. Nondaily smokers: A descriptive analysis. Nicot Tob Res 2003;5(5):755-9.
    1. Moyers T, Martin T, Catley D, Harris K, Ahluwalia JS: Assessing the integrity of motivational interviewing interventions: Reliability of the motivational interviewing skills code. Behav Cogn Psychotherapy 2003, 31:177-184. .
    1. Moyers TB, Martin T, Manuel JK, Hendrickson SML, Miller WR: Assessing competence in the use of motivational interviewing. J Subst Abuse Treat 2005, 28:19-26 doi:10.1016/j.jsat.2004.11.001
    1. Forsberg L, Forsberg LG, Lindqvist H, Helgason AR: Clinician acquisition and retention of motivational interviewing skills: a two-and-a-half-year exploratory study. Subst Abuse Treat Prev Policy 2010, 13(5):8.
    1. Malterud K. Qualitative research: standards, challenges, and guidelines. Lancet. 2001;358(9280):483–8. doi: 10.1016/S0140-6736(01)05627-6.
    1. Mays N, Pope C. Qualitative research in health care. Assessing quality in qualitative research. BMJ. 2000;320(7226):50–2. doi: 10.1136/bmj.320.7226.50.
    1. Sheffer C, Mackillop J, McGeary J, Landes R, Carter L, Yi R, et al. Delay discounting, locus of control, and cognitive impulsiveness independently predict tobacco dependence treatment outcomes in a highly dependent, lower socioeconomic group of smokers. Am J Addict. 2012;21(3):221–32. doi: 10.1111/j.1521-0391.2012.00224.x.
    1. Cokkinides VE, Ward E, Jemal A, Thun MJ. Under-use of smoking-cessation treatments: Results from the National Health Interview Survey, 2000. Am J Prev Med. 2005;28(1):119–22. doi: 10.1016/j.amepre.2004.09.007.
    1. Fu SS, Sherman SE, Yano EM, van Ryn M, Lanto AB, Joseph AM. Ethnic disparities in the use of nicotine replacement therapy for smoking cessation in an equal access health care system. Am J Health Promo. 2005;20(2):108–16. doi: 10.4278/0890-1171-20.2.108.
    1. Fu SS, Kodl MM, Joseph AM, Hatsukami DK, Johnson EO, Breslau N, et al. Racial/ethnic disparities in the use of nicotine replacement therapy and quit ratios in lifetime smokers ages 25 to 44 years. Cancer Epidemiol Biom Prev. 2008;17(7):1640–7. doi: 10.1158/1055-9965.EPI-07-2726.
    1. Solberg LI, Parker ED, Foldes SS, Walker PF. Disparities in tobacco cessation medication orders and fills among special populations. Nicot Tob Res. 2010;12(2):144–51. doi: 10.1093/ntr/ntp187.
    1. Kotz D, Fidler J, West R. Factors associated with the use of aids to cessation in English smokers. Addiction. 2009;104(8):1403–40. doi: 10.1111/j.1360-0443.2009.02639.x.
    1. Ferguson J, Docherty G, Bauld L, Lewis S, Lorgelly P, Boyd KA, et al. Effect of offering different levels of support and free nicotine replacement therapy via an English national telephone quitline: randomised controlled trial. BMJ. 2012;344:e1696. doi: 10.1136/bmj.e1696.
    1. Alberg AJ, Stashefsky Margalit R, Burke A, Rasch KA, Stewart N, Kline JA, et al. The influence of offering free transdermal nicotine patches on quit rates in a local health department’s smoking cessation program. Addict Beh. 2004;29(9):1763–78. doi: 10.1016/j.addbeh.2004.04.007.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj