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  1. Article ; Online: Use of preexposure prophylaxis and condom purchasing decisions.

    Gebru, Nioud Mulugeta / Strickland, Justin C / Reed, Derek D / Kahler, Christopher W / Leeman, Robert F

    Journal of the experimental analysis of behavior

    2024  Volume 121, Issue 2, Page(s) 233–245

    Abstract: Preexposure prophylaxis (PrEP) prevents human immunodeficiency virus (HIV) but not other sexually transmitted infections (STIs). Men who have sex with men (MSM) who take PrEP tend to report reduced condom use, but little is known about the underlying ... ...

    Abstract Preexposure prophylaxis (PrEP) prevents human immunodeficiency virus (HIV) but not other sexually transmitted infections (STIs). Men who have sex with men (MSM) who take PrEP tend to report reduced condom use, but little is known about the underlying mechanisms. For this study, MSM who take PrEP (i.e., PrEP experienced; n = 88) and MSM who do not (i.e., PrEP naïve; n = 113) completed an online study, including the condom purchase task (CoPT). The CoPT assesses decisions to purchase condoms across escalating prices (range: free-$55) for sex with different types of hypothetical partners: those least likely to have an STD (least STD) and those that participants most want to have sex with (most want sex with). When condoms were free, PrEP-experienced MSM had a lower rate of condom purchasing than did PrEP-naïve MSM. For both partner types, PrEP-experienced MSM reached a price break point (i.e., would not buy condoms) at a lower price than did PrEP-naïve pariticipants. For the most-want-sex-with partner at the price at which participants elected not to buy condoms, only 23% of PrEP-experienced MSM chose to abstain from sex when not purchasing condoms versus 53% among PrEP-naïve MSM. Similar patterns were observed for the least-STD partner. The results support the potential utility of the CoPT in identifying behavioral mechanisms related to condom use and PrEP.
    MeSH term(s) Male ; Humans ; Condoms ; Homosexuality, Male ; Sexual Behavior ; Sexual Partners ; HIV Infections/prevention & control ; Sexual and Gender Minorities ; Sexually Transmitted Diseases/prevention & control
    Language English
    Publishing date 2024-02-14
    Publishing country United States
    Document type Journal Article
    ZDB-ID 219405-3
    ISSN 1938-3711 ; 0022-5002
    ISSN (online) 1938-3711
    ISSN 0022-5002
    DOI 10.1002/jeab.905
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  2. Article ; Online: App-Delivered Mindfulness Training to Reduce Anxiety in People with HIV Who Smoke: A One-Armed Feasibility Trial.

    Cioe, Patricia A / Sokolovsky, Alexander W / Brewer, Judson A / Kahler, Christopher W

    International journal of environmental research and public health

    2023  Volume 20, Issue 6

    Abstract: Introduction: People with HIV (PWH) who smoke have reported that managing anxiety is a barrier to making a quit attempt and maintaining abstinence post-quit. This study examined the feasibility and acceptability of an app-based mindfulness intervention, ...

    Abstract Introduction: People with HIV (PWH) who smoke have reported that managing anxiety is a barrier to making a quit attempt and maintaining abstinence post-quit. This study examined the feasibility and acceptability of an app-based mindfulness intervention,
    Methods: Sixteen PWH (mean age 51.5 [SD = 13.2]; mean cigarettes per day 11.4 [SD = 5.4]) were enrolled and followed for eight weeks. A smartphone-based app with 30 modules designed to reduce anxiety was introduced at baseline; participants were encouraged to complete one module daily for four weeks. Symptoms of anxiety and readiness to quit smoking were measured at baseline and weeks 4 and 8. The mean number of modules completed, session attendance, and number of study completers were examined. Generalized estimating equations (GEE) were used to examine changes in self-reported anxiety and readiness to quit at baseline, week 4, and week 8. A brief qualitative interview was conducted at week 4 to explore the acceptability of the app.
    Results: Feasibility was high, with 93% of participants completing the study. The mean number of study sessions completed was 2.7 (SD = 0.59), and the mean number of modules completed was 16.0 (SD 16.8). Anxiety was high at baseline (M = 14.4, SD = 3.9), but lower at week 4 (b = -5.5; CI: [-9.4, -1.7];
    Conclusions: App-based mindfulness training appears to be feasible and acceptable for PWH who smoke and report baseline anxiety. At week 4, anxiety was reduced and readiness to quit was increased, perhaps a key time point for a smoking cessation attempt.
    MeSH term(s) Humans ; Middle Aged ; Anxiety/prevention & control ; Feasibility Studies ; HIV Infections/complications ; HIV Infections/therapy ; Mindfulness ; Mobile Applications ; Smoking/psychology ; Smoking Cessation ; Adult
    Language English
    Publishing date 2023-03-09
    Publishing country Switzerland
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 2175195-X
    ISSN 1660-4601 ; 1661-7827
    ISSN (online) 1660-4601
    ISSN 1661-7827
    DOI 10.3390/ijerph20064826
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  3. Article ; Online: Results of a pilot study examining the effect of positive psychology interventions on cannabis use and related consequences.

    Spillane, Nichea S / Schick, Melissa R / Hostetler, Katherine L / Trinh, Catherine D / Kahler, Christopher W

    Contemporary clinical trials

    2023  Volume 131, Page(s) 107247

    Abstract: Background: Young adults experience high rates of cannabis use and consequences. Cross-sectional work has linked positive psychological constructs (e.g., savoring) to less cannabis use and consequences, and positive psychological interventions (PPIs) ... ...

    Abstract Background: Young adults experience high rates of cannabis use and consequences. Cross-sectional work has linked positive psychological constructs (e.g., savoring) to less cannabis use and consequences, and positive psychological interventions (PPIs) have shown promise in targeting other substance use behaviors. This pilot study sought to provide an initial test of PPIs to reduce young adult cannabis use and consequences.
    Methods: Adults (18-25 years old) who endorsed at least weekly past-month cannabis use (N = 59, 69.6% men, 41.1% White) reported their baseline cannabis use and consequences. Participants were randomized to complete one of three daily exercises (Savoring, Three Good Things, or a control) along with daily text message surveys for two weeks, then completed a follow-up survey at the end of the two weeks.
    Results: Paired samples t-tests indicated that participants in the Three Good Things group showed medium to large reductions in frequency of weekly cannabis use (p = .08, g
    Discussion: Results provide initial support for the feasibility and potential promise of a text-message based PPI as a harm reduction approach for cannabis users. A larger clinical trial is warranted to test the effects of such interventions with adequate statistical power.
    MeSH term(s) Male ; Young Adult ; Humans ; Adolescent ; Adult ; Female ; Cannabis ; Pilot Projects ; Psychology, Positive ; Cross-Sectional Studies ; Surveys and Questionnaires
    Language English
    Publishing date 2023-05-30
    Publishing country United States
    Document type Randomized Controlled Trial ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 2182176-8
    ISSN 1559-2030 ; 1551-7144
    ISSN (online) 1559-2030
    ISSN 1551-7144
    DOI 10.1016/j.cct.2023.107247
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  4. Article ; Online: Pilot Randomized Controlled Trial of Game Plan for PrEP: A Brief, Web and Text Message Intervention to Help Sexual Minority Men Adhere to PrEP and Reduce Their Alcohol Use.

    Wray, Tyler B / Chan, Philip A / Kahler, Christopher W / Ocean, Erik M S / Nittas, Vasileios

    AIDS and behavior

    2023  Volume 28, Issue 4, Page(s) 1356–1369

    Abstract: Suboptimal adherence to oral PrEP medications, particularly among younger sexual minority men (SMM), continues to be a key barrier to achieving more substantial declines in new HIV infections. Although variety of interventions, including web and text- ... ...

    Abstract Suboptimal adherence to oral PrEP medications, particularly among younger sexual minority men (SMM), continues to be a key barrier to achieving more substantial declines in new HIV infections. Although variety of interventions, including web and text-message-based applications, have successfully addressed PrEP adherence, very few have addressed the potential influence of alcohol. This pilot study explored whether the Game Plan for PrEP, a brief, web-based and text messaging intervention, helped promote PrEP persistence and adherence and reduced condomless sex and alcohol use. Seventy-three heavy-drinking SMM on PrEP were recruited online from states with Ending the HIV Epidemic jurisdictions and randomly assigned 1:1 to receive either the Game Plan for PrEP intervention or an attention-matched control. We collected online surveys assessing primary outcomes at one, three, and six months post-enrollment. As secondary outcomes, we also collected dried blood spot samples at baseline, three, and six months to analyze for biomarkers of PrEP and alcohol use. Our results showed that the odds of stopping PrEP or experiencing a clinically meaningful lapse in PrEP adherence (≥ 4 consecutive missed doses) were not different across the two conditions. We also did not find evidence of any differences in condomless sex or drinking outcomes across conditions, although participants in both conditions reported drinking less often over time. These findings were consistent across both self-reported outcomes and biomarkers. Overall, we did not find evidence that our brief, web and text messaging intervention encouraged more optimal PrEP coverage or moderate their alcohol use.
    MeSH term(s) Male ; Humans ; HIV Infections/epidemiology ; HIV Infections/prevention & control ; HIV Infections/drug therapy ; Pilot Projects ; Homosexuality, Male ; Text Messaging ; Anti-HIV Agents/therapeutic use ; Medication Adherence ; Pre-Exposure Prophylaxis/methods ; Sexual and Gender Minorities ; Biomarkers
    Chemical Substances Anti-HIV Agents ; Biomarkers
    Language English
    Publishing date 2023-11-16
    Publishing country United States
    Document type Randomized Controlled Trial ; Journal Article
    ZDB-ID 1339885-4
    ISSN 1573-3254 ; 1090-7165
    ISSN (online) 1573-3254
    ISSN 1090-7165
    DOI 10.1007/s10461-023-04223-9
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Game Plan-a Brief Web-Based Intervention to Improve Uptake and Use of HIV Pre-exposure Prophylaxis (PrEP) and Reduce Alcohol Use Among Gay and Bisexual Men: Content Analysis.

    Wray, Tyler B / Chan, Philip A / Guigayoma, John P / Kahler, Christopher W

    JMIR formative research

    2022  Volume 6, Issue 1, Page(s) e30408

    Abstract: Background: HIV pre-exposure prophylaxis (PrEP) has considerable potential for reducing incidence among high-risk groups, such as gay, bisexual, and other men who have sex with men (GBM). However, PrEP's effectiveness is closely linked with consistent ... ...

    Abstract Background: HIV pre-exposure prophylaxis (PrEP) has considerable potential for reducing incidence among high-risk groups, such as gay, bisexual, and other men who have sex with men (GBM). However, PrEP's effectiveness is closely linked with consistent use, and a variety of individual-level barriers, including alcohol use, could impede optimal uptake and use. Web-based interventions can encourage medication adherence, HIV prevention behaviors, and responsible drinking and may help support PrEP care, particularly in resource-limited settings.
    Objective: We previously developed a web application called Game Plan that was designed to encourage heavy drinking GBM to use HIV prevention methods and reduce their alcohol use and was inspired by brief motivational interventions. This paper aims to describe the web-based content we designed for integration into Game Plan to help encourage PrEP uptake and consistent use among GBM. In this paper, we also aim to describe this content and its rationale.
    Methods: Similar to the original site, these components were developed iteratively, guided by a thorough user-centered design process involving consultation with subject-matter experts, usability interviews and surveys, and user experience surveys.
    Results: In addition to Game Plan's pre-existing content, the additional PrEP components provide specific, personal, and digestible feedback to users about their level of risk for HIV without PrEP and illustrate how much consistent PrEP use could reduce it; personal feedback about their risk for common sexually transmitted infections to address low-risk perceptions; content challenging common beliefs and misconceptions about PrEP to reduce stigma; content confronting familiar PrEP and alcohol beliefs; and a change planning module that allows users to select specific goals for starting and strategies for consistent PrEP use. Users can opt into a weekly 2-way SMS text messaging program that provides similar feedback over a 12-week period after using Game Plan and follows up on the goals they set.
    Conclusions: Research preliminarily testing the efficacy of these components in improving PrEP outcomes, including uptake, adherence, sexually transmitted infection rates, and alcohol use, is currently ongoing. If supported, these components could provide a scalable tool that can be used in resource-limited settings in which face-to-face intervention is difficult.
    Language English
    Publishing date 2022-01-05
    Publishing country Canada
    Document type Journal Article
    ISSN 2561-326X
    ISSN (online) 2561-326X
    DOI 10.2196/30408
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  6. Article ; Online: Game Plan, a Web-Based Intervention to Improve Adherence and Persistence to HIV Pre-exposure Prophylaxis and Reduce Heavy Drinking in Gay, Bisexual, and Other Men Who Have Sex With Men: Usability and User Experience Testing.

    Wray, Tyler B / Chan, Philip A / Kahler, Christopher W

    JMIR formative research

    2021  Volume 5, Issue 11, Page(s) e31843

    Abstract: Background: Encouraging consistent use of pre-exposure prophylaxis (PrEP) is essential for reducing HIV incidence, particularly among gay, bisexual, and other men who have sex with men (GBM), and especially those who engage in heavy drinking. Although ... ...

    Abstract Background: Encouraging consistent use of pre-exposure prophylaxis (PrEP) is essential for reducing HIV incidence, particularly among gay, bisexual, and other men who have sex with men (GBM), and especially those who engage in heavy drinking. Although practice guidelines recommend providing adherence counseling to PrEP patients, clinics and providers may not have the resources or expertise to provide it. Internet-facilitated interventions have been shown to improve HIV prevention outcomes, including medication and care adherence. Game Plan is a website we created to help users make a tangible plan for reducing their HIV risk. We designed additional components of Game Plan to address key individual level barriers to PrEP use.
    Objective: The aim of this mixed methods research is to test the usability and user experience of these components with intended users: GBM who drink heavily and are on PrEP.
    Methods: In study 1 (usability), we completed a detailed individual interview in which participants (n=10) walked through a prototype of the website, thinking aloud as they did, and completed a follow-up interview and web-based survey afterward. Study 2 (user experience) involved providing participants (n=40) with a link to the prototype website to explore on their own and asking them to complete the same follow-up survey afterward. Qualitative data were analyzed using thematic analysis, and descriptive statistics were used to analyze quantitative data.
    Results: Users in both studies gave the website excellent ratings for usability, overall satisfaction, and quality, and most often described the site as informative, helpful, and supportive. Users also rated the site's content and feel as respectful of them and their autonomy, empathetic, and they stated that it conveyed confidence in their ability to change. The study 1 interviews highlighted the importance of the website's esthetics to the participants' engagement with it and its credibility in prompting genuine reflection.
    Conclusions: GBM who reported heavy drinking and used PrEP generally found a website focused on helping them to create a plan to use PrEP consistently to be helpful. Adopting user-centered design methods and attending to the esthetics of mobile health interventions are important steps toward encouraging engagement and reducing at-risk behaviors.
    Language English
    Publishing date 2021-11-16
    Publishing country Canada
    Document type Journal Article
    ISSN 2561-326X
    ISSN (online) 2561-326X
    DOI 10.2196/31843
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  7. Article ; Online: Positive Psychological Characteristics and Substance Use in First Nation Adolescents.

    Schick, Melissa R / Spillane, Nichea S / Breines, Juliana G / Kahler, Christopher W

    Substance use & misuse

    2022  Volume 57, Issue 8, Page(s) 1196–1206

    Abstract: ... ...

    Abstract Background
    MeSH term(s) Adolescent ; Adolescent Behavior ; Alcohol Drinking/psychology ; Cigarette Smoking ; Female ; Humans ; Male ; Marijuana Smoking ; Marijuana Use ; Substance-Related Disorders/epidemiology ; Substance-Related Disorders/psychology
    Language English
    Publishing date 2022-04-28
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 1310358-1
    ISSN 1532-2491 ; 1082-6084
    ISSN (online) 1532-2491
    ISSN 1082-6084
    DOI 10.1080/10826084.2022.2069266
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  8. Article ; Online: "I'm Gay With an Asterisk": How Intersecting Identities Influence LGBT Strengths.

    Surace, Anthony / Kang, Augustine / Kahler, Christopher W / Operario, Don

    Journal of homosexuality

    2022  Volume 71, Issue 3, Page(s) 841–861

    Abstract: Research attributes health disparities between sexual minority (those whose sexual orientation and/or practices differ from society, [SM]) and heterosexual populations to social marginalization. LGBT strengths (e.g., resiliency derived from LGBT identity) ...

    Abstract Research attributes health disparities between sexual minority (those whose sexual orientation and/or practices differ from society, [SM]) and heterosexual populations to social marginalization. LGBT strengths (e.g., resiliency derived from LGBT identity) may reduce the impact of social marginalization. However, it is unclear how LGBT strengths are impacted by SMs' other identities (e.g., racial/ethnic and/or gender). To address this knowledge gap, the present study examined data from the LGBT Stress/Strength project, a qualitative research study investigating minority stress and LGBT strengths in relation to drinking. Participants (N = 22) were self-identified SMs in the northeastern U.S. Transcripts from in-depth interviews were coded using thematic analysis. Participants reported social support from other SMs and empathy toward others were forms of LGBT strength. Sampled SMs assigned female at birth had more intergenerational friendships and relied more on social support than those assigned male at birth. In addition, Black, indigenous, and people of color (BIPOC) participants described social marginalization from within the LGBT community, which reduced their reliance on social support. Our results suggest that LGBT strengths are influenced by LGBT community members intersecting identities. More research can expand upon these results by investigating how the confluence of SMs identities and LGBT strengths impact health disparities.
    MeSH term(s) Infant, Newborn ; Humans ; Male ; Female ; Sexual and Gender Minorities ; Sexual Behavior ; Heterosexuality ; Qualitative Research ; Racial Groups
    Language English
    Publishing date 2022-12-08
    Publishing country United States
    Document type Journal Article
    ZDB-ID 193138-6
    ISSN 1540-3602 ; 0091-8369
    ISSN (online) 1540-3602
    ISSN 0091-8369
    DOI 10.1080/00918369.2022.2132579
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  9. Article ; Online: Peer navigation for smoking cessation in smokers with HIV: Protocol for a randomized clinical trial.

    Cioe, Patricia A / Pinkston, Megan / Tashima, Karen T / Kahler, Christopher W

    Contemporary clinical trials

    2021  Volume 110, Page(s) 106435

    Abstract: Background: Smoking prevalence in persons with HIV (PWH) is high (40%) and cessation rates remain low. Lack of social support and poor adherence to nicotine replacement therapy (NRT) are related to poor cessation outcomes; thus, both factors represent ... ...

    Abstract Background: Smoking prevalence in persons with HIV (PWH) is high (40%) and cessation rates remain low. Lack of social support and poor adherence to nicotine replacement therapy (NRT) are related to poor cessation outcomes; thus, both factors represent possible targets for smoking cessation interventions. Peer navigators (PNs) have been integrated into HIV care with great success to improve engagement and adherence to antiretroviral therapy. However, no clinical trial has evaluated the potential for PNs to provide social support and improve NRT adherence for smoking cessation. We developed a treatment protocol that targets social support, adherence, and self-efficacy for quitting by incorporating PNs into a smoking cessation program. This randomized trial will test whether this approach results in higher rates of 7-day point prevalence abstinence at 12- and 24-weeks, compared to standard treatment.
    Methods: Seventy-two smokers with HIV will be randomized to either Peer Navigation Social Support for smoking cessation (PNSS-S) or standard cessation counseling. All participants will meet with a nurse for a smoking cessation counseling session, which will include discussion of FDA-approved cessation pharmacotherapy. Participants assigned to PNSS-S will receive weekly phone calls from the PN for 12 weeks. The PN will address readiness to quit, using medication to quit, common barriers to cessation, high risk situations, slip management, and maintaining abstinence. Smoking cessation outcomes will be measured at 4, 12, and 24 weeks following the baseline appointment.
    Conclusion: Results from this study will provide preliminary evidence of whether incorporating a peer navigator-based intervention into smoking cessation treatment can improve smoking cessation outcomes in PWH.
    MeSH term(s) Counseling ; Humans ; Randomized Controlled Trials as Topic ; Smokers ; Smoking ; Smoking Cessation ; Tobacco Use Cessation Devices
    Language English
    Publishing date 2021-05-14
    Publishing country United States
    Document type Clinical Trial Protocol ; Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2182176-8
    ISSN 1559-2030 ; 1551-7144
    ISSN (online) 1559-2030
    ISSN 1551-7144
    DOI 10.1016/j.cct.2021.106435
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  10. Article ; Online: Combined Working Memory Training and Transcranial Magnetic Stimulation Demonstrates Low Feasibility and Potentially Worse Outcomes on Delay to Smoking and Cognitive Tasks: A Randomized 2 × 2 Factorial Design Pilot and Feasibility Study.

    Lechner, William V / Philip, Noah S / Kahler, Christopher W / Houben, Katrijn / Tirrell, Eric / Carpenter, Linda L

    Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco

    2022  Volume 24, Issue 12, Page(s) 1871–1880

    Abstract: Introduction: Repetitive Transcranial Magnetic Stimulation (rTMS) has shown promising results in treating several Substance Use Disorders including Tobacco Use Disorder. However, questions remain regarding how to optimize treatment outcomes. Enhancement ...

    Abstract Introduction: Repetitive Transcranial Magnetic Stimulation (rTMS) has shown promising results in treating several Substance Use Disorders including Tobacco Use Disorder. However, questions remain regarding how to optimize treatment outcomes. Enhancement of working memory by rTMS is a potential therapeutic mechanism. The current pilot study examined whether rTMS plus a cognitive training program could enhance the effects of rTMS on smoking behaviors using a controlled, factorial design.
    Aims and methods: We hypothesized that cognitive training plus stimulation would improve control over smoking behaviors, resulting in enhanced cognitive performance and increased latency to smoke on a delay to smoking analog task. Using a 2 × 2 factorial design, nicotine dependent smokers (n = 43) were randomized to receive 10 sessions of active (10 Hz) or sham rTMS delivered to the left dorsolateral prefrontal cortex, plus active or sham working memory training (WMT) prior to and following stimulation.
    Results: Contrary to hypotheses, we observed a significant interaction effect, indicating that combining the two active interventions (rTMS+WMT) resulted in worse performance on the smoking analog task (B = -33.0, 95% CI = -64.39, -1.61, p < .05), compared to delivering either intervention alone. Additionally, although active rTMS (compared to sham rTMS) improved letter-sequencing performance (B = 1.23, 95% CI = 0.08-2.38, p < .05), and active WMT (compared to sham WMT) improved back-digit task performance (B = 1.53, 95% CI = 0.02-3.05, p < .05), combining interventions worsened the effect of each on a back-digit task (B = -3.01, 95% CI = -5.96, -0.052, p < .05).
    Conclusions: These preliminary findings indicate potential iatrogenic effects of combining rTMS and this working memory training intervention and underscore the need for rigorous evaluation of substance specific conceptual frameworks when selecting future combination interventions.
    Implications: Counter to hypothesis, this study found no additional benefit of adding a working memory training program to a rTMS protocol in a sample of daily smokers. The combination condition (active rTMS + active training) resulted in worse performance on a delay to smoking analog task and a measure of working memory performance compared to delivering either intervention alone. These preliminary findings inform strategies for optimizing rTMS in smokers and highlight the need for future studies to consider several key components of candidate combination interventions, including effects on regulation of substance use.
    Clinical trial registration (if any): The trial was registered at ClinicalTrials.gov (NCT03337113).
    MeSH term(s) Humans ; Cognition ; Feasibility Studies ; Memory, Short-Term ; Pilot Projects ; Prefrontal Cortex/physiology ; Smoking ; Transcranial Magnetic Stimulation/methods ; Treatment Outcome
    Language English
    Publishing date 2022-07-30
    Publishing country England
    Document type Randomized Controlled Trial ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 1452315-2
    ISSN 1469-994X ; 1462-2203
    ISSN (online) 1469-994X
    ISSN 1462-2203
    DOI 10.1093/ntr/ntac183
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