Medical student connects smoking cessation, COPD, and delay discounting

Even the best laid research plans can go awry, but sometimes, a strategic reset can produce exciting findings. Kenan Michaels, a fourth-year student at the Virginia Tech Carilion School of Medicine (VTCSOM), learned this lesson when, more than halfway through medical school, he realized he would not be able to recruit enough study participants for his project due to the pandemic.

Michaels carried out his research with his mentors Jeff Stein, assistant professor and associate director of the Center for Health Behaviors Research at the Fralin Biomedical Research Institute at VTC, and Jennifer Vaughn, formerly with VTCSOM and Blue Ridge Cancer Care and now with the Ohio State University.

“Originally, I was researching smoking cessation in patients who were diagnosed with head and neck cancer with Drs. Stein and Vaughn,” Michaels said. “But COVID-19 reduced the number of patient appointments being scheduled, and I just couldn’t get a large enough sample. It was hard to find the population I needed here in Roanoke.”

Michaels decided to tweak the focus of his research and try enrolling participants using a national online survey. The result was a statistically sound, compelling look at whether smokers diagnosed with chronic obstructive pulmonary disease (COPD) within the past five years would be more likely to have quit since their diagnosis if they had lower rates of delay discounting.

Delay discounting refers to how a person values future outcomes, and high rates of delay discounting reflect a greater preference for smaller, immediate rewards compared with larger, delayed rewards. Michael’s hypothesis was that COPD patients who didn’t mind waiting for a reward were more likely to quit smoking.

Michaels recruited 384 participants with COPD from across the country who smoked cigarettes at the time of their diagnosis. Participants completed online surveys to determine specific demographics, their smoking behaviors, and their COPD diagnosis. They also were asked to complete a decision-making task to assess delay discounting, during which they chose between small and immediate, or larger and delayed monetary rewards. Using statistical methods, Michaels was able determine if delay discounting among participants was associated with smoking cessation.

Michaels found that lower delay discounting was associated with smoking cessation; however, stronger predictors were higher age, decreased reporting of the severity of their COPD, and lower severity of nicotine dependence at the time of diagnosis.

“The whole goal of my project was to better understand smoking cessation in the setting of a disease state such as COPD,” Michaels said. “We used delay discounting, among other predictors, to see if we could determine someone’s propensity to be a smoker after diagnosis. Future research could hopefully allow us to use delay discounting clinically to target patients who have higher levels of discounting with more specific smoking cessation efforts.”

Michael’s biggest surprise from his pilot study was that he was able to turn the study around after a slow start and acquire the necessary amount of sound data.

“Kenan invested a lot of time early on in a research direction that didn’t pan out,” said Leslie LaConte, assistant dean for research at the medical school. “This happens often in research, but can be really discouraging for our medical students, because four years can go by very quickly. Kenan did a great job working closely with his research mentors to pivot to a new study and then pursued that research with just as much commitment and energy as he had with his first project.”

Michaels credits Stein for helping him turn things around.

“Dr. Stein definitely has a passion and many creative ideas for the application of delay discounting,” he said. “He was also very knowledgeable and willing to let me take the reins and make the project my own.”

VTCSOM has a rigorous research curriculum that helps prepare physician thought leaders as part of its mission. All students are expected to a conduct original, hypothesis-driven research project before graduation. This requirement ensures that students are immersed in the language, culture, and practice of research.

Michaels anticipates his research will be published in a public health journal later this spring. In addition, he has presented at two professional conferences.

He will give a presentation on his project at VTCSOM’s annual Medical Student Research Symposium, which is from noon to 6 p.m. Friday, March 25. Seven students in the Class of 2022 who selected to receive Letters of Distinction for their project, including Michaels, will give oral presentations. All of the members of the class will provide poster presentations on their projects.

Learn more about the symposium and how to attend.