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Biomedical subjects

D B Abrams

Publications and source records attributed to D B Abrams.

At least 55 records · Page 3Linked to original sources
PubMed1994

Cancer control at the workplace: the Working Well Trial.

BACKGROUND. Few research studies have been conducted on cancer prevention and control at the workplace. This article presents an overview of the largest worksite cancer control trial in the United States--The Working Well Trial--conducted in 114 worksites by four study centers, a coordinating center, and the National Cancer Institute. The trial's organizational structure, research design, dependent measures, and theoretical model for intervention are described. Special features of the trial include using the worksite as the unit of randomization, intervention, and evaluation and a theory-driven conceptual model of intervention that places emphasis on individual and organizational targets for change, uses the transtheoretical stage of change model to guide a sustained 2-year multiple risk factor intervention, and makes use of volunteer resources within the worksite to reduce cost, increase participation, and improve tailoring to individual needs. The trial will have a potential impact on over 25,000 workers. CONCLUSION. The issues raised in this overview have implications for the evaluation and dissemination of cancer prevention and control programs to defined populations.

Health Promotion↗
PubMed1994

An evaluation of the relationship between self-report and biochemical measures of environmental tobacco smoke exposure.

To evaluate the relationship between self-reported exposure to environmental tobacco smoke and saliva cotinine concentrations, we studied 186 nonsmokers. Each participant completed an exposure questionnaire, kept a daily exposure diary for 7 days, and provided a saliva sample for cotinine analysis. Salivary cotinine concentrations were measured using gas chromatography/mass spectrometry. Of the volunteers, 30% lived with one or more smokers, and 84% were regularly exposed to smokers at work. Eighty-three percent of the volunteers had detectable saliva cotinine concentrations (> or = 0.5 ng/ml) (median = 1.1; range = 0.5-7.4 ng/ml). Cotinine concentrations were related to exposure in the household and at the workplace. Volunteers who lived with smokers had significantly higher cotinine levels (median = 1.0; range = < 0.5-7.4 ng/ml) than those who did not (median = < 0.5; range = < 0.5-4.7 ng/ml). Volunteers who reported regular exposure at work had higher cotinine levels (median = 0.8; range = < 0.5-7.4 ng/ml) than those who did not (median = < 0.5; range = < 0.5-3.0 ng/ml). Cotinine concentrations were predicted by a regression equation that included the number of smokers at home and work and the number of minutes of exposure recorded in the daily diary (r2 = 0.29).

Adolescent↗
PubMed1994

Matching high- and low-dependence smokers to self-help treatment with or without nicotine replacement.

BACKGROUND: This study investigated the effect of matching smokers to nicotine replacement therapy (nicotine gum) on the basis of the pretreatment level of nicotine dependence. METHODS: One hundred seventy-three smokers, classified as high or low on nicotine dependence using the Fagerstrom Tolerance Questionnaire, were assigned at random to receive nicotine gum (2 mg), chewed ad libitum, or to not receive nicotine gum. All smokers participated concurrently in a 5-week treatment program consisting of four brief counseling sessions combined with a self-help manual provided by the American Lung Association. RESULTS: Results showed that smokers with high levels of nicotine dependence were significantly more likely to quit smoking during treatment if they received nicotine gum (31.9%) than high-dependence smokers who did not receive the gum (12.2%). There was a tendency for smokers with low levels of nicotine dependence to do worse during treatment if they received gum (13.5% quit) than they did when they received no gum (20% quit), although this difference was not statistically significant. The relative differences in outcomes persisted after 1 year of follow-up, but the high overall rate of relapse (92.5%) rendered the absolute size of the differences statistically insignificant. CONCLUSION: The results of the study are discussed in terms of strategies that might improve the success of treatment-matching approaches with newer forms of nicotine replacement therapies.

Adult↗
PubMed1994

Mechanisms in multiple risk factor interventions: smoking, physical activity, and dietary fat intake among manufacturing workers. Working Well Research Group.

BACKGROUND: Individuals who have multiple poor health behaviors account for a disproportionately large percentage of the preventable U.S. health care cost burden. Understanding the relationships between multiple risk factors is important for the design of both individual and public health interventions. There have been few efforts to examine the co-occurrence of psychosocial and motivational mechanisms that mediate smoking, dietary fat intake, and physical activity in a defined population of blue collar workers. METHODS: The sample comprised 1,559 manufacturing workers who participated in a self-help physical activity intervention and who completed a computerized assessment battery about their smoking, dietary fat intake, physical activity, and demographic characteristics. RESULTS: Twenty-six percent of the sample were smokers, 51% did not exercise regularly, and 35% consumed more than an estimated 40% of calories per day from fat. Almost half of the sample was in the later stages of readiness for physical activity and dietary fat intake, compared with only 3% for smoking. Only 12% of the smokers had smoking as their only risk factor. Smokers were significantly more likely to engage in poor dietary and physical activity behaviors, compared with nonsmokers. The relationship among smoking status and the other risk factors was apparent both in terms of dietary fat and physical activity behaviors, as well as mediators such as motivation for change. Lower dietary fat intake was associated with an absence of the other two risk factors. CONCLUSIONS: The results suggest that there are important mediating mechanisms both within and among workers with one or more risk factors. Smokers are a particularly important target for health promotion interventions, and it may be possible to make initial contact with them through other health programs at the worksite. The role of other lifestyle changes as a gateway to smoking cessation has not yet been explored, but may have potential for reaching smokers who are very low in their motivational readiness to change. The implications of these findings for research and the design of multiple risk factor interventions are discussed.

Adult↗
PubMed1994

Cue reactivity as a predictor of drinking among male alcoholics.

Social learning theories suggest that conditioned responses may increase the risk for relapse. Responses to alcohol use cues (cue reactivity) are associated with variables suggestive of risk but little research exists on the relationship of cue reactivity to treatment outcome. Alcoholic men admitted for detoxification to a treatment program (n = 45) underwent a cue reactivity assessment protocol, and 91% received 3-month follow-up interviews. Greater salivary reactivity predicted greater frequency of drinking during follow-up. Attentional factors added independent variance to the prediction of drinking outcome, with greater attention to stimulus or to response predicting less drinking. Cue reactivity did not predict length of hospital stay or latency to first drink. Results are discussed in the context of information processing, social learning theories, and clinical implications for relapse prevention.

Adult↗
PubMed1994

Smoking at home: the impact of smoking cessation on nonsmokers' exposure to environmental tobacco smoke.

Nonsmokers who live with smokers are at increased risk for chronic disease. This study evaluated the impact of eliminating smoking in the home on nonsmokers' environmental tobacco smoke (ETS) exposure. Nonsmokers participated in measurements of their ETS exposure before and after the smoker in their home quit smoking. A matched comparison group of nonsmokers from nonsmoking homes was also included. ETS exposure was assessed using passive nicotine monitors, an exposure diary, and a questionnaire. Nonsmokers from smoking homes had significantly higher exposure to ETS than those from nonsmoking homes. There was a 60% reduction in nicotine levels following smoking cessation by the household smoker. However, there were still detectable levels of nicotine measured at posttest. These results have important implications for individual risk reduction and public health policy.

Case-Control Studies↗
PubMed1994

The effects of cue exposure on reaction time in male alcoholics.

The present study investigates reaction time (RT) as a measure of attentional deficits produced during alcohol cue exposure. Twenty-four male alcoholic patients responded to a series of computer-generated tones as rapidly as possible during baseline and again during either an alcohol cue exposure period or exposure to a control beverage (water). Patients required increased time to respond to the tones when exposed to alcohol cues. No such increase in RT was found during exposure to a control beverage. In addition, RT was significantly correlated with self-reported urge to drink. These data provide initial validation for the use of RT as an objective measure of cue reactivity. Both theoretical and clinical implications for the use of RT as a measure of the effects of cue exposure are discussed.

Adolescent↗
PubMed1994

Recruitment of work sites to a health promotion research trial. Implications for generalizability.

The characteristics of companies that either accepted or declined participation in a 5-year randomized trial of a multirisk factor health promotion intervention were compared to investigate potential limitations on the generalizability of research findings. A representative sample of 151 manufacturing work sites in the northeast was recruited to participate. Sixty-four of the companies were determined to be eligible and 10 others, which refused to have an administrator interviewed, were presumed to be eligible. Of this group, 27 companies agreed to participate. Work force demographics, shift structure, and prior history of health promotion offerings were not significantly different in the two groups. However, participating companies employed fewer workers and had a more favorable financial outlook than did companies that declined to participate. Implications of these findings for research on work site health promotion are discussed.

Health Promotion↗
PubMed1993

Cue exposure with coping skills treatment for male alcoholics: a preliminary investigation.

Although early investigations were promising, no controlled follow-up studies have investigated the effectiveness of cue exposure treatment for alcoholics. In this study, inpatient alcoholics received either cue exposure integrated with urge coping skills training (CET, n = 22) or a contrast condition (CC) involving daily contact with assessment only (n = 18) in addition to standard treatment. Comprehensive assessment measures were used to investigate change in process and outcome variables. In the second 3 months after treatment, the CET group included more patients who were completely abstinent, had a higher percentage of abstinent days, and tended to report fewer drinks per day than did patients in the contrast condition. The significantly greater use of coping skills during follow-up by the CET group and the significant relationship of these coping skills to decreased drinking suggest that treatment effects were due, at least in part, to the coping skills training, consistent with recent formulations. Theoretical and treatment implications are discussed.

Adaptation, Psychological↗
PubMed1993

Alcohol cue reactivity: effects of detoxification and extended exposure.

Alcoholics' reactions to drinking-related stimuli (cue reactivity) have been well documented and alcohol cue exposure treatment has been conducted recently in several clinical trials. Prior to conducting large-scale clinical trials it is important to know what effects detoxification may have on cue reactivity. However, no information is available about the effects of stage of detoxification or of detoxification medication on alcohol cue reactivity. In this study, 45 male alcoholics, detoxified without medication, were assessed during either their second, fourth or sixth day of withdrawal. Further, their reactivity was compared to that of alcoholics detoxified with chlordiazepoxide (n = 15), and to that of alcoholics in their fourth week after drinking (n = 28). Cue reactivity assessment investigated salivation and urge to drink after 3 minutes of water cue exposure and then after 3 minutes of alcohol cue exposure. Urges to drink were assessed during an additional 15 minutes of alcohol exposure to explore latency to maximum reactivity and habituation. Reactivity did not differ as a function of group membership, although salivation was elevated to both beverages during the first week of detoxification. Of the sample, 70% reacted to alcohol with increased urge and 65% with increased salivation, with no difference between groups in proportions of reactors. The maximum urge to drink occurred in the first 6 minutes of alcohol exposure, followed by a gradual and significant decrease. There were no differences on these measures between alcoholics in their first or fourth week after their last drink. Implications for theory and clinical applications are discussed.

Adaptation, Psychological↗
PubMed1993

Development of a behavior analytically derived alcohol-specific role-play assessment instrument.

Social learning theory postulates that chronic alcohol abusers may have deficits in ability to cope with stressful situations, and these deficits may be associated with relapse after treatment. Attempts to study the hypothesized deficits have been hampered by methodological problems. Therefore, a behavior analytic procedure was used to develop 10 categories of situations based on over 600 drinking situations elicited from alcoholics. Role plays were developed for each of these categories, and samples of alcoholics in treatment were asked to respond as if they were trying not to drink. Videotaped responses were behaviorally rated by trained judges for skill and anxiety, and subjects completed self-report ratings of urge to drink, anxiety, difficulty and skill after each role play. Good interrater reliabilities and internal consistency were found across three samples of alcoholics, with virtually no gender differences. Previous and current investigations show the validity and utility of this instrument. The Alcohol Specific Role Play Test therefore shows promise as a means of assessing alcoholics' reactions to high-risk situations.

Adaptation, Psychological↗
PubMed1992

Motivational characteristics of smokers at the workplace: a public health challenge.

BACKGROUND: Few studies have focused on the motivational characteristics of smokers who do not volunteer for cessation. This study examined the relationship between demographic and selected psychosocial factors and motivation and intention to quit smoking among employed smokers at five worksites. In addition, the distributions of smokers who are at different stages of readiness to change their smoking behavior are presented. RESULTS: Results indicate that, overall, less than 8% of employed smokers are currently ready to quit smoking and that blue-collar workers are lower in motivation than white-collar workers. Predictors of higher levels of motivation to quit smoking included higher socio-economic status, maleness, lower levels of self-reported nicotine dependence, and stronger perceptions that smoking was against the social norms of the workplace. CONCLUSION: Implications for intervention, evaluation, and policy are discussed in the context of the challenge of making a public health impact on reducing overall smoking prevalence.

Adult↗
PubMed1992

Attendance and outcome in a work site weight control program: processes and stages of change as process and predictor variables.

This naturalistic study assessed client changes during treatment and identified salient predictors of therapy attendance and outcome. Subjects were assessed on processes and stages of change, self-efficacy, social support, weight history (including expectations, goals, and reasons for losing weight), and demographics at the beginning, middle, and end of a 10-week, behaviorally oriented work site program for weight control. Significant shifts from contemplation to action occurred for clients remaining in treatment. There were also significant modifications in the use of change processes as a result of treatment: counterconditioning, contingency management, stimulus control, interpersonal control, and social liberation increased while medication use, wishful thinking, and minimizing threats decreased. Change processes employed during the early portion of the group treatment were the best predictors of treatment attendance and outcome, superior to self-efficacy, social support, weight history, and demographic variables. The results supported a transtheoretical model that emphasizes dynamic processes and stages as core dimensions for understanding how people change.

Adaptation, Psychological↗
PubMed1992

A Cocaine High-Risk Situations Questionnaire: development and psychometric properties.

Although high-risk situations have been identified for alcoholism, opiate abuse, and smoking, further research is needed to identify high-risk situations for cocaine abuse. A 233-item Cocaine High-Risk Situations Survey was developed based on a comprehensive literature review and was administered to 179 cocaine users in treatment. Situations that occurred infrequently or that were not often associated with cocaine use were eliminated and the remaining 89 items were factor analyzed using half the sample with confirmatory factor analysis on the remainder of the sample. Only one factor was found for frequency of cocaine use in these situations. The 21 items with high factor loadings and a diverse range of content were retained for subsequent analyses and renamed the Cocaine High-Risk Situations Questionnaire (CHRSQ). Reliability and convergent and discriminant validity of this scale were demonstrated. Frequency of alcohol use in the same situations was not significantly related to cocaine use and abuse, supporting discriminant validity. The findings suggest that the frequency of ongoing cocaine use is not determined by specific situations. Theoretical and clinical implications are discussed.

Adaptation, Psychological↗
PubMed1992

Increased saliva cotinine concentrations in smokers during rapid weight loss.

Although the effect of smoking cessation on weight gain is well-documented, little is known about the effect of weight loss on smoking. We examined the association between saliva cotinine levels and weight loss in a group of 9 obese female smokers during participation in a protein-sparing modified fast (Optifast). For the first 3 months of treatment, subjects consumed only the protein-sparing supplement; for the next 3 months, food was gradually reintroduced. Body mass index and saliva cotinine concentration were assessed at study entry and at 3 and 6 months. A significant weight loss was noted at 3 and 6 months, yet the cotinine level increased significantly over this time. It is unclear whether the cotinine increase is due to metabolic changes or an actual increase in nicotine intake. The results suggest that smoking-related health risks may increase during periods of significant weight loss.

Adult↗
PubMed1992

Assessing elements of women's decisions about mammography.

We investigated motivational and cognitive processes of behavior change with respect to mammography screening. One hundred forty-two women (ages 40 and older) recruited from three worksites answered a 41-item questionnaire consisting of statements based on constructs from the transtheoretical model of behavior change. Principal-components analysis identified two factors: a six-item component representing positive perceptions of mammography (Pros) and a six-item component representing avoidance of mammography (Cons). Analysis of variance showed that Pros, Cons, and a derived Decisional Balance measure (Pros minus Cons) were associated with stage of mammography adoption. Results are consistent with applications of the model to smoking cessation. The model is also discussed as it relates to other theories of behavior change and as a general strategy for analyzing perceptual data pertinent to health-related actions and intentions for behavioral change.

Adult↗
PubMed1992

The stages and processes of exercise adoption and maintenance in a worksite sample.

We applied the model of the stages and processes of change to exercise adoption and maintenance. This model has shown promise in advancing theory and treatment of the addictions and other negative health behaviors, but there have been few systematic attempts to apply the model to positive health behaviors, such as exercise adoption. Questionnaires dealing with the stages and processes of exercise change were developed and administered to a sample of 1,172 participants in a worksite health promotion project. The sample was split randomly into halves for (a) initial model development and testing and (b) confirmatory measurement model testing. Additional model confirmation was obtained by examining the hierarchical structure of the processes of change and by conducting Stage x Process analyses. Results suggest that the underlying constructs derived from smoking cessation and other addictive behaviors can be generalized to exercise behavior. Understanding the stages and processes of exercise behavior change may yield important information for enhancing exercise adoption, adherence, and relapse prevention at both individual and public health levels.

Adult↗