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Biomedical subjects

David W Wetter

Publications and source records attributed to David W Wetter.

At least 19 recordsLinked to original sources
PubMed2007

Reaching and treating Spanish-speaking smokers through the National Cancer Institute's Cancer Information Service. A randomized controlled trial.

Although the prevalence of smoking is lower among Hispanics than among the general population, smoking still levies a heavy public health burden on this underserved group. The current study, Adiós al Fumar (Goodbye to Smoking), was designed to increase the reach of the Spanish-language smoking cessation counseling service provided by the National Cancer Institute's Cancer Information Service (CIS) and to evaluate the efficacy of a culturally sensitive, proactive, behavioral treatment program among Spanish-speaking smokers. Adiós was a 2-group randomized clinical trial evaluating a telephone-based smoking cessation intervention. Spanish-speaking smokers (N = 297) were randomized to receive either standard counseling or enhanced counseling (EC). Paid media was used to increase the reach of the Spanish-language smoking cessation services offered by the CIS. The Adiós sample was of very low socioeconomic status (SES), and more than 90% were immigrants. Calls to the CIS requesting smoking cessation help in Spanish increased from 0.39 calls to 17.8 calls per month. The unadjusted effect of EC only approached significance (OR = 2.4, P = .077), but became significant after controlling for demographic and tobacco-related variables (OR = 3.8, P = .048). Adiós al Fumar demonstrated that it is possible to reach, retain, and deliver an adequate dose of treatment to a very low SES population that has traditionally been viewed as difficult to reach and hard to follow. Moreover, the findings suggest that a proactive, telephone-counseling program, based on the Treating Tobacco Use and Dependence Clinical Practice Guideline and adapted to be culturally appropriate for Hispanics, is effective. Cancer 2007. (c) 2006 American Cancer Society.

Adult↗
PubMed2006

Gender differences in affective response to acute nicotine administration and deprivation.

Men and women may differ in their sensitivity to the mood-modulating properties of nicotine. Male and female adult smokers were exposed to four sessions crossing two nicotine deprivation conditions (12-h deprived vs. nondeprived) with two drug conditions (nicotine vs. placebo nasal spray). Acoustic probes elicited startle eyeblink responses while viewing affective and cigarette-related slides. In-session mood ratings were collected to gauge self-reported negative affect, positive affect, and craving. Nicotine nasal spray reduced startle amplitude in both men and women following 12-h deprivation compared with smoking nondeprivation. During nondeprivation, nicotine nasal spray increased startle amplitude in women compared with placebo spray, whereas no difference was found for men. The startle results suggest that both men and women are responsive to the hedonic properties of nicotine.

Administration, Inhalation↗
PubMed2006

Racial and ethnic differences in predictors of smoking cessation.

Racial/ethnic differences in the determinants of smoking cessation could have important treatment implications. The current study examined racial/ethnic differences in smoking cessation, prospective predictors of cessation, and whether the predictive ability of these factors differed by race/ethnicity. Participants were 709 employed adults recruited through the National Rural Electric Co-op Association or through natural gas pipeline corporations. Data were collected in 1990 and 1994. Although race/ethnicity was not predictive of abstinence, Hispanic, African American, and White smokers displayed differential on tobacco-, alcohol-, and work-related variables. These racial/ethnic differences highlight the specific factors that should be considered when providing smoking cessation treatment to specific populations. Limitations are noted.

Adult↗
PubMed2006

A psychometric evaluation of cigarette stimuli used in a cue reactivity study.

Laboratory studies have demonstrated that cigarette smokers react with significant subjective and autonomic responses (e.g., increased craving and increased heart rate) in the presence of stimuli associated with smoking. Although cue reactivity effects are typically robust, a number of methodological considerations make interpretation and design of cue reactivity studies problematic. Previous research has paid scant attention to the psychometric properties of the cigarette cues presented, and standard cues would enhance comparison and synthesis of studies. In the present study, we evaluated 12 cigarette photos (compared with positive, negative, and neutral photos), used in a separate study, for their ability to evoke self-report of craving in both nicotine-deprived and nondeprived smokers. These photos performed as expected, with cigarette pictures evoking significantly higher craving than neutral pictures and deprived smokers showing a trend toward higher craving than nondeprived smokers. The cigarette picture set was evaluated for internal consistency (Cronbach's alpha = .97) as a 12-item scale and further reduced to multiple 2-item scales with reliability estimates ranging from .70 to .93. A cluster analysis of all pictures showed that, when rated for craving, cigarette pictures clustered together, indicating they had distinct properties compared with positive, negative, and neutral pictures. Effect sizes were calculated for each cigarette picture in both deprived and nondeprived smokers. The craving effect sizes ranged from .57 to .98 for nondeprived smokers, and from .61 to .99 for deprived smokers. The analyses suggest these cigarette pictures have excellent psychometric properties for use in future cue reactivity studies.

Adult↗
PubMed2006

The effects of smoking deprivation and nicotine administration on emotional reactivity.

Although converging lines of evidence suggest that nicotine and mood are related at a fundamental biological level, this link has not been reliably demonstrated in laboratory studies. In this study, startle probe methodology was used to examine the effects of nicotine administration and deprivation on emotional processes associated with motivation. Smokers (N = 115) completed four laboratory sessions crossing deprivation (12-hr deprived vs. nondeprived) with nicotine spray (active vs. placebo). Participants viewed affective pictures (positive, negative, neutral) and pictures involving cigarette cues, while startle probes were administered. Deprivation decreased startle responding to cigarette cues, suggesting an activation of appetitive processes. Nicotine administration suppressed overall startle responding during deprivation. In addition, during deprivation, random exposure to negative stimuli over two blocks of trials resulted in decreased adaptation of the startle response, suggesting that some sensitization to negative emotional cues may take place during nicotine withdrawal. These effects are consistent with formulations of addiction, stressing that withdrawal may both increase the reinforcement salience of smoking stimuli and decrease habituation to negative emotional stimuli.

Adult↗
PubMed2006

At-risk drinking in employed men and women.

BACKGROUND: "At-risk" drinking is associated with a variety of negative health and social consequences. However, little is known about the characteristics of at-risk drinkers or of changes in at-risk status over time. PURPOSE: The objective was to examine the correlates of at-risk drinking and the prospective predictors of maintenance or change in at-risk status. METHOD: Participants were 4,322 employed individuals assessed at baseline and 4 years later. At-risk drinking was defined as 2 or more drinks per day for men and 1 or more drinks per day for women. RESULTS: The baseline prevalence of at-risk drinking was 11%. Four percent of baseline not-at-risk individuals transitioned to at-risk drinking at follow-up, and 54% of the baseline at-risk individuals remained at-risk at follow-up. Several demographic-, work-, and tobacco-related variables differentiated at-risk groups and were prospective predictors of change in at-risk drinking status among those individuals who were not at risk at baseline. However, none of the constructs predicted change among at-risk drinkers. CONCLUSION: The data suggest that at-risk drinking is of public health concern. Eleven percent of the participants met criteria for at-risk drinking. Further, at-risk and not-at-risk drinkers differed on numerous characteristics, and their drinking may be influenced by different factors.

Adult↗
PubMed2006

Smoking cessation 1: pharmacological treatments.

In part 1 of this 3-part review of interventions for tobacco dependence, the authors present evidence regarding the efficacy of pharmacological treatments for smoking cessation. They also present evidence and recommendations included in the U.S. Department of Health and Human Services Treating Tobacco Use and Dependence: Clinical Practice Guideline (the Guideline), evidence from studies published after the Guideline, and recommendations of their own. The authors review nicotine replacement therapies, antidepressants, and other pharmacotherapies, followed by pharmacological treatments for special populations. The evidence indicates that a variety of effective smoking cessation medications are available. First-line medications include nicotine replacement therapies and bupropion. Pharmacotherapy is a vital component of smoking cessation interventions and should be offered to all smokers who want to quit unless contraindicated. There is a need for further research on pharmacotherapies for smoking cessation, and the authors discuss key areas for future research.

Bupropion↗
PubMed2006

Smoking cessation 2: behavioral treatments.

The authors' purpose of this portion of a 3-part review of interventions for tobacco dependence is to present evidence regarding the efficacy of behavioral treatments for smoking cessation. The present review includes evidence evaluated in the Treating Tobacco Use and Dependence Clinical Practice Guideline (the Guideline) (MC Fiore, WC Bailey, SJ Cohen, et al, 2000) as well as evidence published subsequent to the Guideline. A wide range of effective behavioral treatments for smoking cessation is available. These interventions come in a variety of formats and intensities, can be used by all types of clinicians in a variety of settings, and are appropriate for different types of smokers. The authors have organized recommendations in 2 broad domains that account for much of the variability across behavioral interventions, treatment content, and structure. Finally, the authors discuss key directions for future research.

Behavior Therapy↗
PubMed2005

Depression in pregnant women seeking smoking cessation treatment.

The proportion of DSM-IV-based threshold and subthreshold depressive disorders was assessed, using the Primary Care Evaluation of Mental Disorders and a DSM-IV based assessment of depression history, in a sample of 139 pregnant smokers seeking smoking cessation treatment. Sixty-three percent of the sample met criteria for a current or past depressive disorder. Forty-six percent had a current threshold or subthreshold depressive disorder. Twenty percent met criteria for current major depression, with half of those having major depression with dysthymia. Twenty-one percent of the sample was chronically depressed (i.e., dysthymia or major depression with dysthymia). Women with current depression were less likely to tell their doctors that they smoked. Our results suggest that investigation of the prevalence of depression in community samples of pregnant smokers is warranted, as depression may present a major obstacle in pregnant women's efforts to quit smoking.

Adult↗
PubMed2005

Progression of college-age cigarette samplers: what influences outcome.

Experimental and occasional cigarette use among college students is widespread. Little is known about what differentiates the occasional college smoker who becomes a regular smoker from the one who does not. Possible risk factors include peer smoking, lifestyle factors, such as lack of exercise, and health/addiction concerns. The current study investigated the progression of smoking in a cohort of 321 low-level/occasional smokers. Over the course of 4 years, 45% of low-level/occasional users had become nonsmokers, 35% became occasional smokers, and 20% became daily smokers. Baseline exercise patterns, addiction beliefs, and smoking pervasiveness were modestly related to distal smoking outcome. The level of baseline smoking was strongly related to smoking outcome. These results support the wisdom of limiting access and exposure to cigarettes among the college population.

Adolescent↗
PubMed2005

Understanding the associations among education, employment characteristics, and smoking.

The current study examined the association between education level and smoking status in a community-based sample of working adults. Participants were enrolled at the University of Texas M.D. Anderson Cancer Center site of a cancer risk behavior reduction intervention delivered at the worksite. There was a strong educational gradient in smoking status. The prevalence of current smoking was almost threefold higher among individuals with <HS degree than among individuals with at least a college degree (37% versus 14%), while the percentage of never smokers among individuals with <HS degree was less than half that of individuals with at least a college degree (29% versus 60%). The educational gradient in smoking status was extremely robust and education uniquely contributed to the prediction of smoking status over and above the effects of demographics, job status, and job related characteristics. Identifying the mechanisms underlying this association as well as high risk subgroups of individuals with low education could contribute to reducing the educational gradient in smoking status and warrants further research attention.

Adult↗
PubMed2005

What accounts for the association of education and smoking cessation?

BACKGROUND: Education has been identified as a potent sociodemographic predictor of smoking cessation and the Healthy People 2010 goals include the elimination of health disparities attributable to education. METHOD: The current study prospectively examined the association of education with smoking cessation as well variables that might account for that association among employed adults residing in the southeastern United States. RESULTS: A strong educational gradient in cessation was evident. Only 6% of smokers with less than a high school (HS) degree quit smoking during the 4-year study period, whereas 17% of smokers with a HS degree but no college degree and 28% of smokers with at least a college degree quit smoking. CONCLUSIONS: Education appeared to uniquely contribute to the prediction of smoking abstinence over and above the effects of demographic, environmental, tobacco dependence, transtheoretical model, and job-related variables. Obtaining a better understanding of how or why education influences smoking cessation could contribute to reducing the educational gradient in abstinence and warrants further research attention.

Adult↗
PubMed2005

Combined effects of venlafaxine, nicotine replacement, and brief counseling on smoking cessation.

In this study, 147 smokers were randomly assigned to receive either venlafaxine or placebo in conjunction with behavioral counseling (9 weekly sessions) and transdermal nicotine replacement therapy (22 mg/day). Patients began medication 2 weeks before quitting and continued for 18 weeks after quitting, with the daily dose titrated from 150 to 225 mg. in response to symptoms of negative affect and relapse. The results showed no main effect of treatment on abstinence. Post hoc analysis revealed that both at the end of treatment and at the 1-year follow-up smokers consuming less than a pack of cigarettes a day benefited from the addition of venlafaxine to the treatment regimen. Venlafaxine also reduced negative affect for all smokers for up to 6 weeks postcessation. The findings suggest that venlafaxine could have some role to play in the treatment of lighter smokers, in addition to the expected benefits of nicotine replacement therapy and behavioral counseling.

Administration, Cutaneous↗
PubMed2005

Proactive, motivationally enhanced smoking cessation counseling among women with elevated cervical cancer risk.

Current treatment guidelines recommend that all smokers be given motivational or action-oriented counseling, as is appropriate to their readiness to quit smoking. The present study assessed the acceptability and impact of a proactively delivered, motivationally tailored phone counseling program targeted to women with elevated risk for cervical cancer. Female smokers with a recent abnormal pap exam or a colposcopy were contacted and invited to participate, regardless of their interest in quitting smoking. Participants were randomly assigned to usual care (UC) or UC plus motivationally enhanced phone counseling (MEC). The intervention was well received: 79% of eligible women enrolled (n = 275), and 90% completed at least three of four calls. Participation did not vary by baseline motivation to quit. Compared with control subjects, counseling participants were more likely to seek additional treatment services and had a higher 7-day point-prevalence abstinence rate at 6 months (20% MEC vs. 12% UC, p<.05). MEC impact was sustained at 12 months, but abstinence increased among the UC group (18% MEC vs. 20% UC, p = ns). There was no difference in repeated point-prevalence abstinence at 6 and 12 months (11% MEC vs. 10% UC, p = ns). Outcomes were similar in a subgroup of 229 women who, at baseline, were interested in quitting in the next 6 months.

Adult↗
PubMed2005

Race/ethnicity, smoking status, and self-generated expected outcomes from smoking among adolescents.

Racial/ethnic differences in adolescent smoking suggest that different factors may motivate smoking among various racial/ethnic groups. This study examined relations among race/ethnicity, self-generated smoking outcome expectancies, and smoking status. Our findings noted that current smoking was highest among Hispanics, whereas African Americans and Asians were least likely to ever smoke. African Americans were most likely to experiment but least likely to smoke currently. Five expectancies differed significantly by race/ethnicity: reduce tension, image, negative aesthetics, addiction, and cost. However, none were significant mediators or moderators. Racial/ethnic groups most susceptible to smoking initiation and with the highest rates of current smoking should be targeted for prevention and cessation. Research is needed to examine more thoroughly racial/ethnic differences in expectancies.

Adolescent↗
PubMed2004

Late relapse/sustained abstinence among former smokers: a longitudinal study.

BACKGROUND: Relapse remains the most refractory aspect of nicotine dependence, but little is known about relapse that occurs after a period of prolonged abstinence (i.e., "late relapse"). METHOD: The current study examined the prevalence and predictors of late relapse/sustained abstinence in a community-based, longitudinal cohort of former smokers surveyed at baseline and again 4 years later (n = 1143). RESULTS: Late relapse rates declined precipitously and sustained abstinence increased as the duration of abstinence at baseline increased. Although the risk for late relapse appeared to be small when using a point prevalence definition of smoking, that risk increased substantially if fluctuations in smoking behavior over time were considered (i.e., many former smokers relapsed and then regained abstinence during the 4-year study period). Although there were a number of significant prospective predictors of late relapse/sustained abstinence, they did not retain their predictive ability after controlling for baseline duration of abstinence. CONCLUSION: Although late relapse rates in the general population of former smokers appear low, and particularly so for individuals who have been abstinent for long periods of time, fluctuations between abstinence and smoking over time are not uncommon. How these fluctuations influence health or sustained abstinence over time is unclear. Because late relapse rates are generally low, interventions are likely to require careful targeting of at-risk individuals if they are to be efficacious and cost-effective.

Adult↗