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Biomedical subjects

E Lichtenstein

Publications and source records attributed to E Lichtenstein.

At least 19 recordsLinked to original sources
PubMed1992

The context of smoking initiation and maintenance: findings from interviews with youths.

The characteristics of initial cigarette-smoking situations and subsequent situations in which adolescents received an offer to smoke were examined by means of interviews with 287 youths in grades 7 through 10. Initiation of smoking generally took place in a social context (89%), with small groups (2.7 people) of same-gender, older (2.1 years), peers (and siblings) who were smokers (60%). In one-third of these onset situations, another novice smoked for the first time. Most subjects (81%) reported that they smoked their first cigarette because they accepted an offer. The characteristics of the onset situation did not significantly differ between regular and experimental smokers. The situations for later offers to smoke were similar: small groups of same-gender, slightly older, cigarette-smoking peers (and siblings). Descriptive and comparative data also are presented on procurement, perceived prevalence, parental influence, cravings, quit attempts, beliefs about ease of quitting, and intention to smoke. These data suggest that school-based interventions may not be sufficient to address the broad social context surrounding adolescent tobacco use. Community-wide interventions are advocated.

Adolescent↗
PubMed1992

Smoking cessation: what have we learned over the past decade?

This article discusses developments in understanding smoking and smoking cessation, methodological issues, and intervention approaches over the past 10 years. Although effective multisession clinic interventions have been developed, such programs reach relatively few smokers. This has led to self-help, work site, health care setting, and community interventions aimed at delivering less intensive programs to larger populations. Conceptual and empirical developments and trends within these above delivery contexts are reviewed, and avenues of research are identified. Nicotine replacement strategies have benefited from technological advances (e.g., transdermal patches) and present continuing challenges with respect to integration with behavioral strategies and incorporation into primary care medical settings. Research over the next decade should focus on the development of cost-effective interventions that can reach representative and high-risk smokers.

Administration, Cutaneous↗
PubMed1992

Smokeless tobacco habits and oral mucosal lesions in dental patients.

As part of a smokeless tobacco (ST) intervention study, we collected data on tobacco use habits and oral health for 245 male ST users aged 15 to 77. The study sample was identified during routine dental office visits and represents a relatively diverse population of patients. Oral health data collection included grading the clinical appearance of oral mucosal lesions using Greer and Poulson's classification system, as well as identifying and recording the primary anatomic location of ST placement. Results show that 78.6 percent of ST users had observable oral lesions, 23.6 percent of which were in the most clinically advanced category (degree III). Of the lesions noted, 85 percent were in the same location the patient identified as his primary area of smokeless tobacco placement. In a comparison sample of 223 non-ST-users with the same age distribution, only 6.3 percent had observable lesions. A multiple logistic regression model for ST users showed that lesion presence and severity were most significantly related to current frequency of ST use.

Adolescent↗
PubMed1992

Patient referral to a smoking cessation program: who follows through?

BACKGROUND: While health care providers are often urged to refer smokers to a smoking cessation program, little information is available about patient adherence to such advice. METHODS: A group of primary care patients who smoked (N = 1380) received brief advice to quit from their provider, and were then asked to stay and talk to a counselor for more information. Counselors randomly delivered one of two interventions. For the intervention group, referral to a specific group cessation program was emphasized, and for the control group, quitting advice was merely repeated. The referral intervention included a video in which role models testified to the acceptability and usefulness of the HMO's group program. The usual program fees were waived, and patients received a supportive, follow-up telephone call 1 week after their visit. RESULTS: In the referral intervention group, 53.2% of patients agreed to go to the cessation program and 11.3% actually attended, compared with only .006% of the patients who received advice only. Logistic regression analyses revealed that patients who were contemplating quitting were more than five times as likely to respond to the referral compared to precontemplators (smokers who were not seriously considering quitting). Older, heavier smokers were also more likely to attend a group session. CONCLUSIONS: An intensive, specific referral to a group smoking cessation program can increase participation by patients. Most patients, however, will not attend a group program; therefore, a brief office-based intervention for all smokers should precede referral.

Adolescent↗
PubMed1992

Effective smokeless tobacco intervention for dental hygiene patients.

This study was designed to test the effectiveness of a smokeless tobacco (ST) intervention delivered in the oral healthcare office setting. A total of 518 male ST users were identified by questionnaire in clinic waiting rooms and then randomly assigned to either a usual-care control group or a special intervention group. Dental hygienists took the primary role in delivering the intervention, which consisted of a soft-tissue examination with special attention to oral lesions, advice to quit ST, distribution of self-help materials, a short video on why and how to stop using smokeless tobacco, and encouragement to set a quit date. Follow-up assessments conducted three months after the office visit showed that a significantly greater proportion of intervention group patients had stopped using ST (32% of the intervention group participants versus 21% of control group patients, kappa 2 = 8.03, p less than .01). The intervention protocol is described in detail so that dental hygienists may adapt it for use in their practice.

Adolescent↗
PubMed1991

Needs and recommendations for behavior research in the prevention and early detection of cancer.

Because life-style patterns affect many cancer risks, research on health-risk behavior and behavior change is critical to cancer prevention. This report recommends priorities for the next decade of psychosocial research on cancer prevention and detection. The leading priority for future research is to fill gaps in basic knowledge left by the rush to intervention and outcome studies. Such research must be theoretically driven and should aim to develop broad principles applicable to diverse health behaviors. Studies that include relevant process data on various stages of behavior change are considered more desirable than simple outcome studies. Epidemiologic investigations should be expanded to include measures of relevant behaviors, so that their impact on clinical outcomes might be established. More research is needed on lay perception of health risks and on individual and health-system barriers to effective cancer prevention and detection. Studies that address the needs of minority and underprivileged populations are crucial. Funding agencies' narrow categorical mandates impede interdisciplinary research on multiple risk factors and their interactions; these boundaries must be relaxed to promote such approaches. Funding agencies should also consider basic research as a long-term investment towards the development of effective interventions.

Health Behavior↗
PubMed1991

Community Intervention Trial for Smoking Cessation (COMMIT): opportunities for community psychologists in chronic disease prevention.

Opportunities for participation in chronic disease prevention programs are discussed in the context of a description and analysis of the National Cancer Institute's Community Intervention Trial for Smoking Cessation (COMMIT). COMMIT involves 11 matched pairs of communities with random assignment to the intervention condition within each pair. The 4-year intervention is guided by a partly standardized protocol and embodies a number of community psychology principles. The relative congruence of COMMIT with community psychology principles and methods is discussed with particular emphasis on Kelly's (1988) model of community research. Community psychology's participation in chronic disease prevention trials requires understanding of the programmatic framework of National Institutes of Health prevention research and recognition of the constraints imposed by the framework on community psychology practices.

Community Mental Health Services↗
PubMed1991

Nurse-assisted smoking counseling in medical settings: minimizing demands on physicians.

BACKGROUND: In an effort to find more practical smoking intervention models for primary-care settings, three physician-and-nurse team approaches to patient counseling were compared with brief physician advice alone. METHODS: Subjects were 3,161 adult smokers surveyed while waiting to see 1 of 40 primary-care physicians. Physicians delivered a brief stop-smoking prompt to 2,707 (86%) of these smokers and referred them to an on-site smoking counselor (e.g., nurse) who randomly provided a two-page pamphlet (advice-only control) or one of three brief nurse-assisted interventions: (a) self-quit training, (b) recruitment to a group program, or (c) a combination intervention. Smokers usually (87%) agreed to see the counselor. RESULTS: After 3 months, subjects in the three nurse-assisted conditions were more likely to report a serious quit attempt (50% vs 39%, P less than 0.001) than were physician-advice-only subjects. Quit rates at 3 months were also higher (P less than 0.001) in the nurse-assisted self-quit (12.9%), recruitment (14.1%), and combination (13.0%) conditions, compared with those for brief physician advice only (7.6%). CONCLUSION: If long-term efficacy is confirmed, these nurse-assisted counseling approaches will serve as practical smoking intervention models for most medical-care delivery settings.

Adult↗
PubMed1990

The efficacy of social-influence prevention programs versus "standard care": are new initiatives needed?

This study evaluates the effects of a school-based smoking prevention program after 1 year, using school (22 middle/elementary schools, 15 high schools) as both the unit of randomization and the unit of analysis. The multigrade level (grades 6 through 9) intervention was designed to address comprehensively the social influence factors that encourage smoking. Teacher survey data indicated that treatment schools had a median of 10 classroom sessions devoted to tobacco/drug use education, 5 of which were the sessions designed for this evaluation, and control schools had also dedicated a median of 10 classroom sessions to tobacco/drug education. Thus, the study evaluated the incremental effects of the social influence intervention compared to "standard-care" curricula. Among those who reported smoking one or more cigarettes in the month prior to the intervention, there was a significant treatment effect on rate of smoking at one year, but no grade level, gender, or interaction effects. The 1-year covariate-adjusted smoking rate among pretest smokers in the treatment schools was 76.6 cigarettes per month, compared to 111.6 cigarettes per month in control schools, a 31.4% difference. These effects were not accounted for by differential subject attrition. The analyses for nonsmokers, however, showed no significant effects, and the program did not affect self-reported alcohol or marijuana use. Taken together with the results of other prevention studies, these results point to the need for the development and evaluation of new initiatives to prevent substance use.

Adolescent↗
PubMed1990

The inside scoop on the stuff called snuff: an interview study of 94 adult male smokeless tobacco users.

This interview study collected information from 94 adult males about a variety of factors related to their smokeless tobacco (ST) habit. Eighty-nine percent of this sample used moist snuff and most analyses focused on this group. Three measures of self-reported snuff use were intercorrelated and compared to a saliva cotinine assay. Correlations demonstrated potential usefulness of measures such as number of dips per day when biochemical measures are not practical. A majority (68%) of the Ss reported attempts to quit smokeless tobacco use, but relapsed from 1 to 3 months later. Ninety-six percent of snuff users reported awareness of cancer and other oral health risks and 56% reported an intention to quit in the next 12 months. A majority (67%) of subjects report receptivity to receiving advice to quit from medical and dental providers although only one-third had received such advice. The results are discussed in terms of designing an effective cessation intervention in dental clinics for ST users.

Adolescent↗
PubMed1990

Partner behaviors that support quitting smoking.

One month after their quit date, 221 Ss completed a shortened Partner Interaction Questionnaire (PIQ) in which they reported the frequency of 10 positive and 10 negative behaviors performed by a spouse or romantic partner in response to their quitting attempt. A subset, using the same instrument, reported expectations of support prior to quitting. The ratio of received positive/negative behaviors was a consistently better predictor of abstinence than were the frequencies of either positive or negative behavior alone, with higher ratios associated with abstinence. In addition, partners were less interactive than expected but performed more positive behaviors than expected. The overall pattern of results suggests that the context of a relationship mediates the impact of specific supportive or nonsupportive behaviors. Psychometrics for the 20-item PIQ are presented.

Adult↗
PubMed1990

Perceived stress, quitting smoking, and smoking relapse.

Assessed perceptions of stress prior to quitting and at 1, 3, and 6 months following quit date. Self-reported smoking status was augmented by a bogus pipeline procedure at each interview, and abstinence at 6 months was verified by carbon monoxide and saliva cotinine. The analyses provide strong evidence for a relation between changes in stress levels and changes in smoking status. Those who failed to quit smoking for more than 24 hr maintained a relatively high and consistent level of stress over the entire 6-month period. For those remaining continuously abstinent over the course of the study, stress decreased as duration of abstinence increased. Increases in stress with relapse were found across all three panel lags (prequit to 1 month, 1 to 3 months, and 3 to 6 months), and decreases in stress with quitting were found across the two lags where that comparison was possible. The possibility that the relation between smoking and stress is bidirectional is discussed as a possible interpretation of the results.

Adult↗
PubMed1990

The tobacco use research program at Oregon Research Institute.

The research program at ORI deals with both adolescent and adult tobacco use and is guided by a behavioral framework which emphasizes the role of the social context in tobacco use onset, maintenance and cessation. Growing appreciation of the importance of social context variables, combined with an emerging recognition of the need for a public health rather than clinical perspective on tobacco use, have led to a focus on interventions in larger social systems such as schools, worksites, health care plans, and communities. This research requires attention to the science of behavior change at both the individual and organizational levels.

Adolescent↗
PubMed1990

Dental office practices for tobacco users: independent practice and HMO clinics.

Surveys of independent dental practitioners and health maintenance organization (HMO) dentists and their adult male patients in Oregon found that cessation information and advice was being given to tobacco-using patients, especially smokeless tobacco users, and that the tobacco users surveyed expressed interest in obtaining help to quit. Oral health providers expressed an interest in further training in how to help their tobacco-using patients to quit.

Adult↗
PubMed1990

Parent-adolescent problem-solving interactions and drug use.

This study reports on the social problem-solving interactions of young adolescents in single-parent and intact families on substance-specific and nonsubstance-related issues. Although research has shown the impact of families on adolescent substance use, all of the previous results have been based on questionnaire or interview data. A sample of 128 families was selected from a larger sample of 763 within a longitudinal study of adolescent substance use. Parent(s) and one adolescent, aged 11-15, participated in interactions which were videotaped for later coding. In three standard scenarios, the families discussed fictional assignments from a health class teacher about the use of cigarettes, alcohol, and marijuana. In addition, they discussed an issue salient to them that was the source of recent conflict. Results showed that aversive affective behavior was more likely to be displayed by substance-using adolescents, whether or not the issue was drug-related. Mothers' and fathers' alcohol use was also shown to contribute to alcohol and cigarette use among their children, while fathers' smoking contributed to marijuana and hard drug use. These data suggest that such families may not be skilled at resolving issues and coping with life's difficulties whether or not they are drug-related.

Adolescent↗
PubMed1989

An in-depth analysis of male adolescent smokeless tobacco users: interviews with users and their fathers.

Male adolescent smokeless tobacco (ST) users (N = 191) were extensively interviewed, then followed over a 6-month period with monthly telephone interviews. In addition, their fathers (N = 137) were interviewed by telephone. Based on these data, ST use appears similar to cigarette smoking with respect to onset, patterns of use, social influences, attempts to quit, and indications of addiction. Onset and continued use of ST largely occur in a social context. Parents are reportedly aware (73%) of their sons' ST use but appear tolerant. The great majority of S's (92%) believe that there is some health risk associated with ST use. Over half report noticing ST-related changes in their oral cavities, although their dentists generally had not discussed ST use with them. Over one-third of the current users report unsuccessful quit attempts. ST use appears to be part of a more general pattern of substance use, including marijuana and alcohol.

Adolescent↗
PubMed1989

Debunking myths about self-quitting. Evidence from 10 prospective studies of persons who attempt to quit smoking by themselves.

This article examines data from 10 longterm prospective studies (N greater than 5,000) in relation to key issues about the self-quitting of smoking, especially those discussed by Schachter. When a single attempt to quit was evaluated, self-quitters' success rates were no better than those reported for formal treatment programs. Light smokers (20 or less cigarettes per day) were 2.2 times more likely to quit than heavy smokers. The cyclical nature of quitting was also examined. There was a moderate rate (mdn = 2.7%) of long-term quitting initiated after the early months (expected quitting window) of these studies, but also a high rate (mdn = 24%) of relapsing for persons abstinent for six months. The number of previous unsuccessful quit attempts was unrelated to success in quitting. Finally, there were few occasional smokers (slips) among successful long-term quitters. We argue that quitting smoking is a dynamic process, not a discrete event.

Follow-Up Studies↗