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Biomedical subjects

E Lichtenstein

Publications and source records attributed to E Lichtenstein.

At least 37 records · Page 2Linked to original sources
PubMed1998

Lay understanding of synergistic risk: the case of radon and cigarette smoking.

The combination of radon and smoking produces a synergistic risk of lung cancer. Lay understanding of this risk was examined from the perspectives of mental models theory, the psychometric approach to risk perception, and optimistic bias. As assessed by interview, participants (N = 50) had more extensive mental models for the risks of smoking than for the risks of radon or the combination of radon and smoking; 32% knew little or nothing about radon. Despite reading an informational brochure, their risk-perception ratings of the three hazards showed no perception of the synergy between smoking and radon risk, although the combined hazard was rated as less familiar but more controllable than the average of the single hazards (p < .01). No evidence of optimistic bias for the health consequences of radon, or the combination of radon and smoking was observed. Participants appeared to be combining the single-hazard risks subadditively to arrive at their combined-hazard risk perceptions. Further research on the integration of perceived risks would be beneficial for designing optimal communications about synergistic risk.

Adult↗
PubMed1998

Relationship between tobacco use and self-reported oral hygiene habits.

A sample of 34,897 dental patients completed written surveys assessing their tobacco use, frequency of brushing and flossing and perception of oral health problems. Brushing two times per day was reported by 73.5 percent of the patients and flossing one time per day by 35.6 percent. Tobacco users brushed and, particularly, flossed much less frequently than did nonusers. Compliance with daily flossing regimens was particularly low among smokeless tobacco users. Tobacco users also reported more oral health problems.

Adolescent↗
PubMed1998

Using the hygiene visit to deliver a tobacco cessation program: results of a randomized clinical trial.

To examine the effectiveness of advising patients who use tobacco to quit, the authors conducted a randomized clinical trial to test a brief office-based intervention with all tobacco users in 75 fee-for-service dental practices in Oregon. The authors found that the dental hygienist-delivered intervention was effective in getting smokeless tobacco users to quit at three and 12 months and to sustain abstinence at both three and 12 months. They found that the program was not effective for cigarette smokers. The authors discuss the public health implications of program dissemination and widespread program adoption.

Attitude to Health↗
PubMed1998

The medical care system and prevention: the need for a new paradigm.

The American medical care system falls to provide effective prevention services even though some prevention services are among the most cost-effective medical procedures available. Many prevention services are routinely delivered in inefficient or ineffective ways, and new technologies may be widely and aggressively implemented despite serious doubts about their efficacy and cost-effectiveness. The barriers to effective prevention services result from conceptual limitations in our model of medical care systems, particularly the lack of a population-based perspective. A change in paradigm is needed before reforms in our health care system can improve health without bankrupting the nation.

Cholesterol↗
PubMed1996

Effectiveness of a consultation intervention to promote tobacco control policies in Northwest Indian tribes: integrating experimental evaluation and service delivery.

A quasi-experimental replication of an intervention for promoting tobacco control policies in Northwest Indian tribes is described and the process of intervention including issues of collaboration among research institutions and Indian organizations is discussed. The policy intervention was evaluated using a pretest-posttest design wherein 20 tribes that had served as wait-list controls now received the intervention. The intervention comprised a tribal representative attending a kickoff orientation; follow-up visits to the tribes; distribution of tobacco policy workbooks; and phone call consultations. Policy status and stringency were assessed by means of telephone interviews with two key contacts per tribe, and by a count of enacted policies. There were significant pre-post changes in the primary outcome measure, a composite summary score of tobacco policy stringency, and changes were also reflected in enacted policies. The intervention effects observed were similar to those found in the prior randomized trial and suggest a robust, disseminable intervention. Much of the success achieved was attributed to the role of an Indian organization in planning the project and implementing the intervention and evaluation protocols.

Follow-Up Studies↗
PubMed1996

Telephone counseling for smoking cessation: rationales and meta-analytic review of evidence.

We review the various ways in which telephone counseling has been used in smoking cessation programs. Reactive approaches--help lines or crisis lines--attract only a small percentage of eligible smokers but are sensitive to promotional campaigns. While difficult to evaluate, they appear to be efficacious and useful as a public intervention for large populations. Proactive phone counseling has been used in a variety of ways. In 13 randomized trials, most showed significant short-term (3-6 month) effects, and four found substantial long-term differences between intervention and control conditions. A meta-analysis of proactive studies using a best-evidence synthesis confirmed a significant increase in cessation rates compared with control conditions [pooled odds ratios of 1.34 (1.19-1.51) and 1.20 (1.06-1.37) at short- and long-term follow-up, respectively]. Proactive phone counseling appeared most effective when used as the sole intervention modality or when augmenting programs initiated in hospital settings. Suggestions for further research and utilization are offered.

Hotlines↗
PubMed1996

Durability of tobacco control activities in 11 north American communities: life after the Community Intervention Trial for Smoking Cessation (COMMIT).

Durability of tobacco control activities in the 11 intervention sites of the Community Intervention Trial for Heavy Smokers (COMMIT) was examined. Although continuation of COMMIT activities was not a major goal, all communities made plans to continue some tobacco control activity. Information was gathered at focus groups of former COMMIT volunteers and staff who were assembled in each community and asked to describe tobacco control activities in their communities during the past 12-16 months-the period after the termination of COMMIT funding. It was found that a tobacco coalition, board or other structure was still operating in nine of the 11 communities and 10 had some level of paid staff dedicated to smoking control. There was also substantial activity in three of the four channels that COMMIT used as an intervention framework: worksites, public education and cessation resources. Many communities were currently engaged in considerable smoking control activity aimed at youth, an area that was intentionally de-emphasized by COMMIT. Implications for the durability of health promotion programs by communities are discussed.

Adolescent↗
PubMed1996

Tobacco policy rating form: a tool for evaluating worksite and tribal smoking control policies.

OBJECTIVE: To report on the development and validation of a rating scale to code the various components of written tobacco policies. DESIGN: A one-page Tobacco Policy Rating Form (TPRF) was developed to apply to written policies in both worksites and American Indian tribes. Fifteen worksite and 24 tribal tobacco policies from a diverse set of companies and tribes of varying size and economic status were rated on the TPRF by two separate sets of experienced and inexperienced raters. Kendall's coefficient of concordance (W) was computed to measure inter-rater agreement. RESULTS: The scale was found to produce a high level of agreement when used by both experienced and inexperienced raters on both tribal and worksite policies. For experienced raters, W = 0.92, P < 0.0001 for tribal policies and W = 0.97, P < 0.0001 for worksite policies; for inexperienced raters, W = 0.89, P < 0.0001 for tribal policies and W = 0.96, P < 0.0001 for worksite policies. CONCLUSIONS: The TPRF seems worthy of future use as a tool to rate the strength and comprehensiveness of written tobacco policies. It may be extended to other settings such as schools and municipalities, or used by investigators studying behavioural or economic consequences of smoking policies. Those interested in policy change may find the TPRF useful as a way of describing existing policies and as a quantitative measure of change.

Behavior Therapy↗
PubMed1996

Work site-based cancer prevention: primary results from the Working Well Trial.

OBJECTIVES: This paper presents the behavioral results of the Working Well Trial, the largest US work site cancer prevention and control trial to date. METHODS: The Working Well Trial used a randomized, matched-pair evaluation design, with the work site as the unit of assignment and analysis. The study was conducted in 111 work sites (n = 28,000 workers). The effects of the intervention were evaluated by comparing changes in intervention and control work sites, as measured in cross-sectional surveys at baseline and follow-up. The 2-year intervention targeted both individuals and the work-site environment. RESULTS: There occurred a net reduction in the percentage of energy obtained from fat consumption of 0.37 percentage points (P = .033), a net increase in fiber densities of 0.13 g/1000 kcal (P = .056), and an average increase in fruit and vegetable intake of 0.18 servings per day (P = .0001). Changes in tobacco use were in the desired direction but were not significant. CONCLUSIONS: Significant but small differences were observed for nutrition. Positive trends, but no significant results, were observed in trial-wide smoking outcomes. The observed net differences were small owing to the substantial secular changes in target behaviors.

Cross-Sectional Studies↗
PubMed1995

Predictors of smoking during and after pregnancy: a survey of mothers of newborns.

BACKGROUND: Cigarette smoking during pregnancy represents a significant health risk to the fetus, but most women continue to smoke during pregnancy, and most who quit relapse postpartum. This study provides an assessment of psychosocial variables on women who quit, relapsed, cut down, or did not alter their smoking during pregnancy. METHODS: Mothers of newborns in 49 pediatric practices (N = 13,495) were surveyed at the newborns' first well-care office visit to a pediatrician, and 2,901 mothers who smoked in the month prior to pregnancy were identified. Predictive information was obtained by comparing mothers who quit smoking with those who continued to smoke, mothers who stayed quit with relapsers, and mothers who reduced tobacco consumption with those who did not. RESULTS: Thirty-five percent of mothers reported quitting smoking during pregnancy, and 52% had cut down for pregnancy. Factors related to quitting smoking for pregnancy were younger age, higher level of education, lower smoking level, having a partner who did not smoke, and not consuming alcohol. Mothers who quit also reported allowing less smoking in the home. Relapse for quitters was highly correlated with partner's smoking. For women who cut down but did not quit, smoking level and age were most significant.

Adult↗
PubMed1995

The tribal tobacco policy project: working with Northwest Indian tribes on smoking policies.

BACKGROUND: This article reports on the objectives, study design, intervention methods, baseline results, and process data from a trial involving 39 Northwest Indian tribes. METHODS: Tribes were stratified and then randomized to either early or late intervention conditions. Intervention consisted of a consultation process to assist tribes to review and modify existing tobacco policies or to develop new policies relevant for their tribe and that protect tribal members from environmental tobacco smoke. Outcome measures consist of: (a) phone interviews to assess the comprehensiveness of tribal tobacco policy, (b) surveys of tribal leaders to assess norms and attitudes regarding tobacco use, and (c) observations of tribal settings to assess policy implementation and indicants of tobacco use. RESULTS: Early and later intervention tribes were well matched on baseline measures and tribal characteristics potentially related to policy outcomes. There was considerable variability across tribes on all measures though, in general, tribal leaders expressed support for more stringent tobacco use policies. Process data indicated that early intervention tribes strengthened their tobacco policies, but generally did not do so through tobacco policy committees as originally envisioned. CONCLUSIONS: There is good potential for tobacco policy interventions with Indian tribes. Consultation processes and products, such as policy guidebooks, that are sensitive to traditional uses of tobacco and to differences among tribes can help to modify policies to reduce exposure of tribal members to environmental tobacco smoke.

Attitude↗
PubMed1995

Making the most of a teachable moment: a smokeless-tobacco cessation intervention in the dental office.

OBJECTIVES: Primary care medical clinics are good settings for smoking interventions. This study extends this strategy with a smokeless tobacco intervention delivered by dentists and dental hygienists in the course of routine dental care. METHODS: Male users of moist snuff and chewing tobacco (n = 518) were identified by questionnaire in clinic waiting rooms and then randomly assigned to either usual care or intervention. The intervention included a routine oral examination with special attention to the part of the mouth in which tobacco was kept and an explanation of the health risks of using smokeless tobacco. After receiving unequivocal advice to stop using tobacco, each patient viewed a 9-minute videotape, received a self-help manual, and was briefly counseled by the dental hygienist. RESULTS: Long-term success was defined as no smokeless tobacco use at both 3- and 12-month follow-ups, with those lost to follow-up counted as smokeless tobacco users. The intervention increased the proportion of patients who quit by about one half (12.5% vs 18.4%, P < .05). CONCLUSIONS: These results demonstrate the efficacy of a brief dental office intervention for the general population of smokeless tobacco users.

Adolescent↗
PubMed1995

Promoting tobacco control policies in northwest Indian tribes.

A culturally sensitive consultative process to facilitate adoption by tribal councils of more effective tobacco control policies was developed and evaluated. Thirty-nine Northwest Indian tribes were randomized to early intervention or late intervention conditions. Early intervention tribes received a policy workbook and consultation by means of meetings and telephone calls. Late intervention tribes were assessed but received no assistance or encouragement regarding tobacco use policies. The stringency of the policies was assessed via telephone at baseline and after intervention. At postintervention, there were consistent, and generally statistically significant, differences in adoption of more stringent and comprehensive smoking policies for early intervention tribes compared with late intervention tribes. The intervention could be used in other Indian settings.

Cultural Characteristics↗
PubMed1995

Pediatric office-based smoking intervention: impact on maternal smoking and relapse.

OBJECTIVE: To determine the impact of a brief smoking intervention delivered by pediatricians in the context of usual well baby office visits on postnatal maternal smoking and relapse. SETTING: Forty-nine private pediatric practices including 128 practitioners. DESIGN: Randomization of pediatric practices into minimal and extended intervention sites with all enrolled mothers of newborns within a practice receiving the same level of intervention. INTERVENTION: Smoking mothers in minimal condition received a hospital packet containing written information about passive smoking and a letter advising them to quit. Those in extended condition received the hospital packet plus oral and written advice at usual well baby visits: 2 weeks, 2, 4, and 6 months. MEASUREMENTS: Smoking and relapse rates at 6 months postpartum, demographics associated with smoking status, attitudes, and knowledge in regard to passive smoking, and recall surveys of mothers in regard to receiving advice or written materials. RESULTS: Two-thousand nine-hundred-one mothers of newborns were enrolled in the study. Those in the extended condition had higher quit rates (5.9% vs 2.7%, P < .01) and lower relapse rates (45% vs 55%, P < .01) than those in the minimal condition. Mothers' educational status and the presence of a smoking partner in the home were the major demographic variables associated with smoking status at enrollment and at follow-up. Compared with smokers in the minimal condition, those in extended at 6 months postpartum had significantly better attitudes and knowledge regarding passive smoking and allowed less smoking in the home. Mothers attending extended practices reported much higher rates of receiving oral advice and written materials than those in the minimal condition. CONCLUSIONS: A brief program can lead to major increases in the willingness of pediatricians to deliver smoking advice. A 1- to 2-minute intervention delivered in the context of usual well baby care can have a positive impact on maternal smoking and especially upon relapse prevention. A recent smoking history should be obtained from all mothers of newborns so that interventions can be aimed at both cessation and relapse prevention.

Female↗
PubMed1995

Changes in adult cigarette smoking in the Minnesota Heart Health Program.

OBJECTIVES: The Minnesota Heart Health Program was a research and demonstration project designed to reduce risk factors for heart disease in whole communities. This paper describes smoking-specific interventions and outcomes. METHODS: Three pairs of matched communities were included in the study. After baseline surveys, one community in each pair received a 5-year education program, while both cross-sectional and cohort surveys continued in all sites. Adult education programs for smoking cessation included Quit and Win contests, classes, self-help materials, telephone support, and home correspondence programs. RESULTS: Encouraging short-term results were obtained for several adult education programs. Overall long-term outcomes were mixed, with evidence of an intervention effect only for women in cross-sectional survey data. Unexpectedly strong secular declines in smoking prevalence were observed in comparison communities. CONCLUSIONS: The findings suggest that community education may be unlikely to exceed dramatic secular reductions in smoking prevalence. The success of several key interventions and the incorporation of Minnesota Heart Health Program interventions by education communities are encouraging, however.

Adult↗
PubMed1994

Readiness to quit as a predictor of smoking changes in the Minnesota Heart Health Program.

The relation between two indexes of readiness to quit smoking obtained at baseline and subsequent quitting 2-7 years later was examined. Baseline data from the Minnesota Heart Health Program were used to construct 3-item composites of interest in quitting (alpha = .76) and past quitting behavior (alpha = .64). With baseline smoking controlled, both measures predicted quitting at the 2- and 7-year follow-ups but not at 4 years. Only interest in quitting was significant at the 7-year follow-up when both indexes entered the model. Given the representative community sample and the long interval from baseline to the final assessment, the findings provide support for the readiness construct.

Adult↗