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Biomedical subjects

E R Gritz

Publications and source records attributed to E R Gritz.

At least 19 recordsLinked to original sources
PubMed1999

Smoking withdrawal and relapse in head and neck cancer patients.

BACKGROUND: Smoking withdrawal and relapse were characterized among newly diagnosed head and neck cancer patients participating in a physician-delivered smoking cessation intervention. METHODS: Patients completed questionnaires at baseline, 1, 6, and 12 months following intervention delivery. RESULTS: Significant baseline predictors of smoking relapse included medical treatment (XRT versus surgical treatment), stage of change/readiness to quit (precontemplators), age of initiation (younger), and greater addiction (smoking </=30 minutes after waking). Relapsers were significantly more likely to quit using gradual reduction versus cold turkey and had less confidence in remaining quit. Relapsers experienced significantly higher levels of anxiety and craving during withdrawal. Relapse was temporally delayed compared with healthy populations. CONCLUSION: Assistance with cessation efforts should be ongoing for one year and should include nicotine replacement therapy and psychotropic medications to address significant relapse triggers.

Affect↗
PubMed1999

Eating orientation, postcessation weight gain, and continued abstinence among female smokers receiving an unsolicited smoking cessation intervention.

Predictors of weight gain following smoking cessation were assessed among 1,219 female smokers enrolled in a health maintenance organization. Women randomized to the treatment group received a cessation intervention without regard to their interest in quitting smoking. It was hypothesized that cessation would result in subsequent weight gain and postcessation weight gain would be associated with scores on a modified Restraint Scale, the Disinhibition Scale, and a scale assessing tendency to eat during periods of negative affect. Persons who abstained from smoking over the 18-month study gained more weight than did intermittent smokers and continuous smokers, and among 762 women who reported at least 1 on-study attempt to quit smoking, 36% gained weight. Weight gain was associated with disinhibited eating and negative affect eating but not with restrained eating. Weight gain also was associated with continued abstinence from smoking.

Adult↗
PubMed1999

First year after head and neck cancer: quality of life.

PURPOSE: Treatment regimens for head and neck cancer patients profoundly affect several quality-of-life domains. Rehabilitative needs have been identified through cross-sectional analyses; however, few studies have prospectively assessed quality of life, included assessment of psychosocial variables, and identified predictors of long-term follow-up. PARTICIPANTS AND METHODS: The present study addresses these limitations through a prospective assessment of 105 patients with a newly diagnosed first primary squamous cell carcinoma of the oral cavity, pharynx, or larynx. Participants were enrolled onto a larger randomized controlled trial comparing a provider-delivered smoking cessation intervention with a usual-care-advice control condition. Participants completed a battery of self-report measures after diagnosis and before treatment and additional quality-of-life instruments at 1 and 12 months after initial smoking cessation advice. RESULTS: Participants displayed improvements at 12 months in functional status (P = .006) and in the areas of eating, diet, and speech; however, the latter three represent areas of continued dysfunction, and the changes were not statistically significant. Despite these improvements, patients reported a decline in certain quality-of-life domains, including marital (P = .002) and sexual functioning (P = .017), as well as an increase in alcohol use (P < .001). Predictors of quality of life at 12 months included treatment type, the Vigor subscale of the Profile of Mood States instrument, and quality-of-life scores obtained 1 month after initial smoking cessation advice. CONCLUSION: Results reinforce the need for rehabilitation management through the integration of psychologic and behavioral interventions in medical follow-up.

Activities of Daily Living↗
PubMed1999

Intention to learn results of genetic testing for hereditary colon cancer.

INTRODUCTION: This report investigates the correlates of intention to find out genetic test results in colorectal cancer patients undergoing genetic counseling and testing for hereditary nonpolyposis colon cancer. Specifically, we investigated whether intention to learn genetic test results was associated with sociodemographic factors, medical history, psychosocial factors, attitudes, beliefs, and decisional considerations related to genetic testing. MATERIALS AND METHODS: Among 342 colorectal cancer patients who went through an informed consent process and gave blood for genetic testing and who were eligible for a psychosocial questionnaire study, 269 cases completed a baseline interview. Patients were contacted in person during a routine clinic visit or by letter and follow-up telephone call and were interviewed either in person or by telephone. RESULTS: In univariate analysis, intention to learn test results was positively associated with income, quality of life, a belief that being tested will help family members prevent cancer, being worried about carrying an altered gene, and a belief that one has the ability to cope with test results. It was negatively associated with a belief that genetic counseling is too much trouble relative to the benefits. Intention also was positively associated with scales measuring the pros of learning test results and the pros of informing relatives about test results; it was negatively associated with the cons of learning test results. In multivariable analysis, the belief that testing would help family members prevent cancer, being worried about carrying an altered gene, and the pros of learning test results remained statistically associated with intention when other variables were included in the model. CONCLUSIONS: Our findings showed that the positive aspects of genetic testing were more strongly associated with intention than were the negative aspects. They also showed that persons who stated an intention to learn their genetic test results were more likely than persons who did not to affirm both the benefits and the importance of such testing. These results are consistent with the literature on psychosocial aspects of genetic testing for breast cancer.

Adaptation, Psychological↗
PubMed1998

The Agency for Health Care Policy and Research Smoking Cessation Clinical Practice Guideline. Findings and implications for psychologists.

Smoking is the leading cause of preventable morbidity and mortality in the United States, and the health benefits of quitting smoking are substantial. Nevertheless, over 25% of American adults (48 million individuals) continue to smoke, and the vast majority of quit attempts are unsuccessful. The Agency for Health Care Policy and Research recently addressed the smoking problem by conducting a 2-year research project that was published as the Smoking Cessation Clinical Practice Guideline (Fiore et al., 1996). This article reviews methods, analyses, and results from the Guideline project, and highlights major Guideline recommendations. Guideline findings and recommendations are discussed with respect to their implications for psychology.

Adult↗
PubMed1998

Recruitment to a school-based adult smoking-cessation program: do gender and race/ethnicity make a difference?

BACKGROUND: Recruitment to interventional research, clinical trials, and community-based health programs remains a central public health challenge, particularly among low-income and multi-ethnic populations. Utilizing existing community institutions and "opportunistic" communication channels within these settings for recruitment seems an optimal strategy for overcoming barriers to participation. However, such institutions frequently serve heterogeneous populations, and little is known regarding intra-community variations in program uptake. METHODS: This paper reports the gender and race/ethnic differences in subject characteristics and enrollment patterns among 435 Latino and African American participants in a smoking-cessation program delivered through one such community institution, an inner-city school district in Los Angeles County. RESULTS: Enrollees were more likely to be female and Latino. Recruitment strategies tailored specifically to this program were more effective then recruitment through channels such as regular school activities, particularly among African Americans. CONCLUSIONS: Intragroup variations need to be carefully considered in the design and implementation of such programs if they are to receive acceptance and to succeed.

Adult↗
PubMed1997

Correlates of psychologic distress in colorectal cancer patients undergoing genetic testing for hereditary colon cancer.

In this article the authors describe the demographic and psychosocial correlates of 2 measures of psychologic distress among 200 colorectal cancer patients undergoing genetic testing for hereditary nonpolyposis colon cancer. The prevalence of symptoms of depression on the Center for Epidemiologic Studies Depression (CES-D) Scale was 24%. In multivariate analysis, female sex, less formal education, fewer sources of social contacts, and less satisfaction with them were associated with high scores on the CES-D Scale. Characteristics associated with high scores on the State-Trait Anxiety Inventory were younger age, less formal education, non-White race, local-regional stage of disease, fewer social contacts, and less satisfaction with them. Information on psychosocial correlates of psychologic distress may prove useful in guiding genetic counseling sessions, in identifying subgroups that need more intensive follow-up, and in developing interventions to facilitate adjustment to genetic test results.

Adaptation, Psychological↗
PubMed1997

Smoking cessation. 1: An overview of research.

Although tobacco smoking has long been recognized as having negative health consequences, more than one quarter of the US adult population smokes. This article presents (a) national trends in the prevalence of tobacco smoking, (b) health consequences associated with tobacco smoking and tobacco's mode of action (how tobacco/nicotine cause the problems), and (c) a brief overview of the smoking cessation treatment literature and several recommendations based on the review of research.

Female↗
PubMed1997

Smoking cessation. 3: Needed healthcare policy changes.

Smoking is the primary preventable cause of mortality and morbidity in our society, killing more than 430,000 people each year--more than 1,000 a day. Despite this deadly record, the treatment of nicotine dependence has not been integrated into routine medical care. Although professionals from many healthcare fields can be effective providers of smoking cessation treatment, relatively few actually advise patients to quit smoking; and even fewer assist their patients in quitting. Systematic changes in healthcare policies are needed to rectify these problems and improve the provision of smoking cessation services. In this article, the issues of who should be providing cessation treatment, why more providers do not offer this service, and what changes should be made to ensure more widespread inclusion of smoking cessation treatment in future healthcare practice are examined.

Cost-Benefit Analysis↗
PubMed1997

Promoting smoking cessation among cancer patients: a behavioral model.

The smoking cessation clinical practice guideline recently published by the Agency for Health Care Policy and Research (AHCPR) summarizes current knowledge on smoking cessation treatments. Among its recommendations, the guideline encourages physicians to motivate patients who indicate that they are not yet ready to quit smoking. Because medical training typically emphasizes pharmacologic rather than behavioral treatment, we believe that physicians caring for cancer patients may benefit from more extensive instruction in motivating patients to quit smoking. This article describes how a contemporary theoretical approach, the transtheoretical model of change, can be used to promote behavioral change. Multiple studies, primarily in the field of smoking cessation, provide strong empiric support for use of this model in clinical practice. The model consists of five stages of smoking cessation that describe different levels of readiness to quit: precontemplation, contemplation, preparation, action, and maintenance. A diagnostic tool is presented, and specific smoking cessation counseling strategies are suggested for each stage of change. Implications for the use of the model by physicians who counsel and treat smokers are discussed.

Humans↗
PubMed1996

Cancer-risk-related health behaviors and attitudes of older workers. Working Well Research Group.

BACKGROUND: The National Cancer Institute's Working Well Trial was a randomized controlled trial of a two-year, comprehensive, worksite-based cancer control intervention. METHODS: Data from 19,582 respondents to the baseline survey were analyzed to determine the relationships between grouped age (18-29, 30-49, 50-54, 55-59, and > 60 years), dietary and smoking behaviors, and attitudes related to participation in health promotion activities. RESULTS: Workers over 50 had more positive health behaviors, stronger beliefs about the value of healthy behavior, and better self-assessed health; they were more likely to hold attitudes associated with participation in worksite health promotion, more positive about work conditions, attributed greater concern about worker health to management, and were more willing to believe that they would be allowed to attend worktime health promotion activities. CONCLUSIONS: Age may be an useful variable in targeting worksite cancer control programming. Workers in their 50s could be supported in weight management, since rates of overweight and obesity are higher in this group. Other health behaviors might be addressed for older workers.

Adolescent↗
PubMed1995

Targeting adult smokers through a multi-ethnic public school system.

In a unique approach to utilizing an existing intervention, "opportunistic" and targeted school-based strategies were used to enroll 446 adults into a tailored preventive health program featuring a health screening and smoking-cessation intervention. Implemented through a public school district serving a multi-ethnic low-to-middle income urban community, subjects in this randomized trial were interviewed at enrollment and at three-, six-, and 12-month follow-up, and rescreened at 12 months, to assess changes in smoking-related knowledge, attitudes, and practices. Using conservative assumptions, self-reported ever-quit rates and continuous abstinence rates of 57.5% and 2.6%, respectively, were achieved across groups; point-prevalence abstinence rates were 13.2%, 12.9%, and 10.3% at three, six, and 12 months. The study examines issues relevant to smoking status and stages of change in this population. The role of the school in increasing access to needed health programming in underserved communities is explored.

Adult↗
PubMed1994

Reaching toward and beyond the year 2000 goals for cigarette smoking. Research and public health priorities.

The 1980s witnessed decreases in adult smoking prevalence in the face of increasing morbidity and mortality from past and current tobacco use. To facilitate even greater cessation activity, innovative research continues to be conducted on methods of improving intensive, individual approaches to smoking cessation, particularly through pharmacologic intervention. However, the major thrust in this country today is toward broad, systemic, public health campaigns, targeting selected high risk groups and the general public. Vulnerable populations continue to include various ethnic groups, especially those with unusually low or high prevalence, women, persons with smoking-related diseases, and heavy smokers. Self-help methods, physician advice, work site and community based interventions, and antismoking coalitions have been in the forefront. Methodologic and intervention studies are needed, concurrent with ongoing large scale public health efforts. What efforts in research and in the public arena are requisite to reach the year 2000 goals for tobacco use? Prevention remains the number one priority. Bringing about a substantial decline in teenage smoking will require the combination of school based programs, environmental and advertising restrictions, and societal revision of norms toward the relative dangers of smoking and drug use in adolescence. Research is needed to define the optimal combinations of such interventions with booster components to sustain effects. Public health efforts, symbolized by the Community Intervention Trial for Smoking Cessation (COMMIT) and the American Stop Smoking Intervention Study (ASSIST) programs, must be combined with stronger advocacy, taxation, antismoking policy formation and implementation to realize a smoke free society.

Adolescent↗
PubMed1993

Cancer prevention--behavior changes: the short and the long of it.

BACKGROUND: Behavioral factors play an important role in the adoption and maintenance of nutritional modifications, delivered either through chemopreventive regimens or through dietary adaptation. A body of research supports a protective role of fruits and vegetables, dietary fiber, and eating a low-fat diet in reducing cancer risk. There is only limited knowledge, however, about the cancer-preventing properties of specific micronutrients, apart from beta-carotene; about optimal levels of intake of differing micronutrients; and about patterns of food intake associated with reduced cancer risk. Thus, it would seem preferable, overall, to be able to recommend cancer prevention through dietary modification rather than through the administration of individual agents. METHODS: Studies of dietary adherence in cancer prevention have yielded varying success rates, but are generally quite promising. We have developed a model that encompasses the range of behavioral, psychological, social, and systemic variables thought to influence adherence to nutritional regimens. RESULTS: The model is being utilized to influence the form and content of nutritional regimens and to promote short-term change which can then be sustained as long-term lifestyle modification. The model can also be applied to evaluate adherence to nutritional or other behavioral modifications and to determine the factors predictive of success.

Anticarcinogenic Agents↗
PubMed1993

Helping hospitalized smokers quit: new directions for treatment and research.

To date, relatively little work has been done to develop or evaluate effective inpatient quit-smoking treatment programs. However, there is growing interest in programs that motivate and assist the hospitalized smoker to quit smoking and remain abstinent. This article presents the rationale for hospital-based smoking treatment programs and introduces a practical minimal-contact treatment model based on extensive studies of primary-care-based and self-help interventions, on a limited number of inpatient studies, and on several prominent theories of health behavior change. Recent controlled and exploratory studies of inpatient interventions are reviewed, including programs for the general medical population and programs for special patient groups such as patients hospitalized for cardiovascular disease, pulmonary disease, cancer, and drug or alcohol dependency. Major findings are summarized, and recommendations are given for future treatment and research.

Follow-Up Studies↗
PubMed1992

Psychological functioning of daughters of breast cancer patients. Part II: Characterizing the distressed daughter of the breast cancer patient.

Sixty daughters whose mothers had breast cancer were cross-sectionally studied. Daughters age 11-20 reported feeling significantly more uncomfortable about involvement in their mothers' illness than daughters age 20+. Daughters whose mothers died were more likely to report long-term life plan changes and role changes with their mothers during the mothers' illness. The Global Symptom Index was predicted by the daughter's perceived degree of involvement with her mother (during her mother's illness), current emotional resolution (about her mother's illness), and sexual satisfaction. Sexual satisfaction was predicted by role changes during the mother's illness, frequency of sexual relations, and a depression scale.

Adaptation, Psychological↗