Low rates of physicians counseling adolescents about smoking: a critical wake-up call.
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Adolescent↗
Biomedical subjects
H A Lando
Publications and source records attributed to H A Lando.
Age of initiation, smoking patterns, and risk in a population of working adults.
BACKGROUND: Early age of initiation is a significant risk factor for long-term dependent smoking and may also relate to other unhealthy behaviors and increased likelihood of illness, independent of duration of smoking. METHODS: The current study assessed age of initiation in relation to cigarette dependence, interest in quitting, social environment pertaining to smoking, behavioral risk factors, and current health problems. Subjects were 2120 current daily smokers in 24 worksites in the Minneapolis/St. Paul, Minnesota, metropolitan area. RESULTS: Findings were surprisingly consistent with early age of initiation predicting more dependent smoking, less interest and confidence in ability to quit, poorer diet, less use of seat belts, more illness and hospitalization, and greater likelihood of smoking among partner/spouse, friends, and co-workers. CONCLUSIONS: The overall strength of the findings was unexpected. Early initiation of regular smoking predicted a significant constellation of risk factors throughout adulthood. Interventions that significantly delay smoking onset, even in the absence of permanent prevention, could have important public health implications.
Adolescent↗
Predictors of milk consumption in a population of 17- to 35-year-old military personnel.
OBJECTIVE: The purpose of this investigation was to survey an entire population of Air Force recruits (N = 32,144) regarding milk consumption and demographic and health-related factors that may predict milk consumption. DESIGN: All subjects were required to fill out a 53-item health survey at the start of basic military training. SUBJECTS/SETTING: All recruits who entered the US Air Force from August 1995 to August 1996 participated in this study (N = 32,144). STATISTICAL ANALYSES PERFORMED: Potential correlates of milk intake were analyzed using Spearman rank order correlations and multiple linear regression. Variables were removed if they did not make a meaningful contribution to variance in milk intake. Because of skewed distributions, several variables were dichotomized (e.g., age: 17 to 24 vs 25 to 35 years). RESULTS: In terms of milk consumption, 51.7% of the respondents reported intake of fewer than 1 serving per day; only 17.9% reported intake of 3 servings or more per day. Milk intake was positively associated with body weight and fruit/vegetable intake and negatively associated with age, education level, reported milk-related gastric distress, physical activity level, dieting frequency, and concern about weight. Gender (women reported lower intake) and ethnicity (minorities reported lower intake) were independently related to milk consumption. Of all respondents, 16.1% reported themselves to have milk-related gastric distress, but rates varied depending on age, gender, and ethnicity (ranging from 10.2% for younger non-Hispanic white men to 60.4% for older Asian men). APPLICATIONS/CONCLUSIONS: Despite the efforts of large, costly campaigns designed to increase milk consumption, self-reported milk consumption in young adults is extremely low. Given the importance of dairy products as a major source of calcium in the American diet, dietetics practitioners should assess milk consumption among young adults to ensure sufficient calcium intake to maximize peak bone mass in this group.
Adolescent↗
Prevention of relapse in women who quit smoking during pregnancy.
OBJECTIVES: This study is an evaluation of relapse prevention interventions for smokers who quit during pregnancy. METHODS: Pregnant smokers at 2 managed care organizations were randomized to receive a self-help booklet only, prepartum relapse prevention, or prepartum and postpartum relapse prevention. Follow-up surveys were conducted at 28 weeks of pregnancy and at 8 weeks, 6 months, and 12 months postpartum. RESULTS: The pre/post intervention delayed but did not prevent postpartum relapse to smoking. Prevalent abstinence was significantly greater for the pre/post intervention group than for the other groups at 8 weeks (booklet group, 30%; prepartum group, 35%; pre/post group, 39%; P = .02 [different superscripts denote differences at P < .05]) and at 6 months (booklet group, 26%, prepartum group, 24%; pre/post group, 33%; P = .04) postpartum. A nonsignificant reduction in relapse among the pre/post group contributed to differences in prevalent abstinence. There was no difference between the groups in prevalent abstinence at 12 months postpartum. CONCLUSIONS: Relapse prevention interventions may need to be increased in duration and potency to prevent post-partum relapse.
Adult↗
A population comparison of participants and nonparticipants in a health survey.
OBJECTIVES: This study examined the characteristics of Air Force recruits willing to take part in a health survey vs those unwilling to participate. METHODS: US Air Force recruits undergoing basic military training (n = 32,144) were surveyed regarding demographic and health variables. RESULTS: Respondents indicating an unwillingness to participate in a health survey reported less healthy lifestyles than those willing to participate. Prediction equations modeling the characteristics of those engaging in 4 risky behaviors were nearly identical regardless of whether those refusing to participate were included. CONCLUSIONS: Results suggest that, despite some low estimates of health behaviors due to response bias, relationships between most risk factors are generally unaffected by those not responding to health surveys.
Adolescent↗
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↗
The relationship between smoking and body weight in a population of young military personnel.
Evidence indicates that middle-aged smokers weigh less than nonsmokers and that smoking cessation reliably produces weight gain, but recent studies have questioned the weight control "benefits" of smoking in younger populations (the time that people typically initiate smoking). The relationship between smoking and body weight was evaluated in all U.S. Air Force Basic Military Training recruits during a 1-year period (n = 32,144). Those who smoked prior to Basic Military Training (n = 10,440) were compared to never smokers or experimental smokers. Results indicated that regular-current smoking had no relationship to body weight in women (p > .05) and a very small effect in men (p < .05). Ethnicity, education, income, and duration and intensity of smoking did not affect the relationship between smoking and body weight. It was concluded that smoking has no effects on the body weights of young women and minimal effects in young men.
Adolescent↗
Effect of smoking cessation counseling on recovery from alcoholism: findings from a randomized community intervention trial.
AIMS: To assess the effects of a smoking cessation program for recovering alcoholics on use of alcohol, tobacco and illicit drugs after discharge from residential treatment. DESIGN AND SETTING: A randomized community intervention trial design was employed in which 12 residential drug treatment centers in Iowa, Kansas and Nebraska were matched and then randomly assigned to the intervention or control condition. PARTICIPANTS: Approximately 50 adult residents (inpatients) from each site were followed for 12 months after treatment discharge. INTERVENTION: Participating residents in the six intervention centers received a 4-part, individually tailored, smoking cessation program while those in the six control sites received usual care. FINDINGS: Both moderate and heavy drinking rates were reduced in the intervention group. Intervention site participants were significantly more likely than controls to report alcohol abstinence at both the 6-month (OR = 1.59, 95%CI: 1.09-2.35) and 12-month assessment (OR = 1.84, 95%CI: 1.28-2.92). Illicit drug use rates were comparable. Effect of the intervention on tobacco quit rates was not statistically significant. CONCLUSIONS: Counseling alcoholics in treatment to quit smoking does not jeopardize the alcohol recovery process. However, low-intensity tobacco interventions are unlikely to yield high tobacco quit rates.
Adult↗
Differences in preconceptional and prenatal behaviors in women with intended and unintended pregnancies.
OBJECTIVES: This study examined whether pregnancy intention was associated with cigarette smoking, alcohol drinking, use of vitamins, and consumption of caffeinated drinks prior to pregnancy and in early pregnancy. METHODS: Data from a telephone survey of 7174 pregnant women were analyzed. RESULTS: In comparison with women whose pregnancies were intended, women with unintended pregnancies were more likely to report cigarette smoking and less likely to report daily vitamin use. Women with unintended pregnancies were also less likely to decrease consumption of caffeinated beverages or increase daily vitamin use. CONCLUSIONS: Pregnancy intention was associated with health behaviors, prior to pregnancy and in early pregnancy, that may influence pregnancy course and birth outcomes.
Adult↗
Reducing smoking among Minnesota teens in managed care. Smoking.
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Adolescent↗
The role of tobacco cessation, antiplatelet and lipid-lowering therapies in the treatment of peripheral arterial disease.
Despite the widely held belief that there are no effective medical therapies for peripheral arterial disease (PAD), current data suggest that medical therapies can effectively modify the natural history of atherosclerotic lower extremity arterial occlusive disease. The ideal medical therapy would improve claudication, forestall the onset of limb-threatening events, decrease rates of invasive interventional therapies and improve long-term patient survival. These ideal outcomes might be achieved through the use of smoking cessation interventions, including behavioral and pharmacological therapy, and the administration of antiplatelet and lipid-lowering medications in patients with PAD.
Humans↗
Telephone support as an adjunct to transdermal nicotine in smoking cessation.
OBJECTIVES: Transdermal nicotine patches have shown considerable promise in improving smoking cessation outcomes. The present study assessed telephone support as an adjunct to a managed care-based, single-session group orientation smoking cessation program with nicotine patch therapy. METHODS: The unit of randomization was the orientation session (n = 35). Subjects (n = 509) were randomly assigned to a group session without telephone support, the session plus access to a toll-free help line, or the session with telephone help line plus active telephone outreach. RESULTS: Contrary to hypothesis, there were no differences between treatment conditions. Overall abstinence rates were 22% at 6 months and 21% at 1 year. Fewer than 1% of eligible subjects called the toll-free help line. An average of 3.8 of a possible 4 calls were completed in the telephone outreach condition. CONCLUSIONS: Abstinence results obtained in this program were comparable to those obtained with more extensive counseling. However, there was no evidence of benefit from telephone support beyond the initial physician-led group orientation session.
Administration, Cutaneous↗
Nicotine replacement therapy in a group model HMO.
OBJECTIVE: To examine patient response to a smoking cessation program that combined a nicotine replacement system (patch) with telephone support. DESIGN: Randomized trial. SETTING: A large Midwestern HMO. PARTICIPANTS. Five hundred and nine smokers who attended orientation sessions where an overview of the study and the use of the nicotine patch was presented. INTERVENTION: All subjects received a prescription for a nicotine replacement patch (Prostep, Lederle Laboratories, Wayne, NJ). Participants were randomly assigned to one of three intervention groups. Group I participants (n = 166) received no additional support. Group II participants (n = 167) were registered with a 24-hour telephone hotline. Group III participants (n = 167) were registered with the 24-hour telephone hotline and received four follow-up telephone calls from health educators. OUTCOME MEASURE: The primary outcome measure was smoking cessation. Subject satisfaction with study components was also evaluated. RESULTS: Overall, there was no significant difference by group in smoking cessation rates: 20% of patients in all three groups were smoke-free after 12 months. Few patients (1%) used the telephone hotline. The telephone follow-up did not have an impact on cessation rates, and most patients (92%) reported that the orientation session was useful. CONCLUSIONS: The study experience has helped the HMO evaluate various study components and has had an impact on currently used telephone intervention strategies and educational materials.
Administration, Cutaneous↗
Effects of short-term use of nicotine gum in pregnant smokers.
OBJECTIVES: To compare blood concentrations of nicotine and cotinine and maternal and fetal hemodynamic effects resulting from use of nicotine gum versus cigarette smoking in pregnant smokers. METHODS: Pregnant women (24 to 36 weeks' gestation) who smoked chronically were randomly assigned with a 1:2 randomization scheme to either a group that smoked cigarettes (n = 10) or to a group that stopped smoking and chewed at least six pieces of nicotine gum (2 mg nicotine per piece) per day (n = 19). Blood nicotine and cotinine concentrations, maternal heart rate and blood pressure, uterine resistance index, and fetal heart rate and umbilical artery resistance index were obtained before and after one cigarette was smoked at baseline and after 5 continuous days of either chewing gum or smoking. RESULTS: A significant reduction from baseline in nicotine (p < 0.0001) and cotinine (p < 0.0025) concentrations was observed in those who chewed nicotine gum compared with those who smoked cigarettes. No significant differences in the changes in maternal or fetal hemodynamic parameters from baseline to estimated time of peak nicotine exposure were observed between those who smoked cigarettes and those who chewed nicotine gum. CONCLUSION: Short-term use of nicotine gum delivers less nicotine than usual cigarette smoking in pregnant women.
Adult↗
Predictors of tobacco quit attempts among recovering alcoholics.
Reported here are findings from a randomized community intervention trial that followed 90 recovering alcoholic smokers for 6 months. Because the brief (10-min) study intervention had no effect on tobacco use, intervention and control participants were pooled to identify predictors of attempts to quit smoking that may inform clinical practice. During the first 6 months after discharge from residential alcohol treatment, 31% of all participants reported having quit smoking for 48 hrs or longer. Demographic and drug use history variables did not predict quit attempts, but two baseline tobacco use variables did, specifically the Fagerstrom Test for Nicotine Dependence and stage of readiness to quit smoking, p < .01. Participants with high or very high nicotine dependence scores were significantly less likely than those with moderate or low scores to attempt smoking cessation. Compared to those in precontemplation at baseline, those in the preparation stage of readiness to change were about 12 times more likely to make a serious quit attempt.
Adolescent↗
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↗
Promoting abstinence among relapsed chronic smokers: the effect of telephone support.
OBJECTIVES: The present study used telephone support both to sustain abstinence and to encourage renewed quit attempts in smokers who had completed an intensive smoking cessation clinic. METHODS: Subjects were hard-core smokers (n = 1083) who had attended a multisession cessation clinic. They were then assigned randomly to receive telephone support (intervention calls 3, 9, and 21 months after the targeted cessation clinic quit date) or no further intervention. RESULTS: In the intervention condition, subjects who relapsed were significantly more likely to resume abstinence (that is, to recycle) than those in the comparison condition at follow-up (6 months: 17.8% vs 11.3%; 24 months: 25.7% vs 18.2%). Telephone support was not effective in preventing relapse, and overall differences in abstinence outcome were not significant. CONCLUSIONS: The major hypothesis of the current study--that telephone support would enhance the resumption of abstinence--received partial support. However, there was no evidence either of an overall treatment effect or of an effect in preventing relapse. Telephone outreach may be more effective in the context of self-help or other less intensive interventions.
Adult↗
Occasional smoking in a Minnesota working population.
OBJECTIVES: This study examined the prevalence of occasional smoking in a population of working adults, compared the characteristics of occasional and daily smokers, and prospectively examined the long-term smoking patterns of occasional smokers. METHODS: At 32 Minnesota work sites, 5681 randomly selected workers were surveyed at baseline; 5248 of these were surveyed again 2 years later. A cross-sectional sample of 5817 workers was also surveyed at follow-up. RESULTS: Occasional smokers constituted 18.3% of all smokers in the baseline sample and 21.5% of all smokers in the cross-sectional sample surveyed 2 years later. Baseline occasional smokers were significantly more likely than daily smokers to have quit at follow-up. Job monotony or repetitiveness was related to an increase to daily smoking at follow-up among baseline occasional smokers, and a change to a more restrictive workplace smoking policy was associated with quitting. CONCLUSIONS: The results confirm that a substantial proportion of smokers are low-rate users and suggest that the proportion may be rising. Further research on this group is warranted.
Adult↗