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Biomedical subjects

J K Ockene

Publications and source records attributed to J K Ockene.

At least 19 recordsLinked to original sources
PubMed1992

Patient characteristics and the effect of three physician-delivered smoking interventions.

BACKGROUND: This paper investigates individual patient characteristics predicting differential response to each of three physician-delivered smoking interventions after 6 months. METHODS: Participants were 1,286 currently smoking patients seen by 196 medical and family practice residents in five primary care clinics affiliated with the University of Massachusetts Medical School. Of the participants, 57% were female, 92% were white, their average age was 35 years, and they smoked an average of 23 cigarettes per day. Physicians were trained to provide the following interventions: advice only (AO), a brief (< 10 min) patient-centered counseling intervention (CI), and counseling plus prescription of the nicotine-containing gum Nicorette (CI+NCG). The CI+NCG condition included NCG only when appropriate and if acceptable to the patient. Patients were randomized to one of these three physician-delivered intervention conditions. RESULTS: Overall, stratified univariate analyses revealed that AO produced consistently lower cessation rates across most subgroups (generally 9-13%) but was somewhat more effective for certain groups of lighter smokers. Relative to AO, CI was somewhat more effective (about 20-24%) for less addicted smokers, for those with more previous quit attempts, and for those with fewer close associates who smoke, but generally failed to produce higher quit rates for harder core smokers or for women. CI+NCG had an overall pattern of greater effectiveness for both more addicted and less addicted smokers, with the highest absolute levels of cessation (about 27-30%) among less dependent smokers. Women in this group had cessation rates (20.6%) comparable to those of men (23.6%). Condition-stratified logistic regression analyses, controlling for a wide range of covariates, revealed associations similar to those observed in the univariate analyses: An overall logistic model in which intervention conditions were fitted as dummy variables produced the following significant main effects: sex, years smoked, contact with other smokers, symptoms, and CI+NCG condition. Significant interactions were observed for both CI and CI+NCG and smoking when feeling too ill to continue normal activities and CI+NCG and amount smoked. CONCLUSIONS: We observed significant main effects on cessation of variables related to addiction, sex, social factors, and physician counseling interventions. Specific interactions were observed between reported smoking when feeling ill and each of the counseling interventions as well as by amount smoked in the CI+NCG condition.

Adult↗
PubMed1992

Processes of change in smoking cessation: a cross-validation study in cardiac patients.

The processes of change associated with smoking cessation were examined for 213 smokers and recent exsmokers who were scheduled for cardiac catheterization and compared to the processes reported by a sample of 180 nonmedical smokers and exsmokers. Subjects were classified into one of three stages of change depending on their readiness to quit smoking: precontemplation, contemplation, and action. The cardiac sample employed the processes of change more frequently than the nonmedical sample in all stages, but the functional relationship between the stages and processes of change was generally similar for the two groups. The hierarchical structure of the processes of change also was similar for both groups. Differences between the two samples in the use of the processes of change are discussed. These results are the first to support the validity of the stages and processes-of-change model of smoking cessation in a population experiencing severe illness.

Adult↗
PubMed1992

Are we pushing the limits of public health interventions for smoking cessation?

The phenomenon of smoking cessation that takes place outside formal programs, which serve a small proportion of smokers, is an important public health issue. Self-help strategies represent an approach to potentially cost-effective smoking intervention that can be conveniently used by large groups of smokers. In this issue of Health Psychology, Gritz, Berman, Bastani, and Wu (1992) demonstrate that the mailing of self-help smoking cessation materials to nonvolunteer women in a health maintenance organization, without any personal contact, produces little behavior change beyond what occurs in the environment without such distribution. This outcome is not surprising and does not illiminate the possibility of efficacious use of self-help materials with a nonvolunteer population. An essential question is: Could these materials have been distributed in such a way as to increase their use and eventual efficacy? Efforts to attract more smokers to use existing materials are an essential element of self-help strategies. An effective public health approach is a comprehensive one that successfully engages the individual and, through multiple channels in the community, provides reinforcement, supports, and norms for not smoking.

Behavior Therapy↗
PubMed1992

Work-site nutrition intervention and employees' dietary habits: the Treatwell program.

In a randomized, controlled study of the Treatwell work-site nutrition intervention program, which focused on promoting eating patterns low in fat and high in fiber, 16 work sites from Massachusetts and Rhode Island were recruited to participate and randomly assigned to either an intervention or a control condition. The intervention included direct education and environmental programming tailored to each work site; control work sites received no intervention. A cohort of workers randomly sampled from each site was surveyed both prior to and following the intervention. Dietary patterns were assessed using a semiquantitative food frequency questionnaire. Adjusting for work site, the decrease in mean dietary fat intake was 1.1% of total calories more in intervention sites than in control sites (P less than .005). Mean changes in dietary fiber intake between intervention and control sites did not differ. This study provides evidence that a work-site nutrition intervention program can effectively influence the dietary habits of workers.

Adolescent↗
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

Comparison of smoking behavior change for SI and UC study groups. MRFIT Research Group.

BACKGROUND: The results of MRFIT smoking intervention program are presented for the 4,103 special intervention and 4,091 usual care men who reported smoking cigarettes at the first screening visit. RESULTS: Among the special intervention men, the reported cessation rate increased from 43.1% at 12 months to 48.9% at 72 months. The reported cessation rate among the usual care men increased from 13.5% at 12 months to 28.8% at 72 months. Among smokers who reported cessation at 72 months, 51.3% of special intervention men and 22.7% of usual care men had quit smoking within the first year and remained abstinent thereafter. Average thiocyanate and expired-air carbon monoxide served as objective measures of smoking and were significantly lower among the special intervention men than among the usual care men over the entire follow-up period. The reported cessation rates at 72 months varied according to initial levels of smoking. Smokers reporting 1-19 cigarettes per day at entry were more likely to quit than heavier smokers. For each category of smoking at entry (1-19, 20-39, and 40 or more cigarettes per day) significantly more special intervention than usual care smokers reported cessation. CONCLUSION: These results indicate that the MRFIT smoking intervention program was successful in promoting early cigarette smoking cessation and maintaining cessation over the entire trial for a large percentage of cigarette smokers.

Adult↗
PubMed1991

Smoking cessation and change in diastolic blood pressure, body weight, and plasma lipids. MRFIT Research Group.

Cigarette smoking cessation was examined for its impact on diastolic blood pressure, weight, and plasma lipids in 3,470 special intervention males in the Multiple Risk Factor Intervention Trial. Change in smoking status (quitters vs nonquitters) was not independently associated with change in diastolic blood pressure or the subsequent use of antihypertensive medication for smokers who were normotensive at entry. More quitters (35%) became hypertensive than nonquitters (27%, P less than 0.01), although the groups had similar baseline diastolic blood pressure levels. Weight gain subsequent to cessation probably contributed to this excess incidence of hypertension in quitters. Stepped-care antihypertensive therapy lowered diastolic blood pressure similarly for hypertensive quitters and nonquitters. Weight increases of 6 lb or more by the 72-month visit occurred in 47% of quitters vs 25% of nonquitters (P less than 0.01); quitters did not differ from nonquitters in their change in total kilocalories from baseline to the 72-month visit. Quitters who gained 6 lb or more tended to be less obese at baseline, be less physically active, and smoke more cigarettes per day than those who did not gain this amount. Finally, quitters relative to nonquitters experienced an adjusted increase of 2.4 mg/dl high-density lipoprotein cholesterol, but no difference in total or low-density lipoprotein cholesterol. The implications for intervention are discussed as they relate to the common, but not inevitable, increase in weight subsequent to cessation.

Antihypertensive Agents↗
PubMed1991

Cigarette smoking and mortality. MRFIT Research Group.

METHODS: The relationship of cigarette smoking and smoking cessation to mortality was investigated among men screened for and also among those randomized to the Multiple Risk Factor Intervention Trial (MRFIT). RESULTS: Among the 361,662 men screened for the MRFIT, cigarette smoking was an important risk factor for all-cause, coronary heart disease (CHD), stroke, and cancer mortality. These risks, on the log relative scale, were strongest for cancers of the lung, mouth, and larynx. The excess risk associated with cigarette smoking was greatest for death from CHD. Overall, approximately one-half of all deaths were associated with cigarette smoking. Among the 12,866 randomized participants, weak positive associations with duration of cigarette smoking habit and tar and nicotine levels were found with all-cause mortality. For both SI and UC men, substantial differences in subsequent CHD (34-49%) and all-cause (35-47%) mortality were evident for men who reported cigarette smoking cessation by the end of the trial compared with those continuing to smoke. There was no evidence that lung cancer death rates were lower among cigarette smokers who quite compared with those who continued to smoke in this 10-year follow-up period. CONCLUSION: The data are consistent with results of previous epidemiologic studies indicating that the benefits of smoking cessation on CHD are rapid, while for lung cancer, the benefit is not evident in a 10-year follow-up period.

Adolescent↗
PubMed1990

The relationship of smoking cessation to coronary heart disease and lung cancer in the Multiple Risk Factor Intervention Trial (MRFIT).

The impact of smoking cessation on coronary heart disease (CHD) and lung cancer was assessed after 10.5 years of follow-up in the 12,866 men in the Multiple Risk Factor Intervention Trial (MRFIT). Those men who died of lung cancer (n = 119) were either cigarette smokers at entry or ex-smokers; no lung cancer deaths occurred among the 1,859 men who reported never smoking cigarettes. The risk of lung cancer for smokers, adjusted for selected baseline variables using a Cox proportional hazards model, increased as the number of cigarettes smoked increased (B = 0.0203, SE = 0.0076). There was not the same graded response for CHD among smokers at entry. The risk of CHD death was greater among smokers than nonsmokers (RR = 1.57) (B = -0.0034, S.E. = 0.0048). After one year of cessation, the relative risk of dying of CHD for the quitters as compared to non-quitters (RR = 0.63) was significantly lower even after adjusting for baseline differences and changes in other risk factors. The relative risk for smokers who quit for at least the first three years of the trial was even lower compared to non-quitters (RR = 0.38). However, the relative risk for lung cancer for quitters versus non-quitters was close to 1 both for quitters at 12 months and at three years. These data support the benefits of cessation in relation to CHD and are consistent with other epidemiologic studies which suggest that the lag time for a beneficial effect of smoking cessation on lung cancer may be as long as 20 years.

Adult↗
PubMed1990

Teaching risk-factor counseling skills to medical students, house staff, and fellows.

It is important to teach risk-factor counseling skills to medical students, primary care residents, and fellows in cardiovascular medicine. To do this, it is necessary to teach assessment and intervention skills based on the theory and techniques of preventive and behavioral medicine. Physicians should be taught to think in terms of the patient in the context of his or her lifestyle and other interacting factors affecting health and disease, and should develop a new medical "culture" within which the risk-factor and lifestyle antecedents and correlates of illness can be recognized, discussed, and approached therapeutically. In this approach to physician training, risk-factor intervention skills training is integrated into existing teaching vehicles to minimize the burden on the curriculum and maximize the extent to which the material can be incorporated into the daily practice of medicine. The objectives associated with training in behavioral medicine skills and examples demonstrating how specific teaching vehicles that are already established in most institutions can be used to accomplish this training are presented. Strategies for motivating physicians to practice prevention with their parents also are discussed.

Behavioral Medicine↗
PubMed1989

Effects on blood pressure of a decrease in sodium use in institutional food preparation: the Exeter-Andover Project.

To judge the effect on blood pressure, sodium intake of students at two boarding high schools was reduced by 15-20% through changes in food purchasing and in preparation practices in the schools' kitchens. Students were not asked to change their usual eating habits. Each school served alternately as the control or intervention school for one school year. Blood pressure was monitored among 341 subjects during control years and 309 subjects during intervention years. Analysis of blood pressure differences between early in the school year and near the end of the school year, with adjustment for sex and initial blood pressure, showed the effect of the dietary intervention to be -1.7 mmHg for systolic (95% CI = -0.6, -2.9, p = 0.003) and -1.5 mmHg for diastolic pressure (95% CI = -0.6, -2.5, p = 0.002). Such modest and easily attainable changes in sodium intake, if maintained, could have a significant effect on the future risk of essential hypertension among young people.

Adolescent↗
PubMed1989

The epidemiology of pulmonary function and COPD mortality in the multiple risk factor intervention trial.

The potential determinants of the changes in chronic obstructive pulmonary disease (COPD) mortality were evaluated using both the Multiple Risk Factor Intervention Trial (MRFIT) screenees, the longitudinal analysis of the participants, and the differences in special intervention (SI) and usual care (UC) groups. COPD was the underlying cause for only one third of all death certificates listing COPD. Small changes in classification will have a major impact on reported COPD death rates. Cigarette smoking is clearly the primary determinant of COPD mortality. Decreased pulmonary function is an independent risk factor for coronary heart disease (CHD) mortality. Smoking cessation results in a slower rate of decline in pulmonary function over time, especially among heavy smokers. Careful evaluation of smoking cessation, including repeat chemical measures, suggest that the percentage of long-term quitters, especially among heavy smokers has been overestimated. The low percentage of quitters substantially reduced the power to detect an intervention effect. The increased cigarette smoking among recent older cohorts, and failure to substantially reduce smoking, especially among heavy smokers, may be an important factor accounting for the failure to note a decline in COPD mortality among older persons.

Adult↗
PubMed1988

Benefits and costs of lifestyle change to reduce risk of chronic disease.

Individuals do not benefit equally from attempts to change their lifestyles in an effort to lower their risk for disease or to improve their quality of life. A change in one lifestyle behavior may cause an increase in another risk factor and reduce the benefits of the anticipated change. The social environment exerts pressures and makes available resources that also influence the benefits and costs of a particular health behavior change. These pressures and resources vary depending on the individual and his or her social context. This article uses the target behavior of smoking as an example of a lifestyle change and considers the benefits and costs that interventionists need to be aware of if they are to effectively facilitate health behavior change. This approach requires the identification of resources at different levels of the environment (e.g., family, community, institutions) that may influence the cost/benefit ratio. Such an analysis is appropriate whether one is considering a model of individual behavior change or a public health model that seeks to intervene at the community-wide level to promote health and reduce disease risk among a large segment of the population. Specific recommendations based on this approach are offered and it is concluded that both individual and public health approaches are necessary to achieve optimal health behavior change in our population and to optimize the cost/benefit ratio of such change for all individuals.

Adult↗