Biomedical subjects

Kevin Delucchi

Publications and source records attributed to Kevin Delucchi.

15 recordsLinked to original sources

PubMed2006

Peritraumatic fear, helplessness and horror and peritraumatic dissociation: do physical and cognitive symptoms of panic mediate the relationship between the two?

The goal of this study was to examine whether panic mediates the relationship between fear, helplessness, and horror (PTSD criterion A2) and dissociation at the time of trauma. The study sample included 709 police officers and 317 peer-nominated civilians who had been exposed to a variety of critical incidents. Participants filled out measures of critical incident exposure, PTSD criterion A2, panic, and dissociation. Results indicate that together, physical and cognitive symptoms of panic completely mediate the relationship between criterion A2 and dissociation in civilians, and partially mediate that relationship in police. These results provide support for the idea that panic mediates the relationship between fear, helplessness, and horror (criterion A2) and dissociation at the time of trauma. The results also raise the possibility, however, that the mediational role of panic may be further moderated by additional variables.

Adult↗

PubMed2006

Comparing intervention outcomes in smokers treated for single versus multiple behavioral risks.

This study examined treatment outcomes among smokers with single versus multiple behavioral risks. Data were drawn from smokers (N = 2,326) participating in 3 population-based, multibehavioral studies targeting cigarette smoking, high-fat diets, and high-risk sun exposure. Outcomes were compared for participants at risk for smoking only (13%), smoking plus 1 additional risk factor (37%), and smoking plus 2 additional risk factors (50%). The smoking only group tended to be female, older, more educated, lighter smokers, in the preparation stage of change for smoking, with more previous quit attempts and longer periods of abstinence. At 12 and 24 months follow-up, treatment of 1 or 2 coexisting risk factors did not decrease the effectiveness of smoking cessation treatment, and treatment for the coexisting factors was effective.

Adult↗

PubMed2006

Toward evidence-based Internet interventions: A Spanish/English Web site for international smoking cessation trials.

The Internet provides a medium to administer and evaluate evidence-based interventions for highly prevalent public health problems worldwide. The authors report a series of four Internet smoking cessation studies conducted in English and Spanish. These studies examined both outcome (self-reported 7-day abstinence) and mechanisms related to outcome (the impact of major depressive episodes [MDEs] on the likelihood of quitting). Over 4,000 smokers from 74 countries entered the studies. Studies 1 and 2 evaluated a standard smoking cessation guide (the "Guía"). Studies 3 and 4 were randomized trials comparing the Guía+ITEMs (individually timed educational messages) to the Guía+ITEMs+a mood management course. ITEMs were E-mails inviting participants back to the site at specific times. Online follow-up assessments resulted in completion rates of 44%-54% at 1 month and 26%-30% at 6 months in studies 1 and 2. Incentives and follow-up phone calls increased these rates to 70%, 66%, 65%, and 62% at 1, 3, 6, and 12 months in study 4. At 6 months, self-reported 7-day abstinence rates using missing = smoking data were 6% in studies 1 and 2, 10%-14% in study 3, and 20%-26% in study 4. The Guía+ITEMs condition tended to have higher quit rates, which reached significance at the 12-month follow-up in study 3 and at the 3-month follow-up in study 4. Smokers with past (but not current) MDEs tended to be the most likely to abstain and those with current MDEs the least likely. This trend reached significance in studies 1 and 4.

Adult↗

PubMed2006

The relationship between peritraumatic distress and peritraumatic dissociation: an examination of two competing models.

This study examined whether peritraumatic dissociation serves to protect trauma-exposed individuals from experiencing high levels of peritraumatic distress or is an epiphenomenon of high levels of peritraumatic distress. The sample was comprised of 709 police officers and 317 peer-nominated civilians exposed to a variety of critical incidents. Participants filled out measures of trauma exposure, traumatic stress, peritraumatic distress, and peritraumatic dissociation. There was an overall moderate-to-strong linear relationship between peritraumatic distress and dissociation. Among those with high levels of dissociation, very few reported low levels of distress. Among those with high levels of distress, a significant number--but not all--reported high levels of dissociation. Our results do not provide support for the idea that dissociation protects individuals from experiencing high levels of distress at the time of the trauma but rather suggest that dissociation is an epiphenomenon of high levels of distress observed in a subset of individuals.

Adult↗

PubMed2005

Randomized trial of drug abuse treatment-linkage strategies.

A clinical trial contrasted 2 interventions designed to link opioid-dependent hospital patients to drug abuse treatment. The 126 out-of-treatment participants were randomly assigned to (a) case management, (b) voucher for free methadone maintenance treatment (MMT), (c) case management plus voucher, or (d) usual care. Services were provided for 6 months. MMT enrollment at 3 months was 47% (case management), 89% (voucher), 93% (case management plus voucher), and 11% (usual care); at 6 months enrollment was 48%, 68%, 79%, and 21%, respectively. Case management and vouchers can be valuable in health settings to link substance abusers with medical problems to drug abuse treatment.

Adult↗

PubMed2005

Acceptance of nicotine dependence treatment among currently depressed smokers.

This study reports on baseline characteristics associated with acceptance and refusal of available smoking treatment among currently depressed smokers in a psychiatric outpatient clinic who were enrolled in a larger clinical trial. The sample (N=154) was 68% female and 72% White, with a mean age of 41.4 years and average smoking rate of 17 cigarettes/day. All participants were assigned to a repeated contact experimental condition; received a stage-based expert system program to facilitate treatment acceptance; and were then offered smoking treatment, consisting of behavioral counseling, nicotine patch, and bupropion. Acceptors (n=53) were defined as those accepting behavioral counseling and pharmacological treatment at some point during the 18-month study, whereas refusers (n=101) received only the expert system. The number of days to treatment acceptance was significantly predicted by stage of change, with those in preparation entering treatment more quickly than contemplators or precontemplators. In a logistic regression, the variables most strongly associated with accepting treatment were current use of psychiatric medication and perceived success for quitting. Severity of depressive symptoms, duration of depression history, and history of recurrent depression were not related to treatment acceptance. Findings have implications for the psychiatric assessment and treatment of smokers in clinical settings. Psychiatric medication may play a significant role in smoking cessation treatment acceptance by currently depressed smokers.

Adult↗

PubMed2005

Alcoholics anonymous careers: patterns of AA involvement five years after treatment entry.

BACKGROUND: Most formal treatment programs recommend Alcoholics Anonymous (AA) attendance during treatment and as a form of aftercare, but we know very little about treatment seekers' patterns of AA involvement over time and how these relate to abstinence. METHOD: This paper applies latent class growth curve modeling to longitudinal data from 349 dependent drinkers recruited when they were entering treatment and were re-interviewed at one or more follow-up interviews one, three and five years later, and who reported having attended AA at least once. RESULTS: Four classes of AA "careers" of meeting attendance emerged: The low AA group mainly just attended AA during the 12 months following treatment entry. The medium and high AA groups were characterized by stable attendance at the second and third follow-ups-at about 60 meetings a year for the medium group and over 200 meetings per year for the high group, followed by slight increases for the medium group and slight decreases for the high group by year five. The declining AA group doubled its meeting attendance postbaseline, to almost 200 meetings during the year following treatment entry, but by year five they were only attending about six meetings on average. Decreases in AA meetings did not necessarily signal disengagement from AA; at the five-year follow-up, a third of the low AA group and over half of the declining AA group said they felt like a member of AA. Activities other than meeting attendance, such as having a sponsor, otherwise paralleled the meeting careers, but social networks were similar by year five. Rates of abstinence by year five (for the past 30 days) were 43% for the low AA group, 73% for the medium group, 79% for the high group and 61% for the declining group. Rates of dependence symptoms and social consequences of drinking did not differ between the groups at year five. CONCLUSIONS: The prototypical AA careers derived empirically are consistent with anecdotal data about AA meetings: some never connect; some connect but briefly; and others maintain stable (and sometimes quite high) rates of AA attendance. However, contrary to AA lore, many who connect only for a while do well afterwards.

Adult↗

PubMed2004

Impact of stress reduction instructions on stress and cortisol levels during pregnancy.

This pilot study examined whether giving stress reduction (SR) instructions to pregnant women would be effective in regulating stress, mood, and cortisol levels during pregnancy. Forty-one predominantly low-income Latina women, receiving prenatal services at a public county hospital, completed measures of stress and mood (depressive symptoms, positive and negative affect) and provided morning and evening saliva samples to measure cortisol prior to and after receiving SR instructions. We hypothesized that adherence to these SR instructions would result in lower levels of stress, negative mood states, and cortisol levels when compared to baseline values. Repeated measures ANOVA analyses demonstrated significantly lower levels of stress (P < 0.001), lower symptoms of depression and negative affect (P < 0.001), and lower levels of morning cortisol (P = 0.01) under the SR condition, compared to baseline. Health behaviors that were engaged in during the SR condition and implications for prenatal health interventions are discussed.

Adolescent↗

PubMed2004

A meta-analysis of smoking cessation interventions with individuals in substance abuse treatment or recovery.

This meta-analysis examined outcomes of smoking cessation interventions evaluated in 19 randomized controlled trials with individuals in current addictions treatment or recovery. Smoking and substance use outcomes at posttreatment and long-term follow-up (> or = 6 months) were summarized with random effects models. Intervention effects for smoking cessation were significant at posttreatment and comparable for participants in addictions treatment and recovery; however, intervention effects for smoking cessation were nonsignificant at long-term follow-up. Smoking cessation interventions provided during addictions treatment were associated with a 25% increased likelihood of long-term abstinence from alcohol and illicit drugs. Short-term smoking cessation effects look promising, but innovative strategies are needed for long-term cessation. Contrary to previous concerns, smoking cessation interventions during addictions treatment appeared to enhance rather than compromise long-term sobriety.

Convalescence↗

PubMed2004

Does marital status predict long-term drinking? Five-year observations of dependent and problem drinkers.

OBJECTIVE: Married individuals have lower rates of problem drinking, but little is known about this relationship in the context of other factors. This longitudinal analysis examines marital status with other individual predisposing, problem severity and social predisposing characteristics to understand its strength in predicting alcohol consumption over 5 years. METHOD: A probability sample of dependent (n = 600) and problem (n = 992) drinkers was recruited through consecutive adult intakes from a Northern California county's alcohol and drug treatment programs and through a general population survey. Annual volume of drinks consumed over a 5-year period-measured at baseline, and at 1, 3 and 5 years later-was estimated in four nested models using maximum likelihood estimation via PROC MIXED. RESULTS: In simpler models that examined only marital status, married individuals drank significantly less than those never married (p < .01 for problem drinkers and p < .05 for dependent drinkers); however, when our models added individual predisposing, problem severity and social predisposing characteristics, marital status was no longer significant in predicting a trajectory of decreased drinking. For problem drinkers, the following characteristics were more important than marital status in predicting alcohol consumption over the 5 years: individual predisposing characteristics (age, p < .001; income, p < .001; education, p < .001; and age of initiation of regular alcohol use, p < .001), problem severity (number of alcohol dependence symptoms, p < .001; number of alcohol-related social consequences, p < .001; and higher drug severity, p < .05) and social predisposing characteristics (family member with an alcohol problem, p < .05; the size of heavy alcohol- and drug-using social network, p < .05; and chemical dependency treatment in the prior year, p < .001). For those who were alcohol dependent, income (p < .05), number of alcohol dependence symptoms (p < .001), higher drug severity (p < .05) and a heavy alcohol- and drug-using social network (p < .05 ) were more important than marital status in predicting consumption. CONCLUSIONS: In longitudinal models, individual predisposing, problem severity and social predisposing characteristics are more important than marital status in predicting alcohol consumption.

Adult↗

PubMed2003

The role of community services and informal support on five-year drinking trajectories of alcohol dependent and problem drinkers.

OBJECTIVE: The purpose of this study was to examine how informal support and community services impact the course of alcohol disorders by examining the trajectories of alcohol consumption over 5 years in dependent and problem drinkers. METHOD: Alcohol dependent adults (n = 600) and problem drinkers (n = 992) were identified through probability surveys in the general population and in public and private treatment programs throughout a California county. Participants were interviewed at baseline and again 1, 3 and 5 years later. Models controlling for demographic characteristics, problem severity, community services and recovery-oriented social networks were estimated, using a multi-level, mixed model to predict alcohol consumption over time. RESULTS: A significant trend of reduced drinking over time was observed for both dependent and problem drinkers. Recovery-oriented social networks and AA participation predicted decreased consumption for both groups. Contacts with medical, mental health, welfare and legal systems were predictive of reduced consumption for problem drinkers. In the dependent group, only contacts with mental health agencies marginally predicted decreased consumption. CONCLUSIONS: Findings point to the importance of developing mechanisms for better identifying problem drinkers in the course of contacts with health and social service systems and for facilitating use of self-help groups and positive changes in social networks. Development of recovery-oriented social networks should be emphasized to extend the benefits of treatment for dependent individuals.

Adult↗

PubMed2002

A controlled trial of methadone treatment combined with directly observed isoniazid for tuberculosis prevention in injection drug users.

Substance abuse is associated with high risk for tuberculosis (TB) and poor adherence to medication regimens. This study compared completion rates for isoniazid (INH) preventive therapy for injection drug users (IDUs) randomly assigned to methadone treatment combined with directly observed preventive treatment (DOPT) versus those assigned to routine TB clinic referral without methadone treatment. One hundred and eleven opioid-dependent patients with latent TB were assigned to one of three 6-month treatment conditions: standard methadone treatment including substance abuse counseling combined with daily INH DOPT (n=37); minimal methadone treatment without counseling, also combined with daily INH DOPT (n=35); or routine care referral to TB clinic for monthly INH supplies without DOPT and without methadone treatment (n=39). INH completion rates were 77.1% for minimal methadone and 59.5% for standard methadone, as compared with only 13.5% for routine care (P<0.0001). Mean duration of INH treatment retention was 5.7, 5.0 and 1.6 months, respectively (P<0.0001). TB incidence at 4-year follow-up was 0 of 54 subjects who completed preventive therapy versus 2 of 57 who failed to complete. One of these two had been assigned to routine care, and the other to minimal methadone. In conclusion, INH retention time and completion rates were significantly improved by methadone treatment combined with observed INH, whether or not substance abuse counseling was provided. The results of this study indicate that methadone treatment offers clear public health benefits when it is used to deliver preventive medical services.

Adult↗

PubMed2002

Alcohol use affects the outcome of treatment for cocaine abuse.

This study investigated whether alcohol use affects baseline characteristics and treatment outcome in 128 adults who participated in a randomized trial of cognitive behavioral vs. 12-step treatment for crack cocaine abuse. Assessments were taken at baseline and weeks 4, 8, 12, and 26 on biologically-verified cocaine abstinence and psychometric measures. Alcohol use was measured at intake and subsequent assessments using the Addiction Severity Index (ASI) and self-reported frequency of alcohol consumption. Results indicate alcohol use at baseline was associated with increased baseline cocaine use and ASI drug severity but was not associated with ASI psychiatric severity, psychiatric diagnoses, or other baseline variables. Alcohol use at baseline did not predict worse treatment outcome for cocaine abstinence. However, alcohol use after four weeks of treatment did predict ability to achieve cocaine abstinence at assessment points during and after treatment.

Adult↗

PubMedDate not supplied

Smoking cessation research via the internet: a feasibility study.

To reverse the present stagnation in progress toward reduced smoking rates, new widely accessible treatment methods for smoking cessation must be developed and evaluated with large groups of smokers. We tested the feasibility of conducting a smoking cessation study over the Internet using a brief, self-help educational intervention. Through a direct e-mail sent from a large health information web site (WebMD), and with our presence on the Internet, we recruited 538 adult smokers to the study. Most participants (90.5%) completed all baseline questionnaires. Questionnaires showed acceptable to good reliability and were comparable with studies using paper-and-pencil methods. Participants appeared to be highly dependent on nicotine. Forty-two percent indicated being ready to quit smoking at baseline. At 1-month follow-up, 42.8% of baseline participants returned a complete follow-up questionnaire, 40% of whom indicated having made a serious quit attempt, and 8.3% of whom indicated 7-day abstinence. Most follow-up participants rated the site as at least somewhat helpful to quitting (74.9%) and reported at least a slight increased intention to quit smoking over baseline (67.3%). While Internet-enabled self-help interventions for smoking cessation are able to reach large numbers of smokers interested in quitting smoking, additional procedures are needed to retain these users for treatment and follow-up assessments.

Adult↗

PubMedDate not supplied

Design and pilot evaluation of an internet smoking cessation program.

Relatively little is known about how to use the Internet to promote health behavioral change. This article describes a multiple-contact Internet smoking cessation program with an 8-week web-based course, online tools for self-monitoring of behaviors, and computer-tailored e-mail messages timed to enrollees' quit efforts. In a pilot study in 49 smokers, we found that enrollees returned to the website a median of 2 times and completed an average of 2 of 8 educational modules. In follow-up, respondents (n = 26) rated e-mail and web components of the intervention as equally valuable (5.9 vs. 5.5 of 10, p = 0.44). While site had potentially important effects on smoking behaviors (34% of enrollees either quit smoking or had a 50% reduction in cigarette use), we were not able hold the interest of the majority of enrollees over the intervention period. Problems with the design of the site are discussed.

Consumer Behavior↗