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Biomedical subjects

M Belcher

Publications and source records attributed to M Belcher.

18 recordsLinked to original sources
PubMed1992

Randomised controlled trial of nasal nicotine spray in smoking cessation.

Studies with nicotine chewing gum and nicotine skin patches indicate that nicotine replacement can help people to give up smoking. The rapidity with which nicotine is absorbed when given as a nasal spray suggests that it might be effective for those for whom the other means of replacement are too slow. The efficacy and safety of a nasal nicotine spray as an adjunct to group treatment for stopping smoking were assessed in a randomised, double-blind, placebo-controlled trial in which 227 cigarette smokers attending the Maudsley Hospital Smokers Clinic received 4 weeks of supportive group treatment plus active nicotine (0.5 mg per shot) or placebo nasal spray. The main end-point was biochemically validated complete abstinence from smoking from the third week of group treatment until the 12-month follow-up. Side-effects were assessed by self-reports and, where necessary, by physical examination. Of subjects assigned to active treatment 26% (n = 30) were validated abstinent throughout the year, compared with 10% (n = 11) of those assigned to placebo (relative abstinence rate 2.6, 95% CI 1.5-4.5, p less than 0.001). The advantage of the active spray was greatest in the heaviest smokers. Plasma nicotine concentrations from the spray were typically between one-half and three-quarters of baseline smoking levels. Tobacco-withdrawal symptoms, craving for cigarettes, and weight gain in abstinent subjects were reduced by the active spray. Minor irritant side-effects were frequent in both active and placebo sprays, but only 2 subjects had the spray discontinued as a result. No serious adverse effects were encountered. Nasal nicotine spray combined with supportive group treatment is an effective aid to smoking cessation.

Administration, Intranasal↗
PubMed1991

Dream of absent-minded transgression: an empirical study of a cognitive withdrawal symptom.

Among 293 smokers abstinent for between 1 and 4 weeks, 33% reported having at least 1 dream about smoking. In most dreams, subjects caught themselves smoking and felt strong negative emotions, such as panic and guilt. Dreams about smoking were the result of tobacco withdrawal, as 97% of subjects did not have them while smoking, and their occurrence was significantly related to the duration of abstinence. They were rated as more vivid than the usual dreams and were as common as most major tobacco withdrawal symptoms. In subjects abstinent for 1 year, 63% recalled having dreams about smoking. They had on average 5 of them, and about a quarter occurred after the 6th month of abstinence. Having dreams about smoking was prospectively positively related to maintenance of abstinence. An explanation of this finding based on the association of smoking in dreams with aversive emotions is offered.

Adult↗
PubMed1989

Effect of smoke-free cigarettes on 24 h cigarette withdrawal: a double-blind placebo-controlled study.

In a double-blind randomised trial, 40 cigarette smokers used either nicotine-containing or placebo smoke-free cigarettes during 24 h abstinence from smoking. Subjects in the nicotine group experienced smaller increases in irritability and difficulty concentrating and fewer urges to smoke than those who received placebo. Nicotine smoke-free cigarettes were rated as more satisfying, more helpful and more effective in relieving craving than placebo. After 24 h use nicotine smoke-free cigarettes provided average blood nicotine levels of 6.3 ng/ml, i.e., 29.2% of smoking levels. The most frequent side effects were irritation of the throat and coughing. Overall, side effects were rated as not serious. Although the smoke-free cigarette in its present form is not very efficient in delivering nicotine, it was effective in alleviating initial tobacco withdrawal. It is possible that by providing both nicotine and "behavioural" replacement it may be particularly useful in the first stages of stopping smoking. The product is worth further investigation.

Adult↗
PubMed1989

Time course of cigarette withdrawal symptoms while using nicotine gum.

Ratings of withdrawal symptoms were provided at weekly intervals by 147 smokers clinic clients who managed complete abstinence for 4 weeks. The ratings followed a similar temporal pattern regardless of amount of nicotine gum used. Irritability, depression, difficulty concentrating and restlessness peaked in the 1st week or two and returned to baseline by week 4. Hunger was more persistent. Craving was reported to be the most troublesome withdrawal symptom at first, although by the 4th week hunger was cited almost as often. Across all subjects, evenings were cited most often as the worst time of day for craving but among heavier smokers and those who used more nicotine gum mornings were considered worst.

Female↗
PubMed1989

Severity of withdrawal symptoms as a predictor of outcome of an attempt to quit smoking.

In 227 smokers' clinic clients who managed at least one week of abstinence, ratings of withdrawal symptoms were used to predict subsequent return to smoking. Depression, time spent with urges to smoke, and difficulty not smoking during the first week of abstinence were significantly associated with lapse back to smoking during the second week. Depression and difficulty not smoking during the second week significantly predicted smoking status during the third week. No withdrawal symptoms during the third week were associated with a return to smoking during the fourth week. The predictive power of withdrawal symptoms was over and above that of smoke intake and dependence. The findings provide some support for the view that reduction of withdrawal symptoms may be a worthwhile target in programmes for helping smokers to quit.

Adult↗
PubMed1988

Long-term use of nicotine chewing gum. Occurrence, determinants, and effect on weight gain.

Among 538 clients of a Smokers Clinic who were treated with 2-mg nicotine chewing gum, 34 (6.3%) were still using the gum at one-year follow-up. This group represented 25% of lapse-free abstainers. At one-year follow-up, long-term gum users were using an average of 6.8 pieces of gum per day. Long-term gum users were similar to treatment failures in cigarette consumption and tobacco dependence, while "gum-free" successes were significantly lighter and less-dependent smokers. Long-term gum users used more gum during the four weeks of treatment than treatment failures, who in turn used more than the gum-free successes. It is suggested that for many the long-term use of gum was an essential ingredient of their success. Long-term gum users gained significantly less weight than other long-term treatment successes.

Adult↗
PubMed1988

District programme to reduce smoking: can sustained intervention by general practitioners affect prevalence?

A total of 101 general practitioners in 27 practices in inner London took part in a quasi-experimental study designed to examine whether a brief intervention applied to all smokers seen by general practitioners and sustained on a continuous basis could in time have a cumulative effect and reduce the prevalence of smoking among their patients. Of 21 practices approached in our local district (Camberwell), seven were willing to undertake brief intervention with support from the smokers' clinic (SBI), four opted for intervention without support (BI), and six acted as usual care controls. A further 10 out of 12 practices approached in South Hammersmith provided an unselected group of usual care controls. A series of six cross-sectional surveys were conducted over a three-year period. Each survey consisted of all adult patients attending to see a doctor during a defined two-week period, sample sizes averaging just over 9000 per survey. The estimated decline in self-reported smoking prevalence over the 30-month period following the start of intervention was 5.5% (from 36.4% to 30.9%) in the SBI group compared with 2.1% for BI and 2.8% and 3.0% in the two usual care control groups, the decline in the SBI group being significantly greater than in the other groups which did not differ significantly between each other. These interim results provide encouraging evidence that brief intervention by general practitioners with support and back-up from a local smokers' clinic can, when sustained on a continuous basis, reach sufficient smokers to reduce smoking prevalence in their practice populations. However, firm conclusions must await longer periods of observation now that the other Camberwell practices have adopted the SBI procedures.

Age Factors↗
PubMed1987

District programme to reduce smoking: effect of clinic supported brief intervention by general practitioners.

By encouraging and supporting general practitioners to undertake brief intervention on a routine basis smokers' clinics could reach many more smokers than are willing to attend for intensive treatment. In a study with 101 general practitioners from 27 practices 4445 cigarette smokers received brief intervention with the support of a smokers' clinic, brief intervention without such support, or the general practitioners' usual care. At one year follow up the numbers of smokers who reported that they were no longer smoking cigarettes were 51 (13%), 63 (9%), and 263 (8%), respectively (p less than 0.005). After an adjustment was made for those cases not validated by urine cotinine concentrations the respective success rates were 8%, 5%, and 5%. Use of nicotine chewing gum was associated with higher self reported success rates. General practitioners providing supported brief intervention encouraged not only more smokers to use the gum but also more effective use; gum users in this group reported a success rate of 27% at one year. Compliance by the general practitioners in recording smoking state averaged 45%, and significantly higher success rates were reported by patients whose smoking state had been recorded. Brief intervention by general practitioners with the support of a smokers' clinic thus significantly enhanced success rates based on self reports. Better results might be obtained if general practitioners' compliance with the procedure could be improved and if they encouraged more of their patients to try nicotine gum. Collaboration of this kind between a smokers' clinic and local general practitioners could deliver effective help to many more smokers than are likely to be affected if the two continue to work separately.

Adult↗
PubMed1987

Time course of cigarette withdrawal symptoms during four weeks of treatment with nicotine chewing gum.

Ratings of withdrawal symptoms were obtained from 52 Smokers Clinic clients who abstained throughout a four week group treatment programme involving use of nicotine chewing gum. Mean ratings of irritability, depression, hunger, restlessness, and inability to concentrate were significantly higher in the first week of abstinence than at baseline, although only a minority of smokers experienced severe withdrawal symptoms. Disturbance of mood and concentration returned to baseline within four weeks while increases in hunger persisted. The average amount of time spent with the urge to smoke started to decline early in treatment, but the average strength of urges and overall difficulty not smoking did not decline until the fourth week. At the end of treatment 35% were still experiencing strong urges to smoke and 23% reported finding it difficult keeping themselves from smoking. The findings have practical implications for preparing smokers for cessation with the aid of nicotine gum.

Adult↗
PubMed1987

Breath-holding endurance as a predictor of success in smoking cessation.

A pretreatment test of breath-holding endurance predicted end-of-treatment outcome in 56 Smokers Clinic clients (r = .44; p less than .001). The cut off points derived by discriminant analysis were 32 seconds for men and 20 seconds for women, which correctly classified 78.6% of cases. The breath-holding test might sample the type of endurance necessary to withstand the discomfort associated with cigarette withdrawal and may also be relevant to success in quitting other addictive behaviours. However, alternative explanations are possible and more data are needed.

Adult↗
PubMed1986

Which smokers report most relief from craving when using nicotine chewing gum?

Seventy-seven smoker clinic clients who managed at least 2 weeks of smoking abstinence while chewing 2 mg nicotine gum reported the degree to which the gum reduced their craving for cigarette, their daily gum consumption and the extent of urges to smoke despite the gum. Greatest relief from craving by the gum was reported by smokers with higher pre-abstinence expired-air carbon monoxide (CO) concentrations and higher "stimulant" and "dependent" scores on a smoking motivation questionnaire but not greater usual daily cigarette consumption. Gum consumption correlated positively with expired-air CO, usual daily cigarette consumption, and "stimulant" and "dependent" smoking scores. Despite the gum, urges to smoke and difficulty not smoking were reported and the severity of these was associated with "indulgent", "stimulant" and "dependent" smoking scores but not CO or usual daily cigarette consumption. The results are discussed in terms of the possible role of pharmacological and non-pharmacological factors in craving.

Adult↗
PubMed1985

Enhancing the impact of groups: an evaluation of two group formats for smokers.

The effects of two different group formats constituting part of an otherwise identical smoking cessation programme were evaluated. Each group format was in use for one full calendar year. One hundred and thirty-two smokers were treated in 14 'therapist-oriented' (T-O) groups run in traditional didactic style and 138 in 14 'group-oriented' (G-O) groups, where the primary emphasis was on group resources (group support, group pressure and spontaneous modelling of coping responses). G-O groups were significantly more successful. The two types of groups did not differ in the number of clients who succeeded in stopping smoking just after the first meeting, i.e. before the difference in group formats could have any impact; but in the G-O groups more of those who failed initially persisted in trying and succeeded later in the course. Independently of the format, larger groups were more successful and in addition there was significant variation between single groups regardless of both format and size. Group processes seem to play an important role in smoking cessation and the way in which a group is structured can affect outcome.

Adult↗
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Humans↗